When I was told that in order for me and my husband to have a child we would have to try In Vitro Fertilization (IVF), I had no idea what that meant. I thought I did, but I had no idea. In my naive mind, IVF was expensive, but relatively painless. Emotional, or course, but relatively painless. The reality is that the process is unbelievably expensive, almost emotionally impossible, and very painful. To help prepare you, or to help you understand what others go through, I will break down this process as best I can. Bear in mind that for some parts of this process there are no words. Let us begin.
First, the meds.
When we began IVF, we received a calendar from our doctor. This calendar explained, day-by-day for several months, which medications I had to take and when. When I first saw this calendar I was completely overwhelmed. It starts simply with a daily birth control pill and maybe a vitamin. Then, as you get closer to the planned retrieval day, it gets crazy; medications starting, medications stopping, doses changing. I found myself living by this calendar. It ruled my life. I checked it multiple times each day to be sure I had taken what I needed to, when I needed to, and that I took the right amount. Mistakes can halt or throw the process out of whack. It was nerve wracking, to say the least.
The medications themselves are not as simple as just popping a few pills. Some of the medications are in pill form, but for the most part, I was sticking myself with needles multiple times a day. The shots in the beginning are called subcutaneous. This means it is a little needle that penetrates about a half inch below the skin. It’s not too bad after you get over the initial fear. But after doing this three times a day for over a month, my abdomen turned into a bruised and tender mess. And what comes with the bruising is the stress of mixing these medications and worrying if you did it right. You take the powder from this vial and mix it with the sterile water in that vial, then draw it into the syringe with this needle, but inject it with that needle. I’m not a nurse and neither is my husband. The worry over getting it right was just as bad and the needle going into my skin.
And finally, there is the progesterone oil. If you are lucky enough to have to use this, you and your husband or partner are in for a serious test of will. When I met with the pharmacist about this medication he showed me the needle that would be used to inject this progesterone oil. I thought he was kidding. See, progesterone oil is not a friendly subcutaneous injection. This one has to go into the muscle, which means it is a needle that is about 2 inches long. That monster went into my butt cheeks for several months, weeks and weeks before the transfer and weeks weeks after. It has been about ten months since my last progesterone shot and I am still experiencing a weird numbness in one of my butt cheeks. My husband had to administer this shot. It was really difficult for him and I can’t say that I blame him. If I had to plunge a huge needle into his flesh each night, make sure I wasn’t hitting a vein for fear of death, and slowly push a painful thick gel into his body, it would be difficult for me too. This medication, however, was not prescribed to me until my fifth IVF attempt, but I have to admit it was the final and successful attempt, so it was worth it.
Next, we have the appointments.
This part is not as painful as the medications can be, but it does take over your life. At first you go in for a few preliminary appointments. They are often bunched together within a few weeks, but after that you get a break. Then, as the date of your expected retrieval approaches, the infertility clinic, reproductive endocrinology center, or doctor’s office will become very familiar to you. You get to know all the nurses and staff really well, yet somehow it surprises you when they start calling you by your first name. You see, they need to keep a really close eye on your ovaries. That’s where all the action is happening. All those drugs you’ll be taking make your ovaries swell up like balloons. Each of them is hopefully producing lots and lots of follicles, which will hopefully deliver lots and lots of mature eggs.
About 3 weeks before our expected retrieval day, I started going to the doctor about every 3 days or so. Each time I would have to get a trans-vaginal ultrasound. For those who do not know, this involves a long wand-type instrument being inserted into the vagina to give the doctors a good look at what my uterus was up to and how my ovaries were coming along. At this point, since my ovaries were swollen to about 4 times their normal size, this procedure was more uncomfortable than normal. Also, I am lucky enough to have a left ovary that likes to hide, so the doctor would have to get a little aggressive in trying to see it. Not fun. These appointments, instead of every three days, start coming every day very soon. You don’t always know when your next appointment will be until the doctor has a look at you. The doctor is trying to time the retrieval so that you will end up with the most mature eggs possible. These appointments can be a real problem if you are working. Not really knowing if and when they will happen makes it impossible to plan ahead. What this forces you to do is involve your boss, to certain degree, into something very private in your life. But soon enough the doctor will say you are ready for the retrieval. You are almost at the end of the IVF process.
Going into my first retrieval, as I have mentioned, I was very naive. This is what I knew: the doctor was going to retrieve the eggs that my ovaries had been working hard to produce for the last month or so. How this would happen was unclear to me. I had created a process of my own in my mind. Maybe my creation was a way to cope with my fear, but at the time, walking into my first retrieval, I was not nervous. I knew I was going to be knocked out. The retrieval process I had created in my mind went like this: the doctor would use some super scientific contraption to go into my vagina, into my uterus, up to my fallopian tubes and sort of cherry-pick my ovaries. This is not how it happens.
This is how it happened. We arrived at the clinic and I put on a hospital gown. After signing a slough of legal release forms, they stuck me with an IV, after five or six sticks, they got it right. Then I got to meet everyone: the anesthesiologist, the embryologist, the nurses. Then it was time to wait. My husband and I, already on pins and needles, all ready to go, had to wait and wait and wait for the moment to happen. The moment finally came and I was ushered into an operating room, my first ever.
So this is how a retrieval really happens. I’m so glad I was asleep. The tool that is used is very similar to the wand-like one used in ultrasounds, except there is a really really long needle on the end of it. The wand allows them to see where they are going as this needle punctures the wall of the vagina repeatedly. The needle is inserted into a follicle and the egg is sucked out. They do this for each follicle, which translates to a lot of holes in your vagina. A lot! And let me tell you, it fricken hurts!! With one of my retrievals we got 24 eggs. That’s 24 punctures to the walls of my vagina. Recovery took me about two days, but those two days were hard. At first I needed help getting up and sitting down. It got easier, but the pain, and the blood, were unexpected.
After the eggs are harvested, the doctor will tell you how many mature eggs you ended up with. These are the eggs that will hopefully fertilize and then become your embryos.
This part is relatively painless, except for the emotional stress of wondering whether or not it will work. At this point, hopefully some of the mature eggs fertilized and developed into viable embryos. After talking to the doctor and embryologist we decided which embryos and how many to insert. Then the process began.
First I had to undress, the same you would for your pap smear. Then, I had to sign, sign, and sign my name some more. Verifying I was who I was and I knew what I was doing. Then, once all the legal stuff is done, they gave me some Valium. Nice. Though the process is relatively painless, it can take time and they didn’t want my uterus to tense up. So once I am nice and relaxed, they inserted the catheter into my uterus. Uncomfortable, but not bad. The nurse is pressing hard on my abdomen with the ultrasound so the doctor can see where he is going. Once he is happy with the placement of the catheter, in go the embryos. The rest of the process is hoping and praying it all worked. The 9 days or so you have to wait to find out are riddled with anxiety, but you get through it. And even though it took us several tries, it finally worked for us. It fricken hurts!! But keep trying, because it fricken works!!