I don’t know what it was, maybe a woman’s intuition or just a fear-based conclusion, but I’d always thought I might be a part of the 1 in 8 women who are dealt the unfortunate hand of infertility. I am known to be a bit more of a pessimist over an optimist. I try to see the best in things, but I always fear the worst. Somehow, I was right, though. Infertility and IVF have been a part of my story. It’s something I hoped I’d never experience, but sort of prepared myself for.
For those who were like me and are curious prematurely, or if you’re about to embark on this journey, you’ll want to know the ins and outs of what’s involved. In this guide we’ll go through what testing you’ll go through, what medications and the types of monitoring you can expect, what you will experience during egg retrieval. The transfer process and what outcomes you can expect will be in our next article, so be on the lookout for that!
Pre-IVF Testing & Consents
Testing may be slightly different at each clinic, depending on where you are located and what their practice thinks is the most relevant to you and your partner’s history. There are some fundamental basics that come with IVF, though and they include, but are not limited to the following.
One of the first tests you will have is a blood draw for you and your partner to test for genetic disorders. This is to test for genetic diseases that could potentially be passed down to your children.
If the results come back that you are both carriers of a certain genetic condition or conditions, then it will be suggested that you do Preimplantation Genetic Diagnosis testing. Not to go too far down the rabbit hole, but this is done after the embryo reaches the blastocyst stage (about 5 or 6 days after the embryo is fertilized).
A sample is taken from the embryo and sent to a lab. About 2 weeks later, the results will come back letting you know if the embryo is healthy or if it may be affected by the condition you and your partner are carriers of.
Your blood will also be drawn to test for the standard STDs. On day 3 of your menstrual cycle, your blood will be taken to look at your hormone levels and determine if there is anything of concern. One of the more important hormones they will look at is FSH (Follicle Stimulating Hormone). This is used to look at the functioning of the reproductive system. The higher the number, the closer a woman is to menopause.
Another one of the important hormones that will be looked at, which can be tested at any time during your menstrual cycle, is AMH (Anti Müllerian Hormone). AMH gives your doctor an approximate view into your ovarian reserve.
Other Pre-IVF Tests
Your partner (if in a heterosexual relationship or not using a sperm donor) will be asked to provide a sample of his semen for analysis. The clinic will look at things like the count, volume, motility (if it’s moving correctly) and morphology (shape).
Male factor infertility accounts for about 40% to 50% of all infertility cases. That’s why it’s extremely important to have this analysis done if you haven’t already.
Another test you will be asked to get is a hysterosalpingogram (HSG). This test uses a dye that washes through the female reproductive system while being watched through an x-ray. If everything is healthy, the dye should move through the uterus and fallopian tubes without blockage or detecting other abnormalities. If there is any blockage, further discussions will be needed to assess next steps.
Consent Forms & Payment
You may not automatically think of legal consent forms as a part of the IVF process, however it’s a big part of it. Think about it, you are essentially creating life. With divorce rates being where they are at, you can understand where this might come in at.
Many people keep embryos frozen for years for a variety of reasons. Maybe they had a child and they’re not ready yet for another, maybe their relationship is deteriorating, or maybe they have religious beliefs that would prevent them from disposing of or donating the embryos. In any case, these frozen embryos that are sitting in storage have to have their fate decided before any unfortunate scenarios happen to their parents.
You will be asked many questions that are difficult including if one or both of you are to die or divorce, where the embryo would go. Think about these things in advance, because when you are sitting in front of your doctor or a nurse, it’s a bit more difficult to have that conversation with your partner.
Unfortunately, a deposit for the majority of your payments will need to be made at this time. Do expect to receive additional bills in the mail after your procedure, but the clinic will request payment in advance for expenses that they expect to have. The cost can be roughly $10,000 or more per retrieval cycle if you are paying out of pocket. Always check with insurance to make sure that any expenses that can possibly be covered are covered.
Medications & Monitoring – Egg Retrieval
With IVF, the process is split into 2 parts. First is the egg retrieval, then comes the embryo transfer. Your doctor will determine the best course of action as to what exactly your treatment will be and if you will do a fresh transfer or a frozen transfer (I’ll get into what those are a little later).
After all tests are done, you will have a sit down with your doctor or nurses, where he or she details what your retrieval protocol will be. An example of one will be listed here, but of course every one varies depending on your specific needs. You may or may not be prescribed birth control for down regulation. This is done for a period of only a few weeks to control timing and possibly help to prevent or treat cysts.
On day 1 of your menstrual cycle (first day of full flow), you will call your doctor’s office to let them know. You will be asked to come in on day 2 or 3 of your cycle to do a blood draw and transvaginal ultrasound. The blood draw is to test for pregnancy (IVF medications would harm a fetus), estrogen levels, and FSH levels.
The ultrasound is done in order to take note of your baseline number of follicles and lining measurement. This is used to be able to accurately monitor your progression. Your doctor or nurse will call or report through portal or email if you are approved to begin treatment and how to proceed.
You will begin with follicle stimulating hormones such as Follistim or Gonal-F. The purpose of using these medications are exactly how they sound, they stimulate follicles to grow. Your doctor wants to get as many healthy eggs as possible through this process, which is why the medications are used. Your doctor will instruct you on dosage and timing of dosages (they are typically taken during a small window of about 2 hours in the morning and/or evening).
These are subcutaneous injections that are typically found in pen form. Subcutaneous injections are the “easy” ones. Subcutaneous means that they go in your belly. You want to aim for the area next to or below your belly button, but about at least an inch away from your belly button. The needles are typically very small and (if done right) the injection should barely hurt.
The medication is in a small vial in the pen and before each use, you will have to replace a new needle at the top before injecting. Next, you’ll dial the pen to the number of international units (IU) that you will be using. This is done by turning the dial at the end of the pen.
With clean hands, you will prepare the injection site by wiping the skin with an alcohol swab. Next, you’ll pinch at bit of skin on your belly and go for it! If you’re self-injecting, you may want to leave some time before you are supposed to inject since it may take you some time to work your nerves up. I was never able to do them myself, so I’ve enlisted the help of my husband and more than willing friends.
After a few days of the follicle stimulating hormones, your doctor will want you to come in again for an additional scan and more blood work to see how things are progressing. You may be asked to change your dosages of the follicle stimulating hormone.
Between this scan and your next, you may be asked to begin medication to stop you from ovulating. Ovulating would go against the point of this process, as the eggs would likely all be lost during ovulation. Typically, the medication used is Cetrotide.
It is also a subcutaneous injection; however, it’s delivered via syringe rather than a pen. A single kit is typically one injection, which includes a syringe pre-filled with sterile water, a vial containing the Cetrotide powder and 2 needles, one for mixing the powder and sterile water, and drawing the solution back into the syringe and the other for injecting. You will be instructed by your clinic when and how much to inject.
As you progress, your doctor will have you come in more frequently approaching your egg retrieval. They will continue blood draws (now adding progesterone testing) and ultrasounds at each visit. Make sure you ask for a print out of the ultrasound statistics, as they move quickly and even if you’re paying close attention or trying to take notes, you can easily miss something. If you have to go through multiple cycles, it will be beneficial to be able to look back and compare how each round went throughout.
Once the majority of your follicles are around 18 mm and your blood work comes back with appropriate levels, your clinic will instruct you to inject your trigger. This is usually somewhere around 8-12 days after you begin medications. If it’s less or more, I wouldn’t be too worried, your doctor is best at determining when to retrieve based on how your body is reacting to the medications.
This trigger (or these – mine were Ovidrel and Lupron) is another subcutaneous injection. The timing of this is very, very important. Your clinic will give you an exact time to inject, this time it’s not a window. It’s typically within 36 hours of your retrieval. This trigger will send a signal to your body to mature the eggs to prepare for ovulation. The dosage that your clinic recommends is enough to get you close to ovulation, but the retrieval is scheduled prior to you actually ovulating.
The day prior to retrieval, you will be asked to come in for a pre-operative visit. This will include more blood draws and one last ultrasound. The blood draw will be used to confirm adequate absorption of the ovulation trigger.
It’s important when preparing for your egg retrieval, that you use products that are unscented and wear comfortable clothing. The reason for the unscented products is because, apparently, eggs do not like fragrances. You’re going through all this work, the last thing you want to do is ruin it all because you had on some perfume or scented lotion. You will likely come out a bit bloated after the procedure, so the loose-fitting clothing will come in handy.
Egg retrievals are considered to be a surgery. You are under anesthesia for a short period of time and the retrieval itself only takes around 20 to 30 minutes. The follicles are aspirated using ultrasound directed technology. Your partner may be able to watch from another room on a screen showing the follicles being aspirated.
After the procedure, you’ll be moved to another room for recovery for another 30 minutes to an hour. Here the doctor or someone in the staff will alert you to how many eggs were retrieved. The eggs are immediately swept away after surgery to be fertilized. Of course, this requires sperm. Your partner or the donor will have already provided this sperm prior to your retrieval (either that same morning or prior to).
Common methods of fertilization are either conventionally, where a concentrated sample of washed sperm are paired with an egg to allow the sperm to naturally “decide” which one gets to fertilize each egg. The second most common method is intracytoplasmic insemination, otherwise known as ICSI. Here one sperm is injected into each egg by the embryologist. This method is typically used when male factor infertility (MFI) poses an issue. The lab is able to select the healthiest appearing sperm (ones with good morphology, motility, etc.) and inject it directly into the egg, bypassing the need for the sperm to do that part of the work.
The day after your retrieval, you will receive a call to let you know how many eggs were mature of what was retrieved (you may find this out on the day of retrieval) and how many were fertilized successfully. After this point, each lab operates a bit differently. Some monitor daily, whereas some are now letting the embryos rest without monitoring, as it’s been suspected that they progress better without being disturbed.
If your clinic monitors daily, you will likely get reports on how the embryos are progressing each day. If you are doing a fresh transfer, typically between day 3 and day 5, you will be asked to come back in to proceed with the embryo transfer. If you are doing a frozen transfer, about 5 days later you will receive a call to let you know how many have made it to the blastocyst phase.
At this point, the embryo can be frozen and tested if you so choose. Testing includes chromosomal, gender, and sometimes genetic condition screening. If you and your partner are carriers of certain genetic conditions, then you may opt to do preimplantation genetic disorder testing (PGD). If you’d like to test for chromosomal abnormalities or know the gender of the embryo, then that would fall under preimplantation genetic screening, sometimes referred to as preimplantation genetic testing (PGS/PGT).
This testing takes up to around 2 weeks to get the results back. Your doctor will receive the results and call you with them. I’m going to be honest here, this waiting period between retrieval and these phone calls can be just as bad as any two-week wait you’ve had. Do your best to distract yourself and try not to get too much into your head. Positivity and low stress are important leading up to transfers (I know, easier said than done).
As far as recovery, you can expect to be slightly to severely swollen after your retrieval. It can get progressively worse over the course of the week following retrieval. Every retrieval is different, and every person reacts differently.
Some women are up and about the next day and some are bed-ridden or even hospitalized with ovarian hyperstimulation syndrome (OHSS). Although not very common, this is when stimulation medications overstimulate the ovaries and cause excessive swelling and fluid retention. Your doctor may be able to detect this in advance and prescribe medication to help alleviate symptoms.
So now that you’ve read this article, you can put what you’ve learned here into practice immediately and increase your chances of getting pregnant.
Resource 1: Take our Fertility Quiz
If you’re having trouble getting pregnant or staying pregnant, then it’s imperative that you take this quiz. Find out the #1 reason you are having trouble getting or staying pregnant and find out the best ways to fix it by clicking here.
Resource 2: The Cycle Diet
I’ve created a super foods plan that will guide you throughout your cycle and teach you the foods that will significantly boost your fertility.The Cycle Diet is a 28-day system that follows the average woman’s monthly cycle and tells you the optimal foods to be eating during each stage. It teaches you the right food to eat at the right time of your cycle to help regulate ovulation and menstrual cycles, improve egg quality, sooth inflammation and much more…
You can learn more about The Cycle Diet by clicking here.
Resource 3: Egg Quality Vitamin Guide
Are you having trouble getting pregnant or staying pregnant? Egg quality may be an issue for you. This is the #1 most common factor in women who suffer from infertility and miscarriages. Egg quality can be impacted by a number of factors, most commonly advanced maternal age, as well as conditions like PCOS and endometriosis.
Vitamins and supplements are vastly important to make sure the eggs you are producing are of the highest quality. You can do this by downloading my report on vitamins and supplements to improve egg quality and lining issues in the Egg Quality Vitamin Guide by clicking here.
Resource 4: The Wolf Method (TOP SELLING!)
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When all else fails, and you need to get pregnant FAST and reliably, use The Wolf Method. Click here to learn more about the book.
Resource 5: Natural Fertility Shop
In order for natural products such as herbs and nutritional supplements to be effective, they must be of the highest quality. This Natural Fertility Shop focuses on offering the best products which are all hand selected by their highly trained fertility specialists from the finest and most reputable companies in the US. Also, all of their products are GMP (good manufacturing practice) certified and they carry certified organic ingredients and products whenever available. Click this link to check them out!
The information in this document has not been evaluated by the FDA and is not intended to diagnose, treat, prevent, or cure any disease.