Explaining the second half of the in vitro fertilization protocol, from making the baby in the lab to transferring the embryo and confirming the pregnancy. Who knew that making babies the new fashioned way would be like this?
In Vitro Fertilization Protocol Part 2
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!!!
Alright, so last we chatted, the eggs had been hoovered and the guy’s boys have been collected. The eggless lady gets carted home about an hour or so after my procedure (in total, expect to be at the hospital for about 2 hours). The procedure is done under twilight sleep anethesia, so if you have ever had a colonoscopy, you can expect the same protocol. You might feel a little groggy as you wake up, but otherwise, it should be pretty smooth.
Per my doctors, they want me to maintain a low profile the rest of the day, and because the ovaries are still swollen, exercise is still a no-go.
Part 4: In Vitro Fertilization and Embryo Development
Once the docs have the little behbehs to be in hand, it is time to make babies
by adding water! The active sperm is separated, and the sperm and eggs are cultured together overnight. There is another method of fertilizing the eggs called ICSI (intracytoplssmic spem injection), when a single sperm is injected directly into the egg. This is usually used when there might be male factor infertility.
Once the eggs have been fertilized, they are placed into an incubator for 3-5 days, during which time embryos will hopefully develop. It is generally accepted that not all eggs wil successfully develop into viable embryos. During the 3-5 days, the embryos/fertilized eggs are closely monitored, and then the embryos with the greatest chance of success and survival are selected by the doctor for embryo transfer.
Part 5: Embryo Transfer
The number of embryos that are implanted ranges based on the mother’s age, the favorability of their physical condition, and the incubation period of the embryos. In my case, as discussed, they will only be implanting one embryo at a time regardless of the incubation period as we do not want to risk multiples (as much as we can).
Edited to add: Even though it is typical at my practice to transfer 2 embryos for a day 3 transfer at my age and conditions, we opted to transfer 1 to protect myself and the baby. The other two embryos continue to incubate in the lab, but there is only a 30% chance that they will make it to day 5 for freezing, another reason to transfer my embryos day 3.
For the transfer, the embryos are placed in the uterus via a procedure that is similar to a Pap smear–the woman is completely conscious, and all she might experience is some mild cramping! After the procedure, the woman lays low and can be ordered to bed rest for the rest of the day and until the first pregnancy blood test to encourage implantation (see below for explanation).
So, congratulations, you (may) have just gotten pregnant! Isn’t it ironic when getting pregnant requires you to not have sex for 2 weeks before conception and 2 weeks after?
Part 7: Hormonal Support of Uterine Lining
For successful implantation of an embryo and development of a fetus, the uterus must have adaquate lining, which is dependent on the woman’s levels of progesterone and estradiol. Consequently, to support the uterine lining, progesterone will given, and often estradiol will also be prescribed, particularly in cases such as mine (with chronically low hormones across the board).
Historically, progesterone has been administered via shots in the bum (these are the shots that HURT), but there are now a few other options, including vaginal gels and suppositories. Estradiol can be given orally, vaginally, trans-dermal patch, or intramuscular injection. Estradiol and progesterone are usually given from a period of two to 10 weeks.
Part 8: Confirmation of Pregnancy
Pregnancy will be confirmed or not approximately a week and a half after transfer via a blood test called a beta hCG (also known as the “pregnancy hormone,” human chorionic gonadotropin (hCG) is a hormone produced by the placenta after implantation). It is recommended that women do NOT do a urine pregnancy test because of the number of false negatives!
Exercise and sex are still a no until after this test, and sometimes even until after the first ultrasound a few weeks after. Talk to your doctor about exactly what they want you to do or not do! Edited to add: This is to keep the body core temperature relatively low in order to encourage blood to focus on the uterus rather than being diverted to the muscles. Additionally, if you have just gone through egg retrieval, your ovaries will still be swollen and prone to tortion.So THAT'S how IVF works! Glad Suz spelled it out for me #infertility #IVF Click To Tweet
This second half of the IVF protocol is a bit more out of your hands. You keep up with your hormone support, and you do what your docs tell you, but otherwise, it is up to them to create the babies and get them in there properly.
KEEP IN MIND
When we were having our registration appointment, the psychologist said something that really resonated with me: It is not your fault if you don’t maintain the pregnancy. Rather, it means that they (the medical team) messed up by selecting the wrong embryo or not giving you sufficient hormonal support. In a situation as emotional and pressure-filled as IVF, hearing these words really helped me, especially with my anxiety, which is induced by feelings of making mistakes.
I will have a follow up post about the risks and side effects of IVF!
Still making sense? What else are you curious about?