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TitleThe Unofficial Guide to Getting Pregnant (Unofficial Guides)
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Table of Contents
                            The Unofficial Guide to Getting Pregnant
	About the Authors
	Part I: Preparing for Pregnancy
		Chapter 1: A Healthy Start
			The preconception checkup
			Healthy choices
			Age and fertility
			Age and problem pregnancies
			Preserving your fertility
			Pursuing pregnancy after cancer treatment
			The road to pregnancy
			Just the facts
		Chapter 2: Conception and Misconceptions
			Reproduction 101
			The journey toward conception
			When everything goes right...
			Just the facts
	Part II: Pursuing Pregnancy
		Chapter 3: Try, Try Again
			Realistic expectations
			Ovulation: a woman’s key to conception
			Sperm: the key to male fertility
			When everything seems to be going wrong
			Just the facts
		Chapter 4: What Conceivably Can Go Wrong?
			Coming to terms
			Whose problem is it, anyway?
			What’s the problem?
			Structural abnormalities in women
			Structural abnormalities in men
			Unexplained infertility
			Just the facts
	Part III: Doctors and Diagnoses
		Chapter 5: Choosing the Right Doctor
			Putting off the consultation
			Looking for Dr. Right
			Making the most of your consultation
			Taking charge of your fertility treatment
			The doctor-patient relationship
			Switching doctors
			Just the facts
		Chapter 6: Getting to the Root of the Problem
			The infertility work-up
			Narrowing the possibilities
			Specialized tests for women
			Specialized tests for men
			Genetic testing
			Diagnostic decisions
			Getting ready for treatment
			Just the facts
	Part IV: Traditional Treatments
		Chapter 7: Fertility Drugs and Other Nonsurgical Treatments
			Indications for fertility drugs
			Back to basics
			Ovulatory disorders and fertility drugs
			A guide to fertility drugs
			Fertility drugs for men
			Artificial insemination
			Just the facts
		Chapter 8: Surgical Solutions
			Surgical innovations
			Surgical solutions for women
			Surgical solutions for men
			To have or not to have surgery
			Just the facts
	Part V: The Assisted Reproductive Technologies
		Chapter 9: The Current and Future State of the ARTs
			Who do the ARTs help?
			What’s involved?
			The ARTs from A to Z
			Promising new techniques
			Cryopreservation today and tomorrow
			Embryonic stem cell research
			Just the facts
		Chapter 10: Considering the ARTs
			Emotional considerations
			Medical considerations
			Other considerations
			Choosing an ART program
			Making sense of ART success
			Factors influencing success
			Other important decisions to make
			Just the facts
	Part VI: Alternative Solutions
		Chapter 11: Is Third-Party Reproduction Right for You?
			Third-party reproduction options
			Considering third-party reproduction
			To tell or not to tell
			The adoption option
			Just the facts
		Chapter 12: Pursuing Third-Party Reproduction
			Sperm donation
			Egg donation
			Embryo donation (and sperm/egg donation)
			Traditional surrogacy
			Gestational carriers
			A summary of the options
			Finding a program or agency
			Screening and other guidelines
			Important questions to ask
			Just the facts
		Chapter 13: Complementary and Alternative Solutions
			Complementary and alternative medicine (CAM)
			CAM and infertility
			Should you go the alternative route?
			Just the facts
	Part VII: The Social, Emotional, and Financial Sides
		Chapter 14: The Infertile Couple
			...And doctor makes three
			Sex on schedule
			Fertility fights: whose fault is it, anyway?
			How men and women cope with infertility
			Talking it over...and over
			Fertility rights
			Long-term effects
			Just the facts
		Chapter 15: Living and Working in the Fertile World
			Coming out
			The fertile earth
			Job interference
			Working through your problems
			Just the facts
		Chapter 16: Surviving and Resolving Infertility
			A multitude of losses
			Regaining control
			Mourning your losses
			Survival strategies
			Deciding that enough is enough
			Childless by chance...or choice
			Just the facts
		Chapter 17: Money Matters
			The costs of treatment
			The insurance debate
			What’s covered, what’s not
			Cost-cutting strategies
			State mandates
			A few final thoughts
			Just the facts
	Appendix A: Glossary
	Appendix B: Recommended Reading List
	Appendix C: Resource Guide
		Medical organizations
		Organizations for consumers
		Adoption resources
		Alternative and complementary medicine resources
		Other useful websites
	Appendix D: Sample Genetic Testing Flow Sheet
	Appendix E: State-by-State Infertility Insurance Coverage
Document Text Contents
Page 1





Joan Liebmann-Smith, Ph.D.,
Jacqueline Nardi Egan, and

John J. Stangel, M.D.

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not unlike that of most infertility treatment and are discussed in
detail in Part V. The financial costs are, however, considerably
higher, and may be out of reach for many couples—especially
those whose health insurance policies don’t cover the ARTs.
Chapter 17 addresses the financial aspects of infertility treat-
ment, including ART.

Medical considerations
The medical risks are usually short term and associated with the
drug therapy and the egg retrieval typically involved in the
ARTs. Long-term risk considerations include multiple births,
birth defects, chromosomal abnormalities, and cancer.

The drug therapy
The major risk of fertility drugs is ovarian hyperstimulation syn-
drome (OHSS). As we mentioned in Chapter 7, up to 10 per-
cent of women undergoing ovulation induction may develop
mild OHSS, but less than 1 percent get a more serious form that
occasionally requires hospitalization. The good news is that
mild hyperstimulation is associated with a slightly increased
chance of pregnancy. The most severe form, which occurs in
fewer than one in a thousand cases, can usually be treated with-
out hospitalization. (See Chapter 7 for more information about
the risks and side effects of hormonal therapy.) Uncommon
side effects include blood clots where the shots are given, and
local swelling, redness, pain, and very rarely, death.

The egg retrieval procedure
As with almost any type of invasive medical procedure, there are
the side effects from, and risks related to, local or general anes-
thesia or sedation. These can range from the more common side
effects such as prolonged nausea and wooziness to the less com-
mon but serious ones, such as anaphylactic shock. In rare cases,
death can occur. As in any invasive procedure, there is also the
risk of infection, bleeding that can sometimes be severe, or organ
damage. Informed consent is required when undergoing ART.

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Multiple births
Multiple births can be a mixed blessing. After years of infertility,
having two or more children at once certainly is cause for cele-
bration for most couples. But multiple pregnancies can also
cause serious problems for both the mother and her babies.

Women with multiple pregnancies are at increased risk of
miscarriages and pregnancy complications such as preeclampsia
(pregnancy-induced hypertension), gestational diabetes, and
placental abnormalities. They are also at increased risk for pre-
mature labor and may have to be confined to bed rest or even
hospitalized for weeks or sometimes months before delivery.
Pre-term births occur in more than half of twin pregnancies and
from 90 to 100 percent of pregnancies with triplets or quadru-
plets. Caesarian (C) sections are often necessary for twin births
and virtually always required for the birth of three or more
babies. Sadly, those women carrying large numbers of fetuses
may also have to make the extremely difficult decision to
undergo a fetal reduction to increase the survival probability
and health of the remaining fetuses.

The babies that result from multiple pregnancies—especially
triplets or more—are at increased risk for myriad problems,
including prematurity, low birth weight, and even neonatal
death. Indeed, compared with singletons, a twin is 7 times more
likely and a triplet 20 times more likely to die within a month
after birth. Being born prematurely puts a baby at risk for such
serious conditions as respiratory distress syndrome, cerebral
palsy, blindness, and lifetime disabilities.

Watch Out!

When you go for a procedure—no matter how minor, or how little anesthesia
or sedation you’re given—bring someone with you. You probably won’t be
able to drive home afterward, and may not be very steady on your feet. A
companion can help you get home as well as give you emotional support.

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Structural abnormalities in women,

Subfertile, 74
Success, assisted reproductive

technologies (ARTs), 213–219
Support groups, 97, 335–338

costs, 358
endoscopic equipment, 158
history, 111
innovations, 157–159
laser surgery, 158
options, 171–173
small precision instruments, 158

Surgery, men
correcting obstructive

azoospermia, 168
opening blocked ejaculatory

ducts, 169
sperm-retrieval techniques,

varicoceles, 169
vasectomy reversals, 165–168

Surgery, women
about, 159–160
endometriosis, 162–164
pelvic adhesions, 162–164
removing uterine fibroids,

reversing tubal ligations, 160–161
tubal surgery vs. assisted

reproduction (ARTs), 162
unblocking tubes, 160

Talking, infertile couple, 305–308
Tay-Sachs disease, 13
Tea, 17
Tegison, 18
Temperature, ovulation, 64–65
Testes or testicles, 44
Testicular biopsy, 127
Testicular sperm extraction (TESE),

Testicular torsion and trauma, 85

Tests, men
acrosome reaction test, 127
hormone tests, 127
hypo-osmotic swelling, 127
scrotal ultrasonography, 127
sperm agglutination, 127–128
testicular biopsy, 127
ultrasonography, 127
vasography, 127
venography, 127

Tests, women
about, 121, 126
endometrial biopsy, 122
hysterosalpingogram, 122–123
hysteroscopy, 125
laparoscopy, 124
timing, 126
transabdominal (pelvic)

ultrasound, 124
vaginal ultrasound, 123–124

Thalassemia, 13
Therapeutic cloning, 198
Therapeutic insemination, 134
Thermometers, 66
Third-party reproduction

about, 229–230
adoption, 245–248
child’s knowledge of, 244–245
considering, 231–233
egg donation, 254–255
embryo donation, 256–258
family issues, 239–240
fatherhood, 234
finding agency, 266–269
genes, 234–235
gestational carriers, 260–265
HIV, 270
infectious diseases, 271
intrusion of donor, 237–239
legal issues, 240–244
motherhood, 234
options, 230–231
parenthood, 234
physical characteristics, 271
reality, 235–237
screening, 269–271

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Third-party reproduction (cont.)
sperm donation, 251–253
traditional surrogacy, 258–260

Thyroid disease, 10
Tight pants, 26

expectations, realistic, 61–62
specialized tests for women, 126

Tipped uterus, 39
Toxoplasmosis, 11
Traditional surrogacy, 258–260
Transabdominal (pelvic) ultrasound,

Transurethral resection of ejaculatory

duct (TURED), 169
Transvaginal ultrasound aspiration,


about, 105–106
costs, 353–360
embryonic stem cell research,

men, 153–154
preparing for, 130

Trophoblasts, 51–52
Trounson, Alan, 196
True unicorn root, 283
Tubal embryo transfer (TET), 186
Tubal factors, 80–81
Tubal surgery, 162
Turner Syndrome, 78

Ultrasonography, 127
Unblocking tubes, 160
Underweight, 24
Undescended testicles, 84
Unexplained infertility, 87–90
Urologists, 96–97

Uterine Artery Embolization (UAE),

Uterine Fibroid Embolization (UFE),

Uterus, 38–39, 81–83

Vacations, 56
Vagina, 37
Vaginal ultrasound, 123–124
Varicocelectomy, 169
Varicoceles, 84, 169
Vas deferens, 45
Vasectomies, 84

reversals, 165–168
Vasography, 127
Vegetarians, 24
Venography, 127
Vibratory stimulation, 153
Villi, 52
Vitamins, 24–25, 280–281

Waiting, fertile world, 324–325
White blood cells, 117
Withdrawal symptoms, infertile

couple, 303

Y-chromosome deletions, 79
Yellow Pages, 98

Zona pellucida, 50
Zygote intrafallopian transfer (ZIFT),

Zygotes, 50

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