Of course, we all hope that we won’t have a “journey”. We hope that we’ll achieve pregnancy quickly, on our own, like so many friends and neighbours and co-workers seem to do.

When it isn’t easy – when you find yourself on websites, or at your doctor’s office or a fertility clinic-then you are on a journey.

Many patients arrive at a clinic hoping for a very, very short journey.  Others are willing to let things take a little longer if it means fewer tests or medications.  Sometimes finances must be carefully considered.  A Care Plan will help you and your clinical team resolve these sometimes conflicting goals.

A Care Plan often consists of four parts: Assessment, Planning, Implementation, and Evaluation.  This may be a process that you clearly lay out with your doctor, or it can be something you refer to on your own, to keep yourself on track.

What’s involved in an assessment?

From first contact, the clinical team will assess your situation through medical history, do physical examinations and investigations. It can get quite involved.

How far do you want your assessment to go?

Some patients want just the minimum.  I had a patient who planned to carry the embryos for her best friend.  I can tell you, there are a lot of tests that I can order to “ensure” that she will be safe to become pregnant.  From ECHO cardiograms to 3D sonohysterograms, we can do it all.  She wanted almost none of it.  I insisted on a few things – infectious disease testing and legal counseling – but this patient had identified that she was going to minimize intervention. There are risks that something can go wrong, but she felt it was easier and gentler to do few tests.

Other patients want to rule out everything. For them, the stress of a procedure or investigation is easily balanced by their need for an answer – a need to know that they have explored the outer limits of what science can tell us.

Many patients are less certain of what’s right for them as they begin their journey. This is when it is most important to communicate well your doctor. Making sure that we, your care team, and you, the patient have the same expectations and definition of what is “right” for you can be a challenge sometimes.

When my patients are looking for guidance, I start with the easy tests. Of course, it’s easy for me to say “easy tests” and not everyone will agree with how I might define them. The ideal pace of change is different for every patient. Though if weeks or months are passing, I will suggest more tests and more aggressive therapies.

Once you have identified the tests or treatments that you want to do, you are ready for the plan to get you there.

How do we make a plan?

Planning how to organize your treatments and testing is often done in collaboration with your nurse.

Some patients hope to get their investigations over with and treatments started as fast as possible.

But in practice, as-fast-as-possible can be totally consuming, and perhaps incompatible with other life goals (like keeping your job and your mental health).

A good plan will set expectations that can work for everyone.

Is implementing the hard part?

Implementation, at its best, can be a relatively low-stress experience: you are simply doing what you had set out to do.

Your body may not co-operate with your plans, of course, which is what leads us to the final step…

When do we need to re-evaluate?

At the end of every cycle, you should review your situation. Are you happy with the level of investigations? Of treatments? With the pace and intensity of your care? Is your plan clear? Are treatments being implemented appropriately?

A Care Plan will help ensure that you receive medical care that fits.

I hope this approach helps you.  I have found it a useful framework in my own practice to guide us at every step.

The post My partner and I are just beginning our fertility journey. How do we create the best care plan for us? appeared first on Fertility.ca.

In the context of fertility, erectile concerns can often be interpreted as ambivalence about having children. Some men may refuse to have intercourse, or otherwise turn away. They may claim that they no longer want to have children, when really what they are saying is that the situation has created a deep sadness in them.

If your partner might be experiencing male subfertility, talk to him. Validate and listen to your partner’s feelings within the relationship and in the bedroom. I strongly recommend counseling to assist both of you in maintaining healthy communication and a supportive partnership.

The post The emotional side of male subfertility/infertility appeared first on Fertility.ca.

Those who suffer from subfertility often share a profound sense of guilt, as if somehow they could have done better. These feelings get reinforced in subtle and not so subtle ways around us. One example is that funding for fertility has been so difficult to come by. Not just in Canada, but across the world.

For such a common condition, one that affects so many of us on a profound level, that’s remarkable and sad.

It is incredible to me that a country that provides me free ACL repairs so I can get back to the sports that I love would not support even a trial attempt at having a baby.

Gratefully, there are counterforces at work too. Increasingly in Canada, we feel a groundswell of support for making fertility treatments accessible.

Few of us are in control of how and when we may have the opportunity to initiate pregnancy. But as soon as you determine that having a baby is right for you, then through education, supports, and technology where necessary, you can be helped.

It may not have been the way you had hoped or planned to get pregnant, and there might even be uncomfortable choices to consider (such as working with donated eggs and sperm). But there’s always a solution, and I hope that throughout this process you are able to do your best to not resort blaming yourself or your partner, despite some deep external pressures.

I hope and believe we are all just doing our best.

The post Are my fertility issues my fault? appeared first on Fertility.ca.