IVF (fresh cycle)
Why would you be doing In-Vitro Fertilization (IVF)?
IVF essentially means “fertilization outside the body.” People undergoing IVF can have the following diagnoses:
Blocked, damaged, or inoperable Fallopian tubes
Male factor infertility (low count, abnormal morphology, etc)
Women with endometriosis
In general, an IVF cycle consists of a phase where you will suppress your body’s tendency to ovulate with a GnRh agonist subcutaneous medication such as Lupron, then use a follicle-stimulating medication such as Follitism or Repronex to super-stimulate your ovaries into producing a number of eggs. When you have a number of mature follicles, you’ll “trigger” with a shot of HcG, and exactly 36 hours from that shot, your doctor will extract them in a retrieval which is usually done under general anesthesia. From there, embryologists will take the mature eggs and fertilize them with sperm. Transfers of the resulting embryos (6-8 cells) or blastocysts (multiple cells) take place either three (embryos) or five (blastocysts) days after the retrieval. Any excess embryos or blastocysts from the procedure can be cryo-preserved (frozen) for future frozen embryo transfers (FET).
What you can expect
In general, an IVF cycle involves a lot of needles – depending on your protocol, the agonist repression, follicle-stimulation, and trigger medications are delivered via subcutaneous injections. There are some agonists that can be delivered in an inhaler form – you “sniff” the agonist once or twice a day. But generally you will be required to give yourself daily injections.
When you begin your follicle-stimulating medications, too, you can expect ultrasounds and blood draws every other day and/or every day leading up to the retrieval. Additionally, as you get closer to the retrieval, you might become a little bloated and uncomfortable from the extra eggs that are developing in your ovaries.
For the retrieval, like any other procedure under general anesthesia you will be advised not to eat or drink after midnight. When the procedure is over you may feel some pain from the egg extraction and/or nausea from the anesthesia.
And because a doctor is surgically removing the egg from your follicles, there is no corpus luteum to generate progesterone. So after the transfer, you might also be required to have someone give you daily progesterone-in-oil (PIO) intramuscular injections, depending on your protocol (if you’re lucky like I was, you’ll just get the prometrium suppositories instead).
There are a host of potential side effects of the medications you’ll take during IVF cycle. During the repression phase, you may be prescribed birth control pills, which might cause headaches and PMS-type symptoms. In the stimulation phase, you might feel physically uncomfortable and have headaches (I had massive migraines with my Gonal-F until they reduced my dosage). After the retrieval, expect to stay home from work for a few days – you will be bloated and at least a little sore.
Problems that might arise
The biggest issue that might arise is Ovarian Hyper-Stimulation Syndrome (OHSS), where the follicles after the retrieval fill with fluid and leak into the abdominal cavity and into the chest. Symptoms of OHSS include rapid weight gain (2lbs or more per day), inability to urinate, fullness/bloating in your abdomen, and/or a shortness of breath. Mild OHSS will resolve itself in a few days, though if you get pregnant it might take longer. But moderate and severe OHSS can be life-threatening, though fairly rare – less than 1% of patients end up with OHSS this severe.
However, your doctor will monitor your estradiol levels (E2) via bloodwork just before the retrieval. Levels over 5000 are generally not recommended – if this is the case your doctor may have you “coast” (i.e. skip your injections) for a day to decrease your levels.
Take things a day at a time. I was totally overwhelmed with the number of needles and medication I needed for our IVF cycle at first, so I just focused on what I needed to do that day. Before I knew it my medicines were almost gone.
If you can’t do the injections yourself, have your husband do them. I have no issue with needles and did my own injections. However, most women seem to prefer it if their husbands do their injections, and it’s a nice way to keep him involved.
If you do your injection slowly, chances are you won’t bruise. I found that when I rushed my injections I ended up giving myself a bruise. Slower is better.
Drink plenty of Gatorade after the retrieval to replenish your electrolytes. The more fluid you drink, the better chance you’ll have at healing more quickly.
It takes longer than you’d expect to recover from the retrieval. Granted, my E2 was at 5178 when I triggered, so I had a moderate case of OHSS, complete with a burst follicle. But I couldn’t walk far at all for about 5 days after the retrieval, so I stayed home pretty much for an entire week. Just be prepared that you’re going to be uncomfortable and might need to stay home and rest up.