So, you’re starting to look into fertility treatment and your fertility specialist suggests IVF, or in vitro fertilization, as the best route for you…now what?
Here’s a quick walk through of what you can expect:
IVF treatment steps.
1. Initial Consultation
To get started, you’ll meet with a Reproductive Endocrinologist, a doctor who specializes in fertility.
The doctor will talk with you about your medical and surgical history, your pregnancy history, how long you’ve been trying to get pregnant, and your family medical history.
It can be helpful to prep some personal and family history information before your consultation and come prepared to discuss with your doctor.
After your consultation, the doctor will do a medical evaluation to include a Transvaginal Ultrasound, check your vital signs and weight, and make sure lab work is up-to-date. The doctor will use these results along with the information you provide to determine your treatment plan.
How does payment work?
After your initial consultation, you will speak with the financial department to set up payment and review any insurance benefits you may have. They will assist you in determining which pharmacy to use to fill your medications based on your coverage.
2. Pre-Cycle Testing
Your doctor may want you to complete some testing prior to starting an IVF cycle. Some of the most common tests are Hysterosalpingogram, Saline Sonogram, and Hysteroscopy. Each of these tests is used to look at the physical structure of your uterus or fallopian tubes. These tests can be used to determine if there are any structural reasons for your infertility, like Uterine Fibroids, a Uterine Polyp, or blocked Fallopian tubes. Once these possibilities are ruled out, you can proceed with the start of your IVF cycle.
What happens if the tests come back positive for abnormalities?
If any of these tests come back positive for abnormalities, your doctor will discuss with you the possible ways to resolve the issue. These structural issues typically must be resolved prior to attempting to get pregnant, as they can interfere with fertilization, uterine lining integrity, or the implantation of the embryo.
3. Getting Started With Treatment and IVF Medications
The next step is to come into the office for your first appointment to start your treatment. This appointment is scheduled on the second day of your period, often referred to as Cycle Day 2 or 3.
Each appointment during the IVF cycle consists of a transvaginal ultrasound to visualize each Ovary and Follicle growth plus a blood draw to measure your Estrogen level. At your initial appointment on Cycle Day 2 or 3, your doctor will be looking to make sure that there are no dominant follicles or Ovarian Cysts in your ovaries and that your estrogen level is low.
Once your doctor confirms that your test results look appropriate for you to get started, your clinic will provide instructions on how to self-administer your medications and when to return to the office.
What happens if I have a dominant follicle, cyst, or elevated estrogen?
A dominant follicle or a cyst left over from the previous cycle, along with a corresponding elevated estrogen level, may inhibit your ovaries from responding to the medications. This occurs because once your body has chosen a dominant follicle, the other follicles become resistant and are unable to grow in response to the IVF medications. In this case, your doctor will likely recommend waiting a month to get started in order to give your body time to resolve the problem. Your doctor may also change or add medications to try to prevent this from reoccurring.
IVF Medications
IVF medications are Subcutaneous Injections made to mimic the hormones that your body naturally produces to stimulate egg development.
Subcutaneous injections use tiny needles to inject medication into the fatty layer of tissue just below the skin of your belly or upper thigh. Typically, you give these medications each night for somewhere between 10 and 14 nights. Each cycle and each body’s response is different, so the treatment cycle may be slightly longer or shorter than this range.
During the IVF cycle you will have approximately five to seven office visits. Be prepared to be late for work or to schedule around these visits during that time! Unfortunately, these appointments cannot be booked in advance because the dates are decided based on how your body is responding to the medications. Appointment frequency increases towards the end of the cycle as you get closer to your Egg Retrieval. Flexibility is best during this time!
How will the medication make me feel?
As the IVF cycle progresses and many eggs in your ovaries begin to grow in response to the medications, you will likely begin to feel bloated. This is totally expected, but it can be uncomfortable. Because of the bloating, you will need to ease off exercise by about day 6 of your medications on average and can resume once you get your period following the egg retrieval procedure. It can also be helpful to drink a lot of fluid with electrolytes (sports drinks or electrolyte supplements) to help combat the bloating.
4. Approaching the End of Your IVF Cycle & Understanding the Trigger Shot
Once the doctor determines your ovaries look ready based on follicle size indicating that your eggs appear to be mature, the fertility specialist will instruct you to administer your Trigger Shot. The trigger shot prepares the eggs to be retrieved approximately 36 hours later.
The most common trigger shot is Human Chorionic Gonadotropin (HCG). This injection uses a slightly larger needle and is administered in the muscle of your buttocks. It can be helpful to have a friend or family member assist with this injection, but that isn’t a necessity.
Your clinic will give you a precise time to administer the trigger shot. You will then get instructions to show up to the clinic 2 days later for egg retrieval.
Example trigger shot timeline.
5. Egg Retrieval
The egg retrieval is done under mild IV Anesthesia. You’ll be asleep and won’t feel discomfort, but you’ll still be breathing on your own. The procedure lasts about 15 minutes and is done transvaginally using a needle guided by ultrasound to remove each egg from your ovary. Following the procedure, you will recover at the clinic for a few hours and then will head home.
Plan to take that whole day off from work to recover and let the anesthesia fully wear off. The following day you can return to work if you’re feeling up for it.
6. Embryo Development and Testing
On the day of the egg retrieval, the embryologist will fertilize the eggs to create embryos. You will plan in advance with your doctor to use donor sperm, your partner’s fresh sperm sample collected on the day of the egg retrieval, or your partner’s frozen sperm sample.
The lab will place the sperm in a petri dish with the eggs and allow the sperm to go to work fertilizing the eggs or sperm injection (ICSI) may be recommended. Once the eggs are fertilized, they’ll grow in the lab for up to seven days. When the embryos reach a mature state known as Blastocyst, a few cells from the embryo can be removed and sent out for Preimplantation Genetic Testing and the embryo is frozen.
Embryo development timeline.
What is PGT?
PGT is an optional test that involves taking a few cells from the outer portion of the embryo and assessing the chromosomes within the sample. The results show whether each embryo is chromosomally normal (euploid) or abnormal (aneuploid). Later on, when you’re ready for a frozen embryo transfer, using an embryo that was found to be chromosomally normal increases the chances of successful implantation and pregnancy. It’s important to discuss with your doctor whether PGT is a good option for you.
After the embryos are frozen, they remain that way in the lab until you’re ready for your embryo transfer. Your reproductive specialist will work with you to start an embryo transfer cycle based on your preferred timeline.
Click here to learn more about fresh and frozen embryo transfers.