The end of 2019 brings about the end of another year, and the start of a brand new decade. 2020 used to feel so far away, and now it’s here. You’ve been wanting to start your family and now you’re ready to take the next step, to start of the decade with a baby of your own. 

If you’re here, you’ve already been trying for a baby for at least 12 months (or for 6 months for women over 35). Your doctor may have already prescribed you fertility medication, like Clomid, to improve your success.

Now you’re ready to explore your assisted reproductive options. Where do you begin? 

Before You Start IVF

In Vitro Fertilization (IVF) is an option familiar to most people. But there are a number of steps to go through before you get to fertilization:  

1. Lifestyle modifications. As you already know, lifestyle factors like smoking, alcohol, stress, weight (being underweight or overweight), exercise can all contribute to infertility, as can conditions like PCOS. Changing up your diet, exercising more, eating more nutrients (including healthy fats, supplements and cutting down on sugar and refined foods) can all improve fertility in men and women, but it there is also research to support lifestyle factors as key in improving IVF success, too (and that behaviors like drinking and smoking can significantly decrease your chances of success).
   
   
2. Set up a consultation. Your doctor may refer you to a specialist, or you may go to a clinic of your choosing. You’ll be working closely with the team at the clinic. Infertility can be an emotional roller coaster and you’ll be glad to work with a doctor you trust and supportive staff. Often insurance will cover at least some infertility treatment costs. Check with your provider to ensure you’re covered, and talk to the clinic about your financial situation.
   
   Non traditional parents (LGBTQ+ parents, single parents) will want to take extra care to choose a supportive clinic. Not only will it be important for them to welcome you, but to have resources to support you in your journey. Ask about their clientele, support groups, referral options including lawyers
   
   
3. Determine the nature of the problem. Your fertility clinic will likely set you up with more testing, including a sperm analysis, blood work, an ultrasound and an assessment of ovarian function and reserve. Infertility happens equally in men and women, and sometimes in both. Testing will help determine the problem so your fertility specialist can determine the best treatment plan for you. 

Getting to IVF

If IVF is in your treatment plan, you (or your partner with ovaries) will take medication to stimulate egg production, then those eggs will be retrieved, fertilized with sperm (using the sample supplied) and then the embryo is implanted into the uterus. 

Or your plan may look a little different. Sometimes couples need to use donor eggs or sperm in order to form the embryo. They may also use their own previously frozen eggs/sperm to form the embryo. Some couples opt to use a donor embryo. Single parents and gay/lesbian parents will rely on donors. There are options for every family. Your clinic will be able to help you find the best option and connect you to resources for finding a donor.

Non-IVF Options

IVF is one of many options available for starting your family. One common, minimally invasive option is Intrauterine Insemination (IUI). During sexual intercourse, only a small percentage of sperm travel up through the cervix and reproductive tract. By injecting the sperm directly into the uterus--and bypassing the cervix completely--the number of sperm that reach the fallopian tubes increases dramatically. 

IUI treatment can be used in conjunction with an ultrasound so that the procedure is timed to maximize chances of pregnancy. Fertility drugs may also be used to stimulate more follicles to develop (a typical cycle produces a maximum of two viable eggs), substantially increasing the IUI success rate.

Surrogacy is a great option for many couples, especially LGBTQ+ couples and those who wish to use their own egg and sperm but are unable to carry the child the term. Typically couples choose a “gestational surrogacy” which means they provide the egg and sperm (themselves or via donor) and the embryo is implanted into a surrogate, who carries the baby to term. Couples may choose a friend or family member as their surrogate, or work through an agency. Less common is what’s known as a “traditional surrogacy” where the egg is provided by the surrogate, making her the genetic mother as well as the surrogate. This route requires consultation with a lawyer as each state has its own laws surrounding surrogacy regulations and requirements, definitions of parenthood, protections for surrogates and families, and more. Partly for this reason, it can be one of the more expensive routes to go as well. 

Living Well Through Infertility

We recommend that along with your plans for starting your family, you make solid plans to keep yourself healthy and happy. Infertility is not an easy journey. By starting out with a plan, you’ll not only have an easier time with it, but you’ll also keep yourself in the best place physically, mentally and emotionally to make good decisions, navigate the emotional ups and downs and optimize your chances of a successful pregnancy and birth. 

Here are a few tips to help keep you thriving:

• Gather friends and family. Physical health is important, but equally important is your support, especially when things get hard. You will likely be frustrated, sad and drained at certain points and you’ll want to turn to people you love for support. You will also be excited and happy, and you’ll want to share that, too.
• Spend the first three months optimizing your health. New (mature, functional) sperm take about 3-4 months to form. Hit the ground running on your weight loss goals and lifestyle changes so that when you’re ready to start with your fertility plan, you’re ready. Starting off the year strong will not only maximize your fertility, but you’ll feel great and have established healthy habits to see you through any challenges that come your way. 
• Take your vitamins, even if you’re not planning to conceive. You’ll be amazed at how your energy increases, your sleep improves and your skin seems to glow, all because you got serious about your nutrients. Yes, vitamins are essential to a preconception diet--so if you are working to optimize your fertility, both partners should be taking them a full 3-4 months prior to trying to conceive, even by IVF. But their benefits to mood, energy, mental and emotional wellbeing are often overlooked. Talk to your doctor about your specific needs and the best vitamins and nutrients for supplementation. 

It’s a new year, a new decade and a new start for you and your family. Treat yourself well, especially as you start your family journey. It’s an exciting time and you deserve to be supported not just by your loved ones but through your own self care.