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So, you’re looking into IVF because its been taking more then 6 months, 1 year, 2 years, 8 years to get pregnant or you were given what you think is devastating news: You can only get pregnant via IVF.
IVF should not be devastating news! It is important to think positively the whole process of IVF in order to maximize results. Keep in mind – Most ladies who go through IVF have a 50-56% chance of getting pregnant each IVF cycle. When TTC “the old fashion way”, you usually only have a 20% chance each cycle (if you are under 35), so already you have better odds then you would normally!
Yes, you will have to have a battery of blood tests. You will get stuck by needles all the time and worse – you have to stick YOURSELF with needles! I can guarantee anyone who has a needle phobia, that it will be non-existent by retrieval time.
Your next thought – OMG. How the heck do we AFFORD this? Or “my insurance doesn’t cover IVF!” (Hey neither does mine! We’ll come back to insurance in a moment) IVF depending where you live and the clinic you go to will cost anywhere from $4,000.00 - $20,000.00 (US) Keep in mind, most of the medicine just by itself is between $2,500.00 - $5,000.00(US). You can put it on a credit card, apply for a loan, apply for care credit (which is like a medical credit card), take out money against your home, borrow from family, etc. You will need this money fairly fast. It is rare if non-existent for a clinic to work out an extended payment plan. Payment is due before you “cycle in”.
(If you just so happen to live in New York State – there IS a Department of Health grant which can possibly be available to you if you qualify. There are only a few clinics in the state which participate, so take a peak at that first! It makes IVF SO much more affordable. If you make less then $30,000 a year, you’ll be paying under $3,000.00 for the WHOLE thing.
A lot of clinics will also have research studies you can be apart of. Most of them will give meds for free, or knock a significant amount off the price. Make sure you read the study first and fully understand what will be happening before you sign any papers.
So you have insurance coverage! Great! Move right along!
So you don’t have insurance coverage. Me either! Keep reading!
You need to really read the fine print of your plan. My plan will pay for all of the Semen Analysis we need, and for all my blood work, but is not paying for sonograms, meds, or any service relating to infertility. You insurance also might cover any corrective procedure relating to infertility (such as HSG’s, SHG’s, Polyp & fibroid removal, varicose surgery, etc). Speak with the Infertility specialist at your insurance company to find out exactly what will be covered and what won’t be. (Something they might not cover the actual procedure but will cover the anesthesia.)
So, you now need to find a Reproductive Endocrinologist (or RE) who does IVF. Check with your local Department of Health for names of clinics or simply do a google search for “IVF in xxxxxx” Once you find your RE, do some research! Check out their website, do web searches for the doctors names, do your clinics name and the word “bad reviews” to see if anyone has any issues. From there, its time to call for a consultation.
Now is also the perfect time to stop consuming alcohol, stop smoking, stop recreational drugs which you shouldn’t be doing anyway, stop large amounts of caffeine intake. All this can cause infertility and potential miscarriages or birth defects!
Consultations usually cost between $150-$600 dollars depending where you live, with the average being about $300.00. They last about 15 minutes to 1 hour. Bring EVERYTHING you can with you. Bring your fertility charts, your medical records, your significant others medical records, semen analysis reports – Bring it all. The more information the RE has in front of him, the better he can gauge what’s going to happen. You will go over everything and the RE will give you a game plan. From there, the RE will give you a lab slip for a lot of blood work. Sometimes at consults, they also do a sonogram and blood work right there. Be prepared!
You will get your blood work, if not already taken which will include a lot of tests. It will include titers for immunity to things like Measles, Mumps, Rubella, Chicken Pox (Varicella), Hepatitis A, B & C. It will make sure you don’t have HIV/AIDs. Your blood type will be checked along with your RH factor. A CBC (complete blood count) will also be done, and you’re Thyroid Levels and Prolactin levels along with other hormone levels will be checked.
*Note 1* If you are found to NOT have immunity to Rubella (German Measles), you will most likely be told you MUST be vaccinated against it, and then you will have to wait 1 month (sometimes up to 3 months) to begin IVF. So get this test ASAP!
*Note 2* If your thyroid is found to be functioning not normally, you will be put on medicine to regulate it. Do not argue with the doctor! Thyroid problems can and have caused people to miscarry! Take the medicine! The baby’s thyroid begins to function around 12 weeks, so after that point if you REALLY want to come off the meds, talk to your doctor.
Once this is all done, some clinics like to do a baseline CD3 blood work & sonogram the cycle before you “cycle in”. You will go in for that.
CD 3 blood work tests your FSH (Which under 10 is ideal, under 6 is perfect), LH (which should be under 20, under 10 is ideal) and your Estridol level aka E2, (Which should be under 100, under 80 is perfect).
If any of these numbers are high, your doctors will discuss with you what that means. Sometimes a high E2 level indicates a left over ovarian cyst – some doctors will proceed others will want to do a sono and see what’s there and suppress you for longer to get rid of the cyst. High FSH can mean ovarian failure and you might want to think about an Egg Donor.
Between days 7-10, you will also go in for a Water (Saline) Sonogram (SHG) and mock transfer. The day before this procedure you and sometimes your SO will begin a course of anti-biotics. You should take 2-3 Advil before this procedure. The mock transfer shows the doctor what size catheter to use, how your cervix is structured and where to place the eggs. This procedure feels a little worse then a pap smear. You will be a little crampy. The SHG (water sonogram, not to be confused with HSG) for some is really painful and for others, it doesn’t hurt them at all. The saline is infused into the uterus to make sure there are no polyps.
If there are any, your doctor can not proceed with IVF just yet. Polyps can cause miscarriages, so you will be required to have a hysteroscopy with D&C (aka: Polypectomy) to remove said polyps. You will have pre-surgery blood work. You will be knocked out for the procedure (with usually Versed and Propofol. Versed knocks you out and Propofol keeps you asleep) and will be uncomfortable and in pain (your worst ever period cramps) when you wake up. You will need someone to drive you home and will be in bed the rest of the day. The bleeding varies from person to person. Sometimes you will only bleed for a few hours, sometimes you will bleed for 7-10 days. Once this procedure is done, you can move right along!
Somewhere by now, you should have received a protocol calendar. By this point, you will also go through injection teaching.
As soon as its time, you will do your final CD3 blood work and be given the OK to go!
*Note* Every one is on different meds and different protocols. Some women take BCP’s and Lupron (To suppress the ovaries and get rid of cysts), others will never take either. Some women might be on a long lupron protocol and never take BCPs. Almost all women are on 0.1ml or 10 units of Lupron. Make sure you follow your doctor’s instructions!
Injections 90% of the time go in the stomach fat. Sometimes you can also use your thighs, but most clinics recommend the stomach.
Lupron is a drug usually taken between 6-9am. Pick a time and stick with it. Lupron does not hurt or burn. Some people experience headaches, hot flashes, irritability and other menopausal symptoms such as vaginal dryness and yeast infections. If you do get a yeast infection, you are NOT to use anything in your vagina! External cream is ok. You should call your RE immediately and they will give you a prescription to treat the infection. NOTHING should be going into your vagina once you are cycled in. (Sex is ok if your doctor says so). Some people feel no side effects to lupron and if you are like me and BCPs make you insane, Lupron might actually make you feel happy, calm and stable.
Take all meds as told. Once you start your stimulation or “stim” shots, you will be going in every 2-3 days for blood work and a sonogram. The blood work will make sure you are not being over or under stimulated. Usually by the 4th or 5th day of the medicine, you will start to “feel” your ovaries. It is similar to the pains you might feel when you are ovulating. You can usually take Tylenol to ward away the discomfort. Stim meds are usually taken at night between 6-9pm. You might be told to mix your stim meds, you might be giving yourself 2 shots at night. Follow your clinics directions. A lot of clinics say its ok to mix the drugs Bravelle and Menopur. Some clinics say its bad to do such. Again, do what your clinic tells you.
*Note* Call your doctor ASAP if you have ANY skin reactions to your meds! Red circles, welts and hives should be taken seriously!
Once the time comes, you will get told its time to trigger! The day you are told to trigger, you will have pre-surgery blood work and be called and told what time to trigger (Usually late at night, around midnight area). 34-36 hours later, you will have your retrieval. When you are told to trigger you stop ALL meds. Lupron included. Which means you have a day where you don’t have to give injections. Yay!
On the day of retrieval, you will shower in the morning, but do NOT put on lotion, make-up, perfume, etc. They can actually kill the eggs once removed. Shower, dry off and go. When you arrive, they will ask you to empty your bladder and get naked and put on a gown. (You can leave socks on). Leave all jewelry at home and take out EVERYTHING. Earrings, belly rings – it all goes off. Next, they will take some vital signs and the anesthesiologist will talk to you. If you have gotten sick from such in the past, ask for anti-nausea meds. He will start the IV and you will be on basic saline for the procedure. You will go into the room, they will knock you out and you will wake up in recovery where you will stay for 30 minutes to 2 hours depending on how you feel.
You should go home and rest for 1-2 days before returning to work. Some women especially young fertile women end up with Ovarian HyperStimulation Syndrome or OHSS. If you gain more then 5 pounds within 24 hours of your retrieval, have extreme abdominal comfort, run a fever of over 101, or you have trouble breathing call your clinic ASAP or go to the ER if after hours. OHSS can be very serious. When you go home, you will begin Progesterone in Oil or PIO shots as well as another round of anti-biotics and sometimes a drug called Medrol.
*Note about PIO* PIO is a THICK liquid which is generally in peanut oil. If you have a peanut allergy LET THEM KNOW so they can get you PIO in Olive Oil instead. There is a tip to injecting PIO:
1) Warm up your skin where you are giving the PIO shot for 10 minutes with a heating pad.
2) Draw up the PIO with your 18 gauge needle. Put the entire syringe in a warm heating pad until it feels warm to the touch. NOT HOT, but WARM.
3) Switch to a 25 gauge needle. This will save your butt from extreme discomfort! PIO CAN!!!!! BE!!!! INJECTED!!!!!WITH!!!!A!!!25!!!!!GUAGE!!!!NEEDLE!!! ! Don’t let anyone tell you otherwise. 22 gauge needles hurt! A lot! You can buy 1.5 inch long, 25 gauge needles online from a medical supply store -- no prescription needed!
4) Once your butt is warm and your PIO is warm, inject the PIO, rub the area immediately with the heating pad and place the heating pad back on the area for 10 minutes. This is called the pain free method of giving PIO shots.
Some clinics will tell you this can’t be done, but it CAN BE DONE! It does not effect the quality of PIO.
The following morning after retrieval you will be called with a fertilization report. They will tell you how many eggs were fertilized. They will continue to incubate for either 3 or 5 days.
You will have your transfer either 3 or 5 days later, and when you are officially what should be 14DPO; you will have your first beta test. Some clinics also will do blood work 2 days after your transfer to check progesterone and other hormone levels.
When you have your transfer, most clinics will recommend laying in bed and being on STRICT bed rest for 24-36 hours and will tell you to not have sex or engage in any strenuous activities until after your Beta test. Some clinics will now switch you to a vaginal suppository, and take you off the PIO.
Once you have your Beta, you’ll have an answer. Either you’re pregnant, or you will do another round of IVF if you did not have any eggs to freeze or do an FET (Frozen Egg Transfer) if you had frozen eggs. If you need an FET or another round of IVF, it is recommended to wait 1 month to allow your body to get back to normal before putting it through a drug regime again.
Congratulations! You’ve just been taken through the IVF process.
Also I wanted to add:
Some clinics will make you have a mammogram or breast sonogram before hand as well. Do this ASAP. If you are over 35 this is a DEFINETE thing. The stim meds, if you have a funny lump, can actually make it worse.
If you have not had a PAP AND STD testing within the last year, you must also do that even if you have been married for 10 years. Does not matter. Go get that done before you begin IVF! It'll save you time later!
Other helpful hints:
Disclose latex allergies EVERY SINGLE TIME you walk in. Before they do ANYTHING always ask -- "Is this latex free?". Just because they are holding your chart in their hands or just because you've been going there for 2 months now doesn't mean they remember you are allergic! This is ESPECIALLY IMPORTANT before retrieval! Make sure the OR knows you are allergic to latex so they can prep the room with latex free supplies. Not all syringes are latex free, so make sure yours say LATEX FREE on them.
Disclose ALL other allergies in the begining. Especially Penicillen, Peanut or Sulfa allergies.
If you have medicine allergies, ask for a prescription for an at-home EpiPen just in case.
Thank you so much for this thread. I was going back and forth trying to decide if I should do IVF or not. I give all you ladies credit if you've gone through this right now. That's alot to endure and I guess I was a little naive about the whole process. I love the odds but it scares me thinking about going through all of it.
After the Water (Saline) Sonogram, when you get up, do yourself a favor and jump up and down. You will thank me later.
IVF takes up A LOT of time. Be prepared to go to work late, take off from work, and rearrange your schedule and have to drop everything at the drop of a hat. A lot of time you will be doing blood work and sono's at the crack of dawn between 7-9am.
Here are what my meds cost me, it can be used as a guide to what it might cost you:
Bravelle - ~$180.00 per box (5 vials per box or 375 units per box)
Menopur - ~$304.50 per box (5 vials per box or 375 units per box)
HCG - ~$58 dollars per box (each box contains 10,000 units)
Cetrotide - ~$657.19 (for ONE shot).
Endometrium-~$104 (per box of 21, 7 day supply if taking 3 per day)
Estradiol (estrace) $4.00 (for 100)
Medrol - $4.00 (for 20)
Lupron - $80.00 (for a 28 day supply)
Progesterone in Oil *Seseme* - $29.00 (10-12 day supply)
Just as an idea -- all my meds cost me $3,559.90 for one cycle.
Wow, I can tell you've done your homework. I've been following your progress here and in ttc w/ medical asst. Already I've learned quite a few things from you I didn't know before. From someone who is now in the process of doing ivf, thanks for taking the time to write such an informative description on the ivf procedure. Good luck Friday with your embryo retreival. Can't wait to get an update as soon as you're upto it.
Your welcome! The reason why I wanted to make a big huge post about IVF is because my clinic made it seem like this is such a breeze of a process and everything is all daisys and butterflies. Its really not. IVF once you start stimming is a VERY involved process. No one explained the ovary pain, the burning injections, and all the hel- that goes along with IVF.
For people who are curious about the cost of IVF in different parts of the nation - IVF w/ICSI (all meds included) will cost me and DH $12,000. Since we are doing TESE as well that is another $5,000 for a whopping total of $17,000. We live in Virginia.
* eat 2 hard boiled eggs every morning as soon as you start stimming - under the theory "like heals like" - it helps create nice strong eggs. Also eat a lot of protein - I snacked on peanuts and almonds whenever I was hungry
*once you start stimming - really listen to your body and take it easy - make sure you drink a lot of fluids as well - Gatorade will be your best friend!
*Gonal-F and Menopur can be mixed into the same needle! It's very simple to do! Just put the saline solution into the powder mix of Gonal-F (make sure everything dissolves) - then draw it up and inject it into the powder mix of Menopur (make sure everything dissolves).. this will save you from doing more shots than necessary!
* Also if you are prescribed Menpur - use the Q-caps that come with it -- they're a life saver!
* get a fresh pineapple or two, cut them up into 5 equal servings and start eating one a day starting on transfer day - its supposed to help with implantation
* even if your doctor doesn't recommend it - stay on bedrest for at least 2 days after transfer
Thank You Jaidynsmum for my gorgeous siggie!
Last edited by ~April04~; May 25th, 2009 at 07:06 PM.
This is a fantastic thread, ive learnt a lot. I found out today that IVF is our only option to get pregnant and we have been referred to a IVF clinic. As i live in the UK costs are different - we get 3 attempts on the NHS for free and then after that we would have to go private and it would cost about £4000 ($6700).