IVF

I can't believe the whole IVF process will be starting up for us in about a week or so!  To quote my dear sister-in-law: "Deep, cleansing breaths!"

I realize that not everyone reading this blog understands the process of IVF, and so I'd thought I'd describe the process for those who are interested.  If you dislike medical talk or are at all squeamish, feel free to pass this post right on by!  :)

Here's a description of a typical "fresh" IVF cycle:

Initially, you go through some tests - bloodwork, a hysteroscopy (scope of the uterus where they inject saline to make sure the fallopian tubes are clear and also check that the uterine wall look healthy), and a mock embryo transfer - where they actually go through the process of inserting a small catheter into the uterus and pretend they're transferring an embryo to make sure that everything can be done smoothly when the time comes for the "main event." 

When you get your period, you go in for a general ultrasound to check the lining of the uterus and to make sure there are no cysts on the ovaries.  Cysts are not uncommon during menses, but the hormones injected during IVF could cause the cysts to grow, or the cysts could affect the ovary's ability to produce eggs, so if cysts are present, then usually they make you wait a month (this hasn't happened to me).

If everything looks clear, they bring on the drugs.  Generally, you first have an injection that shuts down your ovaries (this is actually started before you get your period and then is administered throughout the IVF cycle).  They do this because they don't want you to spontaneously ovulate on your own; they want to control everything themselves.  This drug is called Lu.pron (or leuprolide acetate = generic).  Sometimes you can be on this a week or two, with one injection each day. 

Then, around Day 3 of your period, you add a second drug that grows the follicles called an FSH (follicle stimulating hormone).  The job of this drug is to grow the eggs in the ovaries.  The ovary is made up of follicles.  In a normal cycle of ovulation, just one follicle of the ovary will produce an egg.  The goal in this step of IVF is to stimulate multiple follicles to grow eggs.  Each follicle has just one egg growing inside of it.  But since the ovary is made of many follicles, the ovary will produce several eggs on this medication.  (Last cycle I have 8 growing on my right ovary and 9 on my left.)

As the eggs get bigger, a second medication will be added to the FSH; basically it's job is to help the eggs mature before retrieval. 

The patient is monitored very closely during this process.  Every 2-3 days, ultrasounds are performed to measure the size of the eggs and blood is drawn to check estrogen levels.  They monitor your estrogen very closely because they don't want to overstimulate you, which can have some pretty awful side affects, and in very rare cases, can put you in the hospital. 

Trigger: usually around Day 12 (give or take a few days). Once a certain number of follicles reach a certain size (I believe it's around 15mm or so), you get a butt shot of HCG (Human Chori.onic Gon.ad.otropin) to trigger ovulation.  This releases the eggs, and exactly 36 hours later they are ready for retrieval.  After the trigger shot, all other injections are stopped as well.

Retrieval:  This is scheduled for exactly 36 hours after the trigger shot.  The patient takes valium to relax and is offered IV sedation.  A needle is inserted through the vaginal wall and up into the ovaries.  The end of the needle is hollow.  The needle aspirates each follicle and sucks the eggs out.  It usually takes between 20 and 30 minutes.

That same morning, the husband gives a semen sample (they have it sooooo rough, don't they!?!? Ha!).  After the retrieval, the lab fertilizes the eggs.  In our case, because of the male factor infertility with compromised sperm count and motility, we do an additional procedure called ICSI - an acronym for some very long name that means that instead of putting the eggs and the sperm together in a petri dish and letting nature take its course, the lab specialist picks out the best looking sperm and injects one into each of the eggs, thus improving the chance for fertilization.  This is often recommended for patients who have low sperm count or low motility.     

Once the eggs are fertilized, the cells start to divide.  The lab grows them for 2 days to see which embryos continue to develop.  Then you return to the office for an embryo transfer (usually 1-2 embryos), and if you have any leftover, they are cryopreserved in order to use later in a frozen embryo transfer. 

The transfer is easy-peasy.  They insert the catheter and drop those little babes off where hopefully they decide to nestle into that nice cushy uterine lining for the next 9 months or so.  :)  On the day of the transfer, you start taking a dose of progesterone.  This is either a butt-shot once a day, or a vaginal suppository 3x a day.  Also, after the transfer, the patient is on bedrest for 2 days to encourage implantation.

With the exception of the the Lu.pron and the pre-cycle testing, the whole process takes about 2 weeks.

About 12 days after the transfer, you have a pregnancy test with a follow-up test 2 days later.  If you are pg, you stay on progesterone through the first trimester.

So, that's IVF in a nutshell. 

This time around our experience will be a little different than I described above:

• We'll do a slightly different protocol, called the antagonist protocol, where I won't take Lup.ron to shut down my ovaries.  Instead, on Day 8 of the cycle, I'll start an antagonist drug called Gan.i.relix that will keep me from ovulating.  
• My doctor is also adding an additional daily injection of a growth hormone that has been found to help eggs mature more successfully with no adverse side-affects.  
• My doctor really wants to grow my eggs much larger than we have in the past - triggering when follicles reach closer to 22-24mm.  Oooh, boy.  I am going to be uncomfortable!
• Because we're pushing my ovaries further, my doctor wants to avoid the risk of hyperstimulation.  One way to do this is to use Lu.pr.on for the trigger, along with a small dose of HCG.  Yup, two butt shots...nice!  Don't ask me why this works, but it does apparently.
• We've also decided that for this cycle, I am going to be put under general anesthesia for the retrieval.  For me, each cycle's retrieval has become increasingly more painful and difficult, so I am thankful for this option.  Not everyone has the same experience with this, so if you are someone facing IVF, I'm not trying to freak you out!  My first times were difficult, but not nearly as painful as it was when we did it last April.  We do have to pay for an anesthesiologist, but I'm glad that this is even an option because enduring another retrieval very well could have been a deal breaker for me.

So for nearly two weeks, I'll be injecting myself 4 to 5 times on a daily basis.  I'll have at least a half-dozen blood draws.  And yes, there's that lovely needle used during the retrieval.  Needless to say, I'm going to feel like one giant pincushion by the time this is all over!!!

For those reading this blog who are considering IVF, I do feel that it's important to mention one other aspect that is significant to this process: cost.  IVF costs us thousands of dollars, because sadly our insurance company does not cover any costs related to IVF.  This is fairly typical for those going through this treatment. So if you're considering IVF, I encourage you to do lots of investigating ahead of time as to what may or may not be covered.   And while I'm incredibly thankful to be in a position where we even have the option to do this, I do have to admit that it's still hard to spend so much money on something that the majority of the population gets for free!  :)  

Still worth it though.

And one more thing.  God is teaching me so much through this journey.  Something that I have to keep reminding myself of is that ultimately I can't put all of my hope and trust in the medicines, the doctors, and this process.  Rather, I need to put my trust in the One who have given me the medicines, the doctors, the process.  Any time a life is formed, it is Creator God who is breathing life into that tiny being.  And while I'm incredibly grateful that God has given us skilled doctors, researchers for medical advancements, and all of the resources needed to help us have a baby, ultimately it is He who will give us this gift of life if that is His will for us.  I pray that it will be so, but more importantly whatever the outcome, I pray that I will continue to trust in His good plan for my life.