My first cycle of IVF

It’s quite the experience going through one’s first cycle of IVF.  For about a week and a half, I had to inject myself twice per day.  There are all kinds of different protocols used depending on the patient, and I’m not familiar with how the fertility doctors choose which protocol.  For mine, I took Follistim in the morning and Menopur in the evening.  The Follistim comes with a pen device.  You change the cartridge and use the pen to dial up the dose you need.

Follistim

On the surface, it’s more attractive than the usual vials and syringes, but in reality you are trying to maximize use of each cartridge since these medications are so expensive.  So on many days, I’d have to finish one cartridge, then change it out, and give myself a second injection to complete the dose I needed.

The injections I needed to take were all subcutaneous, meaning given in the fatty tissue of the lower abdomen, upper thighs, or back of the arms.  I personally didn’t have a problem giving them to myself, so I used the lower abdomen, changing locations with each injection.

The week before the egg retrieval was scheduled, I went in for ultrasounds every other day.  Prior to each of those ultrasounds, I went to the lab to have my progesterone and estradiol levels checked.  These help determine if the dosing of my medications is appropriate.  With the ultrasounds, my doctor checked to see how many follicles appeared to be developing, and measured their sizes.  As they started to get close, he had me start Ganirelix injections along with my evening Menopur.  The Ganirelix prevented me from ovulating spontaneously.

Once the follicles were just about ready, I injected the hCG two nights before the scheduled egg retrieval.  The hCG is called the trigger injection, as it is timed to trigger ovulation.  So I injected it Tuesday night in preparation for a Thursday morning egg retrieval.  And that was my last injection.

While I’m thankfully not afraid of needles, it is a drag having to inject yourself multiple times daily and go to the lab every other day for blood draws.  I feel bad for the women who have a really hard time with needles.

The day of the retrieval, I went into the area of their office that’s like a mini operating room suite.  Just like if I were going to have surgery, I changed into a gown and they placed an IV.  They gave me antibiotics through the IV prior to the procedure, and then for the procedure itself the IV was used for my sedation.

I have to say, I felt a little nervous being on the patient side, once I got into the procedure room.  They have you lay on the procedure table with your legs in the rests to get you in the position for the procedure.  Then they put a strap over you to keep your arms down by your sides, so you don’t accidentally move them during the procedure.  Looking up at the machines and lights from that position is enough to make anyone feel a little nervous, even though I’ve been in many similar operating rooms before.

Once the sedation got going, I don’t remember anything.  They described it as me being in “twilight,” meaning lighter sedation than general anesthesia.  Nonetheless, I don’t remember anything after that.  From watching the procedure a few times in med school/residency, it entails taking an ultrasound, similar to the vaginal ones used in the office to check the follicles.  The difference is that once the ovary is visualized, there is a needle attached that goes through the vagina, and then sucks out the liquid from each follicle.  Ideally, there should be a single egg in each follicle.

This device is attached to tubing that connects to the microscope, so the eggs go directly there.  An embryologist is right in the next room, looking through that microscope, counting how many eggs are retrieved.

I woke up in the recovery area, and felt really sleepy, like I wanted to take a nap.  They did say some people don’t remember this part, which is why they brought my husband in to review post-procedure instructions with me.  But I do remember things after that.

They made sure I could walk around and use the restroom, and then I was able to leave shortly after that.  Even if I felt better, they advised that my husband drive me around the rest of the day.

I remember in residency, I once worked with an attending physician who told patients about the similarities between the ovaries and the testicles.  There is a condition called ovarian torsion, which sometimes occurs when women have cysts in the ovaries.  The weight from the cysts can cause the ovary to twist, which then causes extreme pain.  If left untreated, the twisting can block the blood supply to the ovary and women can lose that ovary.  If caught soon enough, surgery can be performed to untwist the ovary and save it.

The ovaries and testicles have the same origins embryologically.  They develop into one or the other depending on the gender of the fetus.  I remember the attending saying that this twisting of the ovaries is similar to if you twisted a testicle on a man.  That definitely helped get the point across to the male partners of the patients regarding the severity of the pain the ovarian torsion was causing.

So understandably, sedation is needed for a procedure like this where a needle is poking the ovaries multiple times.  Afterwards, I had the expected cramping of the lower abdomen.  It wasn’t super painful, but definitely uncomfortable.  I considered taking something for the pain, but in the end I didn’t bother.  Heat packs helped.  I’m glad I took the day off after the procedure as well, since it would have been tough getting through a full work day not feeling my best.

Even though I didn’t feel nauseous or vomit after the procedure, which they warned can happen, my stomach felt a little off, even a few days after.  Not sure what that’s from.

The day after the procedure, referred to as Day 1, they told me that 3 eggs fertilized out of the 10 that were retrieved.  The embryo transfers (implanting the embryo into the uterus) are usually performed on Day 5.  However, if the embryo quality isn’t looking that great, they’ll implant on Day 3 to try to give them a better chance.  I guess the thought is that the uterine environment might be a little better than the petri dish.

Since 3 eggs fertilizing out of 10 wasn’t a lot, on Day 1 they told me that I might have to do the transfer early on Day 3.  That was pretty disappointing, after going through all of this.  I was hoping that even if this first embryo doesn’t take, I’d at least have another to freeze and try implanting again later.  If there are frozen embryos, then the transfer alone is a less cumbersome process.  I’m not sure exactly what it entails, but certainly not all of the injections to stimulate my ovaries like with the egg retrieval process.  I imagine it would be much less costly as well.

Thankfully, they called the morning of Day 3 to say that the 3 embryos are looking good so far.  One has 10 cells and the others have 8 cells, so they are dividing appropriately.  So I’m on for Day 5 transfer.  Phew!

In the meantime, now that the egg retrieval is complete, I have to take an estradiol tablet and place a vaginal progesterone suppository 3 times a day.  While this is better than injecting myself, it is still a lot to have to remember medications so often.  Thank goodness for the reminders on my phone.

At the IVF center, they gave us some fun toys- a sperm stress ball and an egg that shakes like a rattle.  Of course WZW is having a ball with them.  I asked him what he thought the sperm was supposed to be used for.  He said, “Um, to take stuff out of my nose?”

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So now, I’m waiting for the embryo transfer on Day 5.  From there, they warned us that it will feel like eternity to wait the 2 weeks until the pregnancy test.  Even if it’s positive, I’ll have to keep checking and making sure the levels are rising normally.  And it will also be a number of weeks before confirming the viability of the fetus.  For now, it’s going to be a lot of waiting and hoping for the best.

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