If this is your first time stumbling on this blog because you're searching about IVF then, first of all, welcome. If you want some background information on our decision to be open about our infertility then click here. If you want to read about why we had to seek infertility treatment click here, and if you want to know about the typical IVF prerequisites then click here.
In my continuing saga of trying to get pregnant, this post, and the subsequent ones, will be dedicated soley to IVF (in vitro fertilization): the reasons we opted to go the IVF route, the IVF precursors, the IVF medications, and the IVF process. By the end of this post you'll probably be just as sick of IVF as I am. As I mentioned in the last post, before boarding the IVF train we did two rounds of Clomid, the second round paired with an IUI, and then we took a break from treatment while our insurance changed due to Chris's new job.
The break was actually kind of wonderful. We continued trying on our own but I stopped tracking my ovulation and obsessing over my period. Without the pressure of appointments, drugs, schedules, etc. I felt optimistic again. Even when I continued to have negative pregnancy test results I didn't completely succumb to sadness, instead I started thinking that, eh, maybe kids weren't in our future after all.
But of course we still wanted a kid. Finally, this past June, our new insurance was ready and Chris had made sure to opt for a plan that best covered fertility treatments. Back when we had begun the Clomid treatment I was adamant that I would not do IVF. I said that I would rather adopt because IVF seemed too invasive and much too expensive, not to mention that it seemed unnatural. Were we really willing to spend a small fortune on a test-tube baby? Fortunately, our new insurance gave us some financial wiggle room so we decided to go ahead and at least have an IVF consultation. We made an appointment with a different reproductive endocrinologist (RE) than our former one, this one in North County (the last one had been in Point Loma, which, for us, was too far a drive for bi-weekly appointments).
Right away I was happy with the new,closer location and the facility; a two-story office with couches for seating, dim lights, warm colors, and plenty of non-fertility related magazines to browse through. Then, upon meeting the RE and her staff, I felt right away that we had made a good decision selecting our new reproductive center. Everyone was friendly, professional, and female, the latter being particularly important to me because my former RE was a man and I never felt fully comfortable with him. He was nice and all but dealing with fertility treatment means many close encounters with your vagina and I would just much rather a woman checking to make sure things are working properly down there than a man (after all, we women are generally dealing with the same reproductive organs). After that meeting and seeing all the photos of babies conceived through IVF plastered throughout the facility and hearing the promising statistics of IVF full-term births we decided to throw caution to the wind and go all in.
After having our medical records transferred over from the previous doctor we were finally able to begin! After a vaginal ultrasound and then reviewing my medical history my new doctor asked about the length of my cycles and I told her that I usually got my period every 21 - 24 days and that they were short and light, typically 3-4 days. Based on these details she concluded that my body may not produce enough progesterone to keep a fertilized egg implanted in my uterus. Maybe I had become pregnant at some point in the years that we'd been trying but it didn't stick due to my short cycles. My former doctor had never mentioned this as a possible explanation for my infertility so it was news to me and finally something concrete that we could work with!
Even though we had only gone through two rounds of Clomid and one intrauterine insemination (which is fewer than the average rounds of Clomid and IUI for fertility treatment) we told our new RE that we were ready to ditch the Clomid and to go straight to IVF. We didn't feel like trying our luck again and were ready to bring out the big guns; luckily she consented to our wishes.
Apparently the "big guns" begin with birth control, which came as a complete surprise, considering I'd been off birth control for so many years precisely because I was trying to get pregnant. The reason for putting me back on it was to stabilize my hormones and to have control of my cycle in order to schedule the medications that I would be taking. Scheduling is everything in IVF. If fertility treatments had a personality type, IVF would be type A+. I took one birth control pill every day and had to skip the last 7 placebo pills, which trigger the period, and instead refill the prescription and continue taking the pills.
While I was prepping my body with the birth control I also had to undergo a hysteroscopy, a procedure that allows a doctor to look inside your uterus via a thin, lighted scope that enters through the cervix. There are many medical reasons for having a hysteroscopy but with my IVF treatment in particular it was done so that my doctor could get a blueprint of exactly where she'd implant the embroys once it came to that. Sounds easy enough, right? So six days before my 34th birthday Chris met me at the center where we were taken to an examining room which contained a machine that looked like it should belong in a torture chamber and not anywhere near my nether regions. To add insult to injury, we had to wait there for at least 30 minutes, me undressed from the waist down with a thin paper blanket on my lap, before our RE finally showed up. Then the fun began.
Spread eagle with the assistance of a cold, metal speculum inside of me, I laid back and tried to relax as my RE inserted the hysteroscope. I was staring at the monitor on the torture machine feeling a bit uncomfortable when she looked up at me, hesitated, and said, "The opening to your cervix is tiny because there's scar tissue covering most of it. It's the size of a pinhole so it's going to be a little difficult to get the scope through your cervix and into your uterus without causing you some pain. We can stop now and I can prescribe you some valium and we can reschedule." By that point I was already not feeling super great and I didn't want to have to go through the whole process again so I said to just get it over with. She told me to cough hard so she could try and shove it through. This process had to be repeated several times. Chris sat by nervously fidgeting and trying to hold my hand to comfort me while I focused on not passing out. I was praised for being tough, as if that would help. All in all the procedure was awful and I was so glad when it was finally over. She made a note to dilate my cervix during the egg retrieval so that the next time it wouldn't be as painful. The good news is that once it was inside my uterus everything looked good and ready to go!
After the procedure I got dressed and we met our Doctor in her office. She said that the small cervical opening I have, coupled with the low amounts of progesterone my body naturally produces, could be part of the reason we were having fertility trouble. So two out of the four doctors I'd seen believed the scar tissue covering my cervix was impeding my ability to get pregnant. Did I finally have an infertility diagnosis? No, nothing official, but I think of it as 50% physical and 50% unexplained.
Since the hysteroscopy revealed a healthy uterus we chatted about the next steps and decided on the potential IVF schedule. The most immediate step was to continue taking the birth control until August 13th. In the meantime, they would call in an order at a specialty pharmacy for all the drugs I would have to start taking in a few weeks. Then, on the 13th of August, we would meet with the RN who would instruct us on how and when to administer the drugs that would induce my ovaries to produce multiple eggs instead of the usual one egg that naturally develops each month.
In the midst of the IVF treatment that was rapidly consuming our lives, we managed to find a week during which we didn't have any doctors appointments or laboratory appointments. It happened to coincide with our friends' wedding in Northern California so we packed the car and drove north, first to San Francisco, then to Davis, then to Sacramento, and enjoyed the first and only vacation we were able to squeeze in this past summer. So fair warning if undergoing IVF, it'll be difficult to plan vacations ahead of time. But if you do find time to spend even a couple of days on a quick trip somewhere, perhaps a boutique hotel in your own city, then do it. IVF is stressful. Find ways to alleviate that stress and to bring some joy and relaxation into your life.
Soon after returning from our trip north we were delivered a box that contained our fertility accouterments: vials of synthetic hormones, a Sharps needle container, alcohol swabs, syringes, and countless needles of varying sizes. It was a dizzying amount of drugs, far more than I had anticipated needing. Little did we know that it was only the starter pack and we would soon have to order refills for everything, including the Sharps container. I was so intimidated and overwhelmed by the box of drugs that I didn't even bother to take them out and simply put the lid back on and shoved it underneath my vanity, where it remained for several days like an unwound jack-in-the-box, waiting for us to crank the handle and anticipate its release.
Later that week we went to our reproductive center for a drug administration tutorial. We learned that some of the injectable hormones I would be self-administering (like the Follistim) were already mixed and ready for injecting while others (namely the Menopur) would need to have a powder and diluent mixed together first before injecting - so very pharmaceutical of us. We learned about Q-caps, syringes, and the various needle sizes. We learned that with sub-cutaneous shots - the kind that go into fatty tissue (my abdomen) - the best way to avoid pain is to pinch while plunging. We learned that for the drugs to be most effective they need to be taken around the same time every day. We learned that these shots were going to stimulate my ovaries to mass produce mature eggs; the closest I'll ever get to being a hen. Basically, we took Nursing 101 in thirty minutes and then promptly forgot everything when we got home. Luckily we were given handouts with step-by-step directions for each procedure.
The night of August 16th was the first night I began taking the IVF medications. With Chris by my side I read and reread every detailed step on the print-out we were given and for 20 minutes carefully and slowly prepared the shots. Then I took a deep breath, held the syringe an inch away from my belly, and began to cry. Big, fat tears pooled under my eyes and streamed down my face. I had been focusing so hard on the straight-forward business of preparing the injection that the reality that I was about to stab myself fell upon me as soon as I held that syringe close to my skin.
Chris, always the pragmatist, wiped my face for me (which I couldn't do because I'd already sanitized my hands) and patiently urged me on. When I finally mustered up the courage to pinch my skin and push the needle through I was pleasantly surprised that it hurt far less than the anticipation of it had.
After the drama of the first night, giving myself the shots became easier despite never wanting to do it. For two weeks I shot myself in the stomach and never quite learned how to do it without giving myself a bruise. Did you know you can give yourself a shot through a bruise and it actually doesn't hurt? Yup, I learned that, too. And due to the inevitable dosage increases, some nights I even had to inject myself four times. Our social life also took a hit, as the medication had to be administered at the same time every night, meaning leaving a gathering early or waiting until afterwards to go out (which never happened). Yet, all of this was a consequence of the necessary evil we had chosen to undertake in order to get pregnant so, while not fun in the least, if I had to do it all over again I probably would.
Towards the end of the super fun hormone injection phase of IVF I was bloated due to my ovaries being full of eggs. My RN had described what was happening to them as balloons. She said to think of my ovaries pre-hormone injections as deflated balloons, during injections as balloons that are slowly filling up with air, and after injections as completely inflated balloons. She also cautioned that, just as a full balloon is more easily prone to popping, full ovaries are, too. Thus the laundry list of things I couldn't do: drink alcohol, engage in any type of exercise, lift anything over 5 pounds, dance, fast movements, or submerge myself in a hot, humid environment; think baths, hot yoga, jacuzzi, or suana.
Thirteen days after beginning the hormone injections I had my eggs retrieved, a process which I will share about on the next post. To end this post I just want to say that if you are thinking of IVF as an option and it sounds overwhelming and confusing know that it is. There are extra hormones coursing through your body, making you feel all kinds of way. Not to mention the scary sounding side effects that make you question every little ache and pain you feel. But, more importantly, know that this process will confirm just how strong, amazing, and resilient you are as a woman. Like I said before, there is power in facing your vulnerability and with IVF not only are you facing it but you're grabbing it by the horns and taking it for a ride.