It’s go time! An IVF cycle is like starting a new job. There’s the stress and excitement of tackling a new experience, plus the challenge of learning the “jargon” and committing to daily tasks that will involve your time and energy. This is an important time to take care of yourself. Reducing stress through physical activity (i.e. yoga) or acupuncture can be helpful for some. Surrounding yourself with supportive friends and family can also help you to deal with the stresses of fertility treatment.
IVF patients work with our clinical and IVF nurses to sync calendars and prepare for treatment. Our business office can help prepare you financially. To equip you for your “job” as an IVF patient, we’ve summarized the 5 steps to what will hopefully result in a successful cycle.
1. A fertile field: Growing your eggs to maturity
Eggs develop in a fluid-filled sac called a follicle. In IVF, we’ll supplement the body’s natural reproductive process by stimulating the ovaries with potent hormonal medications (e.g. Follistim, Gonal F, and/or Menopur) to increase the chance that multiple follicles grow. The average number of follicles is around 10-12, but this number can be higher or lower depending upon your age and your previous testing results. Birth control pills are used in IVF cycles for multiple reasons. They can help to synchronize the development of follicles, leading to more ‘orderly’ growth. They can also help to prevent cysts and increase the flexibility of scheduling. Birth control pills are commonly a part of the IVF regimen but may be eliminated in certain scenarios.
Lupron is a subcutaneous injectable medication that tells your brain’s pituitary gland to suppress the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The result is to prevent you from prematurely releasing (i.e. ovulating) the mature eggs before they can be harvested by your doctor. Occasionally, an alternative to Lupron (Cetrotide) may be used. Once you start the stimulating hormones (e.g. Follistim, Gonal F, and/or Menopur), you should plan to visit us every 2-3 days during this 9-14 day stage as we monitor your progress with vaginal ultrasound and blood tests.
Typically, when the 2 largest follicles reach around 20 millimeters and the uterine wall lining measures at least 7 millimeters, we’re ready to “tell” the follicles to prepare to release the eggs. We do this with a shot of Ovidrel (human chorionic gonadotropin). It’s important to fill your prescription for Ovidrel ahead of time from the pharmacy. After the Ovidrel shot, the follicles would typically release (ovulate) the eggs in about 36-44 hours. We actually want to access the eggs just before this happens. Thus, the egg retrieval is typically scheduled for 35.5 to 36 hours after the Ovidrel shot.
Expect to feel: Soreness at the injection sites, moodiness, constipation, cramping, fatigue and breast tenderness.
2. Making the grade: Choosing the best oocytes for the job
We perform an egg (oocyte) retrieval (a minor surgery) in an operating room next door to the lab where the eggs and sperm are taken care of. IV anesthesia will be used to make you comfortable, while still protecting the health of the eggs. We use an internal ultrasound to guide a long, thin instrument to drain the follicles of fluid. Within the fluid are the microscopic eggs. The procedure generally takes 20 minutes, and you’ll know the next day how many eggs fertilized. Remember: It’s quality not quantity that’s most important.
On the morning of the 3rd day after egg retrieval, we will call you with a report of the embryo growth. On this day, we will decide if we are proceeding with the transfer that day – or if we are waiting 2 more days to do the embryo transfer. The decision is based upon the number and quality of embryos. We’ll advise you on the ideal number of embryos to transfer. By day 5 and 6 after the egg retrieval, we will let you know if any additional embryos (in addition to the ones being placed in the uterus) are viable and thus able to be frozen for later use. Having frozen embryos can provide couples with the option to use try a frozen embryo transfer in subsequent cycles if the 1st try doesn’t work – or if the couple would like additional children.
Expect to feel: Fullness or pressure during the procedure and some cramping that day and for several days after.
3. When Harry met Sally: Fertilizing the eggs and growing the embryo
Now it’s your partner’s turn. The day of the IVF egg retrieval, he provides a sample and, within hours, we’ll introduce sperm to eggs in a meticulously controlled environment. Some couples may benefit from intracytoplasmic sperm injection (ICSI), where a sperm can be placed directly inside each egg.
4. Home sweet home: Transferring the embryo(s) to the uterus
This involves placing a catheter inserted into uterus and placing the embryo(s) approximately 1.5-2 cm from the very top. Your doctor may use an abdominal (external) ultrasound to watch as the transfer is taking place. If this is the case, you will need a full bladder. Following the transfer, you will spend about a hour in the recovery area before going home. Your partner can be present for this procedure.
Expect to feel: Some bloating, mild cramping, possible spotting, moodiness and breast tenderness.
5. Breathe: Surviving the waiting game
Our general advice: Be cautious. Avoid sex, orgasm and heavy physical activity for the two weeks following your embryo transfer. Try to avoid fixating on every twinge and pain because physical signals vary widely from woman to woman. “Don’t, I repeat, don’t, expect your breasts to tell you when you might be pregnant,” says Elizabeth Swire-Falker, author of The Infertility Survival Handbook. We’ll nurture your growing embryo with progesterone and estrogen, but you need to take care of yourself. Do yoga. Watch funny movies. Meditate. Studies show the more relaxed you are, the better your chances of conception. The final step is, of course, a pregnancy test exactly two weeks after the egg retrieval. Our hope for you is that this is the start of a new journey marked with great joy and ten tiny toes.
Expect to feel: Light cramping and spotting at embryo transfer and implantation. Call us if you are experiencing bleeding or an increase in cramping.