IVF Primer-- part I

I get a lot of questions about the IVF process-- and I don't mind sharing, because up until December of 2004, I was pretty much in the dark about everything too. Then I spent the next 13 months in a trial by fire becoming a SME (that's 'subject matter expert', haha) on all the high-tech infertility treatments. I thought maybe it might help someone to share what the process looks like, because most women go into it so blind. I didn't have anyone to ask questions of, despite the fact that IF (that's short for infertility) is unfortunately so common these days and more and more couples are turning to IVF (invitro fertilization) for a solution.

#1: Tons of testing.
Before reaching a decision to pursue IVF, most couples have already done this step. Testing on the woman would include blood tests on day 3 of her cycle (FSH, E2, etc) which basically tell the doc whether her eggs are any good. Too high of FSH and yours might be overcooked and you'll be looking at lower success rates and/or the need for donor eggs. You also check your thyroid levels (too high/too low both affect fertility) and a range of other random blood tests. Usually by this point, you have also had some uterine tests done (a uterine fluid ultrasound or a HSG) to determine if there are any issues there. Problems can include fibroids, cysts, blocked tubes, endometriosis, scarring, uterine structure abnormalities, and hydrosalpinx (inflamed or fluid filled fallopian tubes that seem to have a great impairment on fertility-- if these are present, most likely they need to be removed surgically before there is a chance of conceiving).

Men get a gamut of blood tests too and most importantly, a semen analysis. Over 50% of IF is male factor and yet a lot of couples neglect this very simple test due to the squeamishness of their husband. Stupid. Stupid. Stupid. Pass that info on to any couple you know that is having IF issues. If the man has not been tested, they are just wasting time and $$$$ until they have him tested. It is simple and cheap test and if male factor is an issue, it is not easy to fix, but at least the solutions are known and available.

#2 So you've decided on IVF.
Pick a good clinic. Do your research. Have consultations with the RE's (reproductive endocrinologist). I wasted nearly $20,00o on my first doc and after nearly giving up (they told me that my eggs were bad and that I needed to consider egg donation) I had a phone consult with Dr. F at SIRM in Las Vegas. He went over my IVF cycle records and pinpointed the problem as a medication issue and he was absolutely correct. I went from low # of eggs and bad quality embryos (4, max) to being a super-duper picture perfect IVF patient with more high quality embryos than I could believe (27, holy cow!!). So do your best to go with the bigger, well known clinics. The SHER institutes, across the country, are all cutting edge.

#3 Your Med Calender (or shot-bible) Above is an abbreviated example of a med calender. This one was from an FET (frozen cycle) and didn't involve the insane amount of meds that a fresh cycle takes. The reason you have a med calender is because the number of medications and the scheduling and timing of them is mind-boggling. You need a checklist to keep it all straight. Here is what typically is involved:

1-2 months of birth control pills:
This is to regulate your cycle and to decrease the chance of cysts forming on your ovaries. The BCP also help to suppress your ovarian response to FSH/LH (both hormones that affect follicle development).

Lupron (or other suppression drug, like antagon):
This is a sub-cutaneous injection that is done typically with a 1/2 inch insulin needle given in either the fatty part of the stomach or upper arm. I recommend the stomach; it is much easier. These aren't difficult shots to tolerate; I gave myself all my sub-q injections. Lupron's job is to suppress your ovarian function. The point of IVF meds is pretty much to control all your hormones-- you don't want your body to get in the way. So you shut down all your natural hormones and then add back in the ones you want for follicle development. Very controlled. Usually it takes 10-14 days to be suppressed. Some people have bad side effects to lupron; all it caused me was bad headaches and hot flashes. I didn't mind this drug too much. At this point, they check your E2 level (estrogen) to see if you've suppressed and there is usually a baseline ultrasound done to do an antral follicle count. This is where they look at your ovaries to see if have some resting follies ready to be developed. All ultrasounds done during the IVF process are vaginal ultrasounds-- this can be a little disconcerting if you're not expecting it or have never had one before. Ask someone to describe it to you if you know you're going to get one so you're not shocked at the experience :)

Stimulation Drugs:
These are the nasty drugs. There are a number of them that vary depending on what your doc thinks you need. Some of these stim drugs are sub-q (tiny needles) and some are IM (intramuscular 1 1/2 inch needle) injections that go in your hip. You usually have 2-3 shots a day for the next 10-12 days. These drugs stimulate follicle growth and cause bloating, weight gain, gastrointestinal issues-- yucky stuff. Your ovaries grow to the size of softballs-- really. It is uncomfortable and not fun, but if you don't get the follicles to grow, you won't have any eggs to work with. During the stim stage, you are monitored every few days via ultrasound and by measuring your estrogen blood level. They measure each of the follicles for growth and check to see if you're producing enough estrogen to support them. They let the follies grow until the majority are 14-20 mm (about 2 centimeters) in diameter each. This is why your ovaries are softball sized. Uggh! When you're deemed 'fully-cooked', you get the big-shot instructions . . .