The Infertility Guidebook
Stage 6: IVF (In-Vitro Fertilization)
Cost: $10,000 – $20,000
*Meds and dosages significantly impact the cost of IVF, since you need so much of it for this. PGS testing and frozen embryo storage will also make a big difference in your cost, should you need either of those.
Meds: Birth control pills, FSH (Gonal F / Follistim), Menopur, Ganirelix, Trigger shot (HCG or Lupron), Progesterone
IVF… you’ve made it all the way here! First of all, I’m sorry. I’m sure it’s been a beatdown getting here, and it probably hurts your heart. You might be feeling like a failure; like you’ve let down yourself, your husband, your family, your bank account. You might be struggling with how to reconcile this with God. You might be struggling with how to reconcile this with your own plans and dreams. It’s a lot to work through.
I won’t tell you not to feel any of those things, because I know firsthand that’s not possible. My best advice is to find a support group at this stage. (Heck, find one sooner, if you can!) Whether online or in-person–or better yet, BOTH–the support and advice you’ll get in one of these groups is irreplaceable and absolutely necessary. I was lucky enough to fall into an amazing infertility support group, but not until after my miracle baby was born. I can’t even express how much I wish I’d had those ladies by my side while I was going through it. Send me a message if you want more info; we’d love to have you.
Now, underneath all that angst and sadness is probably a bit of excitement too, right? You’re about to have the best chance you’ve ever had at getting pregnant – it’s about to get REAL.
I use the term “about to” loosely, because IVF is a loooong process. From the day you decide to go forward with IVF, to the day you take a pregnancy test can be anywhere from 2 – 3 months. Hellooooo, buzzkill!
Here’s the rough process, broken into four phases:
Phase 1 – Testing:
- Wait for your period to start.
- Between days 6 – 10 of your cycle, your doctor will perform a hysteroscopy (HSC). She’ll insert a small camera into your uterus and then fill your uterus with saline to inflate it so she can look around, and make sure there are no polyps, fibroids, or scarring. This is not fun. Make her give you Valium before performing this kind of medieval torture on you.
- At some point in the middle of your cycle, your doctor will do a mock transfer. She takes a catheter and essentially pretends to transfer an embryo into your uterus, while a nurse does an ultrasound and takes pictures to see where she’s going. She’ll take measurements, and basically make herself a little treasure map of your uterus, so when she’s got your precious cargo on board, she knows exactly where to go, and can be in and out without disturbing anyone (except, ya know, you). You have to have a super full bladder for this one, because, obviously, it’s not uncomfortable enough as it is.
- More blood work. This time they’re looking for infectious diseases, since they’re going to be messing with your DNA in the lab.
- You’ll do a med training session with the nurse. Because you’re essentially going to be a nurse by the end of this (not really–nurses are amazing and take lots of really hard classes in school to do what they do. But it’s gonna feel like it, damn it.).
- You’ll sign 400 pieces of paper, and answer a lot of really hard questions. What happens to your embryos if you die? If your partner dies? If you both die? What if you move out of state? You won’t sue the clinic if you get pregnant with octuplets right? It’s a lot like buying a house… if you only had a 60% chance of actually getting to live in the house when it was all said and done.
Phase 2 – Ovarian Stimulation (Stims):
- Wait for another period. Once it starts, you’ll start 10 days of birth control pills. This makes no logical sense, but just roll with it, okay?
- On day 15-16ish, you’ll start Menopur and FSH injections. Yep, two injections a day, right off the bat. The FSH is to grow the follicles, and the Menopur is to mature them. You’ll do this for about 10-12 days.
- Throughout all of these injections, you’ll go to the RE every other day for ultrasounds to monitor your follicle growth and blood work to check your estrogen levels. Your arms will be black and blue by the end of the month from all the blood draws, so at least you’ll have that to show for it.
- About 6-7 days in, when your follicles start to mature, you’ll add in yet another daily injection of Ganirelix. This is to prevent you from ovulating on your own.
- Once your follicles are mature, you’ll do a trigger shot. (In a swift & dart-like motion, don’t forget!) There are two different options here, either Lupron or HCG. If your Estrogen levels have been trending up too high, then you’ll be at risk for a condition called Ovarian Hyper Stimulation Syndrome (OHSS), which is caused by HCG interacting with all the excess estrogen (or something like that… I’m not a doctor, what do I know?). So, if your Estrogen levels are too high, your RE will probably recommend a Lupron trigger instead of the usual HCG trigger. More on this below.
Phase 3 – Fertilization:
- Two days after your trigger shot, you’ll go in for your egg retrieval. You’ll be put under anesthesia, and then you’ll wake up, talk some smack to the anesthesiologist and nurses (but you won’t remember it, so don’t worry about that), and ask your husband and doctor 47 times how many eggs they retrieved. Anesthesia is fun.
- While your doctor is busy stabbing your ovaries repetitively with a small needle, your husband will be in the room. Doing his thing.
- The embryologist will take the eggs retrieved and toss them in a petri dish with your husband’s goods (or donor goods), and let them do their thing. Another option is called ICSI, where they actually manually fertilize the eggs with the sperm individually, but it’s for extreme cases only.
- You’ll likely find out the next morning how many of your eggs fertilized.
- And then… you wait. Three long days. The good news is, you can do whatever you want during this time! Drink all the wine! Do cartwheels! Jump on trampolines! Guzzle coffee! DO ALL THE THINGS. Your future babies are outside of your body; you cannot hurt them. The bad news is, you may not be able to do any of those things because you’ll be too busy doubled over in pain/vomiting/passed out due to the outpatient surgery you just underwent. Ya win some, ya lose some.
- On day 3, you get a Day 3 growth report, and it’s the scariest, most exciting phone call of your life. Have a pen & paper ready, and write down every word the embryologist tells you, because you just might black out and forget. Or maybe that was just me. At this point, they can tell you how many are Fair, Good, and Excellent quality. The goal is for the embryo(s) to make it to Day 5 (or 6), when they’ll either transfer it back into your uterus, or freeze it for later.
Phase 4 – Transfer! (AKA, KNOCKING YOU UP)
- There are two options for this: either a Fresh Transfer, where they transfer an embryo back into your uterus on Day 5 (or sometimes Day 3, if they think an embryo will grow better in your uterus), during this same cycle; or a Freeze All, where they freeze all the embryos that make it to Day 5 or 6, and do a Frozen Embryo Transfer (FET) a month or two later when your hormones have calmed down and your body is back to normal. This is typically what’s done when a doctor suspects you’ll have OHSS, as I mentioned above, and opts for a Lupron trigger, or if you do an HCG trigger and it does cause OHSS. Since OHSS is caused by HCG (the pregnancy hormone), pregnancy makes it much, much worse and can be very dangerous, both for you and the baby. It’s worth it to wait it out if you’re at risk for it.
- Fun fact: Since I have PCOS, I was at a higher risk for OHSS, so my RE prepped me all along for a Freeze All cycle. We only ordered a Lupron trigger, and though I was anxious to get pregnant ASAP, I had emotionally accepted that I was going to have to wait yet another month for it. And then, at my last follicle scan, my estrogen was still low enough that my doctor said psyyyyche, let’s do a fresh transfer! and I had 12 hours to find an HCG trigger locally. A week later, there was a baby in my belly! Moral of the story: don’t ever make a plan, ever, when trying to make a baby. But you probably know that by now.
- SO, head over to the FET page for info on that route. If you’re doing a Fresh Transfer, you’ll start progesterone supplements a few days after your retrieval (either a gross suppository or more shots, yay!), and head to your clinic on Day 5 with a full bladder. They say the full bladder is to help the ultrasound see your uterus but that sounds fake, so I’m pretty sure it’s just give you one last dose of torture. I mean, as if you’re not already nervous enough, they make you come in literally about to pee your pants?!
- First, you’ll meet with the embryologist, who will show you your little embaby, make you sign yet another piece of paper about how many embryos they’re going to transfer, and then give you and your partner scrubs to put on before heading back to the OR.
- When you get back to the OR, it’s exactly like the mock transfer. It’s actually the only part of the whole process I’m grateful for getting to experience. You get to watch your baby be implanted into your uterus! That’s pretty cool.
- And then… the dreaded two week wait. This is the best of all the two week waits, though! For one, it’s only 9 days long! You’ve already technically done part of the wait, while the embryos were growing in the lab. And second, you’re considered “pregnant until proven otherwise” (PUPO). That means you get to kick your feet up and let your partner take complete care of you.
- 9 days post transfer, you’ll go in for the pregnancy beta blood draw. If you’re really patient and have nerves of steel, you’ll obey the doctor’s orders and not take a test prior to that. But if you’re a normal human, you will have peed on all the sticks by now and will probably have a good idea of what the results will be.
We were very lucky to get pregnant after our first IVF fresh transfer. Two years, a billion shots, and tens of thousands of dollars… and we still feel lucky to have had success at all. That’s the kind of perspective you get from this journey.
If your beta is negative, you still have a lot of options for your next step. You can try again with an FET cycle, if you had frozen embryos leftover. If not, you can do another round of IVF, and talk to your RE about ICSI or PGS testing. It’s not over ’til it’s over!
What to Expect:
- SHOTS SHOTS SHOTSSHOTSSHOTS SHOTS – I mean, if you haven’t gotten over that fear of needles by now, I can’t help you.
- Cramping – You’re basically going to have two cacti where your ovaries once were. RIP abdomen.
- Mood swings – Hormones, anger at the world, annoyance with the endless stabbing… it’s not so much mood swings as it is just a bad mood. Constantly.
- Bloating – Not only are you injecting yourself with all the hormones, but you’re probably eating all the comfort foods, and surprise! you’re not allowed to work out once your ovaries start getting big. See the point above.
- Cysts – After every cycle using injectables, I had monster cysts on both ovaries. These were next-level cysts after IVF meds.
*This should go without saying, but this is the internet and therefore it doesn’t: I am not a doctor and you need to consult your doctor about any kind of medical treatment.