Your first IVF cycle: What to expect

When you first start IVF, it can be daunting. During our IVF and surrogacy journey, I felt excited and hopeful but also overwhelmed. Some weeks fertility treatment felt like a full-time job. And while there are some differences between countries and IVF clinics, here’s what a typical first IVF cycle looks like.

The Preparation

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 male infertility. 

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 approximately how many eggs you have left.

Our first IVF cycle

Day 1-11

·       The first day of your IVF cycle is day one of your period.

·       I took a 75 Gonal-f injection daily (a moderate dose because I had multiple follicles). Gonal-f helps to stimulate your ovaries to over produce eggs. You also need to inject yourself at the same time every night.

Day 6 -12

·       Every two days, I visited the hospital 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 a 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 is crucial as it needs to be taken at precisely 36 hours before your egg retrieval.

Day 16

·       Egg retrieval surgery. 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.

·       The retrieval takes about 30 minutes, but allow a few hours for pre surgery checks, paperwork, and recovery. I was back at work the next day but for three days after, I had 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 were collected, a good result. In later collections, with a higher dose of Gonal-f, I collected 15-20 eggs.

·       The following day, I was told that out of eleven eggs, nine had fertilised. On average, around 60-70 per cent of mature eggs will fertilise.  

·       On day five, I learned 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). 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. But the only true way to measure the quality of an embryo is through Pre-Genetic Screening (PGS).

·       Before they’re frozen, the embryos 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 used 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 your first trimester.

Transfer day – Day 22

·       For the IVF 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 IVF transfer, the embryo is thawed about an hour beforehand. For blastocyst embryos, 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. Sadly our first IVF transfer was negative but it’s not uncommon to take more than one transfer for IVF to work.

This is a run-down of a typical IVF cycle, but you can learn more about all the steps involved here.

The Most Common Infertility Misconceptions

Infertility is a reproductive disease. It’s a medical condition that impacts millions worldwide. And yet, infertility is often suffered in silence and frequently misunderstood. While it’s made traction in recent years, there’s still not enough awareness of infertility and there are many misconceptions.

Here’s some common infertility misconceptions. And how to debunk them.

1. Infertility Only Happens as You Age

There are several causes of infertility. Whether it’s endometriosis, male infertility, the endometrium lining, PCOS…. the list goes on and on. And while your egg reserve does start to diminish as you age, women of all ages experience infertility.

We started trying to conceive in our early thirties. The Anti-Mullerian Hormone (AMH) blood test – the level of AMH in your blood helps predict approximately how many eggs you have left – showed I had a healthy egg reserve. But I have a thin endometrium lining. A thin endometrium lining isn’t due to your age; it’s often genetic and difficult to treat. Our son was born through gestational surrogacy after years of failed IVF cycles and pregnancy losses, due to my thin endometrium lining.

2. Infertility Is Mainly a Female Issue

Many people assume infertility is only a female issue. It isn’t. In fact, 40% of infertility is attributed to male infertility. Fifty per-cent is female and the remaining 10% is a mix of male and female. Sadly, there’s still a stigma with male infertility. It’s not uncommon for men to feel ashamed or emasculated. Despite being almost half of infertility cases, not enough men talk about it which explains why so many people still assume infertility is a female issue.

3. Stress Causes Infertility

Anyone going through infertility has heard the phrase “You just need to relax.” Along with, “You just need a holiday” or “It will happen when you stop thinking about it.” Comments like these are hurtful and ridiculous. If only falling pregnant was as simple as relaxing or taking a holiday. A lot more awareness is needed to debunk this myth. Infertility is a medical condition. Relaxing is NOT a medical cure.

4. Women Can’t Get Pregnant After 35

While it’s true that fertility does start to decrease with age, there isn’t a ‘fertility cliff’ that women suddenly fall off at 35. Yes, there is a steeper decline at 38, and again at 40, but there’s no sharp and sudden fall. There are also many options available today to have a family such as surrogacy, egg donation and sperm donation.

5. Being Fit and Healthy Guarantees Conception

Many people fall pregnant easily, regardless of their health. I’ve known some of the healthiest and fittest people who have struggled to conceive. Many of us do try to be in our best physical and mental shape however to help build our resilience and cope better.   

6. Having One Child Means No Fertility Issues Later

For approximately 1 in every 10 women, this sadly isn’t true. Known as secondary infertility, it’s when you can’t get pregnant, or carry a baby to term, after you’ve been pregnant before and had a baby without any issues.  

7. IVF Guarantees a Baby

I remember when we first considered fertility treatment, a friend of mine said, “Just do IVF if you want to have a baby.” Problem solved! I went into my first round of IVF expecting to be a pregnant a month later. But for us, it took six years, and gestational surrogacy, to have our son. I later learned that for most people, IVF rarely works on the first try so it’s helpful to set your expectations before you begin fertility treatment.

Understanding and debunking infertility misconceptions is key to breaking the stigma. By staying fully informed and truly understanding the process, individuals and couples can make empowered choices and create an easier path to parenthood with the right support and options available.

*As featured in IVF babble.

Genetically Testing your Embryos

“Fifty per cent. That’s roughly how many miscarriages are due to chromosome abnormalities.” I was shocked when our IVF specialist told us this. Fifty per cent is a huge number. But then he said, “We can test your embryos and only transfer any embryos that don’t have abnormalities.” Now he had my full attention.

We were onto our second IVF specialist in Australia. After several failed, and cancelled, IVF transfers, due to my thin endometrium lining, we had decided to get a second opinion. It was at this appointment that he hit us with the hard truth: thin linings are rare, usually genetic, and often difficult to treat. And that our strongest chance of having a baby was through gestational surrogacy. It was a lot to take in. He then mentioned Preimplantation Genetic Testing (PGT-A). In fact, he was blunt, “I refuse to treat a patient who doesn’t genetically test their embryos, so it’s up to you on whether you want to continue seeing me.” He promptly explained what PGT-A is and why it’s so important. Within five minutes, he had convinced us.

What is Preimplantation Genetic Testing (PGT-A)?

It’s a scientific technique, an embryonic procedure, which looks at the chromosomes inside the cells of an embryo. A normal embryo contains 23 pairs of chromosomes, for a total of 46 chromosomes – 23 from the sperm and 23 from the egg. Embryos with more, or less, than 46 chromosomes can cause IVF transfers to fail, or can cause pregnancy loss. By identifying the best embryo for an IVF transfer, PGT-A can increase the live birth rate per IVF transfer.

Today it’s considered standard practice. Several IVF clinics worldwide offer PGT-A, also known as PGS. And for good reason. Many IVF specialists say that the chances of achieving a successful pregnancy can increase – while miscarriage can significantly decrease – with having PGT-A. And while anyone can choose to do PGT-A, it’s especially recommended for females over thirty-five years old. As a woman ages, the percentage of abnormal eggs they produce increases.

PGT-A can also screen for gender

If an embryo has XX sex chromosomes, it’s a female. If it has XY chromosomes, it’s a male. For us, selecting the gender wasn’t an option. Even though our surrogacy transfers were in the USA, through the Utah Fertility Center, our embryos were created in Australia where it’s illegal to know the gender. It’s also illegal in Canada and the UK. But it is legal in some countries like the USA, where it’s become quite popular to select the gender.

PGT-M testing

While not as common as PGT-A, PGT-M tests for gene defects. It’s usually recommended for patients who are at high risk of having a child with a specific genetic disease like cystic fibrosis and Huntington’s disease. In fact, PGT-M can screen for more than 350 common and rare genetic conditions.

PGT-SR testing

The final genetic screening test available is PGT-SR. Also known as PGD, this test screens for unbalanced chromosome rearrangements. What does this mean? Some people have the correct number of chromosomes but in a slightly different arrangement. This means they have a higher chance of passing on an unbalanced amount of chromosome information to their children which can lead to miscarriage, or the birth of a child with health and development issues.

Today, many patients are choosing to do genetic testing. I know during our infertility journey, doing PGT-A, and only transferring the euploid (normal) ones, gave us greater confidence and hope of having a successful pregnancy. And as we had suffered three heartbreaking pregnancy losses, knowing there was a way to help reduce miscarriage, was also very comforting.

I shudder to think how much time, and money, (not to mention heartache) we would have wasted if we had continued transferring abnormal embryos. With so much of infertility outside your control, it’s reassuring to know you have choice to help decrease your risk of miscarriage and increase your chance of a successful and healthy pregnancy.