Today’s post is a little different than my usual! You’ll still find inspiration sprinkled about, but I’m doing a series called “Family Building Alternatives” where I will find an expert to answer technical questions about all sorts of alternatives you might consider to build your family. No alternative is a one size fits all–just keep that in mind and respect this as safe space please!
Topics you have to look forward to are adoption, acupuncture, surrogacy, interuterine insemination (IUI), child free living, and foster care. Today’s segment features my friend Kimberly with IVF in 15 steps!
Without further adieu…
I’m Kimberly and I am thrilled to be writing a guest post for Olivia today! Olivia and I met as contributors to the Quad Cities Moms Blog and quickly bonded over our shared family-building struggles and our desire to help other women who find themselves in the midst of infertility and loss.
I have two children through donor egg IVF (in vitro fertilization, more on that later) and I run a Resolve Infertility Support group in Davenport, IA.
Olivia asked me to write an IVF 101 type post from the perspective of a woman who has “been there.” Believe me, I have been there. The shots, the transvaginal ultrasounds, the longest-two- week-wait ever…boy oh boy have I been there. I am here to address your fears and questions if you are considering IVF but feeling a bit overwhelmed by the whole process. I will break down this very complex process into 10 or so (not easy) steps, so that you can get a bird’s eye view of the process from beginning to end.
Step 1: Someone tells you to consider IVF, and you have to look up what that means…
In Vitro Fertilization (or IVF) is a process by which an ova (or egg) is fertilized by a sperm outside of the body. The term in vitro actually means “in glass” and refers to the test tubes that were first used to facilitate this process. IVF was developed by two scientists in the United Kingdom and the first baby, Louise Brown, conceived from IVF was born in 1978.
Step 2: You choose IVF (or, it chooses you)
IVF is often chosen by people who have exhausted less invasive and expensive fertility treatment options (including medications, injections, and intrauterine insemination) or by people who desire or require testing of their embryos to detect genetic conditions.
Additionally, IVF may be chosen by people who require an egg donor or surrogate to build their family or women who would like to pursue aggressive fertility treatment due to age or other factors. The majority of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3% of intended parents who are struggling with infertility need IVF to start their family.
Step 3: Figure out how you will pay
IVF may or may not be covered by health insurance. Coverage for infertility, including IVF, is now required by a few states, including Illinois but not Iowa. IVF costs around $15,000 – $20,000 per attempt. Additionally, almost no insurance policies cover donor gametes or surrogates, which both cost more than standard IVF. Some clinics offer discounts or warranty programs to certain groups, but the majority of people who pursue IVF pay for it out of pocket or through insurance (which often includes an annual and/or lifetime maximum for IVF coverage).
Step 4: Determine your protocol
Once a person has decided to pursue IVF, their doctor (called Reproductive Endocrinologist, aka RE) will determine their medication protocol based on their infertility diagnosis (or lack thereof). The protocol includes which drugs they will take, the dose, and the order they will take them in. The goal of the IVF protocol is to create enough developed egg follicles to make this expensive and grueling procedure worthwhile, without dangerously overstimulating the ovaries (called hyperstimulation). If this is not the patient’s first time pursing IVF, their doctor may decide to make modifications in their protocol to encourage a better result. At this time the couple or individual undergoing IVF will also decide if they want to use preimlmentation genetics (PGD) or comprehensive chromosomal screening (CCS) to test
Step 5: Procure medications
Once the protocol is established, the patient will order their medications. Sometimes these are ordered from the clinic, but often they are ordered from a specialty pharmacy and shipped to the home. Either way, the number of medications and needles is overwhelming when they arrive. The patient may be freaked out about the number of shots (and I don’t mean tequila) that they will be doing every day. And if they doesn’t bother them, seeing the two inch needles needed to deliver the intramuscular medication will surely freak them out.
Step 6: Dart practice
Often the individual or couple will attend a “medication teaching” class where they learn to give shots by practicing on an orange! The first short will undoubtedly be nerve wracking! But, if they are anything like me, they will be more alarmed by how normal the whole nightly shot routine feels after 10 days!
Step 7: Suppression
Often, the first medication a woman takes is, ironically, a form of birth control! This works to sync her cycle with the clinics “up” time (or times of the year where they are on call 24/7). Next, the patient will take a medication to suppress the ovarian function. One form of this medication is called Lupron and has been nicked “Loopy Lupron” by women who experience its side effects. For me, this meant aggressively picking fights with my family members (sorry Dad) and having an almost out-of- body experience with severe mood swings. I knew I was being unreasonable, but I could not control my emotions or impulses (basically just like adolescence).
Step 8: Stimulation (not that kind, unfortunately) and monitoring
Next, medications are taken to encourage multiple follicles, or eggs, to develop. In a typical menstrual cycle, many follicles mature but only one takes the lead, grows to around 20 mm and is eventually released or ovulated. In IVF, as many as 20 or more follicles may grow and mature enough to be used to create an embryo. During the 10-14 days of egg stimulation medications, or “stimming,” the patient will be monitored to determine how fast the eggs are maturing. She will likely undergo ultrasound imaging of the ovaries as well as hormone assessments (via blood draws) to monitor the number and size of the follicles. When the lead follicles have reached the appropriate size, another shot is given to complete the follicle maturation process. Then, the follicle retrieval is scheduled for 36 hours later.
Step 9: Retrieval and embryo culturing
The procedure to remove the follicles, called the retrieval, is conducted at a surgical site and is completed under IV sedation. The doctors use transvaginal ultrasonography to guide the procedure and remove the follicles by aspiration through a needle. Then, the eggs are placed in a special media to be cultured in an incubator. There are two options for fertilizing the eggs with sperm. Standard insemination means that 50,000-100,000 motile sperm are placed in a dish with the eggs and fertilization occurs on its own. Alternatively, a procedure called Intracytoplasmic Sperm Injection (ICSI) is done in which a single sperm is selected and injected into a single egg to cause fertilization.
At this point, the embryos come under the care of an embryologist in a lab. A fertilized egg is two cells and is called a zygote. Some clinics utilize a day-3 embryo transfer, in which a 4-8 cell embryo is placed in the uterus three days after the retrieval. Often this is used when they are a low number of surviving embryos. The ideal day to transfer an embryo is day 5, when a fertilized egg has become a blastocyst and contains 100-200 cells. A “blast” has a higher potential for implantation and, therefore, fewer embryos will be transferred to reduce the risk of multiples. Some clinics allow a patient/couple to choose how many embryos they would like to transfer, while other clinics set strict guidelines based on age, embryo quality, day of transfer, and the results of their previous attempts at IVF.
Sometimes, a couple may have no choice because they only have one or no surviving embryos on day 3 or 5.
Step 10: Embryo Report
Based on the rate of embryo development and the appearance of the embryos, the reproductive endocrinologist and embryologist will make a recommendation on which and how many embryos to transfer. Any remaining high quality embryos can be frozen for future transfers. On the day of the transfer, the couple may get a report and/or pictures from the embryologist of their embryos. Often, this information is not available until minutes or even seconds before the actual transfer takes place.
Needless to say, this is a very stressful situation for the potential new parents.
Step 11: Transfer
The transfer is a simple procedure that requires no anesthesia. It does, however, require a full bladder (for improved imaging), which is highly uncomfortable! The embryologist loads the embryo(s) in a soft catheter and the Reproductive Endocrinologist places them in the uterine cavity through the cervix.
Then, the embryologist checks the catheter under a microscope to ensure that the embryos are no longer inside. Most clinics require the patient to lie down for 5-10 minutes after the procedure, but few require bed rest (anymore). You may have heard people refer to this procedure as the “implantation.”
Neither doctors nor the women they work with can ensure implantation. They simply place the embryo inside and hope that they embryo will successfully burrow into the uterine lining.
Step 12: The Two-Week- Wait
The Waiting: 10 long days of knowing you have an embryo(s) inside you and wondering whether it has implanted in the uterine wall. Most people over analyze every single twinge, worry the embryo has fallen out, and think that they have some control over what happens next. Unfortunately, there is nothing (scientifically proven) that the patient can do to effect the outcome, so she must just wait.
Wait wait wait. For ten agonizing days.
Step 13: The Beta
Finally, the patient goes in for her “beta” or HCG blood test, approximately 10 days after a day-5 embryo transfer. A number around 50 Is considered “good and pregnant.” Even armed with this good news, she must return two days later to repeat the test and ensure that the beta level is approximately doubling every 48 hours.
If so, she will wait all over again for her first ultrasound, which is usually scheduled for around 8 weeks gestation. If the team detects healthy growth and a heartbeat, then the patient will “graduate” from the Reproductive Endocrinologist to an Obstetrician for care.
Step 14: Repeat
Unfortunately, IVF is only successful around 50% of the time, depending on age and a host of other factors.
Often, this means that the person/couple will now start IVF over again, or use a frozen embryo in an FET or frozen embryo transfer, pursue other family building options or choose to live child free.
IVF patients also have an average risk of miscarrying, so a positive beta doesn’t always guarantee a healthy, full term pregnancy.
Even patients who have a successful round of IVF and welcome a new addition to their family may repeat the whole process again for a sibling. Personally, I underwent four rounds of IVF before having a positive pregnancy test.
Step 15: The Reward
My husband Brian and I are one of the many blessed couples who were finally able to create our family through IVF. Our twins are now two. We are so grateful to the researchers who pioneered and perfected IVF, and our doctors and our donor who made our family possible.