IVF 101 or, You’re Gonna do WHAT to My Lady Parts?!?
Are you and your partner considering IVF? Curious about how things actually work, and how many needles are involved (answer: a lot)? I thought it would be useful to have a better understanding about the steps and process that goes into an IVF cycle. It seems really overwhelming (and it is), but my hope is that having a bit of knowledge under your belt going into the process will lessen the anxiety and nerves you will likely have as you undergo your first IVF cycle.
There are a series of steps involved in IVF. The basics are pretty much the same for everyone, but timing and drug protocol will be different for every woman. Here is the basic outline of how this thing goes down:
Step 1: “Turn off” your hormones
Step 2: Manually controlling your hormones and stimulating ovulation
Step 3: Egg retrieval
Step 4: Embryo Transfer
Step 5: Two Week Wait
Step 1: “Turn of” your hormones
In order to have a successful outcome, your own hormones and cycling need to be turned off. A couple of months prior to your IVF cycle, your RE will prescribe you to begin back-to-back cycles of birth control pills (BCPs). BCPs begin the process of “quieting” the communication between your pituitary gland and your reproductive organs. Approximately two weeks before your cycle, you’ll likely begin another suppression drug called Lupron. Lupron (generic: Leuprolide) turns off your estrogen production, and will be your first taste of injecting yourself with drugs. Fortunately, this drug is injected with an insulin needle which is very fine, and generally injects it into your tummy pooch which doesn’t have a lot of nerve endings. Once you get past the first injection, this part gets pretty easy.
Step 2: Manually controlling your hormones and stimulating ovulation
This is where the fun really begins! Your RE will prescribe you a hormone to inject multiple times a day. This hormone regulates ovulation and growth and development of follicles. Follistim and Menopur are two popular brands used, and they also use a very fine needle and is injected into stomach fat. Depending on your diagnosis, you may be given one or both drugs. These drugs make your ovaries go into overproduction mode. You’ll generally be on this drug, in combination with Lupron, for about 9-10 days, or until your follicles are mature and ready to trigger. During this stimulation period, you’ll go into the clinic to have your ovaries monitored, or as I like to call it, a date with Wandy (if you don’t know who Wandy is, you’ll know soon enough!). They will track your follicle count and size, and when they see that they are mature and ready to trigger, you will be assigned another drug to take. This drug, called hCG, triggers your ovulation exactly 12 hours after injection. Your RE will be very specific about when your take it, because your egg retrieval will be 12 hours after, this way they’re able to catch those buggers before they get out of the ovaries. One note about hCG…it may be difficult for your pharmacist to get a hold of this drug because it is often used in combination with illegal steroid use. Ovadril is a comparable trigger that might be used. hCG is usually injected into your hip muscle, and Ovadril is administered like Lupron and your prescribed stims.
I’d also like to address the very basic fact that this part of the process can get really uncomfortable. Your ovaries are going to be making more follicles than it usually does, and if you are responding very well to stimulants, you very well will end up with ovaries the size of oranges (for reals). It will hurt, you’ll feel them jiggling when you walk (also for real), and you’ll decide that Wandy is the enemy when he gets too close to your ovaries. You’ll probably gain some weight from fluids, and you’ll look 4 months pregnant. This is the perfect time to have your partner wait on you hand and foot. I highly recommend ice cream to be administered by mouth twice a day.
Step 3: Egg retrieval
This is a pretty big day! You’ll arrive to the clinic pretty early in the morning and get ready in a private room for your procedure. You will be given an IV which will have fluids and a light anesthetic for your procedure. You’ll be taken into the procedure room, put into place (aka, legs put into place via stirrups), and put under. And you REALLY want to be knocked out when I tell you how this next bit is done. They take a large needle, insert it though your vaginal wall and into your ovaries and suck out the follicles. It’s a very quick process, and once done, you’ll be taken back to your private room to wake. During this time, your partner will be taken to his own private room to make his own, ahem…contribution. After you wake and are feeling ok, you’ll go home for some R&R.
Later on that day, the embryologist will introduce your follicles to your partner’s sperm. This romantic date will take place in a Petri dish. Depending on your diagnosis, a couple different things could happen here. In a standard IVF, sperm and eggs are introduced together, and nature takes its course. If there are issues with the quality (or age, sorry 30+ ladies), “assisted hatching” could be used. Assisted hatching is the process of applying a chemical that will soften the shell of the egg and let the sperm get in better. If there are issues with sperm motility, a process called ICSI has been used to great success. ICSI is when the embryologist takes an individual sperm and inserts into the egg.
Depending on your RE’s preferred process, how well your eggs are fertilizing, or your diagnosis, your RE and embryologist will decide if the embryos should be transferred back to you 3 days later, or 5 days later as blastocycts. I would just like to impress upon you that if your doctor chooses one or the other, it has no impact on what your final results may be. Try not to read anything into it.
Step 4: Embryo Transfer
You’ll arrive for your appointment nice and relaxed, because most likely you’ll have been prescribed Valium by your RE. TAKE it, you’ll need it! Prior to the procedure, the embryologist will give you the rundown on your embryos. Which ones they’ll transfer, which ones they’ll freeze, etc. Depending on your age and state laws, the team of physicians will tell you how many will be transferred. You’ll be taken in to the procedure room, the embryologist will load up a tube with your embryos, the RE will insert that tube into your cervix, and off you go!
Step 5: Two Week Wait
Here comes the sucky part of the process…the waiting game. While you wait, you’ll be taking progesterone. Some women are prescribed it as a suppository, but most get it as progesterone suspended in oil (PIO) and injected once daily into the hip muscle. This was the worst part for me personally. Between the waiting and the PIO shots (my darling DH got close to my sciatic nerve once, I had zings though my leg for a while), I had an awful 2 WW. Do what you can do to minimize the stress, and I know that is easier said than done. Do funs things, go out on dates, and try to enjoy what very hopefully will be your last two weeks as “just” a couple!!
I hope this was helpful for you! Let me know what else you might want to know about IVF in the comments.
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