How Do You Even "IVF"?

Hi guys! Kay here, get comfortable, you're about to do some learning. Lefty and I have received an overwhelming amount of love and support during our journey to parenthood. So many of our family and friends are so invested in this process, it’s like having our own personal little cheer squad. People also have a lot of questions – after all, IVF isn’t really an everyday topic for a lot of people. This post is going to be a bit of an overview of the process, based on the most frequently asked questions we receive. I do not claim to be an expert, this is just the information I’ve gathered from my research, others going through the process, and some of the staff at the clinic we go to.

IVF refers to the overall $10k process of injecting medications, retrieving eggs, fertilizing them, and growing them in petri dishes for 3-6 days.  FUN FACT: “In Vitro” means “in glass”, so basically, fertilization in a glass petri dish! IVF usually starts with some sort of diagnosis - male infertility, female infertility, or sometimes, unexplained infertility. Of course there are other circumstances such as same-sex couples, or genetic abnormalities, but the idea is the same: we want a baby and we can’t make one the fun way. The doctor overseeing the process is called an “RE” or “Reproductive Endocrinologist”. They make the magic happen.

Photo from: Etsy shop ChiefAndLily

Testing

There is whole bunch of tests anyone contributing any genetic material (read: sperm and eggs) must go through prior to starting fertility treatments. Both/all parties will be tested for an array of Sexually Transmitted Infections, to rule out any “simple” issues caused by something caught during those questionable years in Uni.

Men will undergo:

Semen analysis: (usually several) to assess morphology, concentration, and motility of the little swimmers. If you’re lucky, you can freeze some like we did “just in case” you need it later.

Testing for genetic abnormalities: such as cystic fibrosis, which often causes men to be born without their vas deferens (the little tube that the sperm use to…escape), or XXY syndrome, where a man has an extra copy of the X chromosome which can cause infertility.

Women will undergo:

Blood tests to assess several hormone levels (AMH, FSH): these levels give a good indication of egg quality and reserve (basically, what you’re working with).

Sonohysterogram: a small tube is run through the cervix and saline is injected into the uterus while being viewed on ultrasound to check for any issues with the inside of the uterus, such as fibroids (little tumors made of muscle) or irregular shape of the uterus.

AFC count: this counts your base level follicles (fluid fills “cysts” on the ovaries that contain eggs, usually 1 egg per follicle) on each ovary, to give an indication of how many eggs you can reasonably expect with stimulation.

(There are many more, but I’m only going to talk about what we have gone through, because I have no personal experience with the others.)

Once all the testing is done, and the decision is made to do IVF, you can plan on forking over roughly $10k. Sorry future children, hope you didn’t want to go to college!

Suppression

The woman then goes on some form of suppression (birth control or injectable hormones) to suppress and quiet the ovaries, so that all the follicles can grow at the same rate once they begin stimulation.

Stimulation

Once the woman’s ovaries have been suppressed for 21-35 days, ovarian stimulation begins. Stimulation, or stimming, refers to the daily injection of hormones to promote the growth of multiple follicles/eggs. This phase has to line up with a woman’s natural cycle, so there can be some waiting involved. This includes every-other day (or every day) internal ultrasounds and blood tests to assess hormone levels and follicle size.  

Trigger

Doctors like most follicles to reach 17mm before they “trigger” them to release. The trigger is usually a large dose of HCG (pregnancy hormone) and is injected to promote the maturation of the eggs and the release of the eggs within the follicles. Once triggered, the eggs detach from the inner walls of the follicle and float around inside for about 44 hrs (which would be the upper limit of time).

Retrieval

This step is done by using an ultrasound guided probe to insert a needle through the back wall of the vagina into each ovary to aspirate (suck out) the eggs contained within the follicles, and is usually done exactly 36hrs after trigger. The timing must be precise - too short and the eggs won’t be detached, too long and they will ovulate on their own and be lost.

Egg Fertilization and Embryo Maturation

The eggs are then fertilized and grown in petri dishes for 3-6 days. FUN FACT: Eggs vs Embryos - eggs are just that. Eggs taken from the woman’s ovaries. Embryos are fertilized eggs with the potential to be a baby. The goal is usually to transfer embryos that have reached 5 days of growth, but sometimes they will also let them grow for an additional day, all the way to day-6, to let some slower ones “catch up” (potentially giving you a few more embryos for freeze). The embryologist calls you every day to tell you how your embryos are growing, and a decision is made which and how many embryos to transfer.

Transfer

The number of embryos transferred depends on the woman’s age and how many failed transfers she may have had previously. Once the selection is made, any remaining are usually frozen. The embryo(s) selected will then be placed back in the uterus, and then the finger crossing begins. The difference between a “fresh transfer” and a “frozen transfer” is: a fresh transfer refers to the placement of an embryo back into the woman’s uterus directly after undergoing stimulation, a frozen transfer refers to eggs that have been frozen for later use being placed back into the uterus. About 9 days after a fresh OR frozen transfer, a woman will have her blood drawn to see if the embryo has “stuck”. If so, she is pregnant, yay! Now she waits till she is 12 weeks to make sure the baby is going to “stick”. If not, the couple can wait a few months and try a frozen transfer- if they were lucky enough to have leftover embryos frozen. There is a fee associated with this, but it is substantially less (about $1500). You can do a transfer as many times as you have embryos left. THEN once you run out, you must repeat the whole $10k process again, or look into other options.

TLDR (too long, didn’t read):

-Tests to see why you can’t make babies.

$10k for medication injections to make lots of eggs.

-Eggs taken out and mixed with sperm in petri dish.

-Embryo(s) made and put back into uterus or frozen.

-If the one(s) put back didn’t get you pregnant, try again with frozen.

-If none frozen, $10k again, rinse and repeat.

If you have questions, leave them in the comments below! Lefty and I will do our best to answer them.  We love your feedback, and your continued support!

All the love - Kay.