IVF – one step closer

On Friday, we went to see our lovely charming fertility doctor for the next stage of talks about IVF (he’s definitely getting more handsome each time we see him).

This session followed some tests The Husband and I had to have over the last couple of weeks to check we’re ok to get going. Thankfully, everything is fine - our HIV, Hep B & C bloods came back negative, my ultrasound showed a tiny cyst but the doc isn’t worried about it and everything else in there looked normal. Plus, The Husband’s sperm are plentiful and mighty (there’s about a zillion of them and they’re strong enough to swim through concrete - or something).

Actually, there is one small worry The Husband and I have about his sperm and my eggs. We both have an appalling sense of direction, so even though I have a good reserve and he has lots of strong sperm, what if they have no idea where they’re going? We sometimes amuse ourselves by imagining his sperm swimming frantically round the kidneys and my eggs trying to burrow their way into my liver.

Anyways...this is what we went through with Fertility Doc. We taped the session (with his permission) so I have a fairly detailed account of the discussion. It’s long but bear with it if you’re interested in finding out more about the IVF process:

1. s 1. As I have a decent reserve of eggs (FSH of 3.3 and AMH of 15.7), he thinks the Long Day 21 protocol is best for us, which is a six-week process.

2. I’ll be injecting Buserilin for two weeks from Day 21 of my cycle. As I understand it this will switch off the part of my pituitary gland that produces the hormones which stimulate my ovaries - effectively mimicking the menopause but without affecting the eggs. At this point, I could experience the joys of hot flushes, night sweats, sleep disturbance and mood swings (yay).

3. At the end of the two weeks, I have a blood test and scan to see if the Buserilin worked. If it has (let’s hope so, sounds like I don’t want to carry on taking that shit for longer than I have to), I start with Gonal F injections to stimulate the ovaries again to produce (hopefully lots of) eggs.

4. The Gonal F injections will also last for two weeks, during which time I’ll have bloods and scans on Days 5, 9 and 12. These should show how my follicles are developing – hopefully neither under- or over-stimulating. By Day 12, I should be ready i.e. I should have lots of lovely healthy eggs waiting to be collected.

5. Assuming that’s the case, I then go into hospital where they give me a light anaesthetic and shove a thin needle up my lady bits to collect the eggs from the ovaries. The Husband also comes in to give a sperm sample. Then they introduce the eggs to the sperm and hope they really really like each other and want to get it on (as The Husband’s sperm are good, it’s unlikely we’ll need ICSI and will go with conventional IVF).

6. They then leave eggs to grow and develop and hope around 50% will fertilise. The length of time they leave them will depend on the quality and quantity of the embryos. If we’ve only got a few that are good quality, they’ll put those back around 2-3 days later. If I’ve got lots of good quality embryos (more than five) it becomes survival of the fittest and they leave them for up to five days to get to blastocyst stage. By that stage, they know which are the best ones to put back so we have the highest chance of success.

7. At this point The Husband asked if they screen for imperfections, genetic problems etc. Fertility Doc said in a way they’re screening just by seeing which survive and which don’t. They’re screened on the basis of morphology i.e. what they look like under the microscope, how quickly they’re dividing etc. He then spoke about a much more in-depth, experimental screening which involves making a tiny hole in the egg and taking away a small sample of genetic material so they can analyse the genes and chromosomes. They don’t think this affects the egg but it’s such a new process, they don’t really know yet. There are only two clinics in the UK and two in the US that do it and they’ve only done about 40 of these procedures in the UK (for anyone who’s interested in finding out more, it’s called Pre-Implantation Genetic Diagnosis/Screening). They only recommend it for people who have tried IVF unsuccessfully 3 or 4 times or for women who are heading towards their mid-40s and have a higher chance of genetic abnormality in the embryos. But be aware, it doubles the cost of the treatment.

8. Back to my embryos...if they get to blastocyst stage, they’ll put back the best one or two (our decision at this point). This isn’t under anaesthetic as it should just have the discomfort level of a smear test. Once the embryos are safely back in, the progesterone support begins. We had a bit of a discussion here about whether I’d take suppositories or progesterone in oil (PIO) injections. As I have a short luteal phase and on occasion have had breakthrough bleeding on progesterone suppositories, he advised going for PIO – old-fashioned injections in the backside which, he said, ‘hurt like hell’ but which are necessary if we don’t want to take a chance of the lining breaking down (yay again). I may need to start these one or two days before they put the embryos back in depending on which day they’re put back.

9. And two weeks later you find out if you’re pregnant – simples!

After our discussion, we had a chat with the nurse about timing. We won’t be able to start this cycle as our egg collection could clash with the four days the clinic is shut over Christmas for deep cleaning. So it looks like we’ll be starting the following cycle which would mean injections starting around Christmas day. At least the clinic will be really really clean though.

Between now and then we go for a session with the nursing team to learn everything we need to know about the drugs and injections. We’ll also get a 14-page consent form where we sign our lives away.

And that’s where we are. How do I feel about it? As though I’m heading towards a dimly lit path signposted ‘The Unknown’. I hope as I travel along the path, it will progressively get brighter and that something – or someone – very special will be waiting for me at the end of it.

Until next time.

Juno ☺