IVF – A Beginners Guide

What actually happens in IVF? It varies by patient, but here is my account*

First Lots Of Tests

They need to check everything is OK. Last year this was all part of figuring out why we were struggling to conceive. This year it was to check if anything had changed. So I had ultrasounds to check my endometrial lining and also to see if there were any polyps or scarring that could prevent implantation.

Prepare Your Body

At my scheduling visit I was given a list of instructions for the protocol I am on. They’ve mixed it up slightly from last time so hopefully it will work better. These instructions range from what not to do and what you need to do. No more than 2 caffeinated drinks a day. No alcohol. No exercise except walking. No extreme heat, so saunas and baths are out. No pain killers except Tylenol. We must eat a balanced diet. We must have regular sex! I must take prenatal vitamins. I also need to start wearing an estrogen patch on my butt and change it every two days.

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Wait For Your Day One

All fertility procedures revolve around your Day One. That is code for your period starting. So on this day you call up the clinic and then you find out the exact dates everything else starts. It’s also at this point that you buy the drugs as you know for certain you’re going down the route of IVF. Just in case your period starting wasn’t bad enough normally eh! But in two days I can stop wearing the patches.

Start Injections

An interesting fact is that women are born with a finite number of eggs - that number is determined when we are still in the womb.

The eggs lie in small pockets called egg follicles. Normally only one or two eggs mature enough to be fertilized each cycle. These drugs are designed to encourage more eggs to grow and mature in this one cycle to optimize the change of pregnancy. When you see the ultrasounds you realize how packed my ovaries with these egg follicles. That’s why I can’t exercise, as there is a risk of contortion. If you’re interested, the tablet helps the blood flow, which I guess is helpful! 

So what are the injections like?

One of them is easy to administer as you turn the dial to the required dose, add a needle and then stick it in your tummy! The other two are more tricky as you need to mix the powder with a saline solution, so you are switching needles and moving the solution from a vial to the syringe and back again. I don’t like these ones as I’ve had a few disasters in the past, including spilling the solution all over the floor. That was an expensive mistake!

Last year I ended up having to do it on a train back from Montreal so anywhere seems better than that! I started taking them in the morning at 5:30am in case I needed help from my husband; that was fine on the days he was getting up at 5:30am but not what either of us want to be doing at the weekend.

Having said all that, I can’t complain too much. Diabetics also have to inject themselves regularly. I’ve learned a new skill. I also don’t find them painful so I’m grateful for that.

Measure Progress

At this point it’s hard to plan anything. I already had to cancel a prayer breakfast and a meeting with a friend on Friday because of my scan. Now I’m not sure if we’ll have to cancel events and meetings on Monday or Tuesday. Fortunately most people know we are going through IVF so they are really understanding of these last minutes changes and cancellations. I’m not sure how people do it without telling anyone. I want my husband to come with me to the procedures and because of his job that will mean a lot of inconvenience to lots of people. C’est la vie.

My Saturday scan also showed that more growth was needed, so more injections and another scan on Sunday. After my Sunday scan we were greeted by good news from the Doctor: they are finally big enough! Today is now Trigger Day.

Trigger Day

After almost a week of stopping ovulation, we now need to trigger it. All these natural processes have become medicalized and controlled by injections. This also comes with a long list of instructions and other drugs. A laxative to ensure my bowel movements are normal. A drug to reduce the risk of ovarian hyperstimulation syndrome. A very time sensitive injection to trigger ovulation.

Egg Harvesting

The night before and morning of I need to take a sedative to help me relax. My memories of last year are that I was very relaxed and even enjoyed the procedure, if that is even possible! I was full of excitement and hope.

This year was similar and it was great to have my husband with me. It was an early morning appointment and we were running late but everything was calm and relaxed at the clinic. We changed into scrubs and they attached me to all the monitoring machines, inserted an IV and covered me with hot blankets (I like that bit!) before wheeling me into the operating room. Here they do their best to maintain your dignity and they are all lovely and friendly. They use an ultrasound to guide the doctor and then suck out the eggs with a needle. It’s bizarre seeing all the eggs that you have watched grow be sucked out, leaving nothing behind. The embryologist separates the eggs from the fluid and calls out how many they find.

When we were back in the recovery room the nurse came in to let us know that they had collected 10 eggs. I’m not sure what to think at this point. Last year it was 20 and only 2 made it to the point of implantation. Now we have 50% fewer. I’m trying not to be disappointed or analyze it too much, but I couldn’t help googling to see what is considered a good result. The medical papers say you need at least 15 eggs for a good chance of successful pregnancy. Blogs from people who have gone through it share stories of 2 or 3 eggs and a successful pregnancy. Last year we had 20 eggs and no baby. So no-one knows.

In case I haven’t had enough injections yet, we opted for the progesterone injection this time. The body is a strange thing as too much progesterone at the time of implantation isn’t good, too much during pregnancy can cause difficulties for the baby and yet the body needs it for implantation. So I have targets drawn on my bum and my husband has to inject me with a long needle, being careful not to hit a vein. This will be fun for the next few weeks! After reading the instructions I was sure this was going to be super painful, but I hardly noticed the jab. Maybe I was still under the influence of the drugs!

Overall I haven’t found the whole IVF procedure to hurt that much but I am sure it is due to the drugs! The drugs made me very relaxed and sleepy. We did go for breakfast after we were released but I don’t remember much and I slept for the rest of the day, waking only briefly for some dinner, a short walk and time of prayer with God. Then I slept all through the night!

The Wait

Photo by Matthew Henry from Burst

This morning I woke up and tried to listen to what God was saying to me. All I could hear was “Trust Me”. Last year the nurse called me when I was on the bus to tell me how many embryos we had. By 10am when I hadn’t had a call I tried to convince myself not to read too much into it. But when the doctor herself called at 11:30 I knew it was bad. Only 6 of the 10 were mature and only one had fertilized. Only one. Last year it was 11. I can do math. That does not bode well. According to the embryologist the sperm was healthy but the eggs were very stressed. Stress comes from age (yes I’m 39) and from the drugs (they increased my dose). But if they hadn’t increased the dose then fewer eggs would have matured. I’m not to blame, the doctors aren’t to blame, my husband isn’t to blame. It’s just how it is. When the doctor asked me how I was I cried. I’m upset. I’m disappointed. I’m scared. I didn’t want to be here. I called my family and texted lots of friends. I have been overwhelmed by their response. One thing I know: I am loved and hundreds of people are praying for this little baby right now.

If this one little embryo survives we will implant it on Friday which is Day Three. Right now I’m just praying it survives to this point.

Implantation

On Day Three or Day Five you find out how many embryos have survived and can be implanted. Last time only four got to this stage and they knew two would die before the day had finished. So they implanted the healthiest two. I also remember desperately needing to pee as they pushed on my bladder and implanted the tiny embryos in my womb.

We didn’t even get to this point this year. I knew it was bad when the doctor called again yesterday. Our final embryo had passed away. Numb. Devastated. There are no words. But also very loved. You should see my Facebook page for the number of encouraging words, prayers and messages people have posted. Some colleagues sent us a beautiful food package which was so thoughtful as we really don’t feel like cooking. Another friend is lending me a selection books so I can lose myself in the world of fiction. Other friends have sent me words of scripture and worship songs. I’ve cried on the phone with my parents and sister. My nieces sent a video shouting that they love me. I am loved. We are loved. We are not alone. And for that I am grateful. Grieving takes time and right now we’re just taking it a day at a time.

PS If you want to read about my experience last year you can find it here.

*I am not a doctor and this is not medical advice! It is purely an account based on my own personal experience.
Other accounts can and will vary. Hopefully yours will have a happy ending.