The Six Stages of IVF (in newbie-friendly language)
After a recent planning meeting with my reproductive endocrinologist (RE), I share what my six stages of IVF will look like (in newbie-friendly language). For me, a gal with unicornuate uterus and diminished ovarian reserve, these stages will include ovarian supplements, ovarian stimulation, egg retrieval, diagnostic tests, uterus prep, and the frozen embryo transfer (FET).
“Happy Dreams and Sperm Dates”
I’m not sure if I believe in God.
But there are moments in my life that consistently re-affirm that there’s something mysterious going on out there. You know, those magical coincidences that send shivers down your spine and cannot be explained away by chance. Maybe the magic comes my perception in the moment? Or maybe it really is divine intervention? Either way, something magical happened to me last week.
This past Thursday, Cory, my mom, and I met with my IVF doc for our “re-group,” a second meeting in which the details and timeline of the IVF process are laid out by the doctor. I was nervous for this meeting. Somewhere in the back of my mind, I had this fear that the doc was going to pull the rug out from under my feet and tell me that I was no longer a candidate for IVF. That my unicornuate uterus actually was just a little too wonky to work. That my old lady eggs actually weren’t going to cut it. I was expecting the worst.
So to say that I felt uneasy as I sat in the waiting room at Conceptions Reproductive Associates, waiting for Cory and mom to arrive for the appointment, would be an understatement. I waited alone. Paid my co-payment. Quickly finished my lunch. Checked the time on my phone. Liked a few statuses. Flipped through my fertility binder. I needed something to break the nervous energy.
Just then, the door to the office opened. My mom and twin sisters walked in. That’s when the magic happened. Re-affirmation of the divine mystery. Maybe there is a God. All of my nerves vanished when I saw her. My mother. Wearing the same exact outfit as me. Unplanned. It was just too silly and too magical to feel nervous anymore. We bust out laughing, and my twin sisters snapped pictures. The universe knew I needed a laugh, and so somehow we were inspired to wear the same exact shirt dress. A shirt dress we haven’t worn, we both admitted, in over a year! Was our twinning just chance, or was it something more? Today, I choose to believe in a magical force. I mean, I kind of have to. I am a Unicorn.
"Today I choose to believe in a magical force...
...I mean, I kind of have to. I am a Unicorn."
With the nerves gone, I was ready to take on the appointment. My mom, Cory, and I sat in front of Dr. Bush’s large oak desk in his fancy pants office. He spent over 30 minutes outlining the IVF process and timeframe, slinging medical terminology and citing all the best research. In general, he made the information user-friendly. I walked away feeling hopeful and informed. Now, I will now do my best to interpret his explanation into Kristen language. Here is my understanding of the IVF journey I will be embarking upon, broken down into six main stages.
Stage 1 (July-August 2018): Ovarian Health Supplements, AKA: Egg Health Boot Camp. Because my eggs are so bad, I need to start by taking a millions supplements for eight weeks. I imagine that all the nourishing goo will travel down to my ovaries, nuzzle up against my unhealthy eggs in their individual sleeping bags (i.e., follicles), and gently encourage them to wake up! Rise and shine, sleepy things. It’s a new day, and Kristen needs you to be at the top of your game in two months’ time! My eggs reluctantly get up, dust themselves off, and start doing some stretches. One particularly enthusiastic egg, Junior, jogs around the lazy others, offering words of encouragement. “Our strength grows out of our weakness!” and “Wake up. Work out. Look hot. Kick ass!” Junior passes out sweat headbands and jump ropes. The Rocky theme song slowly swells in the background. Punching bags are hit. Stairs are climbed. Protein shakes are consumed. Mission accomplished.
Also during this first stage, I had to complete a “Genetic Carrier Screening” blood test before starting IVF to see if I am a carrier for diseases such as Cystic Fibrosis and Fragile X Syndrome. This past Thursday, I gave six vials of blood (oof) and a urine sample to check if I am a carrier for genetic disorders.
Stage 2 (early September 2018): Ovarian Stimulation, AKA: Egg Beast Mode. Now that my eggs are super fly after two months of supplements, stage two will stimulate them with a ton of injectable medications so they all mature at the same rate. As we all learned in 8th grade health class, usually only one egg matures each month in the ovaries. Even though women have multiple immature eggs in the ovaries at any given time, only one matures and is released. All the other immature eggs are housed in ovarian follicles, or fluid-filled sacs, within the ovaries. (Bodies are cool, aren’t they?!) I have 12 “resting follicles” with 12 immature eggs at any given time. The meds I take in stage 2 will trick my body into maturing all eggs at once. Arise, all yee eggs! The time is now! Look alive!
I’m feeling really nervous about this stage. First, injectable meds for about 10 days? Ouch! My doctor told me that since my AMH levels are so low, he is going to put me on one of the most aggressive stimulation protocols he has. This makes me think I might be taking more meds than normal. I’m really anxious about what I will feel like with so many intense meds coursing through my body. And the needles! Even though Cory isn’t the best with needles, he told me a couple weeks ago that he’d give me the shots. (What sweet sacrificial love!) Even with all this anxiety, I know I can do it. I have a couple friends who have gone through IVF before, and they all have said that the injections are definitely doable. Another thing I’m really nervous about is the price. These meds are super expensive and not covered by insurance. Double ouch! I guess that’s just the nature of IVF.
Stage 3 (mid-September 2018): Egg Retrieval, AKA: Happy dreams and sperm dates. After as many eggs as possible mature with the stimulation meds, my doctor will go into my ovaries and suck them out through a needle. Thankfully, I will be under anesthesia during this surgery. Watch this short video below to see an actual egg retrieval procedure!
My favorite quotes from this video are: “The woman does not feel the needle coming in because she is asleep and having happy dreams.” and “Later that day, they (the eggs) will have a date with sperm.” That is how I’ll think of this stage going forward: happy dreams and sperm dates! (I’m grateful for my creative coping strategies during this process.) ;) After the eggs are sucked out of my ovaries, they are transferred to a petri dish in a highly scientific lab filled with white coats and microscopes. This is where the sperm date will take place.
Stage 4 (October 2018): Diagnostic tests, AKA: What's going on up in there? In October, my doctor wants to do some tests to better characterize my unicornuate uterus before we implant an embryo. Specifically, we will do an HSG, a radiology procedure where radiographic dye is injected into my uterine cavity. The dye fills the uterus and fallopian tubes.
This will help my doctor better understand the nature of the connection between my right-sided unicornuate uterus and my left-sided uterus nubbin (called a “rudimentary horn” - weird, right?). In my body, these two uterus halves are connected by a long strand of tissue. In the pictures below, you'll see my right uterus (left side of the picture) and my left rudimentary horn (right side of the picture), connected by a long piece of tissue. We aren’t sure if this connective tissue is “communicative,” a fancy word meaning that there is an opening through the tissue that allows fluid to move from one half to the other.
This fancy radiological procedure will essentially help us figure out if the tissue is more like bucatini or spaghetti. :) If the tissue is open like bucatini, there’s the risk that an embryo might accidentally float through the tube and implant in the nubbin (really dangerous). If the tissue is closed like spaghetti, then we’ll know there’s no chance the embryo could escape.
Stage 5 (November 2018): Uterus Prep, AKA: Fixer Upper Uterus Edition. In this next stage, we will be taking my fixer upper uterus and transforming it into a cozy abode any embryo couldn’t resist. Through another 10ish day round of intense injectable medication, we’ll add so much metaphorical shiplap, one tasteful accent wall dressed with graphic wallpaper or a vintage map, and large farmhouse style sink. But don’t worry. While the original character and charm from my unicornuate uterus won’t be transformed, the uterine lining will be! We’ll get multiple offers above asking price. All the embryos will want in, but only one will be allowed (due to tight quarters, of course).
Stage 6 (December 2018): Embryo Transfer, AKA: If you like it, then you better put a baby in it. After six months of preparation, this is the stage where an embryo (if we ultimately have a viable embryo) is finally placed in my uterus!
After the embryo transfer in December, I’ll be asking for all the positive vibes and prayers to the Almighty One Who Inspires Mother-Daughter Twinning.
While I’m so overwhelmed by this process, I’m hopeful. I’m especially hopeful thanks to your support. I am thankful for the questions and well-wishes about the process from coworkers, friends, and family. (“Ovarian torsion really does hurt! Worse than childbirth.” “How’s life outside of work going?” “How did your appointment go?”). I am exploring new coping strategies weekly. This week’s coping strategies are: Mipso (my new favorite group); hugs and support from coworkers; Zevia cream soda (so bomb); Quick trips to Ulta Beauty just so I can sniff the Dolce and Gabbana Light Blue perfume (it’ll have to do until I can afford to buy it...someday long after this IVF process is over); Dark chocolate covered almonds. And last but definitely not least:
Writing this blog.
Thank you all for the support and allowing me to share my story, stages 1 through 6.