Everyone tells you that IVF is a process. It’s not just one procedure. It’s not just a magic pill. It’s not one set of injections. It’s a process. And like any good process, it has a great deal of preparation that goes into it.
I mean a great deal.
My first time through IVF was a flash of paperwork and presentations and monitoring. The nurse I had at that particular clinic was not very forthcoming with information, and I found myself having to piece together the process by myself. I don’t recommend this to anyone. If you find yourself in this situation, sit your nurse and/or doctor down and tell them that you need them to slowly go through everything step-by-step for you. Don’t feel ashamed–it’s their job to do this and clearly they haven’t done it.
Unfortunately, every clinic is different, so I can’t give you a true step-by-step that will be accurate for everyone. But I can explain this cycle in progress and the previous cycle and give you an idea of the prep-work involved.
1. The Testing
No, it’s not torture. But it can be close to it depending on the tests you haven’t yet done or that are outdated. At a bare minimum, clinics are required to have test results on you from the past year on infectious diseases and structural abnormalities. This requires one or more blood draws (with several tubes) and an updated sonohystogram or hysterosalpingogram. A sonohystogram is a procedure where saline solution is placed in your uterus and ultrasound technology is used to clearly view the inside of your uterine cavity and somewhat into the Fallopian tubes. A hysterosalpingogram or HSG is similar, but is done using a dye (in lieu of saline) and an x-ray machine. My sonohystogram was fine. The HSG I had a couple of years back was not fun at all, but it wasn’t horrible.
You may also elect to do other tests at this time, including genetic screening on you and your partner (if you are using your partner’s sperm). These tests can screen for things like cystic fibrosis and Fragile X syndrome. They can only tell you if you and your partner are carriers, though…it can’t determine for certain whether your embryos will inherit such genes.
Depending on your age, some clinics require additional testing for those more advanced in age (35 and over and 40 and over). This may include a mammogram and/or colonoscopy.
2. The Paperwork
IVF is a medical treatment, no doubt, but it also raises several legal questions. Your clinic should go over the consent forms with you carefully and indicate where you need to make certain decisions. Things you’ll want to think about prior to signing the forms include what you want to happen to unused embryos in the event of your relationship ending (or marriage ending in divorce) if you are in a relationship as well as what your wishes are for the embryos if one or both of you dies. They’re hard questions and not ones you’d think you should have to face prior to even getting pregnant, but those who have to deal with infertility often have to face these questions earlier than most.
You will also have to sign consent forms for the use of ovarian stimulation medications such as gonadotropins, for the use of technology with your embryos (such as assisted hatching or, if you choose to do it, preimplantation screening and diagnosis).
Each clinic has it’s own legal releases and various terms and conditions associated with participating in its IVF program. While it’s up to the staff to inform you of these policies, it is up to you to research them and determine if they are reasonable for you.
3. The Down Regulation
Once all of the formality is out of the way, it’s time to get to work. Well, almost. The first month or so of the process is the down regulation period. This is the process of getting your ovaries to essentially shut down for a moment and your cycle to become synced with the schedule of the program.
The first step in down regulation is birth control pills. Yes, you have to take birth control pills to get pregnant through IVF. Go figure. You start these approximately six weeks or more before your actual retrieval and transfer dates. You’ll be on them for 3-4 weeks depending on how your clinic runs.
In my experience, fertility clinics run their IVF program one of two ways: (1) the no-structure method where the clinic follows the dictates of each patient’s cycle as it develops and the clinic does not have a set IVF schedule; or, (2) the scheduled method where the clinic schedules all of its IVF procedures (egg retrievals and embryo transfers) to occur within a window of time on the calendar and down regulation is used to phase people into this schedule. My first round of IVF was done the first way. This round is done the second. There are advantages and disadvantages to both ways and some ways work better for smaller clinics than for larger clinics.
After the birth control has started to regulate your system, you are given another drug, usually Lupron, to stop your ovaries from producing any follicles whatsoever. Lupron is a drug used to treat prostate cancer, but also acts to repress certain hormones. This drug is given through abdominal injections once a day. You remain on Lupron until your egg retrieval, though the dose changes. The birth control stops once you start your stimulation meds.
Next up: the stimulation cycle.