Yup, it is time to discuss one of the biggest aspects of dealing with infertility, the In Vitro Fertilization (IVF) protocol. Don’t worry, this won’t be a lot of mumbo jumbo, but should give you some sort of idea of what the IVF journey is like.
As you all likely know (or perhaps you are a new reader! HI! ::waves::), I rang in the New Year with a different type of body shot than much of the world: I started my IVF shots. This is perhaps the part of invitrofertilization that I was the most nervous about, likely because it just means #itson. So I had my fun and epic Saturday New Year’s Rockin Eve, and then came home to get to business.
As a note, I am going to tell you all quite a bit about my process and protocol. You all know that I am a transparent, wear-my-heart-on-my-sleeve person, so keeping this to myself was just never going to happen. That said, I am going to likely be a bit more vague as we get more into the process (particularly with regards to dates), simply to protect myself and my family and to give us a buffer to deal with both happiness and frustration. I may or may not confirm/deny pregnancy or miscarriage. We are just going to play this by ear, and see how I am doing with it psychologically, which I know (because you all are the best) that you will respect and support! THANK YOU SO MUCH!
Alright, let’s do this!
In Vitro Fertilization Protocol Part 1
aka Making Babies the New Fashioned Way
*I want to be very clear that I am giving you an overview of the process from the BEST CASE SCENARIO mindset. I will go over potential risks and issues in a separate post!!!
Part 1 : Birth Control
As I covered in the my infertility and hormone history, we started me on a birth control a few weeks ago. Birth control, you say? But aren’t you trying to get pregnant?? Well, yes, hence this post. But remember, I have basically no hormones in my body, so going from 0-3000 (basically the hormone levels that we are aiming for) over the course of a few days? Likely not the best idea. So we did what was called a “birth control buffer” to introduce hormones back into my system but also for another very important reason: to regulate my cycle.
As I have not had a menstrual cycle in a few years, we have no clue about what rhythm my body is on, thus we needed to regulate my hormones so that we could fudge a sort of cycle and thus start on the correct day (what would be the “placebo week” of your pack).
Transition: After or the day of your final birth control, you go in for a baseline ultrasound and labs (to check your estrogen, progesterone and beta hCG). They are also confirming clear ovaries and that your estrogen and progesterone are at levels that are appropriate for the next stage. I must have done ok, because I was confirmed and we moved to shots!
Part 2 : Stimulation Medication (Shots)
This is where things get a bit complicated. Basically, the whole point of this first round of shots is to get your body to ovulate like a mad dog so that they can then harvest as many good eggs as possible to make as many embryos as possible so that you don’t have to go through all of these things again.
48 hours after my last birth control pill, we started me on Menopur and Gonal F (or you do Follistim, but this triggers your FSH (Follicle Stimulating Hormone) to get to work. You give them via subcutaneous (via the skin–pinch an inch of skin and stick it in–rather than into the muscle or a vein) injection. The Menopur is a typical syringe (they use tiny insulin syringes) that you mix yourself, and the Gonal is an injector pin that you prime by attaching new needles and twisting to the correct dosage.
Oh, and btw, the Gonal is refrigerated, so you take it out a few minutes before injection to make it more comfortable for you.
So far, the shots have been easy. I gave myself shots every week when I was on Methotrexate, so this is old hat, and actually hurts less!
Part 2B: Ovulation Suppression and Triggering
On day 5 of your shots, you go in for another round of labs and ultrasound to see how you are doing. They are checking that you are producing follicles (which then become eggs) and that the lead follicle is > 14 mm. If it is, you start a third shot, which SUPPRESSES ovulation. Your body is like “WHOA NELLY that is a lot of hormone you have coming at me, and I’m think that it is time to ROCK THIS OUT.” But you are like “WHOA, BODY, chill out a second because we need more than just one egg from you.” So you start a third shot, this one in the AM. I am taking Cetrotide (Ganirelix is the other one).
This is when the lifestyle changes come into play, because you are overstimulating the ovaries (there is actually a potential for negative outcome here, which I will get into in a second). Thus, you increase fluids to at least 8x 12 oz glasses of fluid a day because the meds are very dehydrating. Alex and I looked at each other and laughed at me not meeting this requirement. You also decrease exercise and begin abstinence. Now, why should you do that? Because of heart rate or body temperature or stress?
Nope. So that your ovaries won’t wig out and turn over on themselves, a condition called ovarian tortion, which has to be surgically reversed and is apparently rather uncomfortable. I asked a variety of questions, and from what I gathered, you can walk at any pace you like, and recumbent biking might be ok, but the other are off limits. Sex is off limits not because of the penetration but because, well, the jingle jangling that is necessary. Yoga and other HIIT is also out because of the crunching, twisting, and contorting of the body (remember… you are risking your insides TURNING OVER).
So, my plan is to walk and to do the strength moves that I did when I had a broken back, because I could move that part of my body anyway!
This is also a time when they might adjust dosing of your stimulating medications.
Behavior-wise, you can expect PMS-type symptoms, because, if you think about it, you are basically artificially creating that process in your body, and then making it just wait it out. So bloating, some cramping, being the best possible, most calm and level headed person ever…. (This is when the men all run screaming, especially with the lack of sex).
Part 3: Triggering and Egg Retrieval
The trigger of ovulation will be determined by your physician based on your ultrasounds and follicle level and labs and estrogen level. You can expect to be coming into the doctor every other day or even every day for those types of test as they monitor you. When it is determined to trigger you, you stop the Gonal/Cetrotide and start the Ovidrel at a specific time, based on your egg retrieval procedure, which occurs exactly 36 hours later.
The day before the egg retrieval, you start an antibiotic (Z-pack (azithromycin) or doxycycline) to prep for the procedure. This is done because the procedure is intra-vaginal/via your uterus, and thus they can’t full sterilize you. No food or drink after midnight before the egg retrieval (you take the antibiotic with food after returning home).
And that morning, you either provide frozen sperm or you hubs gets comfy in a room by himself for a bit 😀
Then they hoover your eggs out and you go about your merry way. You also stop the triggering medication shots and start progesterone as indicated by your doctor!
In total, the stimulation medications may be administered for anywhere from 8-14 days, and egg retrieval occurs 10-15 days after starting those stimulation meds.Finally, someone explains IVF in a way I can understand! #infertility #IVF Click To Tweet
Coming up next time: Making Babies aka Fertilization, Embryo Development, and Embryo Transfer!
I hope that this was helpful! Again, this is really glossing over the nitty gritty details. Some women react very badly to the medications (I will go over the adverse effects in another post), and there a number of potentially life threatening conditions that can result. But, if all goes well, this process should go rather smoothly, at least on the medical side.