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.