Things To Think About Before You Begin Treatment

If you are having trouble getting pregnant, what are some things you should consider before starting infertility treatment. We talk with Nancy Harrington, an infertility nurse for over 20 years and a senior specialist of clinical education at AllianceRx Walgreens Prime. 

Transcript

spk_0:   0:08


:   0:08
Note this is an automatic transcription.  Please forgive the errors.  

:   0:08


spk_0:   0:08
Welcome everyone to Creating a Family Talk about Infertility. Today we're gonna be talking about things to think about before you begin treatment. But before we get started, I just want to acknowledge that I know people are worried and scared about the Corona virus and the impact it's gonna have on their lives and their fertility treatment. I just want you to know that we have resources for you at creatingafamily.org.  And we'd also recommend that you join our closed Facebook support group. We've been sharing those support and humor and all sorts of things over there and and we talk about our fears in what people are doing and and and what they're doing to help calm their fears and things. So I really do recommend that you check us out and you can find that group at facebook dot com slash groups slash creating a family all one word. So if I mentioned, we're gonna be talking today about things to do before you begin treatment and we'll be talking with Nancy Harrington. She is an infertility nurse for over 20 years with the specialty certification in reproductive endocrinology and infertility nursing from the National Certification Corporation. She is a senior specialist of clinical education at Alliance Are Ex Walgreens Prime, and in this rule she creates an implements educational programs in training opportunities for patients and providers involved with infertility. She's also an active member of the American Society of Reproductive Medicine, where she received the Milestone Service Award in 2017. Congratulations Dancing. She is also the past president of the New England Fertility Society. Nancy, you are well equipped to help us think through things to consider before you begin treatment. And ah, large portion of our audience is in that exact boat. So thank you for joining us today to start at the beginning and ah, and give people some of the basic information they need when they're first beginning this this journey. Let's call it a, although sometimes it feels more like a roller coaster, but we'll use the metaphor of journey for today. Uh, let's start the very beginning. One of the first questions we will often get is how long you should try before you go. Try to get pregnant on your own, uh, before you go to a doctor. Now we've all heard the general advice. You know, they, uh, wait. If you're under 35 wait. 12 months of trying with time dinner course. We're gonna talk about that in a minute. On if you're over 35 6 months. But let's let's let's parse it down a little more and get into the details. So what would you tell people? So how long should you try on your own before seeking a doctor?

spk_1:   3:03
Sure. Well, thank you, Don. Thanks for having me today. I'm looking forward to talking with you today. Um, yeah. As you mentioned, You know, there is a standard definition. If you're under 35 try to 12 months with exposure to sperm. If you're over 35 6 months, you know, But there's other things that also play in the role of When should I go to a doctor? I mean, we know our bodies. We know we have a history of certain things that could affect fertility. So someone has a certain medical history that could impair any kind of things to do with infertility. You know, one of the first things that women really need to I think about is am I getting my period every month. You know, you talked with women, and sometimes they're like, Well, yeah, I think my period the regular I get them every 2 to 3 months. Well, that's not normal. So even if you're under 35 years old, if you're not getting your period every month, there's a problem.

spk_0:   3:57
It's

spk_1:   3:58
not normal to not menstruate every month. You know that, right? There is a telltale flag that would say, I need to speak with my physician about this again. You know, as you mentioned over 35 you know, let's get there quickly. You know what's happened to is managed care kind of put a definition around. When can I go to the doctor? You know,

spk_0:   4:19
a

spk_1:   4:20
lot of insurance companies won't let a patient even go in for fertility evaluation until they pass just certain amount of months of trying. So I guess it's just kind of, you know, investigate for yourself. What, your benefit model. Maybe if you are covered by insurance and then again look at your physical and your medical state. You know how your ministrations have been over a period of a couple of years. You know, if there's any potential issues with the male. Certainly, you may not know that right away, but if there's any kind of pregnant medical history that should somewhat pushed somebody along a little quicker to get in and have some kind of an evaluation.

spk_0:   5:00
And if you're seeing if you have a regular gynecologist mentioning to her or him at your regular checkup, assuming, assuming you're getting him that you are thinking about trying to conceive, even if it's a year off Ah, that you're and getting some general just sharing information with your Met your general medical provider at the beginning is also before you start is also a good idea. All right? Sure, absolutely. So now we know you called it exposure to sperm, but we also will call it timed intercourse or whatever. Euphemism for having sure. But ah, so let's talk a bit about because that that but when the general recommendation of trying X number of months depending on and I was really glad you mentioned depending on your medical history or your administration history and things such as that, we're assuming that you are used, that you're having sex during the fertile times when you could get pregnant. So let's talk them to call it timed intercourse. So let's talk a bit about the best time to get have sex If you want to get

spk_1:   6:11
sure that again is kind of very per person again. A normal menstrual cycle per se, according to the text books, is somewhere between every 21 to 35 days and limp. And so anything that falls outside of those parameters really needs to be investigated. So again, you know, sit down with a piece of paper kind of look at your past. You know, several months of demonstrations and kind of try to mathematically talk about When is my fertile window well In science, we differ. Defined fertile window. It's usually 14 days prior to when you have your onset of menses or ministrations. So say an average cycle is 28 days, which we all you know, kind of learned about when we learned about menstruation cycles. You know that would put you at Day 14 but say your regular cycles there every 32 days or every 34 days. If you compact 14 days, that's almost always the time that someone would be copulating. And so you know, the fertile window is somewhat considered about six days, 4 to 6 days before ovulation occurs. So without using any kind of mechanical things such as inoculation predictor kit or temperature charting, or that thing you can mathematically kind of take a look at it. Now again, if you do have irregular periods, you really would be much better off talking with your primary care physician. Talking with the gynecologists are a nurse practitioner just to kind of get a better feel for, you know, when that potential fertile window could be, you know. And then, you know, women often act well. Should I have intercourse every day? Should I had intercourse every other day? You know, according to a sonogram, they will tell you you can have intercourse every 1 to 2 days so it still doesn't answer. You know, specific questions to say, Oh, have sex every other day or have sex every day. You know what it's basically saying is that if you've been kind of plan around that window of time, that you would probably both the sperm and the egg around the you know point where they would be most optimal for conception.

spk_0:   8:22
And when you say Day 14. What day do you start counting in your menstrual cycle

spk_1:   8:29
The first day that you have kind of a complete flow. You know, in the, um, fertility centers. When I was a nurse clinician there, you know, patients would say, Oh, wait a minute. I started my period, you know, kind of last night at 11 o'clock. Well, we wouldn't really consider that day one, you know, So once you've had almost, you know, a full flow of the period that's basically considered day one.

spk_0:   8:53
Okay, now you've mentioned nowadays people immediately think in terms that they've got to have and not by start buying ovulation predictor kits. But as you point out, you can get a general feel just by assuming you have a regular period just by counting today. So that's one thing to consider. But there are also some in addition to ovulation predictor kits, which you can buy over the counter. But there are also some relatively low tech methods that have been used for years and years and years before we had over the counter chest that are also amazingly effective. So let's talk and these air for helping you determine when you are ovulating. So let's let's talk some about some of those low tech methods,

spk_1:   9:42
right? I mean, certainly, you know, there are basal temperature grass out there on almost all incident sites to do with women's house with really good instructions on monitoring your temperature when you wake up, you know, and explain to you when there is an increase in temperature. What that isn't relevant to your ovulation. Certainly, you know, looking at cervical mucus or discharge that women most often find, you know, during ovulation changes. You know, they basically can kind of tell also, women. Sometimes we'll have some kind of a little bit of cramping on one side of the other when there are regulating. You know, they may think that kind of feels like something like my like cramps when one gets a period. So there are some medical things, and I think, as you pointed out, it's important to kind of start with the low tech start with the know your body know each month what's going on because I think that way, you know, you kind of have a more closer hold in the hole and a grasp on you know what each cycle is gonna probably introduced as faras conception of it.

spk_0:   10:47
So let's say that a person has been trying for a while, and ah, and they have decided that they need to see a doctor. What type s So we get this question a lot. I mean, most of us most women have a not all, but most of us have a gynecologist that we have seen or some of us even see regularly. So should that be your first stop? Or if you haven't gotten pregnant quickly, should you pop over and and make it appointment with an infertility clinic first? And can you even go to your prime minister? You have a primary provider, but no gynecologist. What type of doctor do you need to see when you're beginning to think? Okay, I need I should be getting pregnant now. I'm not. I need to do something.

spk_1:   11:34
Sure, you know. Certainly we would hope that most women healthy women are being followed regularly by O b g y n a gynecologist, the yearly Pap Smith with those types of things types of screening. It's never too early to start planning for a potential pregnancy. You know, there's lots of things that can be done prior to conception that are helpful as faras the outcome of babies and mothers. And so, you know, certainly the first point of maybe talking with someone would be an O b g y n appointment. But some women are also followed by, you know, Philly. Ah, highly leveled trained women help primary cam positions. And so, you know, it's just important to kind of decide where where is my best care gonna be offered, you know, preconception visit. It's kind of a standard term that we use now in women's health in that, you know, that visit is to talk about all kinds of things related to help prior to pregnancy. So, you know, a preconception visit. Aim of that is to really reduce any kind of adverse health effects that may potentially contribute to both the pregnancy and the delivery. And so, you know, providers should be talking to patients about you know, your vaccinations up to date. You know, what types of medications are you taking? You know, also, you know, the CDC and a cod, which is the American College of Gynecologists, recommend that all women that are trying to achieve a pregnancy, you know, be taking some type of the supplement of folic acid. You know, full look at that has been shown to really have an impact on the reduction off any kind of neural tube defects which, you know, these are things that, you know, we kind of take for granted. But there are so many different site. So there, you know, CDC has dimensional information. American College of Gynecology, American Society for reproductive medicine. You know, even if you go in and Google preconception care, there's a wealth of information about it, you know, And so it is important. You know, you can definitely start with a gynecologist or, like I said, a primary care physician that is focused on women's health because again, they're going to talk about things that you could be doing avoiding alcohol, avoiding tobacco product, you know, recreational drug use, you know, checking to make sure there's no will talks environmental things going on. And so, you know, talking about screening for viruses and things like that. So, again there's it's never too early to start thinking about it and to start talking to your practitioner.

spk_0:   14:13
Okay, so when do you know it's time to see an infertility specialist, a reproductive endocrinologist.

spk_1:   14:24
Well, it's, you know, I think a lot of that is based on a treatment history. You know, if you have gone through some technologies such as, you know, artificial insemination are inter uterine insemination, you know, at the level of the ban Ecologist, depending on age, depending on medical history, you know, it's There are certainly broad age ranges of women that help from a reproductive endocrinologist, which you know, is a doctor that has a specialty training in reproductive endocrinology. You know, these positions go on and do a three year specialty, which training course which basically, you know, provide them with additional information above and beyond the O B G y n level to take care of women. And so again, I think you know there's some women that will go sooner than later again. Getting back to some managed care. Um, you know, types of things. Managed care sometimes, you know, won't cover a visit with a reproductive endocrinologist until a certain amount of trying

spk_0:   15:27
have taken

spk_1:   15:27
place. But what I would really recommend patients to do is when you talk with your gynecologist, talk about who they work with. Kind of out in the clinical setting. Most o b g Y n in, You know, bigger parts of metropolitan United States have some type of a referral patent. You know, they're sending patients to infertility doctors. A lot of the times in the geographical area in there, huh? Little area. They're familiar with them And that, you know, will give you the opportunity to maybe contact that practice. Find out you know about coverage. Find out about cost. Um, and that sometimes alleviates a lot of fear about going toe on infertility, Doctor.

spk_0:   16:12
You

spk_1:   16:12
know, I think a lot of the times patients feel like, Well, if I go to an infertility doctor, I have been fertility, you know? I mean, and I think that that's again something that it's always, you know, off this opportunity is there to move on to a specialists. Just a few with you. No, no, no. B g y n And you have a dermatology problem. You may

spk_0:   16:33
see a

spk_1:   16:33
dermatologist. Or if you had a hair, nose and throat problem, you would go to see a nose and throat position. I think we need to think of the reproductive endocrinologist as the conduit. Just like that,

spk_0:   16:44
someone that

spk_1:   16:45
you know it's time. It's time for me to get an opinion and to get a plan in place and not to really put it off that type of

spk_0:   16:54
thing. I'm glad you said that. Get an opinion. It's interesting, but I often find that people are willing to consider the idea of going to a specialist to get a second opinion. And I think you're right. I think there's a hesitancy to go, because if I go, it means I'm infertile. That's we hear that from people and even even people who know that that is perhaps not logical. It's still an emotional response and natural to I mean, you know, the emotional responses are important, and, uh, and the other thing is that we hear from people is that if I go to an infertility clinic, I'm automatically going to be doing IVF and neither of those are true. So I do think it's important to think in terms of if if you're having trouble giving yourself permission or thinking about it, think in terms of just going for a second opinion and and see what you hear, and maybe you don't need to be there. So it would be helpful toe just to consider that as an option. Um, are there some tests, though that intro or treatments that can be done by your gynecologist are Do are all type of testing? Should you be at an infertility clinic to get the test?

spk_1:   18:04
No. I mean, they're certainly definitely tests that can be done by a gynecologist. You know, they can certainly look at a woman's hormone profile. And so certainly, you know, one of the major things that you need in order to conceive is a nice, healthy egg. And so, you know, a lot of the times gynecologist will order hormone profiles to be done on female patients. And then that way they can look at estrogen levels and progesterone and most types of things and start there. You know, if there's an obvious problem that certainly, you know, requires advanced treatment than they would you know, think about referring that patient out. You know, most O B G y n offices have access to having a semen analysis done, you know, a a laboratory that is somewhat close and distance to the patient And so those types of things also a lot of the times, you know, an x ray of the pelvic area, which is a history helping Graham or in HSG, you know, maybe done at the level of the gynecologist just to kind of look at Is there sperm? Is there an egg? And is there a transportation system which would be the pelvis where these two can meet? And so those kind of basic things that can be done just to do an initial assessment again, based on a patient's history based on her age or his you know, that type of thing, it it may be advantageous to do it at the level of the gynecologist, but also maybe, you know, advantageous for re furrow. And again, reproductive endocrinologists worked closely with gynecologists. And so you know, when you do ah, if you do seek out the care of a reproductive endocrinologist or fertility specialist, you know they will look at your records and they will, you know, determine what has been done in what needs to be done moving forward.

spk_0:   19:53
I'm glad you mentioned a semen analysis because that is something that can be, ah, test that can be ordered by through your gynecologist, and it's it's really one of the first test that should be run. Ah, if for no other reason. It's less expensive and less invasive than most of the other type of testing. But and I'm saying this, I realized that not necessarily you. But we do caution people to not stay at your gynecologist too long and not have too many test run through your through your gynecologist because what we hear is that oftentimes reproductive endocrinologist are going to have to or want to run some of the test again. Ah, they may have different ways of interpreting are different labs that they used, and ah, and time is not on your side. So we don't want to see people spend too much once they realize they've got a fertility issue are a potential fertility issue, and they've had their semen analysis done, and so they have a feel for whether it's female issue or male issue or both. Then don't spend too much time at your gynecologist at this point. If I What I say is if let's say if you have a heart problem at some point pretty soon

spk_1:   21:06
I

spk_0:   21:06
want to go to a cardiologists because that's a person with all the training for helping you. Your heart get well, are for treating this as you can live a full life with our problem. And so the same is true with infertility. Ah, the sooner you get to a specialist who has spent all those years training, the sooner you're going to be able to hopefully get pregnant. Eso Anyway, I just We see people stay way too long, Um, on at a at a gynecologist. So I'm just saying, consider so other than later, right?

spk_1:   21:41
Exactly. And I think to, you know, you have to be a self advocate, you know,

spk_0:   21:45
a lot of behind

spk_1:   21:46
you know, you made him told Oh, well, let's try, you know, three more months or

spk_0:   21:51
let's try

spk_1:   21:51
six more months

spk_0:   21:52
and

spk_1:   21:53
and I think you know, it's like like you just said the thing about the cardiology comparison, you know, know your body, know what you want to get out of your visit with the physicians and then make some decisions based on that, You know, again, Ah, sooner is better than later and

spk_0:   22:11
you

spk_1:   22:11
know also a lot of the times, you know, with population problems, you know, which is one of the most common forms of infertility for women. Young women, you know. And even older women, you know you from a health perspective, need to be menstruating every time you know, every month, you know, So even putting off, you know, not having normal period. That's also a health issue. So, you know, get into a situation where that's corrected, you know, even from a health perspective, so that your hormone levels are adequate, you know that you're menstruating, that your bone health is good. All of those things, you know. Also, our company won some type of inoculation. Problem is corrected. And so, you know, it's kind of too old. Yes, you're trying to get pregnant, but also yes, you're trying to be healthy. You're trying to make sure that from a women's perspective, you're healthy. And like I said, every month, you're doing what should be done from a female perspective.

spk_0:   23:07
Yeah, that's a that's such a good point. So what are some other reasons I mentioned to? Ah, and that is the fear of fear of being diagnosed with infertility and and also fear that your only option is IVF, and I should probably throw out the other one, which is honestly cost. I mean, I think that's tied in oftentimes with the fear of IVF. But But let's listen, let's address some of the fears. What would you tell? Just say to someone who is saying, Oh, I just don't know. I just do not want to get him. But I don't want to get on that roller coaster. I heard somebody say that to me last week when we were talking, actually in the Facebook support group, and she was like, I just do not want to get on that infertility roller coaster. So what would you say? I mean to somebody who is just hesitant to make that first appointment

spk_1:   23:56
a CZ you mentioned, you know, a lot of the times of fear. It's fear of the diagnosis, and I guess it's tryto conquer that fear a little bit by kind of thinking a little bit more positive about what the outcome might be. You know, when you see a fertility specialist, these positions, these nurses, they opened up a whole other avenue in your treatment protocol per se. So you know Once you go in tow on infertility specialist Bacchus, you know you're seeing positions. You're seeing nurses your most often seen a person that specializes in benefits and costs. You're seeing support personnel from either relation social worker, our psychologist, And so you're kind of walking into a whole new arena off care. And so, you know, I think if you go into it with that, I'm going to go to a place that's gonna meet all of my needs. And so you know, the doctor's gonna work up to see why we aren't getting pregnant. But the nurses, you know, our specialty trained and why I'm depressed or why I might be overwhelmed or why I might be fearful, you know, And the social workers are trained to talk about, you know why you're feeling isolated from family and friends. And so I think if you go into it more with more resource is our available. When you go into a reproductive endocrinologist or fertility specialist environment, then say per se, you know, walking out of your gynecologist office and them saying there's nothing else we can do for you. You know, I think sometimes the experience can be quite positive for some patients. I think they're surprised when they get to a fertility specialist office and realize there's a lot of other people there may be in the same boat, you know, and again, one of the key things. I'm from Massachusetts, and so we have a mandate that it's pretty comprehensive. But one of the things, too, is patients are afraid of costs, you know, paying thousands and thousands of dollars. And I think one of the key people that are in fertility specialist offices and I've been all over the country in my positions is there's almost always someone that is a specialist, an expert related to what things are going to cost, what your insurance will coverage, what co pays you will have. You know, physicians have implemented this in the last 10 years to be as important as a nursing position in an office. You know, these are folks that are hired, and that's all they do is to try to be an advocate for the patient, you know, to call the insurance company 10 times instead of two

spk_0:   26:43
times to make

spk_1:   26:45
sure you know they're getting unanswered. Er and you know that to me is a huge resource. Uh, the patient that I think are trying to get pregnant and, ah, lot of the times, you know, you will have, um, folks that don't know about that. You know, they think they're kind of going from one doctor to another. And I do think like I said, there's a fertility specialist Office has varied folks that definitely our specialty trained, you know, to take care of, like you said that fear that, you know, feeling of being on the roller coaster and again patient advocacy. You know what? What do you want to discuss as faras your treatment plan, you know, in and have a plan. You know, baby, basically have a little bit of knowledge about Well, okay, well, if I did do in I wise or insemination, like, how many would you anticipate? And it's difficult because I know I'm a nurse and I kind of have these questions in my brain. But in other medical scenarios, I think we always have to kind of go in with lots of questions and, you know, and lots of dancers that we take back and kind of formulate a plan,

spk_0:   27:58
and I encourage people. If you are concerned about the financial aspect, share that with your clinic. Uh, that's important information for them to know it might influence how they approach treatment. Um, but they're also maybe options they can tell you about that can help lower the cost things that you may want to consider. So all of those are things that, uh and you know, I agree with you that the financial people I often think, or some of the most important people at an infertility clinic because of what we find is that they help reduce some of the anxiety and anxiety is just not good for our general health and not good for our fertility either. So for all those reasons we recommend getting to a clinic and sharing your fears and what your hang ups are in your concerns and and you may be pleasantly surprised all the way around,

spk_1:   28:48
right? And I think to you mentioned about the fertility benefits person. I mean, I know that there are some provided also that even if you're thinking about coming making an appointment with a fertility specialist, ah, lot of providers will offer you a phone call or to talk with someone in their office before you come, you know, so that you're not sitting there on the standing that, you know, this was several hundreds of dollars that I wasn't aware of, you know, And again, you know, can't advertise how important it is to speak to your managed care. Our insurance provided benefits, person, even before you go, you know, so that you get an idea of what would be covered. What wouldn't? Because it, you know, because another thing to underst then, is when you see a fertility specialist, you know, maybe your first visit. It's pretty involved because, you know, you're talking a lot about, you know, health and medical things, but also, you don't move rapidly. I mean, they don't say, OK, tomorrow you're going to do this. You know, most fertility provided have ah have, ah, time frame and even will tell their staff. You know, we're not rushing into this treatment tomorrow because we have to make sure that we have adequately explored all payment options for this patient.

spk_0:   30:01
Whether it

spk_1:   30:02
be, you know, prior authorizations, whether it be she's eligible for some kind of a fertility is program. And so again, you know, I think to know that the folks on the specialty side infertility practices know that you know, there are steps that have to be taken before all of the sudden, you know, you find out the year, you know, undergoing some advanced technology without any kind of prior, you know,

spk_0:   30:27
investigations. Yeah, and And let's be honest, understanding insurance is it's a specialty in and of itself and one that I do not have, and I it intimidates May. And so I really for any type of treatment that would cost any amount of money. I really need to have somebody holding my hand, and it's hard to find outside. And yet you could call up your, ah, your insurance company yourself. But it's also helpful to talk to somebody who's not at your insurance company, who works with lots of of of of health care plans who can help advise you, right? And so, yeah, I just agree. Let me remind everyone that this show, as well as all the resource, is we provide it, creating a family and keep in mind that this show is only one of the many resources we provide. But you we have an entire a dizzy resource section for infertility. All of that. Everything is provided to you of for free because of our partners and these air organizations that believe in our mission of providing unbiased, medically accurate information to the patient community. One such partner is Walgreens and Alliance Rx Walgreens Front. They provide specialized fertility. Pharmacy service is through an experience care team, which is available 24 7 and they were devoted to helping patients achieve successful outcomes. They understand the importance of timing and the need for personalized treatment. And they are committed to compassionate care and support throughout your journey to have a family, and we're so appreciative of their support. All right, so now we've we've kind of heart here a bit on the need to get to a clinic. But how do you find a Clinton? And you've mentioned one way already in which is to talk with your gynecologist because often your gynecologists can refer someone and ah and I will throw out another way. And that is to find out ah, who your friends have used and because the truth is, you're gonna be surprised when you big start becoming more open and you may choose not to. But if you become and start letting people know that you're struggling to get pregnant, you're gonna be very surprised at the number of people in your friend set who have also experienced this. So finding out, getting referrals from your friends. But ah, Nancy, let's talk about some other ways that people confined. Ah, an infertility clinic.

spk_1:   32:50
Sure. Um, I really like what you just mentioned about kind of speaking with friends and family and again, being not being surprised at how many folks have gone through some type of an evaluation or treatment. But when you get down to kind of some specifics about how to find a fertility program, um, the American Society for Reproductive Medicine auras, we refer to What s R. M? They have a website called reproductive fax dot org's. This is a website that you can go in. It's patient oriented Web site. You can search by state. You can search by zip code, but it's going to give you a list of, you know, fertility providers that are in your state are in your region. Um, also it don mentioned, you know, creating a family has an unbelievable, resourceful website, which offers an entire professional service, is directory for all kinds of fertility. Specialist, you know, resolve, which is the National Fertility Association, also provides multiple resource

spk_0:   33:49
is

spk_1:   33:49
one taking specialists, and again, it's just a matter of finding out where they are. And one thing that I've found a CZ I've traveled to the United States is that sometimes patients think, well, that's fertility specialists is 70 miles from me. I mean, in Massachusetts, we don't have that problem.

spk_0:   34:07
You

spk_1:   34:07
have 11 or 12 or 13 programs, all within maybe a 10 or 12 mile radius. But there's certain parts of the country that it's important that you know that. You know, even though the fertility specialists may be far away from where you live, you know it may involve you going, you know, for your first kind of evaluation appointment. But a lot of fertility specialists, they work with satellite operations.

spk_0:   34:33
And

spk_1:   34:33
so, you know, distant sometimes is something that they're helping patients with. And so, you know, although your first is, it may require a bit of ah trip, you know, type of the thing, usually monitoring and ultrasounds, and those types of things Can a lot of the times be set up with some type of a satellite system, some larger than others throughout the country? But again, you know, these doctors and nurses understand that you know, it is a struggle in some geographical areas. But again, I think, you know, talking with folks that have gone through treatment. I get so many phone calls from my kids, colleagues and relationships ass Oh, your mother worked in fertility. Does she know Dr such and such? Or, you know, does she recommended one. And so again, it's just, you know, cruising and looking and kind of just like you said Don, which is I think it's an excellent point, you know, having the ability to talk maybe with a friend or a close colleague or something that has gone through it. And, you know, we all know, Ah, word of mouth is probably one of the best referrals you can get. Um, you know, it's faras. Practitioners go because a lot of the times, even if you go through a difficult procedure, if you were treated while in you a kid for well by a doctor of the North, you go away with a much more you know positive feeling about that

spk_0:   35:58
and more and more comfort going in. Yeah, sure. Um, another resource I'll throw out is Theseus. I ity for assisted reproductive technology. In some ways, the list is's redundant to, ah, the American Society of Reproductive Medicine. But ah, the Society for Assisted Reproductive Technology and the actor everything. We have acronyms for everything in this field and that Are you Miss Sort? Ah, they have good information on their site for evaluating clinics and under, and they maintained site the clinic success statistics and they provide resource is on helping to understand those statistics. And I should mention that it creating a family we also have resource is available on our agency resource page to help you understand both how to choose a clinic. What's important? Ah, and the 2nd 1 is to understand the statistics. So we have resources. There is well, including any guide on choosing a fertility clinic. So just throw that out there. A cz another a cz another option as well. One of the things that I know people get sick of it. But I do say it a fair amount. I always say to people, Time is not on your side. And even then I say this to people, even if they're in their early thirties, which renowned think of is Oh, you know, I've got time and I think no, you really don't. Time is not on your side when it comes to fertility. What? And I'm sure you say that and hear that a lot. Why do we say, Why do we professionals say, Uh, time is not on your side.

spk_1:   37:37
Well, I think you know, one of the things that I learned early on is the nurse was that fertility peaks in women in their mid twenties. And so, you know, in my generation, growing up women considered having babies in their twenties. Now folks have babies in their twenties. You're like, Well, why did she have a baby so

spk_0:   37:56
soon? You know,

spk_1:   37:58
definitely. You know, women's childbirth

spk_0:   38:01
use have

spk_1:   38:01
definitely almost skipped 10 years. You

spk_0:   38:03
know, women

spk_1:   38:04
are thinking about having babies in their early thirties and and, you know, up to 35. But egg quality diminishes, you know, eggs age on. So the most important factor in conception you know, our sperm and eggs. Unfortunately, While I said, Fortunately, firm really doesn't seem to have much, you know, detrimental things happen to it till maybe after age 50. But, you know, with women again, eggs are beginning to age. And so if women wait until you know their midst, Artie's to try to achieve a pregnancy. They are considered already advance to maternal age, you know, at the age of 35. So again, it's really based on ed quality. It's based on the fact that, um, you know, eggs when you're in your late thirties aren't going to be the same as when you're in your late twenties. And so you know, fortunately, unfortunately, women are not ready. A lot of the times

spk_0:   39:02
have baby in

spk_1:   39:03
when their fertility peaks.

spk_0:   39:04
That's intelligent. Try get Yeah,

spk_1:   39:07
it is. It's true. And, um, you know, And so I think you know, it's important early on, like we talked about earlier with preconception, you know, looking at someone hormone levels, looking at how well their ovaries of working and that could be done with simple hormonal testing. You know, you can take a look at the female hormones that are being produced every month, and by looking at the ratio of those hormone levels, you can somewhat get a good prediction on how the ovaries working. And so the other thing to that of counsel patients is that, you know, a lot of folks have a family plan that may involve more than one child. And so

spk_0:   39:45
you know, when

spk_1:   39:46
folks begin to try toe, achieve pregnancy later on in their thirties, you know a lot of the time, you know, after maybe a first baby, they're met with what is called secondary infertility, where you know they're not ableto have another child based most of the time on their age and their egg quality. So again, it doesn't seem quite fair that, you know, fertility peaks at 23 25 years old. But unfortunately, that's biology. And they're really, you know, isn't anything we can do to really, you know, stop that aging process.

spk_0:   40:21
You know, it's such an interesting point, and you're absolutely right that we really have pushed ah, conception by a decade. And, uh, it's absolutely true. Ah, 20 years ago, I heard about Toya 20 years ago, I think, Well, certainly 30 years ago, but 20 years ago two. I think people were, uh really? If you waited to your 30 toe, start your family, you were considered older. Uh, now, if you have a child before 30 you're considered starting a little early, so it's just interesting. I'm shifting its and for a lot of good reasons that has happened, you know, because I our economics of our society and opportunities ever so many things have changed. All right, so impair. Yeah, it's very important to, uh, for us to remember that when we're talking and also for people not to feel bad about their decisions, because they're often is really good reasons why people have made the decisions of the Let me share with you another one of our partners who is who threw their support. We are able to provide you this show in this this interview on that is Christ Internationals Firm and Egg Bank. They're dedicated to providing a wide selection of high quality, extensively screamed frozen donor sperm and eggs, and they come from all races ethnicities in FINA types for both home insemination as well as fertility treatment. Cryo CE International is the world's largest sperm bank and the first free standing independent egg bank in the United States, and we thank them as well for their sport. Today. We're talking about things to consider before you begin to think about fertility treatment, an important topic that we often don't provide a lot of information on. So we're very thankful. Thank thankful today to be talking with Nancy Harrington. She is an infertility nurse and has been practicing and has been doing has been an infertility nurse for many years, and she is also the senior specialist of clinical education at Alliance Rx Walgreens Prime. So, Nancy, we have been talking about infertility, but I think that's something a lot of people don't consider is infertility, but in fact is is repetitive. Miscarriages are recurrent pregnancy loss, so that's a It's a different people. These people can get pregnant, but they can't stay pretty, huh? So where should? But the truth is often that's over there. We're seeing an obstetrician at this point, usually, but where should they seek specialized help? Or where should they seek help along the board if their problem is repeated miscarriage rather than the inability to get pregnant? The first place,

spk_1:   43:11
sure repeated miscarriage or recurrent pregnancy loss is defined as a woman who has two or more clinical pregnancy losses kind of before the 20th week of pregnancy. And it's definitely a concern for patients. And so again, going back to the reproductive endocrinologist or the fertility specialist part of their training is, you know, related to recurrent pregnancy loss. You know. Ah, lot of recurrent pregnancy losses unexplained. And so these physicians really are trained to look at different types of things related to miscarriage, such as, you know, one of the hormone pull files of a woman. What are genetic issues that might be, You know, part of this woman's makeup for genetic makeup will carry a type, you know? Are there any annatto comical issues requiring maybe some surgical intervention? What are her lifestyle choices, you know, Is there have the smoking? Is there alcohol use? Those things really are part of a reproductive endocrinologist evaluation and training when it comes to women. And so it is part of the, um, patient population that you would see in a fertility specialist taco. It's you know, it's not necessarily anyone, you know, sitting in the waiting room having the same problem. You know there's patients in the waiting room that may have cancer and are referred to a fertility specialist to cryo preserve, you know, possible eggs or embryos. You know, there's patients in there again that have had several miscarriages in there to consult about how that can be eliminated. And so again, you know, that's where folks should probably make a visit to rather than just staying put. And seeing that happens again per se, because there are interventions that can definitely, um, you know, show women and, you know, a S r m has some outlined some guys about, You know, the fact that you can have the baby 60 to 80% of the time, even after having three miscarriages. And so patients should just make sure that they're knowledgeable that hey, I'm still going toe continue this journey. But I want to be with someone that has a specialty in helping me with this problem.

spk_0:   45:25
Yeah, And I'm glad you gave this statistic because the odds are actually in your favor again, depending on your age. Yeah. Excellent. Okay. Right. And I know I I I went off on this at the very beginning, but I think it is so important I want to come back just to make certain that we talk a bit about male infertility, Uh, and the importance of a semen analysis. You know, you the old saying, You know, my mother always said, takes two to tango. It takes two to get pregnant, and, uh, and so the and what percentage of the cases of infertility are male related?

spk_1:   46:04
Well, you know, the percentages that airmail related can be almost the same as a female. You know, 30 40% of men for a couples may have a male factor. And again as women, Sometimes we say, Oh, it's just a simple test. Well, you know, maybe a lot of the times it isn't a simple test for a gentleman. You know, go through that. But again, it's the cornerstone of fertility evaluation for all male patients. And, you know, I know back in when I was in my clinic, I would have gentlemen that were presented me and say, Oh, I had a semen analysis done five years ago, and it was normal. I don't need to have it repeated. Well, no, you know, sperm changes. And so you know what? Our clinic we would look at semen analysis every six months to a year, depending on the protocol, in depending on what the patient was going through. So it's important to find out if there is normal sperm. They look at how many sperm there are, you know, How would the sperm swimming holidays shape? You know, Are there any kind of infection yourselves inside the farm? So it's really, you know, something that gives a wealth of information about the mail. And if there is a problem with the firm analysis, you know most often, especially in a fertility specialist office, they will refer the gentleman to a specialty urologist or someone with specialty training in male infertility on DSO again, it's important to note that there is a firm, that it looks healthy and that there's adequate numbers. You know, if someone's going to continue to, as you said, do timed intercourse without any kind of an intervention. But there are so many interventions that we can do now with male factor related toe, you know, kind of IVF in advanced technologies. That's only a very small population of patients that need it. But again, um, you know it's important to have it done and tow. You know, make sure you get any kind of follow up that needs to be done. If there's any abnormalities,

spk_0:   48:05
so will insurance cover infertility treatment?

spk_1:   48:11
It all depends, basically, you know,

spk_0:   48:13
unfortunately,

spk_1:   48:14
I've been doing this for a very long

spk_0:   48:16
time.

spk_1:   48:17
Things have started to really damp up in the last year or two, but it all really kind of depends on where you live and where you work. And so, you know, there are, you know, currently 17 states that have some kind of fertility, you know, offerings or mandates. Um, and what's really a good sign is that there's now seven states that has prepared legislature related toe, you know, fertility preservation related to any kind of disease or cancer. So, you know, again, it's an uphill battle. Um, you know, trying to find out if you have coverage. I would just tell you to just question, question, question. Get things in writing. Um, I have ah, friend that had fertility treatment right here in the state of Massachusetts under a Massachusetts provider, but was living in a nearby state and was somewhat told them that state Oh, you don't have fertility coverage because it wasn't a mandated state. So, you know, research it and look, you know, there are some employers right now. Lots of employers

spk_0:   49:25
was in

spk_1:   49:25
the United States that are developing benefited protocols and benefit models for fertility coverage

spk_0:   49:32
because they feel

spk_1:   49:33
that it is most definitely a big drawer for employees. You know, patients that may need treatment, you know, will pick an employer that has a solid fertility

spk_0:   49:47
benefit. We'll stay at it employer, all right. It's a good it's it's it's really good for employee retention, and I'm glad you mentioned. I mean, we certainly know that there are, um, I think you said, 17 states that require that employers of a certain size provide infertility benefits if they're going to do business in the state. However, what people don't realize is that you can advocate with your company to provide infertility benefits. It is a great benefit packages you mentioned. It's good for for for new hires. It's good for retention. It is a smart business practice if you're if companies air trying to hire people in their thirties and twenties, thirties and forties, so it's smart and let me send people to the resolve dot or GE website. They have some great resource is for helping you advocate with your company, even suggesting there's there's information about, you know, that it makes good economic sense. There's there. They help you provide the argument to your company for why they should provide these benefits. So, uh, let me send you there and say, Please don't give up just because you don't live in a mandated state. Um, that does not mean that you don't You can't take and do it even now and that you're thinking about treatment. This is the perfect time. Just start advocating with your company before before you need treatment. So, yeah, so the perfect time I interrupted you. Sorry about that. But I was still so no, no, no, no. That's

spk_1:   51:26
That's no excellent. You know, I've worked with resolve in over the years on different projects, and one thing they do have, like you mentioned, is good. Resource is they have tool kits per se, you know, in place that you can link to on the website the kind of help you as a self advocate, going to your HR person or going to someone at your employment that you can talk with about this and again. It's an uphill struggle. Um, and you know, I think a lot of us find this a lot of the times with insurance and managed care, You know, sometimes to find out what's covered, what isn't covered. It's exasperating sometimes, but again, just stick with it and just, you know, ask questions and get answers again. Like you said, it doesn't necessarily mean just because you're in a mandated state, you would be covered. But it doesn't necessarily make that if you're not in a mandated state that you wouldn't be so again. I had to educate myself about this in one of my positions that I worked out of the past and learned a lot about. You know, it's not just where you are, it's where you work, and it's kind of complex. But again, there's lots of resource is out there that can hopefully help a patient get through the you know, the maze of it.

spk_0:   52:41
And you're the benefit provider at your infertility clinic is a great source of information as well. So and you don't even have to. Oftentimes, you could just do that. A phone call has supposed todo is scheduling an appointment there, so yeah, something really important Thio to talk about. All right, let's move to talking about medications. Uh, we know that ah, IVF would not just IVF but their oral medications and things. A cz well, So what type of medications are used to treat infertility?

spk_1:   53:17
Sure. You know, medications, infertility medications Per, say, most of us don't realize it, but the majority of medications that are taken to treat infertility issues are pills and by mouth.

spk_0:   53:30
You

spk_1:   53:30
know, only a small percentage of patients will advance to IVF and those types of things. And so, um, you know most of your P o medications or by mouth medications are, you know, dispensed by a regular pharmacy. You go in, you get the medications, you're given instructions on when to take them around your menstrual cycle. Ah, but a lot of medications that are involved with fertility and advanced technologies are injections, and the reason they're injections is because most often their hormones. And unfortunately, we still cannot take you know, the drugs associated with fertility. You know, by mouth, we have to do subcutaneous, which means kind of a smaller allergy kind of insulin type needle injections. Once in a great wild, there would be another type of injection, but it's not very frequent. And so again, um, the majority of these medications are used to either number one correct and population problem. So every month you're not making adequate hormones, so your brain somewhat shuts down and doesn't work properly. Just signal your ovaries. And so, by giving these medications, whether it be by mouth or injection, you're just helping the body along to kind of somewhat supplement those hormones. That's kind of the first line of used for fertility medicine. The second line of use that fertility medicines evolved to was there use with, you know, advanced technologies such as idea in that you want to make multiple eggs. And so you know you're not only just correcting to make one egg, you're giving additional medications and home loans to make and harvest additional eggs so that the procedures have a little bit of a higher pregnancy rate. And so again, um, these types of injectable drugs are supplied most often to the country's through specialty pharmacies. Specialty pharmacies take care of patients with all kinds of chronic and advanced diseases such as oncology. And that's, you know, rheumatoid arthritis and fertility falls into that basket. And so, at a specialty pharmacy, you will get a lot of resource is along with these medications. You know, there are folks that help you, you know, learn how to store the medications, learn how to mix the medications and learn how to inject the medications. And so you know, the model to specialty Pharmacy is, you know, evolved tremendous, really over the last 15 years in that, you know, patients do have a solid resource, such as the lions are its Walgreens crime, which is a specialty pharmacy. Tohave that resource because there's nothing more intimidating than getting a box of medications and thinking. Okay, what do

spk_0:   56:18
we know? What exactly? No,

spk_1:   56:21
no. Now what?

spk_0:   56:21
Now what? It's scared. Yeah, it's absolutely scary. And that's why we encourage people to Bill. First of all, you may have to him. These medications are often not available regular pharmacies, but the other reasons you want to go to a pharmacy, that that's what they do. So when you have a question of, do I have to put this in the refrigerator? They could say Oh, yeah, that's the one you put in. But this other one, you don't And they could just walk you through it, which is? Yeah, I see. God, it really is,

spk_1:   56:47
huh? Yeah. Yeah, it's It's like it's a nice resource for patients. It's one less thing for them to worry about. There is a very, you know, close relationship in close communication between a fertility provider and a specialty pharmacy. And, you know, they get to know each other very well.

spk_0:   57:06
And so,

spk_1:   57:06
you know, they work very cohesively together, and so that ultimately the patient benefits, you know, from that collaboration

spk_0:   57:13
and something else keep in mind is that timing is important. You need your medication when you need it. Because this is all a timed. At some point, it becomes a very closely timed medical treatment. And you need someone a pharmacist who understands the importance of Okay, I've gotta have this now. This is not a polar. Come in next week and we'll get it in. No, that's just not how it works. Yeah, it needs to be done. Exactly. Exactly. So that's okay. Okay. But thank you so much. Nancy Harrington, for talking with us if listeners want to get more information, Where should about ur about Alliance Rx Walgreens prime or about infertility? Or about things to consider at the beginning of the infertility treatment? I know you guys have a fair amount of resource is, too, because you're kind of in the business of helping people at this stage. So where should people go? If they want more information,

spk_1:   58:06
they can go to a lion. UH, alliance. Eirik w p dot com We have a wonderful patient kid book called Understanding Infertility.

spk_0:   58:15
It containing the writer. The information This

spk_1:   58:17
yeah, contains a lot of what we discussed today. It doesn't just talk about, you know, medications that talks about lifestyle and diet, nutrition and stress on those types of things. They can also go to Walgreens dot com slash fertility. You know, Walgreens what's quite closely with Alliance Iris, Walgreens Kind and that they have established, I think, close to 11 fertility specialty pharmacies throughout the country so that there's adequate resource expectations, you know, geographically and regionally. And they can also email me my I am Nancy God Harrington at Alliance are rex w p dot com. With any kind of questions and I'd be happy to help folks and lead them to any resource is that might be helpful on their journey. So thank you again for having me. And, um, good luck to everyone that's out there. The on this journey.

spk_0:   59:11
Thank you so much for helping to demystify the beginning steps. I really do appreciate it into our audience. Everyone take care, stay healthy, wash your hands, and we'll catch the next week.