Tuesday, October 7, 2008

IVF 101

There may be many of you out there asking -- what exactly is IVF anyway? What's the big deal? How does it work?

Simply put, IVF (In Vitro Fertilization), involves collecting eggs and sperm from each partner and placing them together in a dish. Then transferring the fertilized embryo into the uterus where implantation and pregnancy will hopefully occur.

Well that's the easy answer anyway.

But for couples going through IVF, the process is anything but easy.

Let's start with the birds and the bees...

A woman is born with all the eggs she will ever produce. There are approximately half million or so eggs. The normal woman will ovulate one dominant follicle from her ovaries each month that contains a mature egg inside. This egg moves into the fallopian tube where it waits for sperm to come and fertilize it. At least, that's how it happens for the lucky ones!

The unlucky ones may decide to try fertility treatments.

Of course, you don't move straight to IVF.

First you try on your own for at least a year before a doctor would agree to help. We tried for almost two, before we realized that something was wrong and went for our first consultation.

Following that, there is usually a period of trying fertility drugs, specifically CLOMID, a drug that helps you produce usually around 3 or 4 eggs per cycle, to give the sperm more chances. But again, unfortunately, after six cycles, we realized that fertility drugs weren't doing the trick and would need to move on.

Next comes the IUI (Intrauterine Insemination). This is a process where the women will either take oral drugs, injections, or opt for a natural cycle. The man then gives his sperm sample. The sperm is washed to remove all the bad, slow, swimmers, and at the time of ovulation, is injected directly into the uterus with a thin catheter. This process essentially places the best sperm right beside the egg in the woman's body, thus greatly increasing the chances of fertilization. Most couples will try a couple cycles of IUI's before moving to IVF, and in our case, we tried TWELVE, yep, count em, TWELVE, before deciding it was time to move on.

Next comes the biggie. The mother of all fertility treatments -- IVF.

So how does it work you may be wondering?

Well, here's the basic rundown:

PART ONE: Preparation and Testing
This is the stage we are in now, and thankfully, coming to the end of! This is where the couple will interview their first, second, or third RE, depending on where they are in the process. We, unfortunately, have failed 2 IVF cycles already, so our process was interviewing the best doctors and clinics and researching the very best options left available to us. This is the stage where if you are in your first cycle or your third cycle, you will have tests done to eliminate and help shed light on your situation. The couple will also start to prepare their bodies by eating the right foods, taking the right vitamins, cutting out alcohol, caffeine, hot tubs, and generally doing everything they can to help prepare thier bodies.

PART TWO: Planning and Preparing the Calendar
Next the doctor will go over the IVF process with you, you will be counseled on genetic issues, speak to financial counselors, therapists, and ultimately discuss your individualized protocol with your doctor. You will get your IVF calendar from your nurse, attend injection training courses, order and receive your huge box of drugs and needles, and start on the birth control pill if necessary.

PART THREE: Ovarian Suppression
Usually the doctor will want you to go on the birth control pill for about a month to quiet the ovaries and begin to suppress your reproductive system. The pill can also help regulate your cycle and allow somewhat flexibility and more control over your calendar. Now comes the part that I hate! The Dreaded Injections. The doctor will usually put you on a drug called Lupron, which is an injection twice daily. The reason for lupron is to supress your ovaries, turn off your system, prevent cysts, and to make sure you do not ovulate. You will usually take these injections, ideally, for anywhere from 7 - 14 days before you start your stimulation medication. So that usually works out to somewhere around 20 injections.

PART FOUR: Ovarian Stimulation
Now comes the point in the cycle where you need to start making eggs -- and not just one egg, but lots of them! So at this point in the process, you will get your period, the doctor will check your ovaries with an ultrasound, and a few days later, you will begin your stimulation injections. But just so you don't have too much fun, they want you to continue to take the lupron as well, to keep you from ovulating. The stimulation drugs are also an injection which you take for anywhere from 8-14 days, and there is usually not just one, but a combination of drugs -- so you will probably be taking 2 separate injections of stimulation drugs every day. So between the stimulation drugs and the lurpon, this could require around 40 more injections, in addition to the 20 you've already got under your belt. But, needles aside, this stimulation period is the most important of the whole cycle. This is where you make it or break it.

You may be wondering why you need to make so many eggs -- doesn't it just take one? Well yes, but it would be very inefficient to only have one egg available to fertilize when you are spending this much money and putting your body through so much. And many eggs do not make it, are poor quality, or will not result in a normal embryo. Therefore, the female is given very high amounts of drugs to try to stimulate many as many follicles(eggs) as they can -- usually anywhere from 10 - 20 eggs as the optimal number.

But once again, it can never be that easy, and this stimulation part of the program is a tricky line to walk. Too many eggs, and the female may hyperstimulate, which creates other problems and oftentimes leads to less healthy eggs, a cancelled cycle, or hospitalization. But too few eggs, and the chances are lower that fertilization and pregnancy will occur.

During this process the doctor will monitor you every couple of days with a blood test and a vaginal ultrasound to check your hormone levels and count and measure the number of follicles so that he can determine the most optimal time to retrieve the eggs. And once they determine you are ready. They will give you a shot of HCG, a hormone that will allow you to ovulate, and they will schedule your egg retrieval for 36 hours after you take your final (and might I add BIG!) injection.

PART FIVE: Egg Retrieval
Next comes the egg retrieval surgury, which thankfully you are completely asleep for. The eggs are retrieved from the woman's body, while at the same time, the man gives him sperm sample into a plastic cup (yes, I know, he's got a very tough job doesn't he?) After the surgury they give you pain medication and send you home -- but no rest for the wary -- you must start on new drugs that very night! But more on that in a minute, for now, the hard part is done, so take a breath.

PART SIX: Fertilization
Now for the nail biting results. How many eggs did they get? Did they all fertilize? Will they all grow? This is where the magic happens -- in the lab. The sperm is collected, washed and placed together with the egg to fertilize in a dish. Or in our case, and many other cases out there, we opt for a procedure called ICSI, where a single sperm is chosen and injected directly into the egg, allowing for even better results, especially in the case of poor sperm.

Then, once fertilization occurs the embryos begin to grow and divide. Your babies are now growing in a dish! They are watched in the lab for a period of 3-5 days where they are then ready to be placed back inside the uterus.

PART SEVEN: Embryo Transfer
The best embryos (usually 1-3 depending on their quality and the age of the woman) are chosen to be placed back in the uterus. The embryos (or Embabies as I like to call them) are then transferred by your doctor using a catheter and ultrasound guidance -- as they are gently put back inside their mother, where they belong.

The whole process can be seen on a big screen and is an amazing moment. Your embryos are now home! And now it is up to God.

The left over embryos, if there are any, are frozen, and can be stored and used for later cycles making the process less expensive and invasive for the couple the next time around.

PART EIGHT: The Two Week Wait
And just when you think you are done, you have a whole other set of medications to take. Daily intramuscular progesterone shots are given to the woman to increase the chances of implantation. Thankfully, I have always been given the option of using suppositories, but many women are not, and these shots in the lower hip, HURT! The woman will have to take these daily shot for anywhere from 2 -10 weeks, depending on the outcome. Tell me about it -- the fun just never stops!

During this 2 week wait, you also take antibiotics and estrogen patches and other various drugs. But the worst part about this part of the process is the waiting. The two week wait is complete torture as you analyze every twinge, every symptom, and every possible sensation -- as you ask yourself the ultimate question: Did it work? Am I pregnant? Will I finally be a mom? Will I finally be a dad? And you question everything and start to worry about what will happen if it doesn't work? All that time and money and pain down the drain, only to have to start all over again or give up. The rollercoaster of emotions and fears take over, as you wait for two weeks to find out whether or not pregnancy has been achieved. Then, finally, you go for your scheduled blood test, to get the much anticipated results. And you wait for your doctor to call you with the news.

Whew! I'm exhausted just thinking about it.

So now you have an idea of how the whole process works, and you can see, that it's not quite as simple as 'putting an egg and a sperm together in a dish'. If only it were!

Those birds and bees sure do have it easy, don't they?


Polly Gamwich said...

I will definitely direct my friends here who don't understand the IVF process ... I've been doing this for months now (waiting to have a baby for years) but people still don't get it!

I also wanted to point you toward a similar post I did ... though it's the progression from fertility to infertility, it's fun too.


And yes, I do know Annie from 1week ... I met her on FF and I *think* I found your blog through her!

Great writing!

Lisa said...

Thanks Polly,
I have to remember that people don't really know what I'm going through if I don't tell them. And not everybody knows the details of how IVF works. It's easy to forget because we know it so intimately.

Thanks for directing me to your post. Definetly a true read.