All About IVF
If you haven’t read my previous post All the Things We Tried, I suggest you read that first and then come back to continue the story. If you have, thank you. It took a lot to document the process, but at the same time, it was like a form of therapy for me. Having something to dump what I was going through, my frustrations, and just generally, a long-ass list of things, helped me look back on the time and feel proud of where we ended up.
As always, I want to start by acknowledging that everyone’s opinions, experiences and emotions are different when it comes to the topic of having kids, fertility, trying to conceive (TTC) and all other related topics, so if there is something you do not agree with, that’s OK. I am by no means ever trying to push my ideas or experiences onto anyone else, just as I would hope no one does the same to me.
Instead, let me focus on telling you about my experience with the IVF process, as my previous post took us right up until the end of our second IUI, but I did reveal that I am currently pregnant with our first baby.
Scheduling, documentation etc.
As we went through the testing and IUI process, it didn’t really have so many specific steps, so I largely used my iCal (computer and phone calendar) to have appointments scheduled and make notes of when certain things had to happen. I had a few TTC/cycle tracking apps, but they all felt kind of useless when it came to the actual logistics of what needed to happen. I also took notes on my phone, and that worked well enough.
When it came time to move to IVF, they gave me a piece of paper showing the approximate timeline of the medication and appointments, but it also came with a big heads-up that it really has to be taken day by day, as each test reveals certain results, which then determines the timing of the next step. The reason why I’m explaining this now is that I found what worked best for me was a google sheet. Yes, a fucking spreadsheet. I can access it from my computer (but mostly phone), and I created my own genius template to track everything. Appointments (also still on the calendar), little checkboxes for blood tests or scans, colour coded columns for symptoms, taking my vitamins, what exercise I did, key dates, when to take certain medications and of course a notes column. These notes will be invaluable for me to be able to write this, and the tracking of everything else will also help me recount what happened and draw conclusions between various things.
Next step: IVF - Warning: descriptions of needles/medical procedures
At the end of an IUI cycle, once you’ve found out it’s a negative pregnancy test, you still need to have a few more blood tests to check your levels have returned to zero. On my last blood test I said to the nurse that I wanted to move straight to IVF and she told me that the Dr might ask me to wait a month and book another appointment to discuss the next steps. I went home that day and received a call from the Dr (usually a nurse calls with results) and she told me herself that my levels were all back to zero/normal and if I wanted, we could start the IVF stimulation cycle immediately.
I had no reason to wait, I just wanted to keep up the momentum and keep going, so she talked me through the process again (she had explained all the various options in our first appointment, where she also explained that she doesn’t encourage more than 2 IUIs before moving to IVF, so this was all very much anticipated). She sent the medication to the dedicated pharmacy and told me a nurse would be in touch that day with links to instructional videos on the injection process. We had already done 2 trigger shots (1 per round of IUI), so we knew how one type worked. Some are like a little pen that you twist to get the dose, and others are individual needles with the full dose in there ready to go. The trigger shots actually required mixing a powder with a liquid, and then drawing it up into another needle. Again, this was all done by my mum, but I still made sure Alex and I knew how to do it, in case we had to.
I watched the videos with my Mum (who was a nurse) and she knew exactly what to do. The pen was a little new to her, but we both made sure to double-check the doses each time.
So, IVF literally started that evening.
The Stimulation Cycle and Process
How IVF works is pretty cool. Every month, a woman grows follicles in her ovaries, which sometimes contain an egg. A normal unmedicated cycle grows one large follicle and releases one egg. With IVF, the goal is to slightly overstimulate the ovaries with hormones/medication, to grow more than 1 follicle and more than 1 egg. If you have PCOS, you might naturally grow more follicles each month, which can often be painful, and so they will be overly cautious with the medication, as they do not want you to end up with hyperstimulation syndrome. I do not have PCOS, so this was not a concern, however they generally start you on a low dose (especially for the first cycle) to see how your body responds. I started on Gonal-F 225mg for 4 nights (single injection into the lower abdomen, below the line of the belly button). On the 5th day, I had a blood test to check my levels, and we safely increased the dose to 275. This dose remained for the rest of the days (12 days total). On day 5 I also started Orgalutran, a second injection (pre-loaded, individually dosed syringe) which is a drug to stop the body from releasing the eggs too early, and let them keep growing.
After each injection (you have to be sitting, to pinch your fat) I would lie down and put a head pack on my stomach, and eat some chocolate.
On day 6 of medication, they did another blood test and an ultrasound to look at the follicle growth. On the left side I had 1 “big” follicle, 4-5 small ones and on the right I had 1 small. This was steady progress for the halfway point.
On day 8, I had another blood test and scan, and the nurses call each test day with an update, telling me they were all medium-sized and I had about 6 on the left and 2 on the right. Something I might also clarify is that not every follicle contains an egg.
On day 11, I had another blood test and scan. I had an upset stomach, but apart from that, felt OK. This is the part of the process (9-14 days) where you start speculating when you’ll do the trigger shot and when your egg collection day surgery will be. They could see about 13 follicles at this point. They also measure the size, as those that are too small don’t count. Like I mentioned before, though, they don’t want to push it too far or too long, and push you into HSS. It really is day-to-day.
On day 13, I had another blood test and scan. Out of the 8 on the left side, 6 are mature. 3 on the right, maybe 1-2 could mature. The lining looks good for a fresh transfer (more on this in a bit). I get a call at 4:30 pm to confirm tonight is the night for the trigger shot, which means both the Gonal-F and Orgalutran stop. This trigger shot is pre-loaded in a pen, and not a powder/liquid mix like the one we used for the IUIs. The trigger shot counteracts the Orgalutran and allows the eggs to burst out of the follicles. You do the trigger shot 2 nights before your egg collection surgery, and the nurses have to schedule your surgery to be able to tell you the exact time to do the trigger. It’s very specific and well-coordinated.
I was told to do the trigger at 7:50 pm on a Wednesday for a 7:50 am surgery on Friday. On Thursday, you do not take any medication and simply prepare your hospital admission forms.
The Egg Collection (Day Surgery)
This is the part of the process where you start tracking “days since trigger shot”, as you need to see those drugs leave your system over a few weeks, to be able to tell what’s going on. So we are day 0 PT and it’s the day of the surgery, a 20-30-min procedure in a day hospital in the same building as my IVF Drs office. It was really great that it all happened in the same place, and felt nice and familiar. I won’t go into excessive detail about Alex’s part in all of this, but the short story is that he had to abstain for a few days to be ready for this day. We arrived at 6:50 am for the 7:50 am surgery. I was taken in before Alex, and he was left to do his part of the process. You are shown to a curtained-off section of the room and put a gown on. You can keep your socks on, and a lot of people like to wear fun socks for good luck. The nurses on the floor were super kind and then I met the anesthetist, who told me that this was not a general anesthetic, but more of a twilight state. He checked I hadn’t had any bad reactions to anesthetics in the past and that was that. Then the Dr came in and went through the procedure with me once more. It all seemed pretty simple.
If you want to google how the actual egg collection works, go for it.
Then a nurse walked me into the operating room, I lay on the bed and the Anesthetist started chatting away with me about work, etc. I recall them adding an IV drip, and then that was it. I woke up in a bed and initially felt no pain. I just felt a bit drowsy, and just kind of looked around the room to suss out the situation. I was just across the floor, opposite the little curtained-off area where I had originally put the gown on.
I look at the palm of my right hand to see a piece of surgical tape with a number written in permanent marker - 7. They collected 7 eggs.
It’s hard not to have an opinion about this, but I never want to compare my experiene to others so minutely, so I was honestly really happy. There is no ideal or perfect number. 7 was good for me. I stayed positive.
I was given a heat-pack and told I would need to stay in the bed while I had 1L of saline through the IV drip in my left hand. As someone who had to overcome a needle phobia, this was slightly jarring to see, but I worked through it in my head, and focused positively on how proud I was to have done this and be where I was, no matter what the end result was.
I was given liquid panadol and 1/2 an Endone, as I did start to feel some cramping/pain, but it wasn’t even as bad as a typical period for me.
Then, they walk you over to a curtained-off section, you sit in a comfy chair and have tea, biscuits, cheese and crackers - and some apple juice. It’s fucking delicious.
They make you go to the toilet before they will take the cannula from the IV drip out.
They told me a scientist or embryologist would call me later that day with an update, and then the next day, and the Tuesday (4 days post retrieval).
If you are considering freezing your eggs, the process stops here. I hope this was helpful in explaining how that all works. Your eggs are frozen without being fertilized, unless you wish to use donor sperm or your partner’s sperm to freeze embryos for the future.
At midday, a scientist from the lab called to confirm they did collect 7 eggs and the sperm was “great”. They leave it overnight and call back the next day with an update.
This is the most basic/original way of doing IVF. Some people might need to do ICSI, where they inject a single sperm into a single egg, but they generally do not do this for the first round, as they want to see what happens naturally.
A statistic you’re told is that generally for every 4 eggs collected, 1 will fertilize. So we had 7, I could expect 1-2 to fertilise.
The day after the collection, I started progesterone pessaries. I am so thankful that this is the standard protocol in Australia (and the UK, it seems), or at least with my Dr, as I have watched countless youtube videos with Americans doing progesterone-in-oil shots that are insanely painful, causing lumps and bruises. Pessaries are like suppositories, and you basically pop one up there in the morning and evening. It’s messy, but it’s not an injection, so I embraced it. The pessaries are to prepare you for an embryo transfer, which we hoped we could move straight into.
The scientist called at 10am the next day to say… all 7 eggs fertilized normally! They expect a drop-off of about 50%, but this was a good head-start. They’ll call again in a few days with an update.
Symptoms at this stage were swollen boobs, cramps and lower back pain. But again, nothing too terrible honestly.
On the Tuesday I needed another blood test. This was 4 days post-collection/4 days of the eggs and sperm in the petri dish, turned into embryos.
I had been told that there were 5 embryos that had made it to day 4, which was really exciting given the odds we were told.
I was told my progesterone levels (aided by the pessaries) were “very good” and that I would be coming in the next day, day 5 post collection, for a fresh embryo transfer.
Embryo Transfer
If there is a viable embryo to transfer, and your body is in the right state to receive it, the standard protocol for your first cycle is a fresh transfer. This means, if there is no reason to do genetic testing on the embryo, they will pop it in fresh (no freezing and defrosting). I have found that in some countries like the US, they are overly clinical and prefer to freeze, test and defrost, and do frozen transfers, but this is not always the case. It is my understanding that there are risks involved in the freezing, testing (poking it with a needle to extract DNA) and defrosting process with embryos, as they need to remove the water, freeze it, defrost, and rehydrate it. But it’s mostly the testing process of tampering with the embryo that can sometimes result in damage.
Given this was our first round and we did not have genetic issues pop up on our blood tests, and that my body was primed and ready to go, we did a fresh transfer.
On the day, I showed up knowing that there was one good embryo to transfer, and did not yet have an update on the rest.
The Dr came out to the waiting room and we opened a door to this small changing room area with a super-high-tech locking system (green light, red light), and there I changed into cap, gown (only took bottoms off), kept shoes on with booties over. She told me there was one good embryo to put in that day, and the rest would be left for another day to see what happens.
She told me to go through the next door when I was ready. The next room had access from the other side. The Dr, embryologist and a nurse (to operate the ultrasound) came in. I lay in the reclining chair and they explained the procedure to me. The embryologist was to my left, at the microscope, and to my right they showed me on the monitor what the embryo looked like. “Text book”, they called it. A good thing. They prepare you in a similar way to a pap smear, then put a catheter into your cervix, and the nurse has the ultrasound going at the same time to guide them. The embryologist comes over with a super-fine needle, and they insert it into the catheter and inject the embryo through the cervix and into the uterus. They show you on a screen as it happens and tell you “see that tiny white dot?”. I did not catch it - it was too quick.
And that was it. Less than 5 minutes. No pain. They didn’t have my lie down for any amount of time. I stood up and went back through the same door, got dressed and was on my merry way.
There is a tradition in the TTC community, to have McDonald’s fries after a transfer, so we did.
Post-Transfer, AKA the 2-Week Wait
The next day, I got a call at 8:30 am from one of the scientists to tell me that 3 embryos reached the right stage and they were able to freeze them. I cried. 7 eggs became 4 embryos. What an amazing outcome for the first round. I was and still am so happy.
Now this is the time we call the 2WW, and we start counting the days-post-transfer. We’re still counting the days post trigger shot, as we cannot confirm a positive pregnancy with the trigger shot in our system (it takes 14 days to leave). Some people choose to “test out” the shot, which means taking daily pregnancy strip tests right after their transfer, seeing a false-positive for most of that time, watching it fade and then hopefully darken again into a real positive. I am not this person. I have self-control and wanted to focus on positive thoughts and enjoy the time with no tests and drugs, aside from the suppositories.
Throughout this time, I experienced lower back pain, bloating, slight cramping, headaches, upset stomach and was a little sad and teary sometimes. Of course, all of this can be symptoms of those pesky progesterone suppositories. So it’s super fun trying to mentally switch-off and not think too much about the what-ifs. The other main purpose of the progesterone is to make sure your period doesn’t start, and keep your body primed for implantation of the embryo into the lining of the uterus. It doesn’t help that these symptoms mirror early pregnancy symptoms.
Most of this time was spent doing little daily mantras in my head, telling myself “My body is ready, my mind is ready, my heart is ready - I am pregnant now”.
I knew my blood test would be 14 days post-transfer, hence the 2WW, which is also 20 days post trigger. I mentioned that the trigger should leave your system after 14 days, so technically you have about 5-6 days where you could test at home if you were curious, but it still may not be as accurate as a blood test.
My birthday was in the middle of the 2WW, and I did not want to be sad on my birthday, so I waited until we’d had a nice day out on the Saturday and told myself I would test on the Sunday.
I didn’t do it in the morning, but around 2pm I just had the urge and did a basic strip test (not a digital one with a +/- or smiley face or the word pregnant/not pregnant).
It was positive. At 3:30pm I did 2 more tests. Both positive.
I didn’t tell anyone. I just sat with this information, and went about my day.
On the Monday, I tested again twice, both positive.
Tuesday - blood test day. I told the nurse I tested Sunday and Monday, and it was positive. She told me that should be late enough. She asked me if I had any bleeding - no.
At 1pm, I got a call from one of the nurses. I’m pregnant! HCG 650 - it needs to be above 50 to be positive. Progesterone 61 - it needs to be above 30.
By the end of this week, I am technically 5 weeks pregnant. The next step is a scan to see the embryo/baby and hopefully hear the heartbeat. My Dr does not like to do scans early than 8 weeks, because otherwise it’s often too early to hear/see a heartbeat.
So just when you thought the 2WW was painful, try knowing you’re pregnant, but having to wait 3 weeks for an ultrasound.
The 3 Week Wait for an Ultrasound
From week 5-8 is the 3WW, and the 1st trimester symptoms start to kick in. Still taking the pessaries morning and night. Starting to feel icky. Best way to describe it is a mild hangover all day. Morning sickness is an inaccurate term and should be phased out. It’s all day. But I didn’t vomit. Not once. The multiple nightly wee breaks have started. Bloating and sore boobs. All good signs that things are progressing. How could I be excited to feel shitty? I’d waited long enough, so I embraced it.
On 7W6D, I had my scan. Alex was with me (Sydney lockdown had started late June, but the office still allowed partners for such important appointments).
Bébé was 1.7cm and we saw and heart the heartbeat. I cried immediately and the Dr said “If you cry, I’ll cry”.
Then I was told in 2 weeks at 10 weeks I would get the NIPT blood test to check for genetic issues and also find out the sex if we wanted to.
My Dr asked which OBGYN I wanted to be referred to and at which hospital, and shit got real.
She wished us the best and off we went, onto the next chapter of this rollercoaster of an experience.
I am 25W2D while writing this today, and of course I have continued to document every day since, in my super-dooper google spreadsheet.
I truly hope if you made it to the end of this post, that you learnt something or at least have a better understanding of what people go through with the IVF process. My story is not harrowing, it’s not sad, it’s not traumatizing, but so many are. I hope you understand that there are so many people going through multiple stimulation cycles, multiple transfers, PCOS and Endometriosis which affects their experience, as well as miscarriage and loss. Those are not topics for me to discuss, but I want to make sure you heard my version of my story, as all experiences are valid. I also wanted to tell a positive story in case you’re considering IVF and have only heard horrible tales. It doesn’t always end in tragedy. Science is amazing. I am pregnant, and I can’t wait to tell you more along the way.