Saturday, November 20, 2010

IVF 101

I'm not even sure I am qualified to teach this course, but it was requested from one of my non-IF besties and I thought it might help some of the less experienced.

So, IVF is In-Vitro Fertilization, which means they put the sperm and the egg together outside of the body, and then implant a growing embryo (or several) back into the woman's uterus.

There are different protocols, but I am going to talk about mine: Antagonist. On day three of my period, I started stims, which means I started injecting the drug that stimulated my ovaries to produce eggs. Most women only produce one egg a month, sometimes two, so we use the drugs to stimulate more. Hopefully a lot more, but I will get to that later.

After four days on stims, I started taking an inhibitory drug, Ganirelix, which is designed to keep my body from ovulating on it's own, as well as slow the growth of my largest follicles (the space in my ovary where the eggs are created) and allow the smaller ones to catch up. Ideally, every follicle growing evenly. Starting on day five of stims, I had daily ultrasounds to measure my growing follicles as well as my uterine lining in order to assure a lining thick enough to support implantation.

After 7 days of stims, the Reproductive Endocrinologist started checking my Estrogen levels (E2), mostly to see how my eggs are maturing. Some RE's rely on follicle size, and others on E2 levels, but I think most keep an eye on both and make a determination from there. I don't think there is an ideal number, because everyone is different, but there will come a day when the doc says "This is it!" and instructs you to trigger.

The Trigger is an injection of HCG (human chorionic gonadoptropin) which helps mature your eggs further and will cause you to ovulate. If I were doing IUI (Intrauterine Insemination), I would be timing my insemination to coincide with my ovulation. However, with IVF, they will actually go in surgically to remove my eggs.

Approximately 36 hours after I inject the trigger, I will go into surgery under anesthesia. This is called Egg retrieval (ER). The RE will use an ultrasound guided needle to aspirate the eggs out of the follicles. This should only take about 20 minutes at most. Simultaneously, my husband will be making a donation because as soon as those eggs come out, they go to the embryologist.

The embryologist will look at the eggs and determine how many of the retrieved eggs are mature. They will perform ICSI (intracytoplasmic sperm injection) on the mature eggs, and then wait to see how many are successfully fertilized using this method. I should know all of this later that day or at the latest the next day.

Now starts the waiting game. I will be transferring the two best embryos on day 3 after ER. This is the Embryo Transfer, or ET. Some RE's wait for a five day transfer, but the study I am participating in requires two embryos transferred on day three.

There is always the chance that only some of the eggs retrieved will be mature. It's also possible that a few eggs won't fertilize, and that some stop growing before transfer can occur. Depending on how many embryos you have, you may have the option to grow them to blastocyst and then freeze them for a future FET (frozen embryo transfer).

A huge amount of eggs isn't really a good thing because it puts you at risk for OHSS (ovarian hyperstimulation syndrome) which can be serious and put you in the hospital. It can also impact your egg quality. Of course, having too few isn't ideal either. These cycles aren't easy on your body, and are very expensive, so if you come out with too few follies, that isn't really a good thing either. I'm pretty upset that I only have four even remotely mature follies - for me to have anything worth freezing, I would need all four of them to be mature, fertilize and grow. So now I am just hoping I have two good ones make it to transfer.

If my little embryos make it to day three, I will go in for my ET. They will perform assisted hatching which means they will remove a small part of the zona pellucida, hopefully assisting the embryo to break out and attach to the uterine wall. At this point, I will be on strict bedrest for five full days. While not all RE's feel this is necessary, it's a precaution mine takes.

18 days after ER, I will go in for my pregnancy test, and see if all the daily injections, blood draws and dates with the ultrasound machine was worth it. I hope I covered everything, and maybe gave a good intro to anyone confused or looking to learn about the IVF process. If you have any questions, please let me know and I will do my best to answer them!

1 comment:

  1. Dips! This is SO helpful! Thank you for doing this! Now I feel like I can follow your journey and understand what's going on. All exciting stuff!

    I'm praying for you friend, that this will be your chance and that all the doctors involved are on their A game. Sure sounds like they will need to be in this process. Xoxo!

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