Well friends, it’s time for a follow up to the original how it works post. I’m not sure I can make this one as entertaining as the first, but I’ll do what I can.
We started our first IVF cycle on Saturday. The week has been a flurry of calls between us and the doctor’s office in Ohio, us and the credit card companies, us and the airlines, us and our relatives. Lots of coordinating over here. I think all the major details are finally ironed out and I can finally take off my IVF coordinator hat and put back on my ABD Grad Student hat. A lot of folks have asked us how, exactly, this procedure works. It’s somewhat fun to watch the whites of their eyes grow as we divulge the nitty gritty details, but it’s also exhausting to tell the same story over and over so I’m gonna put it all here for the record.
Before we were allowed to start the cycle we had a four hour visit with the RE in Ohio. During that visit he briefly reviewed R’s medical history, and then examined her uterus and ovaries by ultrasound. He took some kind of measurements to understand the size and shape of the uterus and that process looked rather uncomfortable. I was happy to be seated in a vinyl chair next to the exam table. After the exam, we were escorted to a small room at the center of which was dinosaur of a laptop primed with an equally dated educational video. Here’s a screen shot of instructions for me, “the husband”:
After we’d watched (or slept through) the video, a nurse came in with a pile of paperwork more voluminous than the stack we signed to close on our house.
A ream of paper later, the nurse reviewed R’s med schedule. There are at least eight drugs from this doctor, plus prenatal vitamins and fish oil, and two types of Chinese herbs prescribed by her acupuncturist. We had to make a spreadsheet, and set alarms for ourselves. We tacked the spreadsheet right next to a fertility talisman from Israel, which has thus far failed us but perhaps needed to be closer to water? (We moved it to the bathroom.)
All the meds have different effects and are therefore administered on different days during the cycle. The first drugs are meant to synchronize follicle development; in a normal cycle, a woman’s body has a wave of follicles that that all start the race to ovulation. Typically, the most mature follicle wins, and occasionally the two most mature follicles win. But all the competing follicles grow at slightly different rates, and if they were all encouraged to continue growing and mature to ovulation, when they were released from the ovaries they’d be different sizes and some would be too old and some would be too young to have a fighting chance at fertilization. So R takes oral birth control pills for 14 days to suppress the growth of the follicles and keep them maturing at the same rate. It’s kind of like ovarian socialism – we’re leveling the playing field and giving all follicles an equal chance, rather than using internal competition and market forces to let the best (or most crooked!) follicle win the prize.
Once the follicles have been stabilized and readied for growth, we give them a three day rest period. Then we feed them some superfood (Follicle Stimulating Hormone, injected into R’s abdomen in very high doses) to nourish their growth and encourage dozens (hopefully) to keep maturing as though each will be fertilized. On the third day of stimulation, we go the lab to get a blood test to make sure things are going according to plan. Then we adjust the medications as needed, and perhaps start a second injection to prevent R’s body from naturally releasing the outsized crop of follicles. On the sixth day of stimulation we fly to Ohio to see the RE who will count and measure the follicles and determine how much more time and medication they need before harvesting.
Most women need about 10 days of stimulation prior to harvest, but some need fewer and some longer. We’ll be monitored closely to determine the right time to have all the follicles harvested. On harvesting (AKA “retrieval”) day, we’ll check into a hospital where R will be sedated and the mature follicles will be removed from her ovaries. They’ll be rushed to a laboratory, where a technician will examine each one for quality and contents. An unknown proportion of the follicles will lack an egg, and therefore not particularly useful to us. But the ones with an egg inside will have our donor’s sperm injected into them in hopes that they’ll fertilize. Another unknown proportion of eggs will fail to fertilize, but the ones that do will spend three to five days growing to the embryonic stage in a petri dish in the lab. On the third or fifth day after the retrieval, we’ll go back in to the hospital, and the doctor will transfer the two best embryos into R’s uterus, where we hope they’ll get cozy and implant. The remaining embryos, if we have any, will be frozen and stored for future use. The day after the transfer we’ll fly back to the PNW, and I’ll try not to worry about the in flight radiation exposure to my embryonic twins. We will wait ten agonizing days before getting blood tests to find out if neither, one, or both of the embryos implanted and continued growing.
So that’s the story, morning glory. The entire process involves 12 drugs, 3-4 blood draws, 3-4 ultrasounds, 2 surgeries, and 12 drugs over the course of about 45-50 days. Oh, and it costs an arm and a leg. And we’ve already spent an arm and two legs, so between us we have like, a torso, left and only a modicum of sanity. Hope the kids won’t mind!