11 months.
We tried ‘naturally’ for 11 months with one chemical pregnancy. When it came time for us to start IVF the feelings were bittersweet. On one hand we both felt so defeated and mad that we had waited so long to make the decision we had to try at all, and then angry that what other people get for free was going to cost us 20k+. On the other hand it felt very much like go time. We felt a bit more productive, but we still really had no clue what IVF entailed and what to expect.
I started out with a clinic that had a local office where I live. I didn’t know much about anything to be honest, and I trusted that my doctors and my nurses would guide me through the process.
I learned really fast that there would be no hand holding.
I got a phone consult with my doctor, and super quick monitoring appointments in the clinic. A crash course on meds and injections via zoom, and was left to my own devices.
I didn’t know what I didn’t know.
There were some things I wish had been explained to me in more detail. A few questions that arose were:
- What do each of the meds actually do?
- What are the stages of an IVF cycle?
- How long does a cycle actually take?
- Why did my doctor choose the protocol they did for me specifically?
- Should I be doing anything else to improve my chances?
- What are the risks?
None of this was provided by my clinic, so I started to seek out online forums on social platforms to ask these questions and get the lay of the land. I used Reddit, Facebook, Instagram and a few popular baby making apps. Soon, I realized there was a lot more to IVF that I wasn’t aware of. What I thought was an exact science was far from it. I’ll do my best as I write here to explain this stuff in case anyone new to IVF needs some insight.
There are a few stages of an IVF cycle.
- Birth control pills, estrogen or other hormones. Before you start IVF treatment, your doctor prescribes meds for ‘priming’. This can be anywhere from a couple of weeks to over a month or more.
- Ovarian stimulation, which this includes the dreaded injections (this lasts 8-15 days on average). During this stage your ovaries over produce eggs with the help of very strong hormones.
- Egg retrieval. This is where they extract the eggs you’ve grown, using a transvaginal ultrasound with a long needle attached. You’ll usually be sedated for this, but the type of sedation varies depending on where your clinic is located. You’ll find out the number of eggs retrieved that day.
- Fertilization is when they take your sperm sample and create the embryos. This can happen via standard IVF where they put a bunch of sperm into a petri dish with sperm and let them have at it. ICSI is another common form of fertilization where they inject the eggs with one individual sperm. You’ll usually be told the day after your retrieval how many fertilized. It’s common for not all eggs to fertilize.
- Embryo development happens over the course of 5-7 days after fertilization. It occurs in the lab, and usually no updates are given until day 5-6. The wait is painful.
- Embryo transfer occurs either on day 5 after retrieval if you have embryos that have met the blastocyst stage (a certain number of cells, shape, etc., or for others, all the embryos are frozen during a process called vitrification. Some may be biopsied before freezing for genetic testing for abnormalities. The transfer would then occur at a later date after thawing the embryos in the lab.
- Pregnancy…. that’s the goal anyway.
- Pregnancy Support is often needed with IVF, which includes taking progesterone and sometimes estrogen up to 10-12 weeks of pregnancy.
You’d think the clinic would tell us this, but they did not. We took it day by day learning as we went.
We started with a Saline Sonogram – a process where they insert a catheter through your cervix into your uterus, then pump saline solution into the uterine cavity to investigate it’s structure and rule out abnormalities. We then began our medications in November – beginning with birth control priming (more so to time the cycle to the clinic’s schedule). I started my stimulation meds (from here on referred to as Stims) on November 22.
I forgot to add that I am terrified of needles. Bloodwork makes me cringe, I fainted during an IV placement years ago, and am forever paranoid it will happen again.
Some couples have the partner do the injections, because it includes them in the process and they can look away. I am too much of a control freak to allow someone else to poke me if I can help it, so I did the injections myself. You do these injections generally in your belly, in a ring around your belly button while pinching the skin/fat.
I started on what is referred to as an Antagonist Protocol (never did learn why!), and was put on a dose of Gonal-F 300 IU, Menopur 150 IU, and Orgalutran .25mg. This is considered a fairly high dose due to my age. A few things I learned after starting stims:
- Stims are effing expensive (with no insurance coverage my Stims meds cost approx $10k CAD on top of my cycle cost for 11 days).
- Ice packs are your friend. 10 mins before and 5 mins after.
- Giving injections to yourself is scarier looking than it is in practice. I was TERRIFIED. After 3 days I was fine and could do it like a pro.
- When you start stims, giving an extra 30 minutes to prepare everything helps. Watching an injection video while doing the injections initially also helps (youtube is fine). It helps you follow along with the steps, including jabbing yourself.
- Some meds go in the fridge and some don’t. Making a list of steps helps you make sure you don’t mess up dosing or accidentally refrigerating something that isn’t meant to be cold.
- The timing is really specific. If you’re considering doing IVF and have a busy life with many obligations, it can be a big adjustment. Some meds happen in the AM while others happen mid day or at night. I did all of my first cycle of meds around 5:30pm because it worked for me at the time.
At the end of stims they make you take what is called a “Trigger Shot”. It’s one final shot which is timed exactly (!!!) 36 hours before your retrieval appointment.
With an antagonist protocol, here’s what the meds actually do:
Gonal-F (Rekovelle works the same), Menopur: Stimulate the ovaries and follicles to produce more than one egg at a time.
Orgalutran/ganirelix: Prevents ovulation of those eggs. If they ovulate, your cycle can be cancelled.
Trigger: Causes the eggs to “mature” in preparation to be retrieved. Mature eggs are the only eggs used for fertilization.
One thing they didn’t tell us is that if you have a hCG trigger, you can do a pregnancy test to confirm the trigger took. The trigger will show up the same as the pregnancy hormone will on the tests, so this provided a little bit of added peace of mind. This will only work with this type of trigger though, so caution against doing it with other types.
So we did our trigger at 8:00pm on December 3, one day after my 38th birthday and awaited the egg retrieval to follow on December 5 at 8am. I triggered and had one day reprieve from my injections in between as I prepared myself for the egg retrieval.
Our retrieval was to take place in a different city, since our clinic was a small satellite clinic of the main location, so we hopped on a ferry that next day, checked into our hotel and binged bad cable TV. I was bloated, uncomfortable, but so ready to get this part over with.