Your First IVF Cycle

When you first start IVF, it can be daunting. I remember feeling excited and hopeful but also overwhelmed. Some weeks fertility treatment felt like a full-time job. Today I want to share what a typical IVF cycle looks like. 

1. Paperwork. Police checks, child protection checks, consent forms and payment forms. 

2. Mandatory couple’s counselling.

3. Blood and urine tests. This includes testing for infectious diseases and checking your hormone levels.

4. Pelvic ultrasound. To assess your uterus and check for any abnormalities, e.g., cysts.

5. Semen analysis. To measure the number of sperm and their ability to move. About 40 per cent of infertility is attributed to sperm. 

6. The Anti-Mullerian Hormone (AMH) blood test. A hormone secreted by cells in developing egg sacs (follicles). The level of AMH in your blood helps predict roughly how many eggs you have left. 

   
   

   Day 1-11

   • The first day of my IVF cycle was day one of my period.

   • I took a 75 daily dose of the Gonal-f injection (a moderate dose because I had several follicles). The nurse was quick to point out that I needed to inject myself at the same time every night for it to work. Gonal-f helps to stimulate your ovaries to over produce eggs.

   Day 6 -12

   • Every two days, I would visit the hospital before work for an ultrasound and blood test to monitor my follicles and to check my hormone levels (progesterone and oestrogen).

   Day 9-13

   • Towards the end of my egg stimulation phase, I started to take the Orgalutran injection. This is used to prevent you from ovulating too early.

   Day 14

   • Ovidrel injection, the ‘trigger’ shot. The injection to make you ovulate. The timing of this injection is crucial as it needs to be taken at precisely 36 hours before your egg retrieval.

   Day 16

   • Egg retrieval surgery. This is a day procedure where the eggs are collected from your ovaries. Under general anaesthetic, an ultrasound probe is inserted into your vaginal wall to identify follicles and then a needle is guided through. The needle goes into each of the ovarian follicles and gentle suction is used to pull out the fluid and the egg that comes with it.

   • It only takes about 30 minutes, but I was in hospital for half the day with pre surgery checks, paperwork, and a couple of hours in recovery. For two to three days after, I experienced cramping, and bloating

   • Once the eggs are collected, they are fertilised. We fertilised our eggs using Intra Cytoplasmic Sperm Injection (ICSI). This is where a single sperm is injected into each egg. It is often considered your best chance of fertilisation because there is no risk of the sperm swimming aimlessly in the petri dish unable to find an egg.

     
     

   My results

   • Eleven eggs collected, a good result. In later egg collections, with a higher dose of Gonal-f, I collected 15-20 eggs.

   • The next day, the nurse called to say that out of eleven eggs, nine had fertilised. On average, around 60-70 per cent off mature eggs will fertilise.

   • On day five, she called again to say five embryos had made it to blastocyst stage and were being frozen.

   • A blastocyst embryo is an advanced stage of development. Blastocyst embryos are graded – A, B, and C. Simply put, A and B are the best; they have well defined and smooth cells. In contrast, C embryos have irregular and dark cells and few of them. The only true way to measure the quality of an embryo though is through Pre-Genetic Screening (PGS) testing.

   • Before they’re frozen, the embryos also undergo assisted hatching. A laser is used to gently thin the outer shell of the egg (the zona). If the embryo can hatch out of the shell more easily, there’s a higher chance of implantation.

   Day 17-35

   • From three days after Ovidreal injection until the pregnancy blood test on day 35, twice daily I inserted vaginal progesterone pessaries. Given progesterone is usually produced during a women’s natural cycle, the pessaries are needed to maintain progesterone levels during early pregnancy.

   • If you receive a positive pregnancy result, you continue the progesterone pessaries throughout the first trimester.

   Transfer day – Day 22

   • I had my transfer in the morning and I was in at work an hour later. For the transfer, an embryologist prepares your embryo by placing it in a catheter. Under guided ultrasound, the fertility specialist then threads the catheter up through your cervix and into your uterus. It only takes about 10 minutes. The most uncomfortable part is having a half full bladder

   • On the day of the transfer, the embryo is thawed about an hour beforehand. For blastocyst embryos, we were told that approximately 90 per cent of embryos survive the thaw.

   Day 35 – The pregnancy blood test

   • Two weeks after my embryo transfer, I had a blood test to measure my hCG, THE pregnancy hormone.

     
     
   
   

IVF: What to expect

When we first started trying, I assumed it would happen quickly and easily. We were in our early thirties and had no fertility issues (that I was aware of then) so it never occurred to me that we would struggle to fall pregnant. But a year on, and still not pregnant, I was becoming increasingly upset and frustrated. We decided to see a fertility specialist. She checked my egg quality and count and my husband’s sperm, and she did an ultrasound of my uterus. Everything came back ‘normal’. But to ensure I was ovulating regularly, she prescribed Clomid. Three months later, no pregnancy.

It was then some friends mentioned IVF. They told us that if we were having trouble conceiving, we could “just do IVF.” Problem solved. And I believed them. But it didn’t just magically happen for us. In fact, it took us six years to have our beautiful son, born through gestational surrogacy.  

Reflecting back, here’s some things I wish I had known before starting IVF.

It’s a marathon, not a sprint

I assumed that IVF would guarantee a baby, and the first IVF transfer would work. I think many of us assume this. But sadly, for many people, it takes multiple transfers. I think if you go into IVF with those expectations in mind, it will make it a bit easier if it doesn’t work right away.

It’s a waiting game

There’s lots of waiting when you’re in the throes of fertility treatment. Waiting for an appointment, waiting to get started, waiting for the right time to transfer, and of course, the dreaded Two Week Wait. Waiting can be tortuous. Especially the Two Week Wait, in my opinion. I always found it useful to keep busy, distract myself and do things that made me happy. Often that meant going for walks, catching up with friends, having a weekend away or binging a TV series. 

Self-care is crucial

There’s no sugar coating it, infertility is tough. It’s an emotional roller coaster. It can be emotionally and physically draining so be kind to yourself and put yourself first. Whether that means setting boundaries and saying no to certain things (i.e., baby showers, gender reveal parties) or doing something just for you.

The medication side effects can also be brutal. Everyone is different so you may have mild side effects, or you may experience a truck load. If it’s a lot, self-care is vital. Finally, I found therapy helpful. I first started seeing a therapist – who also did hypnosis – after our second pregnancy loss and she was instrumental in helping me heal and navigate the next chapter. 

Be your own advocate

It took me a while to advocate for myself but once I did, it was invaluable. Come to your appointments prepared with questions, do your research, talk to others going through IVF and get a second opinion if you feel you need it. You can read more in our article on advocating for yourself during fertility treatment.

Some people will get it, others won’t

I was shocked that so many people – who weren’t medical specialists – had an opinion. You may get tonnes of unsolicited advice from “You just need to relax” to “It will happen when you stop trying.” Comments like these are hurtful and ridiculous. Infertility is a reproductive disease that affects 1 in 6 couples worldwide. “Just relax” is not a medical cure.

Connect with others

Talking to someone who is also going through IVF can help you feel less alone. You may also learn about different treatment options. Wish for a Baby Australia is a great way to meet others going through the same journey as you and to also meet all the fertility specialists under the one roof. 

Be Your Own Advocate: Taking Control of Your Fertility Journey

So much of infertility is outside your control. It’s a medical condition that affects millions worldwide. But one of the very few things in your control, is to advocate for yourself. Not speaking up enough with our IVF specialists is one of my regrets during our journey. And advocating for yourself when people offer you “advice” is also crucial. It helps to protect your mental health. Whenever I was offered unsolicited advice, “You just need to relax”, I would privately get upset but in the moment, I stayed silent. It wasn’t until later on that I spoke up. 

When we first started IVF, my knowledge was limited. I trusted in the medical team, and I rarely asked questions. It wasn’t until our fourth cancelled IVF cycle (which I later learned was due to my thin endometrium lining), that a nurse remarked, “Your lining is a bit thin.”

This was during a monitoring scan. I had no idea why the lining was important, but her comment made me curious. I started to research, and I quickly learned that the endometrium lining is crucial to falling pregnant. As the wallpaper of the uterus, it becomes thicker with pregnancy so it’s ready to receive an embryo and support the placenta. 

Knowing this, we raised it with our IVF specialist. She dismissed it. She told us that plenty of people still get pregnant on a thin lining and that it wasn’t an issue. Not convinced, I continued to research, and I found out that with a lining under 6mm, it was extremely difficult to fall pregnant or sustain a pregnancy. A healthy lining is 10-12mm. My lining was measuring in the 4’s. We promptly booked a second opinion and I’ll be forever grateful we did. Our second IVF specialist immediately diagnosed me with a thin lining and told us that our best chance of having a baby was through gestational surrogacy. And thanks to his diagnosis, and gestational surrogacy, we now have our beautiful son.  

How to advocate for yourself

Arm yourself with knowledge

Online communities, blogs, books, and podcasts are invaluable in helping to expand your knowledge. And attending events like Wish for a Baby Australia, are extremely helpful. You’ll get plenty of invaluable information and you’ll have all the specialists under the one roof. 

Join a community

Talk to others going through infertility. Learn from their experiences. The #ttc community on Instagram is a great start. And you’ll meet other people going through the same journey as you at Wish for a Baby Australia.  

Come prepared to your appointments

Bring a checklist of questions. For example – What are the success rates (and for your age)? How many embryos make it to Blastocyst stage? What is egg donation? Sperm donation? What’s Pre-Genetic Screening (PGS)? There are so many questions you can ask. And at Wish for a Baby Australia, you can book a private appointment with an IVF specialist and ask all your questions. 

Take your time at your appointments

Don’t feel pressured to be rushed out the door. Go through your questions. And don’t stay silent if you don’t feel satisfied with an answer. Fertility treatment is one of the most emotional investments in your life. You have the right to take your time and to ask for clarification on anything you don’t understand.  

Get another opinion

Get a second or even third opinion if you think you need it. If we hadn’t got a second opinion, I’m not sure we would have ever had a child. 

Advocate for yourself when you’re offered unsolicited advice

Whenever someone would offer me ‘advice’ I would point out the facts: Infertility is a reproductive disease, a medical condition that impacts millions worldwide. And if I was feeling extra bold: “Relaxing is not a medical cure. Imagine telling someone who has cancer to ‘just relax’ and they would be cured. That would be hurtful and insulting. Infertility should be no different.”