IVF Questions Answered: Our First Joint Post!

Nity (you can find her at I Believe in Miracles) & I decided to do a "joint post" (see her blog) to answer all the questions we asked last week in our IVF teachings. We both attended IVF classes last week, and thought this might be helpful in answering many of the questions we all have about IVF. My answers are in red, and Nity's are in blue. Hopefully, this will help someone out there - it was certainly educational to compare notes, and I'm learning a lot about this crazy process. It's interesting to note the differences between treatment protocols.

Thanks for your help with this, Nity!

1. ICSI vs. natural fertilization. When is this decision made? Do we have to make it ahead of time or can we wait to see how things are going naturally before opting for ICSI?
   L: Our nurse said that it is most advisable to make your decision about this before egg retrieval day. If you give the green light, the embryologist will do whatever she has to do to ensure fertilization (i.e. ICSI or assisted hatching). Apparently, it is advisable to make this decision before hand so that you're not trying to do this after a very important window of time has passed (i.e. no eggs are fertilizing naturally – what should we do now?).
   N: Since we're approved for ICSI, we're definately going to have the option of doing it on the table. However, they said the # to try and not try would be based on how the eggs/sperm were mixing. They do not want to do it unless necessary because it is a lengthy, extensive process. They mentioned the decision is usually whether or not you can have the option to do it and like L, it will be made the day of egg retrieval. With assisted hatching, they said this might occur if the woman is over 38, but I shouldn't have to worry abou it at this point. I didn't even have a consent form to sign.


2. Recommended time off after egg retrieval and transfer.
   L: Our clinic is pretty liberal with this. It is most advised to do whatever makes you feel comfortable. They do not recommend anything other than "having a relaxing day" after transfer – if this means laying in bed, fine. If it means shopping, also fine – just no strenuous exercise. But, after paying 15K for a procedure that gives us a chance to get pregnant, you will find me in bed or on the couch for at least 2 days post transfer (and maybe 3 if I'm having a really good time).
   N: They recommended is to take the day after (at least) for the egg retreival; and one or two after the transfer. Essentially "no working or flying." They did not say 'strict bed rest' but did imply that taking it easy, so resting, lying low, not doing much. I plan on taking time off, and hanging out on the couch.
   
3. 3 vs. 5 day transfer - is the lab able to recommend/handle a 5 day transfer (I've heard that some aren't equipped to do this).
   L: This is determined based on how the embryos are developing. The lab will call to give us progress on a daily basis. The five day transfer is sometimes recommended in instances of numerous embryos as the doctor wants to wait and see which embryos are strongest for transfer. Pregnancies obviously result from both.
   N: They no longer do 5 day transfers at my clinic.


4. Do meds have to remain refrigerated throughout the cycle -can you travel with them?
   L: Meds have to be refrigerated prior to opening them.. They need to be at room temperature of course (not baking in your car trunk), but the refrigeration is what keeps them viable for lengthy periods of time. Not all that sure about this one – I plan to research this a little more when I actually have the meds in my possession.
   N: I have a wedding to go to after I start the lupron, so I asked about traveling with the meds. They said it was fine; we could get a small cooler and the nurse would write me a note to take on the plane. Different medications have different max temps. I think a lot of whether or not to refrigerate depends a lot on how warm/cool your house is and what you feel comfortable with.
   
5. Traveling home after transfer.
   L: Again, it's whatever we feel comfortable with. There is no research that says that traveling in a car will lead to negative results, but you want to look back on this process and know that you gave it everything you had to make it work. We plan to stay put for 24 hours post-transfer.
   N: This doesn't apply to me too much since our clinic is about 30 minutes away. They did talk about your partner or friend needing to pick you up afterwards (i.e. they would not put you home in a cab) because you'd still be under the influence of anesthesia.


6. How is the pain of the egg retrieval handled - I've never been under an anesthetic so I'm curious how this works.
   L: According to my husband (who is in the medical profession) and the nurse, the med they're going to give for this will make me pretty much out of it during the ER. After it, however, I will probably feel discomfort (and from what I've read in the blogging world, I pretty much expect that this isn't going to be a pleasant moment in the process)..
   N: They discussed not haivng anything to eat or drink 8 hours prior to the procedure (not even water), otherwise you would need a spinal, which did not sound like fun because it would require 4-6 hours of recovery time on a bed floor! They demonstrated how they go in under u/s and get all the follicles. Even though some might not fully be developed yet... As you recover there are different amounts of nice drugs to help with the pain (hence the not go to work afterwards or next day) and it would be uncomfortable. I'm assuming this could be as bad as bad cramps or but not as bad as labor. Just need to put it in perspective.


7. What kind of stim will be used -Gonal F is what we used during IUI - I'm hoping they'll stick with that since I responded well and since I'm familiar with the pen.
   L: My clinic usually uses Follistim, but since I've responded well to Gonal-F historically, that's what we're going with.
   N: Each of us have individual plans. I think on a whole our clinic uses Gonal-F. I will have both Gonal-F and Repronex. Apparently they want to give me an extra boost.


8. General timeline questions: how will things progress in terms of the timeline?
   L: I start Lupron Oct. 1 with plans for ER and Transfer Halloween week. Hmmm…a little frightening and somehow very appropriate.
   N: So L we are on almost the EXACT same timeline. I start Lupron Oct 2... with everything finished probably before the end of October. This is great. I can go to the weddings without a problem. :o)


9. What sort of monitoring will be done throughout the timeline? (this sort of falls under travel, but my clinic mentioned once I start, I need to be fully committed and be there).
   N: I have to go in for baseline U/S Oct 11 and blood test on cd 2-3; then start Gonal-F, Repronex and lower Lupron. cd7-15 will be close monitoring (i.e. be around daily) and then ET and transfer. Start antibiotics with ET and progesterone.. Go in for a scheduled beta 15 days after the transfer, because pregnancy tests can be deceiving. If pregnant, keep doing progesterone for 10-12 weeks of pregnancy, vaginally.


10. Number of eggs they are aiming to retrieve? I've seen a lot about quality vs. quantity.
    N: They never gave me an exact #. They said they would go in and get all the follicles, but nothing on the # they like to see or not go above. That's part of the daily monitoring.


11. How many eggs planned for the transfer? Statistic, probability, expectations - when will I hear about what your prognosis is during our timeline?
    N: Embryos for transfer will be discussed the day of transfer in the pre-op. A lot of this relates to the quality of embryos, age, etc. Our hospital is really worried about multiples and they are trying lower their numbers of twins. Max they put in 5, min 1. Although the doctor will go off of what you say... they will give you their medical input. Regarding the timeline, you will hear the # that are retrieved and then the # fertilized. The specifics will be given the morning of the transfer.
    
12. Heard about possible bed rest for 2 days after transfer... is that suggested?
    N: Suggested to "take time off", but not specific on # of days.


13. Have you had a mock transfer?
    N: Yes.


14. Acupuncture after egg retreival/transfer?
    N: Was told: Acupuncture is fabulous. It could only improve the situation. It has definately helped older couples.


15. What is the protocol/process regarding embryo freezing? Is that covered under insurance?
    N: Generally you can freeze; but it is a decision that you need to make with your partner. Some people do not want to fertilize anymore than they want to transfer, other people do. Our clinic does not do embryo adoption, so our options are to freeze, discard, or give to science (i.e. for practice of ICSI in lab). I still need to look into what is and isn't covered by insurance.


16. Can we order our meds from Europe? Does insurance cover them?
    N: Insurance covers our meds, not need to worry about this. Mine should be ready to pick up on Monday...