some ins and outs of IVF

[i do not write this by way of complaint about my lot in life as i contemplate IVF. i write to educate. and i write to document, so that someday, when it’s been years and years since i lived through my 6th IVF cycle, i will remember some of the things i experienced.]

i’ve written on my blog before about the drugs. mostly administered with a needle in my belly. like this post. there are others.

but have i written about all the blood draws and ultrasounds?

yes. i have mentioned that they happen. but i haven’t explained anything in detail.

and i know you want details.

well. here goes. [this is how my doctor does it. i’m sure there is variation from doctor to doctor on the exact logistics, but i’m also pretty sure it’s pretty similar from doctor to doctor.]

the drugs you take at first are intended to encourage the follicles in your ovaries to grow and produce a mature egg. one egg per follicle.

before you start any drugs, they do a transvaginal ultrasound (look it up if you don’t know or can’t figure out what trans + vagina means) and baseline blood test to get the lay of the land.

at the initial appointment, they count the number of resting (i.e., naturally occurring and drug-free) follicles. and the blood test looks at your estradiol and fsh and other hormone levels. based on what they see in your blood and on the ultrasound, your doctor tells you the dosage and cocktail of drugs that you should take each night.

after a few days of shots, you go back for another transvaginal ultrasound and blood test to see what your follicles and blood are doing.

perfect world.

1. you have tons and tons of follicles. after all, more follicles = more eggs. more eggs = greater chances to have mature eggs. mature eggs = greater chances of fertilization. greater chances of fertilization = greater changes of fertilized eggs becoming embryos (they’re really looking for high-quality blastocysts).
2. your follicles grow 2 mm each day.
3. your follicles all grow at the same rate and are therefore all the same size.
4. your uterine lining will be beautiful and getting thicker.
5. your estradiol levels climb, climb, climb.

real world.

1. you may or may not have a lot of follicles. i’ve always had some. lucky me, really.
2. your follicles may or may not grow 2 mm each day.
3. your follicles may or may not grow at the same rate. mine don’t.
4. your uterine lining may or may not be beautiful and thickening. i have always had a beautiful uterus and uterine lining. it’s the major thing i’ve got going for me.
5. who knows what your hormone levels will be in your blood. they rarely tell me and i usually forget to ask.

the follicles show up on the ultrasound as black circles. when a follicle is at least 10 mm in diameter, they start measuring.

depending on where you fall between the perfect and real worlds described above, the dosage of your drugs might change with each visit and/or you will do shots for more or fewer days than originally estimated. where you are on the continuum also dictates how many ultrasounds and blood tests you will have during your IVF cycle.

i have been known to have an ultrasound on monday and friday of one week and then monday, wednesday and thursday of the following week. as an example.

that’s a lot of transvaginal ultrasounds. and a lot of blood draws.

anyway. they keep checking every couple of days until at least a couple of your follicles get to about 18-19 mm. and then, assuming your blood looks good, they schedule your egg retrieval.

things you might think about along the way as you give yourself injections and submit to transvaginal ultrasounds and blood tests.

are my follicles growing fast enough?
what if they grow too slowly?
what if they grow too fast?
have the drugs always given me headaches this bad?
if i don’t have headaches after a few days, does that mean the drugs aren’t working anymore?
what if i feel bloated and uncomfortable?
is it a bad sign if i stop feeling bloated and uncomfortable?
is this going to work?

and so on.

as michelle at my doctor’s office says, “don’t over-analyze.”

gee, thanks. like that’s easy to do.

but the bottom line is that there are so many things going on, so many variables, that as long as your doctor doesn’t tell you that things aren’t working, they’re probably working just fine.

i do have a friend who had her IVF cycle canceled because her follicles weren’t responding uniformly to the drugs. they did IUI instead. now she has a healthy baby boy.

i have another friend whose follicles, according to her memory, just stopped growing, so they went ahead and scheduled the egg retrieval instead of waiting for the follicles to get to the “right” size. now she has a healthy baby boy.

and then there’s me. i’ve always “looked” fine in my ultrasound and blood results, but i didn’t get pregnant the first four times we tried.

it’s all one big fat “go figure.”

whatever thing is going on with you that isn’t aligned with the “perfect world” does not mean that something is wrong, that you can’t or won’t get pregnant.

of course, i can’t guarantee that you will get pregnant if things look perfect or close to perfect.

but you’re trying. and that means you might succeed. so let’s focus on the possibility of success and not think that every little thing you notice about your body is probably a bad sign.

not sure who i’m talking to because i never assume the worst.

you want details about any other part of IVF?