The IVF Process – What to Expect (Part 2)

In Part 1 of this guide, we take you through your first consultation at the in-vitro fertilization (IVF) clinic to the point when it’s time for you to give yourself shots.

Here, in Part 2, we share the steps of egg retrieval, fertilization, and pregnancy determination and follow-up.

(Like every good sequel, you don’t have to see the first one to follow the second one but it makes it so much easier to follow.)

Your Follicles Are Full!

As you know from Part 1 (and from that bloated feeling you are no doubt experiencing), you’ve spent the last ten to fourteen days taking hormone shots to stimulate your ovaries. These hormones gently nudge your ovaries to produce multiple follicles and in every follicle is an egg. When you’re going to the fertility clinic—often—the doctors are monitoring many things (the hormone levels in your blood, how many follicles you have, your mood, how many times you curse during the exam, etc.), but they are also measuring the size of your follicles to get an idea of how mature the eggs are inside.

Once the doctor sees that the follicles are of a certain size and count, that’s when they recommend that it’s “trigger shot” time and they schedule your egg retrieval.

Your clinic will show you and/or your partner or spouse how to give yourself the trigger shot (also referred to as hCG).

This shot will alert your body that it’s ovulation time, but in this case, a doctor will be retrieving the eggs as opposed to your body naturally releasing them. The egg retrieval is typically 36 hours after the shot is given.

Tips: Give Him a Shot with the Shots. For the hormone shots you have to take, consider having your husband/partner take care of them. My husband actually enjoyed being the one to give them to me as it made him feel more a part of the process (and quite frankly, I can’t even pluck my own eyebrows let alone inject myself with anything).

If you have any worries about HOW to give yourself the shots, many clinics offer online videos for review. That being said, if you’re at all concerned about doing it incorrectly or just feel it’s too much, you can hire (or beg) a nurse to help.

The Egg Hunt is On

You are given a specific date and time to show up at the clinic for the retrieval. You are also advised not to eat or drink anything after midnight the night before. Although this is not a highly invasive surgery, it does entail light sedation so it’s preferred that you have an empty stomach.

Now let’s be honest: You’re uncomfortable, you’re probably hungry at this point, you’re feeling a little like a pincushion after so many needles and you’re being handed a hospital gown, socks, and a cap for your hair. While this is not the sexiest or the most fun situation, you have the easiest job—take a cat-nap while others do the challenging work. The egg retrieval only lasts 15 to 20 minutes at most. When you wake up from the light sedation, you will be offered some juice and crackers for a job well done.

The egg retrieval involves having your reproductive endocrinologist (RE) use an ultrasound guide and a thin needle to go through the vagina and into the follicles to retrieve the eggs. While this is happening, your husband/partner, if there is one, is taken into a separate room to offer his contribution (yep, semen for sperm).

When you’re in recovery, you are typically told how many eggs were retrieved.

Tip: Comfy Clothes and No Plans. While you may feel totally fine before and after, you want the space physically, mentally, and schedule wise to do and feel however you want after the egg retrieval process. And really, after having a needle in your vagina, you deserve to put on yoga pants and head straight home. (I also personally recommend wearing a fun party store plastic tiara because after all that you’ve been through, you deserve to!)

Go Home, Be Pampered, and Wait

After the retrieval, take it easy and do nothing if that makes you happy.

Some women report having no discomfort after their retrieval while others report feeling cramps similar to those they get around their period. You can take over-the-counter pain medication should you feel any mild pain. You can also use a heating pad. If you experience major pain, heavy bleeding, a fever, or anything out of the ordinary, though, call your doctor immediately.

Meanwhile, your embryologist is busy “washing the sperm” which isolates the healthy sperm that are then carefully mixed with your eggs that were just retrieved. This is to encourage and activate fertilization. In situations where there may be a sperm quantity or quality concern, a procedure called intracytoplasmic sperm injection (ICSI) is used. This is when a single sperm is injected directly into an egg to more carefully achieve fertilization. In either case, the eggs are monitored to confirm that fertilization and cell division are taking place. If this occurs, the fertilized eggs are considered embryos.

When you’re going to the fertility clinic—often—the doctors are monitoring many things (the hormone levels in your blood, how many follicles you have, your mood, how many times you curse during the exam, etc.), but they are also measuring the size of your follicles to get an idea of how mature the eggs are inside.

Then, it’s the big wait for…The Fertility Report. You know how many eggs were retrieved but the big question is how many embryos form from the eggs-sperm combination.

If you’re doing a fresh IVF cycle transfer, within a day, you will get a call updating you and it may go something like, “We retrieved X number of eggs and we fertilized Y number (using ICSI). Of those Y number eggs, Z became embryos and we want you to come back on such-and-such date to transfer one of the embryos.”

If you’re going to have genetic testing done like Pre-implantation Genetic Diagnosis (PGD) or Pre-implantation Genetic Screening (PGS), which is something discussed in advance with your doctor, the embryos that are created would need to be frozen and tested before transfer. The transfer would be delayed until the test results come back.

Tip: Embryos Over Eggs: Remember that while producing a good number of eggs is a good beginning, it’s the number of embryos that matters. I speak as someone who was a decent egg producer but only had a few embryos to show for it. I’d get so hopeful, then feel let down when I’d hear how few embryos developed. Keep the ratio of eggs to embryos in perspective and maintain your optimism (as optimism can be hard to come by) for the embryos you do have!

And – Keep drinking water and refer to this great pregnantish article IVF Constipation: 5 Natural Remedies to ‘flush out’ your system.

Transferring the Embryos (and What to Do with Your Remaining Ones)

Whether you’re doing a fresh transfer or a frozen transfer, the procedure is the same. The difference is with the frozen, the embryos would first have to be unfrozen, obviously. Same goes for whether the embryo is being transferred to you or to a surrogate—it’s the same procedure.

You once again get to wear the lovely hospital gown but this time, you will not have to be sedated. A catheter will be gently inserted and passed through your cervix (it’s super thin and other than the teeniest cramping, you hardly feel it). Through the catheter, they transfer the embryo (or embryos if they are transferring more than one).

After the transfer, they typically have you lay down for at least a few minutes and then you are free to return to your regular activities.

Should you be fortunate enough to have any embryos left over, you can freeze them. They can be used should this cycle be unsuccessful or if this cycle is successful, they can be used in the future should you want to try for more children.

Tip: Enjoy a Belly Laugh. According to a study done in 2011, if a patient laughed (yes, laughed) after an IVF transfer, there was a greater chance of embryo implantation and IVF success. Now, this may not be the most conclusive study but I’d much rather try laughing after an IVF transfer than worrying or crying, so it’s worth a shot (no pun intended).

The Two P’s: Progesterone and Pregnancy Test

As soon as you are PUPO (Pregnant Until Proven Otherwise), your doctor will have you start taking progesterone. This is (in theory) to help the pregnancy “stick” (not the technical term). Progesterone comes in several forms: injectable, vaginal suppository, or vaginal gel. They each have advantages and disadvantages.

The injectable—Progesterone in Oil (PIO for short)—is a (guess what?) oil shot. It’s thicker than the hormone fluid and has to be done more slowly. Otherwise, it can hurt and, to be blunt, after you inject it into your butt, your behind can get a bit lumpy. Isn’t that fun?

Some women put the PIO into their bras ahead of time, for 20 minutes or so, to get it as close to body temperature, to help it absorb more easily. Some women really rub the injection site after they have given themselves a shot also to help improve absorption.

Keep the ratio of eggs to embryos in perspective and maintain your optimism (as optimism can be hard to come by) for the embryos you do have!I asked Dr. Serena H. Chen, a reproductive specialist at the Institute for Reproductive Medicine and Science at Saint Barnabas in New Jersey, if this has any medical validity to it and she advised, “As far as I know, there are no international, multi-center, randomized, placebo-controlled, double-blinded cross-over studies looking at this. But, in my personal experience from talking to many patients and nurses over a couple of decades in the IVF business, [many] do say that massaging the area will help the injection site feel better. It seems to make sense and does not seem to be harmful, so might be a reasonable thing to try.”

With the suppositories or gel, you can avoid needles and vials in your bra, but, well, they can be a bit messy. Mini period pads will be your best friend.

Vaginal gel typically comes in a pre-filled applicator and is used twice daily. With vaginal suppositories, they are inserted vaginally two to three times daily and the suppositories dissolve. When inserting either the gel or suppository, pain is uncommon but due to the frequent use, it may cause discharge, hence the need for mini-pads.

Bottom line—take your time reading the instructions on each option, ask advice from fellow IVF’ers on what worked for them, and maintain a sense of humor as best you can.

About 9 to 12 days after the embryo transfer, an official pregnancy test is ordered at the clinic. This is known as a “beta test.” Some people take a home pregnancy test ahead of time but this may not be entirely reliable. When you do the blood work, they are looking for an hCG level of 25 or higher. This means you are pregnant. Home pregnancy tests (depending on which one you buy) may not detect an hCG level below 50. If you can check the box before you buy, it typically tells you how sensitive the tests are. If you have the money to buy a bunch of tests and it will psychologically make you happy to pee on things, test at home. Ultimately, the serum pregnancy test (yes, more blood work) that they do at the clinic is the most reliable.

If the test is positive (yaaay!), the clinic will repeat it in a few days to see if the numbers are going up, indicating that the pregnancy continues to develop.

If the test is negative (WTF?), the clinic will still repeat it in a few days to see if the numbers remain the same.

If you are pregnant (woo hoo!), your doctor will have you continue to take the progesterone for several more weeks while they continue to monitor you with blood work and ultrasounds, until they feel it’s safe for you to “graduate” to an OB/GYN (typically after about 8-10 weeks of monitoring).

If you are not pregnant, you will stop taking the progesterone and schedule a “WTF appointment” (not the medical term) with your fertility doctor to talk next steps.

Tip: Take Care of You. If you are NOT pregnant, I highly recommend that you look into some serious self-care for the next week or two and if that entails throwing yourself a well-catered pity party, so be it.

IVF is not fun but it’s also not the end of the world. This year marks the 40^th that IVF has been available as a family-building option. It’s important to acknowledge that approximately eight million babies have been born because of this technology. While it’s not how many have hoped to have children, there are countless people out there who are grateful that IVF exists.