what to expect – IVF 201

This blog initially was dedicate to helping those not struggling with infertility understand what’s its like to struggle. However, throughout the duration of the blog, many fellow TTC friends have began following. I receive questions all the time about what to expect during IVF cycles. So here are some of my thoughts and answers!

What are some good questions to ask during the IVF consult?

The initial consult with the doctor can be really overwhelming! If you have reached the point of having an IVF consult, you likely have ruled out most, if not all, other options of conceiving. Your heart is tender as you grieve this new reality of having a more invasion route of creating a baby. However, it is also a really exciting time! IVF comes with much higher chances of success than other fertility assistance. So when you sit down to discuss this with your doctor, its important that you bring with questions to ensure that your clinic is the right match for you, as well as learning as much as you can in the short allotted time.

One thing I recommend before going into this consult appointment, is to check on the SART website to check out information on your clinic and region. You can do this simply by going to http://www.sart.org/find_frm.html. You will then want to pull up the ART Data Report. This will give you a good idea of the amount of cycles and successes that your clinic has had.

Next, the questions. Here is a list that I put together and used for my appointment. It certainly is not all inclusive so please personalize them!

– Based on my medical history, what are the percentages you would give me to get pregnant with one fresh cycle? – What about the shared risk program? (Many clinics offer a flat rate, 3 fresh, 3 frozen cycles package)
– What is the clinics pregnancy success rate with people in your age bracket with similar infertility issues?
– What is your policy on embryo transfers? 1 or 2? (My personal opinions is that clinics that are willing to transfer more than 2 are in it more for the positive ratings of pregnancy then the health and wellness of baby and mom. Of course, in the 40’s age bracket, 3 is acceptable.)
– What would a cycle look like? What type of timeline do you use, start to finish?
– Would I work more with the nurse or with the doctor?
– Do you have the clinic open on weekends? (Personal opinion: They should be willing to do retrievals and transfers all days of the week, including weekends. Otherwise, it is what works best for them and not for you). It may be helpful to specifically ask if they transfer and retrieve on weekends.
– How often does the clinic see OHSS cases (hyperstimulation – typically this happens when the doctor overstimulates – the rate should be low and he/she should reassure you of that).
– Every clinic has a “base” medical IVF standard they use (starting patients on a med program). Based on my history, how would you adjust the medications specifically for me? (You want to see that they are considering your case, for example, my doctor saw I had low progesterone in other cycles and started me higher than what the preprinted book recommends.)
Don’t be afraid to ask follow-up questions, such as “You are telling me your clinic has a 80% success rate with live births, but SART’s website says its 54%. Can you explain that difference?” Make sure you feel comfortable with the answers that you are given. Don’t be afraid to stop them to ask them what certain medications or abbreviations mean. You should walk out of this appointment feeling like you understand what is ahead of you.
When you leave, you may feel overwhelmed. You will have dates and medications and best and worst case scenarios thrown out. It’s okay to take a few days to decompress. Talk to a trusted friend or family member. Call the clinic back if you still have questions. Always remember that you are paying them to provide you a service so you have absolutely every right to make sure you comfortable and satisfied.

What’s next?

Typically once you decide to do a cycle, you will have a nurse consult appointment. It’s at this appointment you and your partner will sign waivers regarding the rights of the embryos in several worse case scenarios (death, divorce, etc.). You will also obtain your prescriptions and walk through any medication questions you may have regarding the shots. Some clinics have you go to a injection training class, others will have you watch online videos. I watched the online videos prior to my RN consult appointment so that I could ask follow up questions. Freedom Pharmacy has some helpful videos if you would like to check them out! (http://www.freedommedteach.com/player/Videos.aspx) Just make sure you watch only the ones that involve the shots you will use. Otherwise watching them all might overwhelm you! (I made that mistake!)

I just got my prescription – I’m terrified! What do I do?

The prescription list is long and can be incredibly overwhelming. It is the patients responsibility to obtain the medications. I suggest asking the RN if they can recommend any specialty pharmacies that they are aware of others having success with. Many patients do not have insurance that covers the cost of these medications, so shopping around to find the cheapest place is helpful. My clinic faxed the prescription to 3 companies with my phone number. I was then able to take their calls and find out their pricing. Each one was very different! Sometimes you may find ordering some meds from one company and some from the other will provide you the best pricing. All the companies I have worked with will ship for free overnight and also will provide all needles, syringes and a sharps container for free. (I did have to purchase my own alcohol wipes at Target.) Many pharmacies will offer discount programs, such as $20 off a box of progesterone if you give them your email address (create a new one!) or if you spend more than $1,000, you can get $100 off if you enroll in another program with a $25 enrollment fee. These aren’t scams, they are just ways for companies to save you money.

I got my medications, do I refrigerate them?

I have read SO many different opinions on this one. My go-to advice is simply call a pharmacist. Read the box carefully. Certain medications HAVE to be refrigerated (for me, it was Follistim) and others can, but don’t have to. Others shouldn’t (Progesterone in Oil). Instead of doing what I say, or a friend online, I would highly suggest simply calling the pharmacy and save yourself a several thousand dollar re-order headache.

When does the medication start?

Every cycle of IVF is different, as doctors use different protocols for different reasons. I was on a protocol where I used birth control and Lupron injections daily to suppress my ovaries before I began stimulating them. Once stimulation begins, you typically will use a mixture of a Follicle Stimulating Hormone (like Follistim or Gonal-f) and a Human Menopausal Gonadotropin (like Pergonal, Repronex or Menopur). There is a range of days you will be on these stimulation medications. Most range between 7 – 12 days, but varying doesn’t mean anything “bad”.

The goal is to stimulate your follicles so that they become large (preferably in a pack) so that they can be retrieved and hopefully contain eggs. Your doctor will do routine ultrasounds and blood work to check your follicle size and check your estradoil levels to ensure they are within a range. If they are not, they will simply adjust your dosage. Do not panic if this happens! If anything, be assured that your doctor is closely monitoring your progress and wants the best outcome for you. In all of my cycles, I have had medications played with mid-cycle. Please do not stress and see this as a bad sign that your body isn’t responding well. Everyone is different and the starting medications was simply a best guess.

What happens when everything is ready?

When your follicles are the right size and your estrogen levels match, your doctor will typically have you administer at home a Human Chorionic Gonadotropin (hCG) shot. This is commonly known as a “trigger shot”. hCG is a hormone that helps stimulate egg maturation and release from the follicle and this shot is typically done somewhere between 30 and 36 hours before your scheduled egg retrieval. (This means that you likely will not know when your egg retrieval is going to be until a day or two before it happens.) Most hCg shots are administered in the upper quadrant of your butt and the size of the needle can create a lot of anxiety! It is not as bad as it looks and is that final step of closing out the stimulation phase! You can do it! (If it helps, hold a stress ball or have a show playing in the background. Chances are, you barely feel it though.)

It’s egg retrieval day! How should I prepare?

This is an incredibly exciting, yet scary day! It feels like everything has led up to this moment – to find out how many eggs you will have and what kind of quality they are. The calmer you can stay, the better! Your clinic will tell you not to eat or drink anything for at least 8 hours before hand. When you get home, you will be sore and uncomfortable, not to mention sleepy from the medication. I have always made sure my “spot” was set up before I left, so I could come home and crash on the couch with my blanket and pillow already waiting for me. Also, if you do want to change when you arrive home, have the clothes laying out. You may be hungry so its helpful to have a meal already planned or prepared so you don’t have to worry about that either.

For the retrieval itself, I highly suggest wearing something COMFY! You are already feeling incredibly bloated from all the stimulation so chances are your normal pants aren’t fitting. Take advantage of yoga or sweat pants, leggings or a comfy dress. You may spot after the procedure so you may want to bring a normal size pad with you. (Don’t worry, they will give you one if you forget, it’s just GIGANTIC). I also brought a bottle of Gatorade with so driving home I could re-hydrate. On the way home, I wanted to just lay down and close my eyes, so I also brought a pillow with me in the car.

What can I expect when I get home from the retrieval?

Plan on resting that day. Take it easy. When you think about what your body has been through, it’s only fair to give it time to catch up. You also will want to hydrate. There are differing opinions on gatorade vs. water. I was a gatorade girl. When they puncture your follicles to retrieve the egg, the follicle will then fill back up with liquid. The bloat after retrieval is the worse part for many girls. Your body can quickly become dehydrated as the follicles are pulling in the liquid so drinking a LOT is helpful. It’s also a great idea to eat a lot of salty foods, such as potato chips, pickles, fast food, etc. Your body is going to be withholding liquid already, so what the salty foods do is pull the fluid throughout your whole body so that its not solely built up in your ovaries.

What’s one thing no one told you to expect?

Truthfully, that constipation will come with this! The pain medications and dehydration result in a bad combo. Constipation combined with swollen innards can actually cause excruciating pain.  I would highly recommend taking stool softeners well BEFORE the retrieval and continue them afterwards. Also, some fiber juices, celery, ice coffee and herbal laxative-like teas can be helpful.

What about the day of transfer?

Depending on whether you are doing a day 3 or day 5 transfer, the day is still the same – it will be one of the most special days of your life as you meet your baby/babies and watch as they are transferred into you. For many, this will be the first time of ever experiencing pregnancy. Doctors have different opinions on bedrest or returning to regular activity immediately. I will let you and your significant other determine that with your physician (I was always on 48 hour strict bedrest), but I will say, when you do move around afterwards, don’t be terrified. My doctor explained the embryos placement well – she said “its like I stuck 2 peas on a piece of bread thickly smeared with peanut butter. Those peas aren’t going anywhere.” The chances of the embryos moving around are slim, although it does happen at times, but do not stress yourself out over a sneeze or walk to the bathroom. Try to keep stair movement limited and also, try not to sit at a 90º angle as it puts a lot of pressure on your uterus. This day I also brought a pillow in the car so I could lay back and rest on the way home!

And then you wait. And wait. And over-analyze. And have moments of completely negativity where you just “know
this didn’t work. Then you have moments where you have such an intense bond with your little ones  that you just know it did. All of these emotions are normal. Try to keep yourself busy with books, tv shows, mild activities. I find incredible peace with my time with God, worshiping and praying.

These experiences are simply that – my experiences, thoughts and things that I have learned. In no way am I a doctor or am I telling you to do anything of these things OVER what your physician is telling you. This information is solely for informational purposes and is not intended to provide medical advice.

13 thoughts on “what to expect – IVF 201

  1. daymon11 says:

    Thank you for this. I start my Lupron in 9 days for my first IVF cycle and it was very reassuring to have it explained from someone who has been through it. My mind feels better. Still working on preparing my heart for all of this & trusting God to fill in the gaps that I can’t.

    • chels819 says:

      You are so welcome! Thank you for reading it and I am so glad that it has made your mind feel better. I will be praying for you as you embark on your first IVF cycle and pray that it brings you the miracle your heart desires!! You will be a champ at this!

  2. Jen Knudson says:

    Wow. I had no idea. Thanks for educating this naïve woman. Your blog has helped me to grow closer to God through seeing YOUR trust in Him. I just am in awe at how much I can take things for granted without even realizing it! I am humbled and so grateful to God for my kids, as well as you and your willingness/comfort to share the intimate details of this journey. Having not gone through this, I can see how maybe my need/ability to totally surrender and trust God, has not been fully developed. My time will surely come, where my faith and trust in His strength will be needed/tested, but until then, I live completely naïve of the depth of trusting in Him. I guess that is why Paul tells us to embrace trials in our life. (I think I read this from James?) Your story/situation helps me to understand why he (Paul)would ever advise anyone to welcome trials in our lives. (Which to be honest, when I first read that, it was a little difficult to swallow.) Thanks again Chelsie. Praying for you and Frosty!!!

    • chels819 says:

      Thanks so much Jen! I am a huge fan of that verse from James (hence the web address Trials Bring Joy) because truly, when embraced, tough times are the most beautiful times. I am thankful for your prayers!

  3. Lauren says:

    Do you have any advice about what to tell your job or boss when going thru ivf? Is it possible to not say anything and ‘be sick?’ I am hopefully starting ivf next month for the 1st time and am wondering your advice. This page is incredibly helpful!! Thank you!!
    Lauren

    • chels819 says:

      What a great question! I found that it was easiest to be open and honest with the few above me during IVF simply so I didn’t have to feel like I was hiding it or unable to be sick when I was sick. I found that they were extremely understanding and compassionate and it gave me some flexibility as well. Truthfully your employer shouldn’t need to know everything, but letting them know you are going through infertility treatments and provide a note will be a good place to start and then you can feel out how they respond. You also can be honest and let them know that you would appreciate not being asked questions as well. Hopefully you are in a work environment where confidentiality is respected and you feel safe to share. I have found few states that will allow FMLA coverage for IVF which is unfortunate but many will respect the ADA in regards to considering infertility treatments responsible to work around. Feel free to email anytime with more specific questions! :) Best of luck to you and I hope your cycle is nothing but successful!!

  4. Elena says:

    This is great, I have been using this page of yours for a few weeks now, I find myself referencing it all the time just to make sure I’m doing what I’m supposed to! Great job explaining everything so well! Thank you!

  5. Amy in Austin says:

    I’m just finding your blog as we are dealing with unexplained infertility. I’m currently at the tail end of my two week wait after our first round of IUI. We test on Monday to find out if it worked. Next step for us is IVF, and we only have one shot at doing it. Thank you so much for the wealth of information you have provided, and for sharing your journey. It is much appreciated!

  6. Allie says:

    Chelsea, Thanks for your blog… I start my first IVF cycle today as I found myself at 40 finally deciding to have children only to find out my AMH levels are very low to continue trying naturally. I monitored this morning and I’m now waiting for the doctors orders to hopefully start injections tonight. Overwhealmed with emotions of all sorts, but mostly scared beyond words as I’m embarking my healthy body into a trip of hormones that I don’t know how will they feel… Just I believe the fear of the unknown and the even bigger fear of knowing the end results are not guaranteed. I felt compelled to write you as just the knowledge of talking to someone that had gone through it before apeaces my emotions… Thanks for your blog as it gives us all a space to bond. Love, Allie

  7. caleb keila says:

    thank you so much for all your blogs. I thank God for your words that help me understand IVF and my doubt about it wether its God’s way or not. Its like reading myself in your every words. I cant help but thank God for speaking to me through your words of encouragement. God bless you…

  8. liz says:

    Hi
    thank you for this.I have just started my menopur..and i am not handling the injections well.Am basically terrified of this whole process and the whole needle part.I had a miscarriage last November and was mis handled in hospital,i almost bled out and was stabbed 21 times approximately because they could not find my veins.I think i have PTSD now so am finding this journey pretty hard.Hopefully it works first cycle because i doubt i will do more cycles.thank you for all the extra info in your blog ..i will definitely get some laxatives and take your advise on board.Good luck everyone ..babydust to all…xxx

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s