Based on her personal experiences with IVF, author Monica Bivas created this journal to help you organize the process, handle stress better, and bring focus and clarity to your personal IVF journey. She created The IVF Planner both as an information guide and for you to write your own story. She touches on everything from the basics of the process to financing to a support network and more.
Bivas communicates that the IVF journey, no matter the end result-negative, positive, or even cancelled cycles-takes strength, takes courage, and teaches you to be disciplined. Though expensive and challenging, it's a journey to be proud of.
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THE BASICS OF IVF TREATMENT
The Struggle is Part of the Story.
A basic understanding of the IVF process is crucial before you begin treatment.
In vitro fertilization (IVF) places a woman's egg and a man's sperm in a laboratory dish for the purpose of creating a viable embryo. The fertilized eggs become embryos, and then several, based on how many are viable, are placed in the woman's uterus, where they hopefully will implant.
Every cycle is different, but most follow a basic system. To be prepared for your specific situation, you must understand how the cycle works. I've divided the cycle into five phases to make it easier.
This marks the beginning of your treatment, and it lasts a few weeks. Your body is being prepared for treatment, and you will have multiple appointments and tests at your clinic. You will receive schedules, instructions, medications, and so on from your RE and his or her team. Most women begin taking some medications in this phase.
A precycle includes some of the following tests and medications. A hysteroscopy and/or sonohysterography examines your uterine cavity for any issues. A semen analysis checks the quality, quantity, and motility of your partner's sperm. Both partners will be screened for infectious diseases, such as HIV/AIDS, hepatitis B and C, and chlamydia. Both will have to provide records from up-to-date physicals from their primary doctors. Some patients will take contraceptive pills during this phase to ensure their cycles will start at the right time or to regulate irregular cycles. Suppression medications are also given in this phase to ensure you do not ovulate too early. The RE will check your ovarian reserves to evaluate your egg supply. Some clinics use an follicle-stimulating hormone (FSH) or day 3 testing. It all depends on your RE and the clinic team. These tests, if they are performed, mark the close of the precycle phase.
This phase is all about egg production in the follicles. The main purpose of this phase is to stimulate the ovaries to produce multiple follicles or eggs instead of the single egg that is normally produced each month. This is necessary as not all eggs will be successfully fertilized. Retrieving more eggs increases the probability of having fertilized eggs. Keep in mind that fertilized eggs do not always develop normally, which is another reason for using multiple eggs.
During this phase, you will have regular transvaginal ultrasounds and blood work to check your hormone levels and ovaries. This part is also known as monitoring, which is done every other day. Based on the results of your monitoring tests, your RE will prescribe specific medications, adjusting them to your situation. You will also learn how many follicles are developing in each ovary. However, you must keep in mind that ultrasounds are not always accurate so there may not be a mature egg in each follicle. The exact number is known only after your egg retrieval.
Stimulation can last anything from a few days to two weeks. It is finalized with the trigger shot, a dose of medication given intramuscularly to induce ovulation and help the eggs to mature for fertilization. Your eggs will be retrieved between thirty-four and thirty-six hours after the trigger shot.
Egg Retrieval and Semen Collection
This is the procedural phase of IVF. Your RE will ask you to arrive at the clinic at a specific time and day for your egg retrieval. Most women are instructed not to eat or drink anything that morning. Other instructions may include not using perfume, deodorant, or scented lotions, which can interfere with lab procedures. Some clinics have a big team and allow your partner to be there during the procedure.
Additionally, many times it is not your RE who does the retrieval or transfer. This happens because clinics use work rotation schedules, especially when they have big medical teams. If you do not live close to the clinic, semen will be collected at the same site. However, if you live close, it can be collected at home and brought with you.
Once semen is collected, it is "washed," which means the sperm is separated from the seminal fluid and prepared for the fertilization process. Egg retrieval (also known as follicular aspiration) is a minor outpatient procedure during which the eggs are removed from your ovaries. Using ultrasound images for guidance, your RE inserts a very thin needle through the vagina and into the ovary. This needle is connected to a suction device that pulls the eggs out of the follicles one at each time. In most cases, an anesthesiologist provides intravenous medications so the patient sleeps through the procedure and doesn't feel a thing. You may experience some cramping and discomfort after the procedure, but this goes away within two days.
This procedure is done to both ovaries and only takes about thirty to thirty-five minutes. Once you are awake, your RE or nurse will tell you how many eggs were retrieved. After your eggs are retrieved, they are transferred to a lab and are kept in a warm environment similar to the environment in your fallopian tubes and uterus.
On the same day the eggs are retrieved, you will begin to take progesterone through either injections or vaginal or oral tablets, depending on your situation and your RE. Progesterone prepares your body for a possible pregnancy, helping the lining of the uterus get ready to receive the embryos.
Fertilization and Growth
After retrieval, your partner's semen and your eggs are placed together in a culture medium. A culture medium is a nutrient-rich substance that is used to cultivate microorganisms, providing ideal, specialized conditions for the egg and sperm and then resulting in the embryo. This is done with the hope that the sperm will enter and fertilize the eggs.
Depending on the quality, quantity, and mobility of the sperm, your RE may decide it is necessary to do an intracytoplasmic sperm injection (ICSI). Some patients also decide to do screening tests, such as a comparative genomic hybridization (CGH) and preimplantation genetic diagnosis (PGD).
Because these tests are expensive and not all clinics perform them, some patients decide not to do them. However, they are worth considering as they can help to find chromosomal abnormalities and diagnose previous causes of failed IVF. Assisted hatching is also recommended, depending on maternal age or previous failed IVF cycles. This is done before embryo transfer.
Embryo Transfer and Results
About three to five days after egg retrieval, depending on whether the patient used genetic testing, ICSI, or assisted hatching after fertilization, the embryos will be transferred to your uterus. A day 3 transfer means the embryo or embryos will be placed in the uterus after three days of growing in the lab; a day 5 transfer means they will grow in the lab for a total of five days.
The RE, clinic, and embryologists may change your transfer day, depending on how the embryo is growing. You might be set for a day 5 transfer, but if the embryologist determines that a day 3 transfer is preferable, your date will change.
On the transfer day, the most viable embryos are selected for transfer. The quality of embryos is usually determined by the number of cells an embryo has and how they fragment. Each clinic has its own grading system so this determination is very subjective. The Clinic Operations Chart in this journal has space for you to take notes about the grading system your RE and clinic team use.
When you arrive at your clinic for the transfer, your RE and embryologist will talk to you about the embryos' quality and the number to be transferred. Some clinics will even provide a picture of the embryos, which you can take home with you. Before the transfer, you might be given a mild sedative to help you relax. You will also be asked to drink water so your bladder will be full during transfer. Even though this is uncomfortable, it allows your RE to have the best access to the uterus.
A catheter is inserted through the vagina and cervix into the uterus, similar to an intrauterine insemination. Then a syringe containing the embryos is attached to the end of the catheter, and the embryos, cushioned by fluid, are pushed into the uterus. The waiting period after transfer depends on each clinic, but most will let you go after fifteen or twenty minutes of rest.
If you have extra embryos of a good quality, the clinic will offer to freeze them for transfer later. You will continue to take progesterone until the pregnancy test, which will be done ten to fourteen days after transfer and the HCG levels in your blood are measured. If the test comes back positive, it is repeated a few days later to see if levels of HCG are rising the way they are supposed to. You might be required to continue progesterone and any other support medications for a little longer.
Risks, Cancellations, and Possible Outcomes
Like any other medical treatment, IVF has some risks associated with it. The procedure may be canceled, even if it is already underway. My second IVF cycle was canceled because the dose I was told to inject myself with was too high. As a result, I got ovarian hyperstimulation syndrome (OHSS), which could be dangerous and even life threatening. Also the results of IVF are not always set in stone. A positive result on an IVF treatment does not always finish in a full-term pregnancy.
In this journal, the Clinic Operations Chart in chapter 3 will guide you through clinic-specific terms.
You can discuss these in detail with your RE and clinic team. IVF increases the risk of multiple-birth pregnancies, especially in women over thirty-seven years and when more than one embryo is transferred to the uterus at a time.
Fertility drugs can cause OHSS. When this happens, the ovaries become swollen and very painful as a result of developing too many follicles. You may experience bloating, vomiting, nausea, diarrhea, and abdominal pain. This may result in cancellation of your IVF cycle. It can last from a few days up to a week and can also be life threatening.
Here are some common causes for canceling an IVF cycle:
Premature ovulation, when the egg is released before the egg retrieval date
OHSS, which means that too many follicles develop at the same time
An inadequate number of developing follicles
Ovarian cysts, which can be detected before the treatment or develop during
An IVF cycle does not always end with a healthy, full-term baby. While that is well known, it is good to acknowledge all the potential outcomes so we are mentally prepared and ready to face unwelcome surprises. When a patient faces one of these situations, there is more waiting, testing, and decision-making. Your clinic and RE play an important role to help you through this part of the cycle. The best thing you can do to prepare is to be aware of all the possibilities — good and bad.
Even if the pregnancy is developing normally and you have a confirmation ultrasound, a miscarriage (MC) can still happen. The chance of a miscarriage is 15 to 20 percent, which is the same as the chance of miscarriage in a natural conception.
This occurs when the embryo implants outside the uterus or in a fallopian tube. The percentage of women having an ectopic pregnancy with IVF is 2 percent.
This is also known as an anembryonic pregnancy and occurs when the embryo attaches itself in the uterine wall and forms a pregnancy sac but does not develop.
This is also common in natural conception and is actually a very early miscarriage, which takes place before anything can be seen on an ultrasound scan — usually around the fifth week of pregnancy. It means that, even though the embryo attached to the uterine wall, it failed to survive.
Some Causes of Infertility
Many factors cause infertility, and every patient who goes through IVF or any other fertility treatment is unique. Below you will find some causes of infertility, but if you need more information, please talk with your RE or medical team. There is also a list of organizations later on in this journal that you can refer to for more information.
Unexplained infertility happens in about 10 to 20 percent of patients, and there is no known cause. Health conditions like thyroid disease, cancer, celiac disease, and other diseases can also cause infertility.
Fallopian tube blockage or damage makes it extremely difficult or impossible for a fertilized egg to reach the uterus. Ovulation disorders, such as irregular ovulation or follicles failing to produce mature eggs, can cause infertility.
Endometriosis, a condition when uterine tissue grows outside of the uterus, affects the functionality of the uterus, fallopian tubes, and ovaries. Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects fertility in women of reproductive age.
Sperm issues, such as low production, reduced motility, or abnormalities in shape, can make it impossible for the sperm to fertilize the egg. Premature ovarian failure occurs when women before the age of forty lose normal ovarian function. This happens because the ovaries do not produce a normal amount of estrogen or release eggs on a regular cycle. Finally, uterine and ovarian fibroids and cysts, which can grow in the uterine wall, interfere with embryo implantation.
This is just a short list of possible causes of infertility, but the most important thing for you to do is understand your own diagnosis. When you learn about your condition and what options are available, you are more prepared for what will come.
This journal includes a Diagnosis Chart (chapter 2) for you to record your medical information and options.CHAPTER 2
PREPARING FOR IVF TREATMENT
The difficulties of life are intended to make us better, not bitter.
Your IVF journey can be a stressful road, a roller coaster of emotions and surprises. Even when things seem to be going perfectly, unexpected situations can arise. Here are a few tips on how to prepare for your IVF cycle and make the process smoother and more positive.
Understand Your Treatment Cycle
Not knowing what to expect can be stressful and make the treatment more difficult. The outcome of an IVF cycle is always unknown, so do not focus on the "what ifs" or your worries about it. Instead I suggest you focus on the treatment in a positive and calm way. How? Well, make your best effort to understand the treatment itself, your diagnosis, and all the possible outcomes before you even start. By doing this, you demystify your treatment and are more mentally prepared for any possible outcome.
Organize Your Time
IVF treatments generally follow a basic timeline, but they can still be unpredictable. Unexpected changes can create stress and uncertainty when they force you to alter your schedule.
I recommend adopting a flexible mind-set so you are less bothered by unexpected changes.
Waiting is also something you must be prepared for. IVF involves a lot of time spent waiting, which can be very time consuming.
If you work, my suggestion is to give notice to your manager about your IVF treatment. If you don't work and are a housewife, organize your schedule so that you have flexibility.
Think About Your IVF as a Positive Journey, Not a Destination
IVF cycles are not quick treatments. There can be many months between finding out this is your only treatment option and the final conclusion of an IVF cycle. In some complicated cases, treatment can take years.
I am not saying this to scare you. I just want to prepare you in case your treatment takes longer than you expected. This is why I call it a journey. You can find more information about the success rates of IVF cycles at the Society for Assisted Reproductive Technology's website (www.sart.org).
Find a Network and Group Support
IVF is not an easy road. Sometimes we might find it difficult to share the journey with others — even with close family. But it's important to realize it is not healthy to walk this road alone, which is why I recommend joining or forming a support group of women who are also undergoing treatment. You have no idea how much a supportive group who know what you are going through can help. I have also seen many women build long-lasting friendships in the support group that I host. Facebook, Twitter, Instagram, and Pinterest are great sources for finding IVF and fertility support groups.
Using the Charts
The first charts in this journal cover your diagnosis information and IVF treatment plan. I suggest you complete the Diagnosis Chart ahead of time so you are less stressed about explaining your medical situation.
The Diagnosis Chart can be completed when you meet your RE, so make sure you ask for a detailed explanation of your diagnosis. Based on this, your RE will provide you with the necessary information and the plan he or she recommends. Make sure you take detailed notes of all he or she says.(Continues…)
Excerpted from "The IVF Planner"
Copyright © 2018 Monica Bivas.
Excerpted by permission of Balboa Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Part 1 — The Basics of IVF Treatment, 1,
Chapter 1 — The Basics of IVF Treatment, 2,
Chapter 2 — Preparing for IVF Treatment, 10,
Part 2 — Medical Providers and Clinics, 16,
Chapter 3 — Your Medical Team, 17,
Part 3 — Finances, 29,
Chapter 4 — IVF Treatment and Your Finances, 30,
Chapter 5 — IVF Treatment and Taxes: US Citizens Guide, 39,
Part 4 — The IVF Cycle, 43,
Chapter 6 — IVF Cycle Scheduling, 44,
Chapter 7 — The Cherry on Top: Medications, Stimulation, and Procedure, 49,
Part 5 — Your Wait Time and Results, 73,
Chapter 8 — The Two-Week Wait (2WW), 74,
Chapter 9 — Preparing for Your Results, 91,
Chapter 10 — Dealing with the Results, 96,
Part 6 — Mind, Body, and Spiritual Support, 100,
Chapter 11 — Surviving the IVF Emotional Roller Coaster, 101,
Chapter 12 — Gathering Your Support Network, 117,
Part 7 — FET and Multiple Cycles, 122,
Chapter 13 — FET and Multiple Cycles, 123,
Part 8 — Glossary of Acronyms and Terms, 135,