Ocean Dreamer

Here’s a summary of what I learned about IVF both at my appointment on Monday and from what I’ve read from the clinic so far.  I’m writing this down to help organize my thoughts and solidify my understanding as well as to provide a bit of details and info to those of y’all who are looking at doing IVF in the future.  Of course, YMMV with this whole thing.  It’s long, so I’ve tried to make it easier to read by putting it in sections.  (Also, of course, I’m not a doctor; there are sites on the web where clinics explain this whole process.  However, as I said, it helps me to gather my thoughts and I thought it would be helpful for y’all to hear it from a lay person.)

The actual IVF process lasts two cycles: first a suppression cycle, followed by the actual IVF cycle.

Birth Control Pills & Lupron (Suppression Cycle)

For the first cycle, I will be taking birth control pills.  This starts on day 2 of the cycle and lasts at least two and up to four weeks.  I will only be taking the active pills.  The birth control pills will help to suppress my system.  The IVF coordinator explained that in a normal cycle, you have several follicles initially, but one becomes dominant and that one develops.  You don’t want this to happen when you’re doing IVF because you want multiple follicles to develop.  Often your body decides which will be the dominant follicle in the first day or two of your cycle, hence the need to start the BCPs on cd 2.

Also, on day 2, before I start the BCPs, I have to have my ovarian reserve checked, since it hasn’t been checked in a year.  This tells you your estradiol and FSH levels and must be done on cd 2-4.  Ideal estradiol levels are below 80 and ideal FSH levels are below 10.  The ovarian reserve gives some indication of how many eggs you will produce or something – I’m not exactly clear on what it shows, honestly, but only that they want to know it.  The doc told me, but now I can’t remember.

Sometime between two and four weeks after starting the BCPs, I will start Lupron injections.  Lupron inhibits the pituitary, preventing it from releasing the hormones that would normally cause follicles to develop on your ovaries.  Soon after this I will stop taking the BCPs, but continue with the Lupron.  Once I stop the BCPs, I will likely have a period.

Soon after stopping the BCPs and getting my period, I will go back to the clinic for a suppression check.  This is also payment due day.  The suppression check involves a blood draw (to test my estrogen levels) as well as an ultrasound to make sure that my system is indeed suppressed and my body will not produce only one or two dominant follicles (but instead the 10-15 – or more – that are ideal for IVF.)

IVF Cycle – 1st Half

The next day, I start my IVF drugs (and continue the Lupron, at a lowered dose.)  I don’t know yet what those IVF drugs will be.  My IVF coordinator says she can get me vouchers and free samples as much as possible, since I am paying for this out of pocket.  (Like I said before, I really feel that they are taking care of me now that I’m doing IVF – I think especially because I’m doing this on my own.)  It is considered day 1 of the ART cycle (and is usually a Friday because, you know, its more convenient for them.)

The clinic continues to monitor me every couple of days via ultrasound and estradiol blood tests, starting on day 4 and continuing every other day until about day 9 or 10, when they will become daily.  They become daily once the largest follicles are approaching 18mm (can’t remember how close – maybe 14 or 16mm) – when they reach 18mm, they are mature and ready for egg retrieval.  The ultrasounds are generally between 8:30 and 10 am, which means I will be taking a lot of days off work during those two weeks.

IVF Cycle – 2nd Half

The night that the largest follies reach 18mm, I will give myself an HCG injection.  The next day, there are no medications.  Exactly 35 hours after the HCG, they do egg retrieval.  This will either be in the clinic or at the hospital; I have to figure out what I want to do.

At the egg retrieval (usually day 12), the doc uses a vaginal ultrasound with a needle guide attached to it to remove the follicles.  The needle scoops up the follies and they pass through it into a small container.  When all the follicles are collected, they are immediately passed to the embryologist, who is waiting in the room with a special microscope kept at body temperature (to avoid stressing the eggs/follicles.)  The embryologist removes the eggs from the follicles (some follicles won’t have eggs.)

Once the eggs are removed, they are brought to the embryology lab.  Then, the embryologist either puts the eggs in a solution of some sort and lets them sit there with the spermies (this is traditional IVF) or they perform what’s known as ICSI (Intracytoplasmic Sperm Injection.)  That’s what they’ll be doing for me, since I’m using donor sperm.

In ICSI, they insert one individual sperm directly into each fertilization-ready* egg.  They choose the 100 or so best-quality spermies and put them in another of those solutions and then add something that causes the spermies to slow down.  Then, they choose the ones with the best morphology (the ones that look the best) for ICSI.  They suck each individual li’l swimmer up into a needle and then insert it directly into the egg.  Apparently it is kind of tough to do because of the egg’s shell.

My clinic also does assisted hatching, which I *think* happens on this day, too.  They use a special laser to thin the egg’s shell (called the zona pellucida I believe); this assisted hatching helps the embryo to break out of its shell and grow.  Apparently as women age, their eggs’ shells become harder and thicker, making it more difficult for the embryo to develop.  (I think I’ve understood this part right, but we didn’t talk a lot about it.)

This is considered day 0 for the fertilized eggs and they let them sit in their supportive fluid overnight.

*Interesting fact I learned from the embryologist: eggs initially have two sets of chromosomes! (just like other cells.)  Hello, high school biology, you taught me wrong….  As the egg readies itself for possible fertilization, it moves one set of chromosomes into this little polar pocket (the actual name was something like this, but I forget exactly what it is.)  So the embryologists know the egg is ready to be fertilized when they see that it has this polar pocket on one side!

They check the eggs on day 1 and hope to see eggs with two nuclei inside (one from the egg and one from the sperm.)  Ideally these continue to grow until they have 4-8 cells on day 3.  Sometimes the eggs will be put back at this point.  However, my doc will probably wait until day 5, the blastocyst stage, when there are 100-150 cells.  The stronger embryos tend to make it to this point, making it easier to choose which is the most ideal candidate(s) for transfer.  The clinic also freezes remaining embryos at this stage (they won’t freeze them on day 3.)  At the blastocyst stage, you can also see the cells gathered together in one section, surrounded by what will hopefully become the placenta.

On day 3 or (most likely) day 5, I’ll return to the clinic for the embryo transfer.  My understanding is that this is kind of like an IUI, only with an ultrasound simultaneously – they deposit the embryo in your uterus, using the ultrasound to place it in the most ideal location.  My understanding is that I’ll be awake for this procedure.

As for meds during this time, I start daily progesterone shots two days after egg retrieval and on the night of the embryo transfer, I also start estrogen patches.

Then, 15 days after the egg retrieval, I take a pregnancy test, which will hopefully be positive.  If it is, then I continue progesterone injections (though weekly now instead of daily) through the 10th week of pregnancy.

And that’s it!  I hope its been useful to y’all.

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