Tomorrow is the big day when we should find out our schedule for IVF. My body once again has failed to cooperate and I ovulated early this month, which means my period started early this month. This throws off our schedule a bit, but I talked to the nurse this morning (I love my doctor’s nurse almost as much as I love my doctor) and she assured me it was ok. She’s going to make up my schedule today and we’ll go over the details at my appointment tomorrow.
So what exactly does IVF entail? Here’s what I know. You start birth control pills. Yes, I know, we’ve been trying two years to get pregnant and the first thing we have to do is start back on birth control?? Crazy, but true. The idea is to suppress the hormones that your body normally makes, and stop any follicles from developing naturally. We want to control the whole cycle. After a week or two on the pill, you get an ultrasound to make sure your ovaries are nice and quiet, then you go to the pharmacy and pick up about $1000 worth of medications. This is actually a bargain. If I were doing this anywhere other than UW, it would be more like $3000-$4000 worth of medications.
Here are just some of the fun medications I will get to take this month:
- The aforementioned birth control pills. I actually have a stash of these at home, hopefully they will just let me take those.
- Follicle stimulating hormone (Gonal-F). This is an injectable medcation that I will take each day for about 10 days. This stimulates the development of (hopefully) multiple follicles in the ovaries. The trick is we want to stimulate all the follicles to grow at the same rate. If one gets too big, it will keep the others from developing. The goal is more than 10. I’m hoping for 20. I’ve always been an overachiever. And actually, I completely made up those numbers so I don’t really know what we are aiming for.
- Cetrotide. This is a gonadotrpin releasing hormone (GnRH) antagonist. GnRH is a hormone made in the hypothalamus that stimulates the pituitary to produce LH and FSH, the two hormones that control follicle development and ovulation. Once you have a follicle that’s about 14 mm, it makes enough estrogen that the brain thinks it is time to ovulate, and the GnRH stimulates an LH surge by the pituitary which then tells the ovaries to release their eggs. You don’t want that in IVF. You want to decide when to ovulate. So once one or more follicles are over 14 mm, I take a shot of cetrotide every day to block the effects of GnRH and prevent the LH surge. I will ovulate when I’m good and ready, thank you very much.
- Novarel. This is synthetic hCG (the hormone produced during pregnancy) which looks a lot like LH to the ovary, so it is used to trigger ovulation. It’s another shot. I’ll just take this once.
- Progesterone in oil, which from what I hear should be a really fun shot. This one is intramuscular which means big needle. This is used to get the lining ready for implantation. I think I start this right around the time of egg retrival.
So once we get ovulation under our control, we have to get the eggs out. Because that’s what in vitro means–“in a petri dish” (ok not really, I don’t know what it means, but it bascially means we are conceiving our child in an incubator). 36 hours after the trigger shot, I’ll go in, get put to sleep and my doctor will suck out the eggs. We are all better off not imagining how this is done because it involves needles in places where there should never be needles. I’ve seen this done before, and it is basically like a video game. Find the follicles, suck out the eggs, repeat.
The eggs are handed off to the embryologist, who mixes them with the sperm that was provided earlier that day (seriously, that’s all the guy has to do in this whole process) and they get stuck in the incubator. The next day they check to see how many fertilized. They keep watching them for 3 days. On the third day they check to see how they are doing. If there are a few that look really good and the rest look crappy, we’ll go ahead and put those ones back into the happy uterus which has been primed with all that progesterone to accept the little embryo. If most of the eggs still look good, they will let them grow for two more days to see which ones are the true rockstars. Then I’ll go back on day 5 and have the embryos returned to their proper in vivo location (I know what in vivo means = “in the body”).
And then we wait, probably about 10 days. Pee on a stick and voila–success or failure. The whole process probably takes about 4-5 weeks depending on how long I stay on the birth control pills. I’m hoping we’ll be done by Labor Day weekend. I’ll update with my schedule once I have it. It’s going to be quite an adventure!!