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Wednesday, July 26, 2006

IVF--Fresh Cycle

IVF (fresh cycle)
by Serenity

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
Unexplained infertility
Immunological issues

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.

Personal tips

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.


Anonymous said...

thanks. this was simple and helpful.

Anonymous said...

This was helpful and good to hear from someone else in the same boat.One day at a time is the best advice. It's easy to get overwhelmed.


Anonymous said...

Thank you. My estradiol level is 5012 and am going in for the retrieval tomorrow morning. I've been worried about being overstimulated too, so it's helpful to know that you took it easy for 5 days afterwards.

gorgonzola said...

Finally! I've been searching all over for exactly this. Thanks.

Anonymous said...

I am currently in the stimulating phase. I have cramps and severe headaches. Has anyone else experienced this too?

Anonymous said...

I have retrieval tomorrow. My E2 yesterday was 6000. I am a little worried that I will have to freeze all the eggs to prevent OHSS. It is so complicated!! Trying to have a hopeful and positive attitude!!

Anonymous said...

I just went through a retrieval this past Saturday and wish I had read this ahead of time, as I had scheduled no less than 4 can't-miss things this weekend. I could walk, but it was very uncomfortable and though I am feeling much better now, I have these occassional twinges of pressure that feel almost like gas, trying to pass but hurt. Anyway, I've decided to start blogging about this in the hopes that it'll help other people going through the same thing and I also hope it will help me process it all. If you have any interest, check it out:

JoyfullyHis said...

My best friend is gearing up to do her first IVF and recommended reading your post first so I'd get a better picture of what she'll go through. Thanks so much for spelling it out. It's always easier to get through if you know what to expect. Now I know exactly what I can do to help her through this. Thank you.

Zetetic said...

My hubby and I did IVF because we both had factors regarding infertility. I was at risk for Ovarian Hyperstimulation, but luckily I was able to complete the cycle. I had 18 eggs. Unfortunately, I think something was wrong with my eggs because I only had two viable blastocysts to implant. I got pregnant and carried for 8 weeks. I suspect that my embryo was not developing as well as it should have. At 6 weeks they insisted that I come back in 10 days. At that time I didn't even know something was wrong because I felt very pregnant and had morning sickness. When I showed up at the 8 week marker, I brought my husband because I wanted him to see the baby's heartbeat. The doctor had to tell us there was no heartbeat anymore. I was so upset, they had to take us into a separate room because I couldn't stop crying. I told them I needed them to prescribe something to get me through the week. They gave me Zanax. I wanted to find out why the baby had died. I had never been pregnant and I felt like I had been robbed. Later I was told it was trisomy seven(not compatible with life), a random mutation. It has been four months and I am now considering a second cycle. I am thinking of starting in April.