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Tuesday 17 March, 2009
Source: Society for Endocrinology BES
A recently discovered hormone could help infertile women regain their fertility.
It's called kisspeptin and British scientists believe that this protein can stimulate the release of reproductive hormones which control the menstrual cycle.
Kisspeptin and the gene that serves as its blueprint, KISS-1, is produced during adolescence and triggers the release of the hormones that bring on puberty. In animals, kisspeptin has been shown to play a role in reproduction too where lower production levels of kisspeptin triggers the loss of reproductive urges. Animals and humans lacking kisspeptin do not go through puberty and remain sexually immature.
Lead researcher Dr Waljit Dhillo from Imperial College London studied 10 women who were not menstruating and were infertile. The women were then injected with either kisspeptin or a placebo.
Blood samples were taken to measure levels of the luteinising hormone and follicle stimulating hormone, both of which are crucial for ovulation and fertility.
Kisspeptin led to a 48-fold increase of luteinising hormone and a 16-fold increase in follicle stimulating hormone compared with the inactive salt solution.
The study is the first to show that kisspeptin can stimulate sex hormones in women suffering from infertility and confirms earlier research that the treatment leads to the production of sex hormones in fertile women.
Sarah Williams
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1. Buy and carry an extremely cute puppy. As there are more dog lovers than kid lovers in the world you will instantly attract attention away from smug pregnants and their cute toddlers.
2. Introduce the dog in a gushing cutesy voice as ‘my/our baby' which will stop people asking the whereabouts or existence of a real baby. Nobody ever said to Paris Hilton, "Nice dog but when are you having a baby?"
3. Consider having a T-shirt boldly emblazoned with the name of your fertility clinic, e.g., Monash IVF and wear it. That way people will instantly know where you're at without asking or else they will ask about what it means and you can tell them. Either way you will be educating a group of ignoramuses and that can't be a bad thing. Also guaranteed to give instant immunity to birth/baby story viruses.
4. Arm yourself with phrases like "Of course for our next trip to Paris we'll be staying at the Ritz. It's far more convenient to those fabulous magasins (shops) off Rue de Rivoli, the ones where Katie Holmes shops." or "What have I been up to? Well in between learning mandarin, setting up my art studio and planning my volunteers trip to Nepal I've hardly had time to scratch myself." 6. If someone says, "So when are you starting a family?" simply reply, "Good question. I have no idea but let me consult my herbalist, fertility counsellor, gynaecologist, clinic nurse and God. If any of they can enlighten me, I'll get back to you." 
7. In response to the oft and thoughtlessly repeated phrase, "Having children makes you less selfish," do not choke on your hors d'oeuvre or spit out your drink, as much self-restraint as this will require. Calmly point out that you find this puzzling because you always see evidence to the contrary. When asked what you mean, roll your eyes, laugh and say, "Where do I start?" before launching into how this morning alone you have been run over by two wide-bodied prams without apology, viciously cut off by an oversized vehicle driven my a ‘selfless' mother and at lunch your table and others at the café became a de facto playground courtesy of a nearby group of mothers who were busy enjoying their lattes in a selfless manner.
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'When trying to conceive becomes a battle to stay sane'
by Jodi Panayotov, The Australian
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I knew there was something wrong with me when I began frantically pulling everything out of the rubbish bin for the third time. Or should I say something else wrong with me. I already knew I had endometriosis, hyperthyroidism and that my hormones were out of whack (all under the infertility umbrella of afflictions), but this? It felt like something in my brain had gone into overdrive and was compelling me to do previously unimaginable things obsessively and repetitively.
How did it get to the point where I was on my knees rifling through salad scraps like a hungry street person? Except instead of food I was looking for one of a dozen discarded pregnancy tests, just in case a second line had shown up in the hour since I'd shoved it to the bottom of the bin in disgust.
This condition, like an obsessive disorder, had snuck up on me in the year since my first miscarriage and had become more pronounced in the year since my second miscarriage. My husband and I had been trying unsuccessfully to conceive for a few years and at some point recently it had taken over our lives and in particular mine.
At the time of the rubbish incident I was on herbs to correct my various reproductive ailments. This had involved the taking of my temperature every morning and charting it which may have been useful for my herbalist but was doing my head in. I'd taken to setting the alarm so I could get an accurate reading by taking it at the same time every morning. A temperature too high and I'd failed to ovulate, a temperature too low and I wasn't pregnant.With shaking hands I'd reach for the thermometer and depending on the reading of my basal temperature, I'd either leap out of bed happy or retreat under the covers. I became Linda Evangelista-esque in that a number dictated whether I got out of bed or not, although for her there was a dollar sign in front of the number while my number had a small elevated circle after it.
As for the temperature chart, I'd taken to studying it instead of the papers throughout breakfast, analyzing the little peaks and troughs as if it was a stock market graph. Did they mean I was ovulating or was I perhaps, oh God please, pregnant? And my mood would swing in peaks and troughs accordingly.
I realized how dependent on the temperature taking and charting I'd become when on one weekend my husband and I went away to the mountains and as we were halfway to our destination I remembered I'd left the thermometer and chart by the bedside. ‘We have to go back!' I screamed. There was no way I could face a weekend without it. It was as if my very existence now depended on that thermometer, it so dictated my days and moods that I wouldn't know what to feel without it.
At dusk we finally arrived at our destination, a villa tucked away in the mountains. The next morning was one of the mornings I wanted to stay in bed like Linda but breakfast was included so I dragged myself out to face a sumptuous buffet. At first it looked very inviting, laden as it was with fresh and home-made local mountain products. Then as I moved along with my plate the items started to turn into something else before my eyes. The plump dried figs became shrivelled ovaries, the berry jam endometriotic clots and the poached eggs blighted ova. I knew than that I needed help but I wasn't sure whether to call a gynaecologist or a psychiatrist.
As it happened I ended up seeing both. After that weekend I called my gynaecologist in Sydney and booked an appointment for IVF. I really didn't trust things to be left in my own hands any more, not when I was capable of turning a breakfast buffet into a dysfunctional reproductive system. And through a friend I found a ninety-year old one-legged psychiatrist who had more empathy for how my fertility problems were affecting my life than anyone in the medical fraternity.
The medical fraternity are all, ‘Swallow this, have another blood test, take this, try this,' but they seem completely oblivious to the emotional side of what you're going through. For instance, not once in any medical report do they say, ‘There are many side-effects to infertility beyond the physical ones. Some common ones are:
Homicidal thoughts towards pregnant women, Homicidal urges towards people who mistreat their children, Temperature Charting obsession, Repetitive Pregnancy Test taking to the point where you consider taking shares in the company who manufactured them, Extreme mood swings, Bursting into tears at someone else's pregnancy news, for example Liz Hurley's. And the less common: When foodstuffs remind you of faulty reproductive organs.
If I thought IVF would be the answer to both my reproductive issues and my mental issues I was very mistaken. Yes, it produced a baby but the emotional toll took ages for me to recover from it. On the one hand IVF took the onus from me and placed it in the hands of a medical team but on the other hand I had to play a far greater role in it than I had with my herbs.
Everyone knows IVF involves injections but what I didn't realize was that there would be a plethora of blood tests that left my inner arms looking like that of a junkie and these were carried out at obscure hours in the morning. Sometimes these were paired with internal ultrasounds, after which I'd spend until mid-afternoon obsessively awaiting the results and whether we would continue the next day. It was like doing an exam every day that you had no way of studying for.
I'd thought my mental state was pretty ragged until I started the IVF drugs. To put them in perspective, I seriously believe that one day, ‘My client was under the influence of Lucrin and Puregon when she killed him, Your Honour,' will be a valid defence in a trial. It's like PMT tripled. And coming on the tail of the years of trying to conceive stress it can be a force to be reckoned with. I think that for the first time in his life my husband was scared of me when I was on those drugs.
The day I got the positive pregnancy result from the IVF clinic it was like being let out of prison, a mental prison that I'd been in for the past three years. But I was on parole until after the scans that showed a viable pregnancy. Suddenly I didn't know what to do with myself. I put the thermometer away, the charts, tipped out the herbs and thought, ‘what now?' It was as if I had to invent a new life for myself, which I did, although I had some scares during pregnancy which had me back in a state of high anxiety for a while.
Now when I look back on the diary I kept during the infertility years, which I've since turned into a book, it's not the procedures, the drugs, the temperatures that predominate but the insanity which accompanied them all.
Friends who've read the book are taken by utter surprise and say they had no idea what had been going on. Yes, they knew of the herbs, the IVF etc but they had no idea what was going on with me. It wasn't as if I was going to ring them and say, ‘Can you believe it, I've just spent an hour trawling through my rubbish and the pregnancy test still says negative,' or ‘I really think that figs look like ovaries, don't you?'
You see, when people speak of infertility nobody mentions that it has an insanity clause.
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Maybe they had guides showing them from room to room. ‘And here is the room where it all happens and that's the stirrup chair. What, the guy in the white coat? He's the embryologist. You wanna photo with him? Sure, wait till he brings the blastocyst up on screen…' Actually I had it wrong. An IVF tourist is someone undergoing IVF who chooses to do it in a vacation spot. Greece is one of the more popular ones if the marketing can be believed. Here you can have it all, apparently - embryo transfers, ultrasounds, ruins, and sun and sea all in the one package. And who can resist an IVF clinic in a quaint stone village? Or a donkey ride up a cobbled alley before the Egg Extraction? How about a set of worry beads to help you through the two week wait? Getting your pregnancy test result at a taverna with a jug of ouzo handy in case it's negative? There are so many plusses you can hardly stand it. Right. But where do you go to organize this? My travel agent? Or do you buy the plane tickets direct from the IVF clinic? Hmm, this is all a bit unusual. How about the accommodation - is it attached to the IVF clinic, part of the same complex? ‘Oh you'll be staying in the luxury Hellenic Fertility Villas, breakfast buffet and blood tests included.'‘Great but what about the ultrasounds?' ‘For them to be included you'll have to upgrade to our Deluxe Infertility Package which also includes donkey transfers to and from the clinic.'
‘Fabulous, where do I sign up?' And of course the airline is one of those budget ones with one kilo of hand baggage and ten kilos of check-in between you. So you have to discard almost all of your clothes as the IVF ice box with all the preliminary drugs that you received weighs more that the hand baggage limit on Aristotle Air. You'd forgotten what it was like getting through airports these days with all the security measures and what should be a simple three and a half hour flight (they forgot to mention the ten hour transit in Athens) turns into almost a twenty-four hour ordeal. By the time you reach the villa you're exhausted, shattered. But you have a week to recover before the egg retrieval and you realize you're going to need it. Now if only that rooster that seems to have stationed itself beneath your window (it's 3am) will shut up. The next day you'd kill for one of those greek coffees that the entire population of the island sits sipping in the cafes, but coffee's not part of the IVF diet. So you head to the beach, having first injected yourself in the thigh with a follicle stimulating hormone. You get so sunburnt you can barely move and spend the next few days leaving trails of skin and syringe packets throughout the villa. Though every now and then you must drag yourself to the little surgery down the alley to have blood tests administered by a surly woman. All of this, combined with the relentless consumption of greek salad (fried foods are a no-no in the pre-conception diet), the smell of souvlaki wafting in from the taverna on a nightly basis, are giving you nightmares about calamari. Though this could well be the as-yet un-researched effect of a foreign diet when combined with Gonal-F.
The donkey sent to fetch you for the egg extraction looks as regretful as you feel. How did you let the travel agent talk you into this? Your partner is practically estranged. He's gone off on his own donkey as he's still cranky about you berating him for being carried home unconscious from the taverna last night. He said someone spiked his ouzo but it's obvious he drank till he passed out. The smell of souvlaki must have taken up residence in your nostrils as the clinic, the only building on the island with working air-con, smells of it too. Surely they can't be chargrilling sheep out in one of the back rooms as that could be the only other explanation? The doctor has the same manner as your doctor at home but there is something express-lane about this place. Maybe it was the crowd of sunburnt sweaty foreign couples in the waiting room, some of whom obviously hadn't opted for the donkey package and looked as if they'd been hiking for hours in the blazing sun to get here. The injection of the anaesthetic gives you the first rush of relaxation since you arrived. When you wake up in recovery the smell of souvlaki has gone and you are told it was a good harvest. They are optimistic but they don't know about your partner's ouzo sperm. Surely they'll be too drunk to swim properly. The only taxi on the island is here to take you back to the villa, a relief until it starts to move. Every cobblestone is felt in your uterus, it's the most excruciating car ride ever. The next few days pass in a haze of boredom. You've already read the couple of books you brought, having imagined an entirely different holiday scenario involving floaty summery dresses and romantic beach walks and dusky tans. A German woman departing from the next villa recognizes the desperation in your eyes as your partner departs to partake in yet another dangerous beach sport and hands you a used fashion magazine. The anxiety of watching him suspended at the end of a dodgy-looking parachute attached to a boat driven by Kostas is more than your fragile mind can take so you accept it gratefully. It occurs to you that under normal circumstances if this were a holiday without IVF you'd probably have broken up with your partner by now but you're bound by whatever's happening in the lab on the hill. It also occurs to you after turning a few pages that German fashion is an oxymoron. The dejected donkey is waiting to take you to the embryo transfer. Tomorrow it'll be waiting to take you to the boat transfer to the airport or the trip home. It's the one thing you'll miss about this place and sadly at the moment you feel it understands you more than your partner does. You take a photo of it on the off chance that one day you'll have a child to show it to. The boat comes in, bearing a bunch of tired but hopeful couples. Amongst those waiting for the boat you recognize some couples from the clinic. They look stricken. Actually they look in dire need of a holiday. Jodi Panayotov author of In Vitro Fertility Goddess » 
Apparently there exists a phenomenon called the IVF tourist. My first thought when informed of this was of someone in golf pants and white joggers doing tours of IVF clinics during their annual leave. The kind of tourist who's bored with monuments and wants an ‘experience'.
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Is it possible to believe you have miscarried and still be pregnant? Well, yes, especially if you are twenty-five year old Leanne Wright of Greater Manchester, UK.
She claims she presented at the Royal Bolton Hospital at six weeks pregnant with symptoms of miscarriage and was sent home and told to take ‘labour-inducing pills'.
Two weeks later she was devastated to find she hadn't miscarried and was still pregnant, with the baby due in February.
Now there is a part of this story that I can't relate to in any shape or form and that is the bit where she is devastated to find out she's still pregnant. When I had my three miscarriages I think I'd have personally handed over the keys to my home and my car if it meant I could have heard the words, ‘Sorry but you're still pregnant.'
How may of us have the reverse happen, the thinking you're pregnant, having all the symptoms then having a scan which reveals you haven't technically been pregnant for several weeks and all that's there is a sac containing either a dead under formed foetus or nothing at all?
And how many of us would have killed to be in Leanne's shoes at that point? Excuse me while I hastily obtain a dangerous weapon.
Regardless of what Leanne may or may not have been feeling, the question begging to be asked is, how did this happen? How on earth could a hospital get it wrong, resulting in a woman being convinced she was miscarrying when she wasn't?
The hospital has simply said that ‘all pregnancies are not straightforward' and I got taste of this when I was miscarrying for the second time and blubbering in my doctor's surgery. I'd used up all of my doctor's tissues and was halfway up my second sleeve when she interrupted me to say that, despite the fact that I was bleeding substantially enough to be using maternity pads and had cramps I may in fact not lose the baby.
Slowly I ceased snivelling as she went on to say that when she was pregnant with her second child she thought she was having her worst period ever - bleeding, crippling pain and clots - and she was not only pregnant but went on to have a healthy child.
Yet as a precaution she sent me for a scan, which rapidly killed my new false hope when it showed that I had indeed miscarried. I have to wonder if the Bolton Hospital had actually done a scan or, busy with Friday night drunks, had simply sent her away without properly examining her. We don't know.
There is no doubt that many women bleed both regularly and even substantially during pregnancy but don't miscarry however they are not the majority. Whilst it is important to try and stay positive unfortunately you have to be realistic.
For every Leanne, angry about being pregnant when she thought she wasn't, there are thirty women like me, sobbing because they aren't pregnant when they thought they were.
If there is one constant, it is that neither pregnancies or miscarriages are straightforward, of that you can be certain.
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I never thought I'd see ‘miscarriage' and ‘good news' in the one sentence, or even for that matter on the same page, but even the most unlikely couplings can occur. And what, in this instance, brings these strange bedfellows together?
Firstly miscarriages, treated by much of the medical profession and most of the well-meaning-no-idea-relative-and-friend-society as being due to some unfathomable deep dark force that you can't argue with, are actually due in most cases to something both identifiable and treatable.
Obviously a first miscarriage is unforeseeable and therefore in theory unavoidable yet it can be the cue to get checked out before another occurs.
The medical profession, however, have other ideas. They like you to experience three consecutively before springing or at times limping into action. Then they officially label it as ‘recurrent miscarriage' which opens the door to all sorts of tests although often you need to ask for the key.
Unfortunately at this point you're so stressed and stricken with grief you aren't feeling very assertive so unless you have a pro-active doctor you still may not have any answers.
See, there are many factors which have been identified as causing or contributing to miscarriage and these include diabetes, high blood pressure, polycystic ovary syndrome, fibroids and thyroid abnormalities. As well there are chromosomal abnormalities, blood-clotting disorder and weak cervix.
And here's the thing, the good news as it were - except for the chromosomal abnormalities they all are easily treatable. Even the non-treatable chromosomal abnormalities have their jaunty side. As the cause of 50% of miscarriages they are usually random and therefore one-off unlike miscarriages that have an underlying medical cause.
So the idea is, get thoroughly checked out for all possible causes after a miscarriage although some doctors, like Mary Stephenson, MD, a professor of obstetrics and gynaecology and director of recurrent-pregnancy-loss program at University of Chicago Medical Centre says when planning to get pregnant you should get checked out. Sensible woman, I say.
Having talked my doctor into getting every test in the solar system done after my second miscarriage, which showed up my thyroid condition, I wish I'd had those tests done first. Then again it's probably not practical to have every woman of fertile age lined up at pathology clinics and letting enough blood to keep Count Dracula comfortable in retirement.
So how, short of pleading with your GP, can you be tested for miscarriage-causing conditions? According to Stephenson a specialized recurrent-pregnancy-loss clinic will be able to identify and test for underlying problems which can manifest themselves in someone who is outwardly healthy.
Once picked up, it is a matter of treating them, usually with a course of medication. Hence for women who have experienced the devastation of recurrent miscarriage there is plenty of hope that they can conquer it and win. In the gloom and doom surrounding pregnancy loss this can only be good news.
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Hollywood has been embracing it for years, although they still don't care to admit it, and now it's catching on throughout the rest of the western world. It's IVF and it's coming to a place near you, if it isn't there already.
While existing IVF clinics are expanding and upgrading to bigger and better premises, in the downtown of some cities they're popping up on every street. Pop out for a carton of milk and there's an IVF clinic where the 7/11 used to be.
Once the domain of a few well-heeled older career women, now women of all ages and socio-economic backgrounds are turning to it as fertility rates fall and infertility rates climb.
In previous times it was a hush hush thing, not to be discussed, now the internet is awash with woman trawling the infertility sites at all hours of the day and the night. Entire communities, even societies, are being formed in cyberspace and IVF is the hot topic, the strongest link.
There was a saying, when your taxi driver starts talking about share investment it's time to sell. Well now there's every chance your taxi driver knows something about IVF as his niece/cousin/wife is having it. So it's time to sign up or stop, you decide.
IVF is like the little black dress, the one size fits all approach to infertility although, like the little black dress it cannot compensate for all ills. Like the LBD, what you resort to when nothing else suits, IVF is what women turn to when in doubt or when all else fails.
And did I mention that it can also burn a considerable hole in your wallet?
Similarly, its status in the infertility field is dominant. On the sites it outnumbers the other topics in hits and posts significantly.
Most importantly, what black is to fashion - a main stayer that has been around for a long time, is here to stay and getting bigger every year - IVF is to fertility treatment. If you don't believe me ask your taxi driver.
Jodi Panayotov author of In Vitro Fertility Goddess »
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There exists a form of treatment that in future years may become an alternative treatment to IVF for the under -35s. It's called IVM -In Vitro Maturation.
Currently it is being offered to women with polycystic ovaries instead of IVF. Why? Because it doesn't involve ovarian stimulation and women with PCOS are more likely to suffer ovarian hyperstimulation syndrome when undergoing IVF treatment.
A cycle with no sniffing and no injecting! When can I sign up, you say. How does it work?
Firstly there are only a handful of clinics in the world at this stage offering the procedure, which is in its early stages of development. They are currently offering it to women with PCOS in their early to mid-thirties. For others, if you have just been born and are reading this no doubt by the time you reach your infertile years you'll be able to access it on any street corner. Anybody else will have to wait and see.
The way it works is that the follicles normally produced in a menstrual cycle are extracted when still immature - sized between 2-8mm as opposed to in IVF when they are grown to 10 mm or more. Most of the action then occurs in the lab, including the heavy petting, the maturing of the eggs and the fertilization, via ICSI.
The downside however is that success is far more likely in the under 35's due to the reliance on the ovaries to produce their own healthy eggs.
The pregnancy rate in some UK clinics is 20-30% for those under 38 with PCOS. Four hundred babies have been born worldwide as a result of IVM. It is expected that in the future it will overtake IVF as the preferred treatment for under 35's, being cheaper and without the drug side-effects.
Jodi Panayotov author of In Vitro Fertility Goddess »
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Sick to death of drinking green tea, taking herbs, hanging bat-like from our bedroom ceilings, and forking out barrels of money for IVF?
Then maybe it's time to take a fertility tip from the former Spice Girl and self-promoting fertility goddess Victoria Beckham. But, I hear you say, wouldn't taking reproductive advice from Posh Spice be the equivalent of getting parenting tips from Michael Jackson or relationship counselling from Jerry Springer?
Not quite. Remember that the scowling skeleton with a bob has managed to produce three children. Her secret, apparently, is to get a fertility tattoo on her inner thigh. Reportedly she is flying a celebrity tattooist to LA for that very purpose.
So convinced of success is Posh that she's even getting the symbol for a girl done, so she can take it shopping.
Now the gossip magazines can wait with baited breath to see if it works. And if it does we can be sure inner thigh fertility symbols will be the next big thing.
Jodi Panayotov author of In Vitro Fertility Goddess »
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So you are finally at the doctor's office after years of unsuccessful copulating, seeking an answer with a side of treatment. Admittedly it's been a relief to share with someone who's not going to run off and tell everyone you know your intimate secrets. Especially if it means your doctor is going to DO something.
The tests he sends you for are both embarrassing and painful but because they're going to shed fluorescent light on what ails you and your partner you'll live with them, even welcome them.
"You want me to put my feet, where..THERE, but they won't fit….auuuggghh!"
"How long did you say the needle had to stay in?" "Do I get anaesthetic?" "It's been twenty-four hours - should I still be in this much pain?" are all pressing questions you find yourself asking the doctor, whilst for your partner it's, "But how do I get it in there?" and "Do you have anything else but scotch/Penthouse?"
A couple of weeks later you're back, all anticipatory that they'll have found something and an indicated treatment will be offered.
Your partner is the first to receive his results and has to refrain from doing a Toyota ‘Oh what a feeling' leap out of his chair at the news that his ‘boys can swim'. Whilst happy for him you realize that this must mean it's you with the problem and nervously await the verdict.
It takes a while as there is much frowning, paper shuffling and throat clearing and mumbling on the part of the doctor.
‘CHRIST,' you think, ‘what's going on? Do I have a whole range of fertility issues?"
Eventually, as if he suddenly remembers there is a couple sitting in his office and it is not, after all, time for a leisurely Sunday-morning-paper type-browse of your notes, he looks up.
Both you and your partner stare at him, dry mouths slightly ajar.
"I'm afraid," he says, and you nod, feeling quite afraid yourself.
"I'm afraid that you have what we refer to as…um.."
Your hands grip the chair and you lean forward.
"It's ….er…UNEXPLAINED INFERTILITY."
"What's that???" you demand an explanation.
"It happens to about one in ten couples."
"What does?"
"The unexplained infertility as I've just said. It means basically that the tests didn't find anything untoward. Your tubes are clear, there's minimal endometriosis, and you're ovulating very month."
You realize it's like the answer to a multiple choice question - ‘none of the above'.
"But are there other tests you can do, you know, something else…?"
"No those are the main ones we use."
"So what now?"
"Well it's up to you."
"Up to me?"
"Yes, you have three options. We can do a course of fertility drugs or we can try a cycle of IVF or we can do nothing."
Nothing, of course is out of the question, otherwise you wouldn't BE here. But IVF???? Already? When there's nothing discernibly wrong?
"T-tell me about the f-fertility drugs," you stammer.
"Well you take a course of Clomid which boosts ovulation, producing more eggs so increasing your chances of conception. But."
Why is there always a ‘but'? "But what?"
"You also increase your chances of multiple births."
"Oh, is that all."
"Yes, I just had to inform you so that you make an informed choice."
"One more thing," you say after he's written a prescription and is holding it there in front of you like he's a game show host and you're about to take ‘the money or the box'.
"How, if we have ‘unexplained infertility', do you think this may work?"
"By boosting ovulation…"
"But you said I am ovulating."
"As I said, you'll produce larger and more eggs which increases your chances .."
You and your partner leave the office, taking the prescription and your unexplained infertility with you.
That night you pour a glass of water and open the packet of pills. Opening your mouth you pop the pill in, move it to the back of your tongue and take a large gulp of water.
There, you've swallowed it.