Everything you ever wanted to know about IVF
First – a couple of caveats – this is written by me, Günce, about me, Günce, and my six – yes, six – IVF cycles. I am not a doctor. (Just a very, very determined and lucky infertility patient.) My fifth and sixth cycles worked and I have a daughter and a son. But along the way, I basically lost my mind, gave up my job, handed over my body, and spent an insane amount of money. (More on that later).
If you are looking for this article to answer the question: Should I do IVF? I’m afraid that I cannot much help you. But hopefully, I can answer a few other questions.
IVF is terrible. It most definitely falls into that category “What doesn’t kill you makes you stronger.” It hurts more than you think it will. And it lasts far longer than it should. When it does not work, it feels a punch in the gut combined with the unexpected death of your childhood pet.
But, but, but….when it does work, it is nothing short of a miracle.
IVF is usually your last stop at the end of a long journey. You have probably spent years trying to get pregnant every which way. Nothing has worked. And that’s what finds you at a fertility clinic staring at a Reproductive Endocrinologist (RE), trying not to cry.
(Tip 1. Use SART.org to find a great center and a decent doctor. Doctors are not as important as the centers. For me, this was the order of importance: the success of the center, the # of doctors it has (more is better), the kindness of the nurses, and then the quality of your individual doctor.)
After your initial consultation, you will probably be given a battery of tests. If you think you start IVF right away, you are mistaken. Usually it is a two- to six-month process from the word, GO! Even if you feel like you have already done every test conceivable, your doctor might want to repeat some and ask for new ones. It’s never a smooth start. AFTER all the results come back, AND you and your doctor agree that IVF is the way to go, AND decide on a protocol, THEN you actually do the most perverse thing of all: you start on birth control. (This is done to control your cycle and to decrease the chances of creating cysts.) With your cycle firmly in hand, you get down to the business of generating as many eggs as possible.
(Tip 2. Medicine for IVF is not usually covered. And it can cost thousands of dollars. (My medicine cost a little less than $5000 per cycle.) Do shop around. Don’t assume that your local drugstore is giving you the best rates. Also talk to your doctor about “Mini-IVF” – which is essentially an un-medicated cycle. Some people are great candidates for Mini-IVFs. Some are not.)
In a normal ovulation cycle, one egg usually matures per month. In an IVF cycle, the goal is to have as many mature eggs as possible, as this will increase your odds of success with treatment. In the stimulation phase of the IVF cycle, injectable medications are used for approximately 8-14 days to stimulate the ovaries and produce eggs.
Let’s talk a bit about the injectable medication for this phase. Honesty, these are not that bad. Other than the fact that they can make you bat-shit crazy, they are quite manageable.
(Tip 3. IVF is an intense experience that makes you feel very vulnerable. Surround yourself with people who love you and more importantly, who can tell the difference between when it is the medication talking, and when it is you talking.)
During this time, you will be closely monitored. That means bloodwork and ultrasound either every day or every other day. It’s a huge time commitment. The only slight positive is that it is kinda cool watching your follicles grow slowly day by day. (You are aiming for them to get over 18mm.)
(Tip 4. Use Glow. Start taking notes. No one is more vested in this process than you, and your listening skills depreciate noticeably when you are in stir-ups with a wand in your vagina. It’s important to end every session with the question “What’s next?” and write it down. The same with the follow-up calls that nurses make every afternoon. Write it all down.)
When your eggs have sufficiently matured, you get a trigger shot. This means that your eggs will be harvested within the next 36 hours.
When the big day arrives, you go to the center, and are put to gentle twilight sleep, while your doctor makes tiny incisions through your ovaries and individually takes out the eggs. When you stop and think about it – it is pretty damn cool. You wake up cramping and slightly unhappy. Your recently liberated eggs are whisked off to meet your partner's or donor's sperm. Three to five days later, they are put back into you, all fertilized and ready to implant.
But wait – you are not done yet. If you are one of the lucky ones – like me – you now start your progesterone shots. Let me tell you: these hurt. They really hurt. I recently fell and broke my ankle in 2 places and if you ask me if I would rather do that again or take 6 cycles worth of Progesterone shots, I’d hand you a hammer and prop up my ankle.
From this point on, it’s all a numbers game. How many eggs did they harvest? How many were mature? How many fertilized? How many lived past the first day? How many have divided enough to plant back in you after 3 to 7 days? How many managed to implant after 14 days?
For me – on a typical cycle, the numbers were as follows:
+ 17 eggs harvested
+ 12 mature eggs
+ 5 eggs fertilized
+ 4 fertilized eggs kept dividing till day 3
+ They put back 2 fertilized eggs (saved 2 for a later cycle).
+ Neither managed to hold on for those requisite 14 days. 8-(
You can just imagine how nerve-racking each step of this process is. How each step lends itself to failure. They could harvest 10 eggs, and none will be mature. You could have 5 mature eggs and none will fertilize. You could have 3 perfectly fertilized eggs and none may implant. Or worst of all, you could – as I did on my fourth cycle – go through all this, and get pregnant, only to miscarry a few short weeks later.
When they ask me what the worst part of IVF is – the cost? The time commitment? The pain? – I always say “No, no, no.”
The worst part of IVF is the uncertainty. It is the fact that you could go through all this trouble, sacrifice everything….and still not get a baby out of it.
I thank the universe every single day for the two blessings that are softly snoring in their beds as I type this article. Every. Single. Day. Because I know how easily my story might have had a different ending altogether.
Pursuing IVF treatment is a personal decision and there is no right or wrong – there is only what you feel, what you can endure, what you can sacrifice.
My only other tip for you to trust your instincts. Trust your gut. After my fourth failed cycle and miscarriage, everyone who saw me suffer wanted me to give up. "Enough already," they said. But it wasn’t enough for me. I knew, I somehow knew, that the next one would work. And it did. Maybe because of the healthy choices I made after my miscarriage, maybe because of my positive thinking, maybe because my doctors finally figured out the correct regimen – whatever it was, it worked.
And like I said, when it works – there is no greater miracle.
(I'm always here if you have any questions. I will leave this pinned for a bit. Thank you!)