With the growing number of community members daily, it seems only fair to address IVF newbies. If you and your spouse have recently started considering IVF, you probably have lots to worry about, especially as it is an expensive procedure, with no guarantees. The journey into the unknown can seem pretty scary, which is why we are here to give you an overview of what to expect. Knowing what lies ahead can be all the confidence boost you need. First, yes IVF does not guarantee a Big Fat Positive, but thousands of women have been lucky enough to get pregnant with their first cycle. The journey to IVF usually starts with making the first appointment; this could be your first visit to a Fertility Doctor if you haven’t been to one before, or the first one that concerns IVF, if you and your doctor have explored other means of Assisted Reproduction. Either way, it would seem as frightening as a baby learning to walk, but we trust that your doctor, and the nurses, would be on hand to put you at ease. Ask as much questions as you have and make sure every tiny detail is explained to you accurately.
You will have a blood test to determine if your hormonal levels are optimal. The first step in the process is hormonal suppression, or what my Gynaecologist likes to call Down Regulation. The hospital would make a calendar for you, and the suppression treatment should start around day 21 of your menstrual cycle. The treatment could last from two weeks to six weeks, depending on how soon satisfactory levels are achieved. The reason for down regulating is to suppress the follicles so as to ensure that it can be stimulated in a controlled manner. The next stage involves stimulating the suppressed follicles. There are multiple follicles in the female body, but every month only one or two follicles develop dominantly, and are thus the ones that release ovum during ovulation. Follicular stimulation usually done with injections ensures that multiple follicles develop, so as to harvest enough eggs for fertilization.
During this stage, you would be started on the minimal dose possible, and the development of the follicles is monitored with regular ultrasound scans. The dose would be increased if necessary, and once you have enough large follicles, you would be scheduled for egg collection. An injection would be given to you, which must be timed to ensure you do not ovulate before the eggs are harvested. It is very important to follow instructions to the letter, and call the hospital if any issue should arise. On the day of egg collection, you are not to go in with nail lacquer, make up, fragrance or any strong scent that could cause the ovum to die off. It is also advisable to go with someone who would take you home, before you would likely feel dizzy after the effect of the intravenous sedation. The procedure takes between 15 and 30 minutes, and you are likely to be awake during the procedure. You should feel twinges and slight discomfort but you should not be in pain.
Usually your spouse would need to drop a sperm sample on the day of collection, or prior to the day, if he isn’t going to be available. The sperm is usually washed and prepared while the eggs are placed in an incubator, and graded according to their development for 3-8 hours before mixed with the selected sperm. In some cases, the sperm and eggs are placed together into assigned dishes, while in some other cases, a single sperm is injected to each mature egg and then put in the dishes, which are left in the incubator overnight to allow fertilization take place. The temperature of the incubator mimics that of the uterus, to make the process as close to nature as possible. The night after egg collection can be filled with worry for you and your spouse, but try not to think about how the eggs are doing. The embryologist would take great care of them. Do something to take your mind off it; read a book, watch a movie, pray and hope for the best.
Not all eggs would end up fertilized, which is why multiple eggs are collected to increase the number of viable embryos that emerge. The hospital should call you the next day to inform you if fertilization has occurred, how many embryos are available and to schedule a transfer. While that is going on, division of cells is occurring with the embryos and the hospital would advise you on whether to do a 3 day transfer or a 5 day transfer. If you are lucky to have surplus good quality embryos, you would be advised to freeze the rest for future use.
The embryo transfer causes very minimal discomfort and you might be placed on progesterone shots to help prepare your uterus to host the embryos. Depending on the thickness of your uterine lining, you might also be given drugs to boost the lining. After the transfer, you would be advised to wait for two weeks before testing. This period is called the 2WW in the fertility world, and you should stick to every instruction given by the hospital. If you are placed on bed rest for the entire period, please take a leave of absence from work and stay in bed. You would also be given medication, and advised to eat things like pineapple core, which are all supposed to help with implantation. Implantation optimally starts three or four, five, or even six days after transfer, depending on how soon after fertilization the embryos are transferred. However, it could be delayed and take longer. This 2WW is a good time to catch up on magazines, books, movies or anything fancy that would help keep your mind at rest.
After the 2WW, you go in for a scheduled hCG test, which determines if you are pregnant or not. Hopefully, you would get a BIG FAT POSITIVE. We look forward to sharing your journey with you in our IVF Group.
Godspeed to us all.
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