29 Aug Wait… What is Fertility Nursing?
If you are sitting in a room of 6 couples, statistics show that approximately 1 of these 6 couples will have some experience with infertility, yet this topic is so “hush-hush”. Why? Of course, it’s an extremely personal process to have to endure, but the more people talk about it, the easier and simpler it becomes.
I feel so lucky to have the opportunity to give the gift of a family to those who cannot conceive naturally. It makes me feel like we (at my clinic) are doing something really good every single day. I remember learning about the term “beneficence” in nursing school, which is a principle of nursing ethics that essentially means “doing good” – I really do feel like I am incorporating this into my practice every day in my nursing career.
When I started in the world of fertility, I was introduced into the many procedures and accompanying acronyms that are involved in reproductive medicine. Let’s cover the basics, shall we!
Intrauterine Insemination (IUI)
At the clinic I work at, there are many ways to go about achieving a successful pregnancy. Typically, the process starts with a diagnostic cycle, which is completed through cycle monitoring. This includes blood work to monitor hormones and ultrasounds to monitor the follicles in the ovaries.
Once a diagnostic cycle has been completed, patients will typically progress to intrauterine insemination (IUI). The goal in a medicated IUI cycle is to have one or two good, mature follicles that may be fertilized by the passage of sperm into the uterus. Some patients will come into the clinic for ongoing monitoring throughout their cycle to determine the best time for insemination; whereas others will use at-home ovulation kits and will travel to the clinic for more extensive monitoring (blood work and ultrasound) once they have tested positive for ovulation at home.
Once it is deemed the appropriate time in the patient’s cycle, the patient will undergo IUI, which is completed by a nurse, or doctor if the patient feels more comfortable with this. This involves taking their partner’s sperm or a donor’s sperm and passing the sperm through the cervix and into the uterus via a very small catheter. The procedure is very similar to a pap smear, painless, just a wee bit uncomfortable.
In Vitro Fertilization (IVF)
After multiple unsuccessful tries at IUI, a patient will usually move on to in vitro fertilization (IVF). In the most basic form of IVF, the patient will undergo an ovarian stimulation regimen, which will stimulate the ovaries to produce and mature multiple eggs, as opposed to just 1 in a regular cycle. This is done via subcutaneous injections containing a follicle-stimulating hormone (FSH).
After approximately 10 days of stimulation, the patient will undergo an egg retrieval, which involves using a long, thin needle to puncture the ovaries and drain the follicle fluid in hopes of retrieving an egg. The eggs are then in the hands of the embryology team to create embryos. Some clinics will use classic IVF (the sperm and egg are placed in a dish and fertilize naturally) and some will use ICSI [intra-cytoplasmic sperm injection] (the sperm is injected directly into the retrieved egg to achieve fertilization).
The embryos are typically grown in the lab for 5-6 days and the embryo can be transferred into the patient (similar to an IUI) via an embryo transfer on day 3 to 5, or the embryos can be frozen (cryopreserved) for later use in future frozen embryo transfer (FET) cycles.
Frozen Embryo Transfer (FET)
Once embryos have been created, graded and potentially tested for genetic abnormalities (depending on patient preference), they may be transferred back to a patient or gestational carrier to hopefully achieve a pregnancy. In a frozen embryo transfer cycle, the patient’s uterus is prepped using estrogen and progesterone to build and maintain a uterine lining that will support the implantation of the embryo.
The frozen embryo transfer process is similar to that of an IUI; however, instead of passing sperm into the uterus, the doctor is passing an embryo into the fundus (top) of the uterus via a small catheter that is guided by ultrasound imaging. Again, the most uncomfortable part about this procedure is typically the pressure from the speculum, or potentially, poking around the tip of the cervix.
Following the embryo transfer, the patient will continue on prescribed medications to maintain a nice “home” for the embryo to implant and grow into a baby. The next step in this process is a couple weeks following the FET and involves the patient testing their beta human chorionic gonadotropin (BHCG) via blood work, which is the hormone that indicates a pregnancy has or has not occurred. This can be a very emotional and challenging couple of weeks for patients!
Once a pregnancy is achieved, medications typically continue throughout the first trimester to help maintain the pregnancy. This usually includes taking oral estrogen, prenatal vitamins with folic acid, and progesterone (whether taken as vaginal progesterone suppositories, intramuscular progesterone in oil injections, or oral progesterone). It certainly isn’t glamorous; however, the end goal is what ultimately keeps patients going throughout this journey.
Some patients may undergo many rounds of IUI, IVF and FETs. This can be costly both financially and emotionally. It can put a strain on romantic relationships and also relationships with others (especially with family or friends who are not supportive or may not understand the process). In the future, if you know of someone enduring fertility struggles, give them a hug and commend their strength as they endure this extremely emotional journey. IVF moms and dads are some of the strongest people out there.
This post is just touching on some of the things I do as a fertility nurse, but I hope it helps to clarify the basics for some of you who may not have known much about this sector of nursing (I know I certainly didn’t just over one short year ago!).