The Path of IVF - in 7 easy steps!

Hello Bleaders....are you seeing that I have a lot on my mind lately?

It's come to my attention that even though I may have discussed our series of appointments, I haven't really discussed the actual process of IVF.  So that's what today's post is about...what actually happens next month?

First step, take birth control pills for a set time (yup, that's where we currently are).  Now so many people look at me like I just sprouted another head when I say that's the first step.  "Isn't that the opposite of what you want to do?!"  They ask.  Thinking I knew what I was talking about, I said, "I think it's so we get to a baseline and make sure there are no cysts in there."  I was partly right.  This is the precursor to IVF apparently.  According to The Couple's Guide to In Vitro Fertilization, this "grants the RE a tighter rein on the their patients' treatment by determining the start of menstruation, which usually determines the start of IVF.  In addition, research suggests that it helps prevent ovarian cysts from forming and lays the groundwork for successful egg development."  See, partly right.  But then the other book IVF: The Wayward Stork, "Many women start the IVF process by taking birth control pills to prevent ovulation and allow the ovaries to rest" and to "improve egg quality."  So right about now my little ovaries are sleeping...man are they in for a rude wake up in about 14 days!

That brings us to our first couple appointments.  May 31st we go to Dr. H's to meet with Holly H. and have our "injection class".  Yup, they teach us  me how to inject myself.  J is not a fan of needles.  I'm not really either, but I do WAY better than he does.  We'll revisit this more a bit later.  Holly H. will also go over the crazy chart she gave me which she loving refers to as my "protocol."  It details all the drugs I'll be taking, but I have yet to understand it.  We go back on June 1st for our first IVF appointment with Dr. H (and our first payment!).  Here, they will do some blood work on J and myself, and I get a "fun" ultrasound to see how things look prior to any drugs.  They figure out our dosages for drugs for the next few days, but I don't officially start drugs until June 3rd I think.

That brings us to step 2: suppression and developing eggs - it gets a little hazy here.  According to the books and reading off my protocol, I start an injection into my thigh once a day but the books say something different than my protocol so not quite sure exactly.  Obviously protocol is more tailored to me, Follistim (which simulates the ovaries) is the drug I take first...an injection, somewhere.  This begins to "awaken the eggs" and get them developing with superovulatory drugs.

Now usually when a woman ovulates, she pops out one, maybe 2 eggs.  We're shooting for 10-20 eggs...so you can imagine that I'll probably feel bloated.  I relate it to a chicken and her eggs!  Very full!  Which I anticipate will make me uncomfortable.  Throughout this process, there are another 2 or more appointments with Dr. H depending on how I am doing...they may change drugs, reduce/increase dosages, etc.  Every appointment, I'll have blood work done and another ultrasound.  As we get close to ovulation, they'll give me my trigger shot.  I've done this before.  It is a shot you do about 36 hours before the retrieval.  It allows the eggs to go through their final stage of maturation and loosens the attachment of each egg from the follicle wall that it is growing in.  We may have to take antibiotics here, not quite sure, to make sure that we don't have bacteria.

Step 3: Retreival!  This is the day that I have been instructed to take off from work.  J takes me to the doc very early and they'll give me an anesthesia.  Because anesthesia was mentioned, I thought this meant that there would also be an incision, but nobody ever talked about how to care for that or anything, so I was confused.  Thankfully, I was wrong.  As I sleep, a "special syringe is inserted through lady land and gently sucks the mature eggs out of their follicles" while being watched with the ultrasound machine.  Supposed to take about 20 minutes, but then the other book says several hours...we'll see about that.  Meanwhile, J is off on his own generating his sample.  When I come out, they'll tell us how many eggs they got.  Then it's off to home for me where my Mom and Mama K will tag team babysitting while J goes to work.  I'm a little worried about being home all day by myself, just because I remember watching Guiliana (on Guiliana and Bill) have some issues, and having to be in bed all day.  So need to make sure I have some warm bodies around if something goes awry...and J is just down the road at work.  Don't get excited, I still have drugs to take.  No rest for the needles just yet.

That brings us to step 4: Fertilization of the eggs.  The doc or some highly paid, highly educated (I hope), lab technician will put the eggs and the spermies together - this is called Intracytoplasmic Sperm Insemination or ISCI and Assisted Hatching - which hopefully get us past the fertilization hurdle.  They will develop in petri dishes (after all, In vitro fertilization is Latin for "fertilization under glass" because petri dishes used to be glass...now the are plastic, yes I knew this off the top of my head!).  So the eggs are developing into embryos hopefully and we'll get updates about how they are doing.  Some may be excellent, some may be good, some may be poor, and some may simply dissolve.  Let's hope for lots of excellents!!!

Now, big guns, step 5: Embryo Transfer (tentatively set for the day AFTER the wedding - no not my wedding - just my friend's wedding that I am in).  This day could move.  Forward...to Monday, or Tuesday, but not backwards to Saturday...I asked!  They'll tell us how many embryos are good, and what they want to put in, no more than 2 though.  Probably even give us pictures to take home.  This procedure is very similar to the IUI.  I lay on the table and they insert the embryos into my uterus.  Then I lay there for about 30 minutes, go home and lay down some more.  IUI (we did 3 of these in 2009) was mini-IVF, not as many drugs, more hope that the spermies would find the egg...here we give them directions and the keys to the castle, and make sure they get in the door before driving away.

Step 6: Prepare the uterus and the two week wait.  This whole time I have been taking a variety of drugs, but especially Progesterone to thicken the lining of my uteran wall.  Apparently, these are the worst injections because the drug is oily and goes into a muscle.  GREAT!  J may have to do this injection because it's in my bootie!  We'll see how that goes down.  The two week wait isn't much fun.  Just waiting. Hoping. Praying.  And more waiting!

Step 7: Pregnancy test.  I go to the doc's and they'll do a blood pregnancy test.  I also took this day off from work.  I just didn't want to get the results there, good or bad.  But this process doesn't end here...it only means that we could be pregnant.  If the numbers look right, they'll continue to monitor me until they are sure and get a heart beat.  Sometimes the drugs can still be in your system too that create a false pregnancy.   (I don't know how blogging will go down during this time...too many family/friends read the blog and this is NOT how they'll get told.)  So if I go silent, please understand we're waiting and I'm at a loss for words...doesn't happen often!

From there we have a couple options:
1) We're pregnant and we progress that way - this is the optimum choice!
2) We're not pregnant - we do another round of IVF depending on if we have embryos to freeze or not, or we take a break, or we move on to surrogacy.  Kind of depends how this cycle went and what Dr. H thinks.

So there you have it folks...$9,000, pages and pages of IVF books, and tons of doctor education broken down to a very long post on IVF.  Wish us well.  We're not far off now...7 days until appointment #1.