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What is IVF?

Hello world. Last we spoke, Taylor and I had just had our IVF consult. If you know me at all, you know that I’m pretty OCD about clutter and cleanliness, and I’m especially anal about anything sitting on the kitchen counter. Well after we got home, I let that IVF packet sit on the counter for almost a month. A MONTH.

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I agree, Monica

But last week I finally felt ready to bring the feels back on. I seriously cannot stress enough that infertility is a constant roller coaster of emotions. Right when you think you’re okay and have accepted things.. BAM! It hits you across the temple like a bag of bricks.

I have gotten quite a few questions on what IVF actually is, so I figured I would make this blog post to bring everyone up to speed. Ready for IVF 101?

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Of course I had to throw in a Disney reference…

How did IVF come to be? (this is the boring part, so unless you’re a science/history nerd like me, you may want to skim over)

Although IVF has only recently been widely used to treat infertility problems, people have been seeking medical help to overcome reproductive barriers for a long time.

In 1884, the first known artificial insemination using donated sperm took place—and the woman inseminated did not even know what had happened. A couple having fertility problems were examined by Dr. William Pancoast of the Jefferson Medical College in Philadelphia. After finding that it was the husband’s sperm that was the problem, and the woman’s reproductive system was fine, the doctor realized their fertility problems could be solved using donated sperm through artificial insemination. This had not been done in humans previously, and such an idea at the time would have been rather scandalous, possibly even considered to be an act of adultery.

Consequently, the woman, and most likely the husband as well, were not told what was causing the fertility problems, or what the “treatment” would be. She was told only to return for a follow-up appointment to have “her” fertility problems fixed. When she arrived, she was knocked out with chloroform and the doctor chose a sperm donor from his medical students that were present. The student masturbated into a cup and the semen was injected into the unconscious woman’s uterus. It was successful: Nine months later she gave birth to a baby boy, still not knowing how she became pregnant.

Not until the 1930s did the idea of artificial insemination receive much publicity. During the 1940s, researchers found how to successfully freeze donated sperm, which led to many sperm banks opening in the 1970s. However, artificial insemination is only beneficial when the infertility of a couple is due to the “male factor.” If the woman is having reproductive problems, the situation can be much more difficult to solve, although this was greatly helped with the development of pregnancy-stimulating hormones in the 1960s. However, because such drugs can only help so much, the arrival of IVF revolutionized the existing field of assisted reproductive technology.

Like all science, IVF didn’t come out of nowhere; researchers had been performing the studies that enabled the development of IVF for around half a century. In England in 1890, Walter Heape transferred embryos from one rabbit to the reproductive tract of another rabbit, and successfully had the recipient rabbit give birth to offspring using this method. For decades, more animal studies built upon Heape’s original findings.

But scientific research cannot progress without the proper tools. Techniques for culturing cells improved during the 1960s and 1970s and, together with a better understanding of the hormones released during pregnancy, this allowed researchers to eventually culture embryos outside of the human body.

In 1978, the first person was born from IVF. Lesley and John Brown had been trying for nine years to have a child, but one of Lesley’s fallopian tubes was blocked and consequently her eggs could not travel down to the uterus to be fertilized. On their mission to have their own biological child, Mr. and Mrs. Brown met Drs. Robert Edwards and Patrick Steptoe, who had been working on IVF treatments. Previous couples had tried IVF, but none of the treatments resulted in successful pregnancies. However, the IVF treatment worked for the Browns and on July 25th, 1978, Louise Brown was born.

So what exactly is IVF? (In case you were sleeping, this is back to the good stuff)

IVF is terrible. It most definitely falls into that category “What doesn’t kill you makes you stronger.” It hurts more than you think it will. And it lasts far longer than it should. When it does not work, it feels a punch in the gut combined with the unexpected death of your childhood pet.

But, but, but….when it does work, it is nothing short of a miracle.

IVF is usually your last stop at the end of a long journey. You have probably spent years trying to get pregnant every which way. Nothing has worked. And that’s what finds you at a fertility clinic staring at a Reproductive Endocrinologist (RE), trying not to cry.

In essence, in IVF sperm and eggs are removed (sometimes from donors) and fertilized outside of the body (in a Petri dish) and then implanted back into a woman’s uterus. (The term “in vitro” literally means “within the glass” in Latin and is often applied to the study of a normal biological process replicated outside of an animal. In the case of IVF it is a bit misleading as the embryos are not placed in a glass tube, but in a plastic Petri dish.)

One treatment, or “cycle” of IVF, takes about four to six weeks from start to finish. Before the eggs can even be removed from the woman, her ovulation cycle is strictly regulated using drugs that first prevent ovulation (for two weeks) and then drugs that stimulate ovulation (for about ten days). This is achieved with injected medications, and this phase is called “stimulation”, or “stim”. This helps ensure that she will have a large number of eggs ready to be harvested at a given time.During this time, you will be closely monitored. That means bloodwork and ultrasound either every day or every other day. It’s a huge time commitment. The only slight positive is that it is kinda cool watching your follicles grow slowly day by day. (You are aiming for them to get over 18mm.) About 34 to 40 hours before the eggs are to be harvested, the woman is given a final drug to “ripen” the eggs.

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IVF Medications

When the big day arrives, you go to the center, and are put to gentle twilight sleep, while your doctor makes tiny incisions through your ovaries, or uses a needle through the pelvic floor, and individually takes out the eggs. When you stop and think about it – it is pretty damn cool. You wake up cramping and slightly unhappy. Your recently liberated eggs are whisked off to meet your partner’s or donor’s sperm.

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Fertilization with ICSI (intercytoplasmic sperm injection), where the sperm is injected directly into the egg for better fertilization chances

Three to five days later, they are put back into you, all fertilized and ready to implant.

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Fertilized egg, now an “oocyte” progression

Only a few days after the eggs are removed, the best embryos are selected to be implanted; the embryos have about eight cells at this point. A thin catheter is used to insert the embryos, usually one or two, back into the uterus. (This is easier than removing the eggs; no anesthetic is used.) Two weeks after implantation, the woman undergoes a pregnancy test; if it is positive, the pregnancy should progress normally.

Anyway….

From this point on, it’s all a numbers game.

How many eggs did they harvest? How many were mature? How many fertilized? How many lived past the first day? How many have divided enough to plant back in you after 3 to 7 days? How many managed to implant after 14 days?

You can just imagine how nerve-racking each step of this process is. How each step lends itself to failure. They could harvest 10 eggs, and none will be mature. You could have 5 mature eggs and none will fertilize. You could have 3 perfectly fertilized eggs and none may implant. Or worst of all, you could go through all this, and get pregnant, only to miscarry a few short weeks later.

When they ask me what the worst part of thinking of IVF is – the cost? The time commitment? The pain? – I always say “No, no, no.”

The worst part of IVF is the uncertainty. It is the fact that you could go through all this trouble, sacrifice everything….and still not get a baby out of it.

Pursuing IVF treatment is a personal decision and there is no right or wrong – there is only what you feel, what you can endure, what you can sacrifice.

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I apologize that I have written a novel, but I hope that this post has been informational and enlightening to those wanting to know more about the subject. Taylor and I are slated to go through with IVF in May, meaning we will start treatment in April. We are so thankful for our friends and family, we could not do this without you all!

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Plans and Probabilities

Today was the day, our IVF consult. We have been looking forward to this for a month. Until last night. Last night the reality finally hit me of what we were going for. This morning when we arrived at the clinic my stomach dropped as if I had fallen off of a cliff.

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I know what you’re thinking. It was only the consult… but it just felt different. We knew the procedure. We had an idea of the cost. But going in and talking about it, seeing things on paper, and scheduling feels completely different.

Basically, the decision for us comes down to probabilities. With IUI, our probabilities after seeing our counts after the sperm wash were just too low for us to justify the cost, when that money could be going towards IVF where we have a great possibility. Dr. Dunaway thinks that with my age and my eggs, that our probability of success with transferring two embryos would be as high as 90%. So that’s what we will go with.

The soonest that our clinic can get us in is for the May cycle. That is much later than we were anticipating, but we are comfortable with Dr. Dunaway and trust his judgement. Now we start the process of evaluating the financial portion and what exactly we want to do. I’ll be doing another post soon explaining the IVF process.

So how am I feeling?

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Yep. That about sums it up. It will get better, it’s just an overwhelming amount of information. Are we ready? Yes and no. Personally I’m ready to have it over with. Honestly, thinking about all of the stresses that we have right now it’s probably best that we wait until May. Soon we will have our heads wrapped around all of this and we will be ready to move forward. Thank you all for your love and support. It’s impossible to go on this journey alone.

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Fertility Treatment Running Cost:
Ovulation Kits for a year: $80
Pregnancy Tests for a year: $100
Vitamins: $300
GYN Apt: $50
Semen Analysis: $175
Semen Analysis w/Urinanalysis: $250
Fertility Institute Consultation: $166 ($250 without insurance)
Clomid: $9.60 ($100 without insurance)
IUI Payment #1: $880
hCG trigger: $125
IUI Payment #2: $485
IVF Consult: $100

TOTAL: $2,721