This post was originally published on 3/25/2019 but has been updated with more resources and information for your benefit.
I asked on my Instagram Stories what questions people had about the IVF process and I got a pretty good mix of seriously in depth questions about medication types, avoiding OHSS and tips for people who will be going through IVF & a bunch of general questions about the process itself for people who haven’t been through IVF/don’t need IVF to get pregnant. So I’m breaking up this post into two parts: Part 1 will be the questions for those who have never been through IVF/won’t need IVF to get pregnant and Part 2 will be the more in depth questions as well as how to avoid OHSS + my tips for your next IVF cycle.
For IVF Warriors, check out our IVF Journey Journal to help you process emotions, keep important information and remember the milestones of your journey.
Let’s get started! A cycle of IVF can start one of two ways— timed with birth control or naturally as your cycle begins. Our cycle was started naturally without birth control to time my body (which may have actually been beneficial for us because sometimes I just really don’t know what my body is doing… but I’m also crazy on birth control, so I was happy to start without it). We went in on Cycle Day 3 for a baseline ultrasound and blood work. (Please note: We did a clinical study and the study protocol had us do way more blood work than a typical IVF cycle) The baseline ultrasound checks to see if your uterine lining is at the right thickness to begin your follicle stimulators. Aka if your body is ready to start the process of getting pregnant. The blood work also let the doctors know where my hormones were at, also to make sure that my body was ready to start the process of getting pregnant.
Once your body is ready, you begin Follicle Stimulators. Follicles are where your eggs are released from during your cycle. It is normal for women to have 1 follicle (sometimes more will grow, but 1 is pretty typical) that matures enough to release an egg. During IVF, the goal is to get as many eggs as possible, so Follicle Stimulator shots are administered in the belly to help grow as many follicles as possible to maturity. A follicle is considered mature when it is 18mm or just over 2cm.
For us, we did follicle stimulator shots for 10 days. On day 7 of stims, we started using a medication to prevent early ovulation. Ovulation is prevented for a few days to help more follicles reach maturity. After 3 days of ovulation prevention, it was time to do what is called a “trigger shot.” This shot preps the body for egg retrieval. 36 hours (literally to the hour) after the trigger shot is administered you go in for your egg retrieval.
The actual Egg Retrieval procedure is relatively simple. They put you under general anesthesia and then the doctor goes in with this funky needle thing and basically sucks out the eggs from each follicle. (I think of it like one of those booger suckers for babies… like a nose frieda but for eggs, not boogers)
After the Egg Retrieval, they attempt to fertilize the egg and the sperm. There are two different ways to fertilize embryos. One process is the traditional “test tube baby” way where they put the egg and the sperm in a test tube with some fluid and allow them to fertilize on their own. And then the other way is called ICSI (intracytoplasmic sperm injection) where they inject an individual sperm into an egg. Due to our study protocol, some of our eggs were fertilized via traditional IVF and some were fertilized via ICSI. Most of the time though, it will be one or the other.
Once your baby embryos are fertilized, it is time to let them grow for a few days. They have to get to a certain stage before they can be transferred back into the body or frozen for a later transfer date. The decision of a “Fresh Transfer” versus a “Frozen Transfer” comes down to a few things:
1. Is your body ready?
2. Have the embryos grown enough?
3. The number of Eggs Retrieved (to avoid OHSS- ovarian hyperstimulation syndrome)
From what I’ve read, there is some research stating that frozen transfers are more successful, but other articles state that there is more research that needs to be done.
For those who do a fresh transfer, the transfer happens 5 days after egg retrieval. For us, our study protocol stated that if more than 20 eggs were retrieved at the egg retrieval then we would have to do a frozen transfer. For a frozen transfer, you wait one (or more) cycle(s) for your body to level out from all of the hormones that were given to you in preparation for your egg retrieval. Some families also wait longer between their retrieval and frozen transfer for financial reasons.
Before your transfer (whether it is a Fresh or Frozen transfer), you take progesterone. Progesterone helps prepare a woman’s body to get pregnant and then also helps a woman stay pregnant once she becomes pregnant. There are different forms of progesterone that are taken— pill, suppository, or injection. For frozen transfers, progesterone is administered via injection and is taken the weeks leading up to the transfer and also for a number of weeks after the transfer.
The fertilized embryo is thawed (if frozen) and transferred into the woman’s body. It is recommended that the woman stay down and rest for at least 3 days after the transfer.
The Frozen Transfer was also a relatively simple procedure. I was given Valium to help me stay calm and relaxed during the procedure. The Embryologist and Doctor and a Nurse Practitioner were all present for the Frozen Transfer. The Embryologist showed us our embryo in real time via a microscope video. I verified that the name and embryo were ours. Then they brought in the syringe (at least that's what it looked like haha) and handed it over to the doctor. She then transferred the embryo from the syringe to my body. After the doctor was finished, the Embryologist checked the syringe to make sure that the embryo didn't get stuck in the syringe and that it transferred properly. Once that was verified, we were done and ready to go home and we were officially Pregnant Until Proven Otherwise -- aka PUPO.
After the transfer, the dreaded “2 week wait” (as it is known in the infertility world) happens. After 10 to 14 days, you go back in to your doctor, where they take a blood pregnancy test and let you know whether or not you are pregnant from your IVF cycle. If you are pregnant, then at 7 or 8 weeks you will go in for your first ultrasound. The fertility clinic will continue to monitor your pregnancy up to 12 weeks and then you graduate from the fertility clinic to a typical OBGYN!
Sounds relatively easy, right? hahah. Just kidding. It’s taxing. Your body swells up like a big balloon and you look 4-5 months pregnant after 10 days, so that’s cool. See below for my “pregnant belly” I wasn’t actually pregnant. My ovaries were just huge because we had so many mature follicles.
There are a few risks that can happen with IVF as well as tests that can be done to make sure embryos are viable (that they will be actual babies. about 50% of embryos are not viable). Genetic Testing can be done to ensure that embryos will be viable (fun fact, you can find out the gender of your embryos through genetic testing and know from DAY 1 what gender your baby will be. crazy, huh?)
Fertilized Embryos may not grow to day 5 (the size they need to be to be frozen or transferred for a fresh transfer).
Frozen Embryos can die during the thawing process when it comes time to do a Frozen Transfer.
Most of the time 1-2 embryos are transferred (it depends on maternal age. Women older than 40 often have multiple embryos transferred). The number of embryos transferred doesn’t necessarily mean the number of babies that are born. Embryos can split once they are transferred producing multiples (twins, triplets, quadruplets, etc.).
And sometimes none of the embryos implant and pregnancy does not occur. IVF, unfortunately, is not a guarantee. Not getting pregnant from IVF can be devastating.
If you or someone you know needs to do IVF to grow your or their family, send them love often. Tell them you're aware of their situation and you care about them. Cheer them on because IVF can be so, so taxing physically, mentally, financially, and emotionally.
For all of my TTC sisters out there who aren't quite ready to do IVF yet and need a place to process their emotions, decisions and journey, check out our Infertility Journey Journal!
If you have any questions or I missed anything, feel free to comment below! To read Part 2, go here!