What is IVF?

Assuming all is going well with the medications I am currently taking, we should begin our IVF cycle on June 11th. Right now, I am taking: prenatal vitamins, Metformin, Vitamin D, and birth control pills (the active pills only, not the placebos).

I've been looking online for someone who can explain IVF step by step better than I ever could, and so I double copied this. I took portions from "Our Baby Making Journey!" by Lexi and Sarah who are IVF bloggers who recently conceived. They borrowed portions of their step by step process from another bloggers page "Deuces Wild & an Ace in the Hole". So, this is a 3 party blog, the 2 bloggers mentioned previous and myself. Any dates or medication are relative to me, as those are what my RE and nurse prescribed for this cycle. Hope this is a good overview!

There are six main phases of the IVF process. The process is completed during the same amount of time it takes to complete a normal one-month menstrual cycle, not inclusive of the start time for taking birth control pills.

1. Controlling the Menstrual Cycle
2. Ovarian Stimulation
3. Egg Retrieval
4. Fertilization
5. Embryo Culture
6. Embryo Transfer

Controlling the Menstrual Cycle
Some doctors like to have a controlled cycle before they do the actual IVF cycle. In my case, our RE has all IVF patients on the same cycle where egg retrievals occur within 2 weeks of each other, and embryo transfers occur within the following 2 weeks. For my IVF cycle, it is preceded with 34 consecutive days of active (no placebo) BCPs, and does not interrupt the ovarian reserve. I started it sometime in May towards the end of my menstrual cycle. Cycle control also includes taking Lupron via an injection in the abdomen, which shuts off all of the reproductive hormones in the body that it naturally produces so the RE can intricately manipulate those hormone levels during the cycle. Headaches, bone or joint pain, and fatigue are very common. I begin taking Lupron on June 11th, and continue to take it at least until June 30th.

Ovarian Stimulation (stims)
During ovarian stimulation the ovaries are stimulated using powerful fertility drugs with the goal of having as many eggs as possible mature. Having as many eggs as possible mature is necessary because some may not fertilize, while others will fail to develop normally after they are fertilized. The stims I will be taking are called Bravelle and Menopur, both mixed in a saline solution and injected through the abdomen in the morning. During ovarian stimulation, my ovaries will be closely monitored by frequent ultrasounds; estrogen, prolactin, and progesterone levels will closely monitored by frequent blood work and urine samples. When any of the follicles get close to measuring on the “mature” range (usually above 14 mm), we will schedule a date for egg retrieval. I begin my stims around June 26th.

There is a condition called Ovarian Hyperstimulation Syndrome (OHSS) which can occur during ovarian stimulation. I am at a higher risk for developing this condition because I am young and most likely stimulate well to medications. The ultrasounds will also allow my doctor to watch for OHSS developing during ovarian stimulation.I am not sure what the side affects will be for me on the stims, and I do not do well with drugs. I'm hoping for the best and preparing for the worst - poor Lara :( She always has to take care of my erratic emotions on all these fertility drugs.

Egg Retrieval
The egg retrieval procedure is performed as a same day outpatient surgery. My RE indicated the procedure takes less than 1 hr to perform. This should occur around July 1 - July 4.

Eggs are retrieved by a transvaginal ultrasound-guided aspiration procedure. Basically, during the procedure an ultrasound probe is inserted into the vagina to identify mature follicles. Then, a fine needle is guided through the vaginal wall and into the follicle where the egg is aspirated (retrieved) through the needle. I will be fully sedated throughout the whole procedure. So I hear, it tends to be pretty painful for a couple of days afterwards too, so I may be home guzzling Gatorade and sitting with a heating pad for a couple days. I see Game of Thrones or Arrested Development reruns in my future...

There are many variables that influence the number of eggs that will be retrieved from any one woman.

Fertilization
Shortly after egg retrieval, eggs are placed with motile sperm in a petri dish. Our RE automatically takes this process one step further with a procedure called intracytoplasmic sperm injection (ICSI - pronounced: icksy). During ICSI, a single sperm is injected directly into each healthy retrieved egg. Thereafter, the sperm injected egg is placed in individual petri dishes with nutrients where the eggs will hopefully fertilize and become embryos.

The day after the egg retrieval we will receive a report on how many eggs fertilized successfully. Fertilization is documented by the presence of two nuclei. One nucleus is from the sperm and one is from the egg.

Embryo Culture: A Three to Five Day Process

Day 1: After fertilization, the nuclei from the egg and sperm fuse and the cellular division process of the newly created embryo begins.

Day 2: The embryos are carefully monitored for growth and proper cell division. The embryos are growing from a two-cell embryo to a four-cell embryo.

Day 3: The embryos are in the six to eight-cell stage now. Depending on the number of embryos, day three may be the transfer day. If three or more eight-cell embryos are present, a 5-day transfer is very possible. Five-day transfers allows for better embryo selection since some of the embryos will not progress beyond the eight-cell stage. The decision on whether to do a 3-day or 5-day transfer is largely dependent on the number of embryos present and their quality.

Day 4: Eight-cell embryos that continue to grow and develop will now be at the morula stage (15-32 cell embryo).

Day 5: The embryos who make it to day five, form a cavity called the blastocoel (which is why the embryo can now be called a blastocyst).

Everyone going through IVF hopes for embryos that are strong enough to make it to a 5-day transfer.

In summary, there are three critical development points that must occur if a 5-day transfer is to take place:
Fertilization
Four to eight-cell embryo stage
Morula to Blastocyst Stage

Embryos are “graded” using a numeric grading system with a Grade 1 embryo being the best and a Grade 4 embryo being the worst. It is important to know that the grade an embryo receives is no indication whatsoever about whether it will become a healthy or unhealthy baby. The grade is meant to only give doctors and their patients a means by which to measure the viability of any one embryo. A Grade 1 embryo has a much higher chance of actually implanting into the uterus and becoming a viable pregnancy whereas a Grade 4 embryo’s chance of becoming a viable pregnancy is not impossible, but very unlikely.

Obviously, we will be hoping for many Grade 1 embryos that can make it to a 5-day transfer! My RE seems confident that we will have a 5 day transfer, but no absolute guarantees.

Embryo Transfer
During the embryo transfer, the doctor inserts a catheter through the cervix into the uterus and transfers one or more embryos. The embryo(s) is/are strategically transferred to the particular place an embryo would naturally implant in the uterus. If the embryo continues to develop in the uterus, it will hatch from the egg’s outer layer and implant into the uterine lining approximately six to ten days after the egg retrieval.

Depending on a woman’s age and the viability (grade) of her embryos, the American Society for Reproductive Medicine recommends transferring one to three embryos. We plan on transferring two embryos!

A video that quickly explains it all:



Cryopreservation

What to do with any “left over” embryos?

Any remaining embryos following the embryo transfer can be frozen for future use.
This is perhaps the most controversial aspect of the in-vitro fertilization process.

If there are any “extras” and the first cycle of IVF fails, we will not have to go through any of the first four steps described in this post. A certain number of frozen embryos will be “unfrozen” and then transferred into my uterus at a third of the cost of this first, fresh IVF cycle. This is called frozen embryo transfer (FET). This also means either coming back to Reno for an FET OR transferring our frozen units to another RE in the PA area.