Demystifying Fertility Treatments: A Guide for Doulas
by Lara
There are a variety of reasons that someone might seek fertility treatment, and they are not always obvious. 1 in 6 individuals worldwide experience infertility, and even more than that, 42% of people in the United States have accessed fertility treatments or know someone who has. The data speaks for itself: as a doula you will, inevitably, encounter folks who have accessed fertility treatments to conceive. In addition to those who are seeking fertility treatments due to infertility, solo parents by choice, queer families, and those using donor gametes will often utilize fertility treatments.
Whether or not you intend to ever offer fertility support as a part of your birthwork practice, it can be beneficial to understand a little bit about fertility treatments so you can meet clients where they are at, regardless of when you are meeting them in their journey to parenthood.
For folks navigating infertility, they will generally turn to the support of a doctor or fertility clinic under one or more of the following conditions:
They have been trying to conceive for 6-12 months without intervention and success.
They already know they will have difficulty conceiving due to a prior diagnosis or prior infertility
They cannot try to conceive at home (i.e., solo parents and queer families)
Keep in mind – people can get pregnant by the help of a known donor at home, but this piece will focus on clinical interventions only. While this piece does not constitute medical or clinical advice, we hope this overview helps you understand what your clients may have navigated to get to where they are now in their journey.
Common Journeys to Conception
Timed Insemination and Cycle Tracking
For folks who have no known or major diagnoses that are affecting their fertility, and who have access to a uterus and sperm at home, fertility clinics may recommend timed insemination as a first step. This looks like cycle tracking,monitoring, and, sometimes, the addition of medications to increase chances of success. Cycle tracking might occur solely at home with luteinizing hormone (LH) tests, or it might involve visits into the clinic for blood work and ultrasound to ensure that timing is correct. Cycle monitoring in the clinic looks at various markers to see when and if ovulation is coming up, including follicle growth, the thickness of the endometrium (uterine lining), and hormone levels. Medications may be given to increase the chance of ovulation or increase the number of eggs released (common ones are Letrazole and Clomid), and an injection may be offered to trigger ovulation, too.
Intrauterine Insemination (IUI)
The next step up on the ladder of interventions is IUI: intrauterine insemination. This involves a clinician placing carefully prepared sperm directly into the uterus. It can be utilized as an intervention when there are issues with the sperm causing an inability to conceive and when there is an unknown cause of infertility. It is also often the first line of treatment for queer or solo parents whose only issue is the lack of sperm and require donor sperm. It can be done with or without the addition of medication. Typically, the medications given during an IUI cycle are the same as or similar to what would be given during a timed insemination cycle. IUI can also be done at home with the assistance of a midwife, or in a midwife’s office; this can be a great option for folks who are interested in a less clinical approach, although often cycle monitoring via bloodwork and ultrasound is not available to those who use this option.
In Vitro Fertilization (IVF)
The next option is IVF: in vitro fertilization. This is what often comes to mind when fertility clinics are mentioned, or what we are familiar with from the media in relation to fertility clinics: daily injections, many appointments, and a high price tag. In reality, each IVF cycle is catered to the person undergoing it, with different medications and regimens being prescribed to suit the individual. The key points of IVF do stay the same though: medications are given to encourage multiple eggs to grow and mature instead of the typical one egg per cycle. These eggs are removed from the body and fertilized in a lab, and then once embryos are grown, they are placed back in the body to hopefully start a pregnancy. Embryos can also undergo genetic testing after several days of growth and can be frozen for future use.
While IVF is often sensationalized as a surefire way for someone to conceive, this is not always the case. For some, it takes multiple rounds of egg retrievals and multiple embryo transfers to become pregnant. For others, fertility treatments are never successful.
Within an IVF cycle, there are two options when it comes to egg fertilization: conventional IVF or ICSI (intracytoplasmic sperm injection). Conventional IVF involves setting up each harvested egg in a laboratory dish with many sperm so that fertilization can occur similarly to how it would in the body: with the egg and sperm meeting and fertilizing that way. ICSI involves the selection of a specific sperm, which can be useful in cases where sperm quality is otherwise low, and injecting that sperm directly into the egg. At this point, the processes return to being the same, and the fertilized eggs are left to (hopefully!) grow into embryos.
Providing Supportive Care
When we meet our clients once they become pregnant, it can be helpful to understand what process they went through to become pregnant. Many people do not begin their conception journey thinking that they will need fertility treatments, and this shift can affect how they feel about their pregnancy and even their postpartum experience. Conception with the help of fertility treatment is often expensive, exhausting, and sometimes grief-filled. For many, that grief persists. Knowing a bit about what your clients went through can help them to feel supported and held in their experience.
Interested in learning more? Join our upcoming Fertility & Conception CE Course to take a deep dive into fertility, conception, and supporting clients who are currently navigating or have navigated a TTC journey.
Lara (they/them) is the Project Manager and Core Teacher here at BADT. A full spectrum doula specializing in supporting queer and trans folks through fertility, pregnancy, and postpartum, they also offer lactation support, childbirth education, and mentorship for other birthworkers. Lara is the parent of a baby who they conceived through the help of fertility treatments. You can connect with Lara on their website or social media @theplanteddoula.