Warning: What you are about to see is a VERY long post (I originally typed it in a Word document, and it gave a word count of over 3,000… ridiculous, really)! And for anyone not going through or considering/planning an IVF cycle, this post will probably be insanely boring.
For anyone who IS interested in IVF, and either beginning a cycle now, or thinking about it, you may want to grab a nice cup of coffee and settle in, because I tend to get a little long-winded. There are LOTS of things I wished I’d known before we began our first cycle of IVF. Actually, since we began treatment for IVF on July 18, 2013, I have kept a running list of the things I’ve learned, and the things I wished I had known prior to beginning our own IVF cycle. I want to share these things while they are still fresh in my mind!
This list is pretty comprehensive, and covers the IVF process from start to finish. Because of this, there are some topics I skim over rather quickly. With those topics I tried to include links that lead to more detailed posts for anyone who needs them.
The IVF process is different for everyone. We all respond to the physical, emotional, and financial stress differently, so you may find that there are some things on this list that you do not experience when you undergo IVF, and you may find that there are things you encounter that are not on this list. Either way, I would love your feedback!
1) You will likely have to take birth control pills for two weeks before you can begin your IVF medication regimen, regular monitoring appointments for ultrasound and blood work, etc. You will be so excited and feel so ready to really delve into the IVF process that these two weeks will seem like an eternity. Just be prepared for them to drag on a bit.
2) Before you even begin the shots, you will become very well-acquainted with your IVF nurse. And then after you start the shots, she will become your BFF. You can expect to talk to her every day, either on the phone or in person at the doctors office. I seriously consider my IVF nurse my friend now. Meeting her has been one of the rewards of IVF.
3) You will think of new questions or concerns daily during the several days leading up to your shots, and during the 10-12 days that you are giving yourself shots. Its okay to call your nurse and ask her anything you want! My nurse told me it would be weird if I didnt call most days, as most people do. So do not feel bad, or like you are disturbing the office, or being high maintenance. They expect it!
4) If you are told to start taking baby Aspirin on the day you take your first shot, be aware that it may make you bruise more easily than normal, and bleed a bit more than normal with your shots. I definitely noticed that this was true in my case. My stomach bruised almost every time I gave myself a shot, and I bled more than I have in the past. (The reason some doctors recommend baby Aspirin is that studies have shown that baby Aspirin may improve blood supply to the uterus.)
5) At the beginning of the IVF process, before you start the shots, and immediately after you finish the birth control (or possibly before you even start the birth control), you will go in for an appointment that will be extremely uncomfortable. At this appointment, the doctor will perform a transvaginal ultrasound, which will be totally routine to you by this point. They will also do a trial transfer, which is slightly uncomfortable, but not unbearable. Finally, they will do a scratch of the uterine lining. My doctor warned me that this would be pretty uncomfortable for about thirty seconds. Just breath deeply and slowly. I wished she had given me a more fair warning, and told me that this was going to be one of the most painful things Id ever felt in my life. For about thirty seconds, I wondered if I was going to pass out. When she was done with the scratch, the pain did not go away. The cramping sensation was indescribable. There is no way I could have been prepared for it, but I sure do wish someone had told me in advance how difficult it was going to be! I bled A LOT the rest of that day, and the day afterward, and was incredibly sore. Im not complaining it was worth it! But I want anyone else preparing for IVF to have a heads up!
6) Every patient is different, and every doctor is different, so all IVF patients will not necessarily take the same shots. The shots I took were Follistim (for ten days), Menopur (for ten days), and Ganirelix (for ten days). Then, the day before the transfer I took Pregnyl as my trigger, along with Lupron.
7) Your meds will come in the mail, and will be delivered in a HUGE box. Once you open the box and see that it is filled to the brim with medication, you will probably be inclined to panic. But dont worry. You do not take everything at once. Each medication comes with its own set of instructions, but your nurse probably will have gone over everything with you already, and she will probably give you instructions that are much easier to follow. If there is anything you are unsure of after looking over the instructions, do not hesitate to call your nurse. It is vital that you take these properly!
8) The Follistim was easy peasy. The shot looks like a pen, and once you put it together the first time, all you have to do is put a new needle on it each night before you use it again. Not only is the prep for this shot pretty simple, but giving the shot is easy also. The needle is soooo small, and there is not a burning sensation or anything (at least, there was not in my case, but everyone is different). The directions that come with the Follistim (there is a whole booklet) say to keep the medicine refrigerated, and to take it out of the fridge prior to giving yourself the shot, in order to let it get down to room temperature. Believe me, you do not want to skip this step! If you give yourself the shot while it is still cold, it will burn. I took the Follistim out of the fridge thirty minutes before giving myself the shot.
9) The needle on the Menopur was bigger than the Follistim, and the medication did burn quite a bit going into the skin. The prep work was a bit more involved, as you have to mix saline with powder before giving yourself the shot. After the first night or two, it will be a cinch mixing and administering the Menopur. And remember, if you have any questions at any point, just call your nurse!
10) The Ganirelix injection site was always a bit tender for about an hour after I gave myself the shot, but the actual shot is very easy to give. It comes already in the syringe, so all you have to do is take it out of the package no mixing required.
11) Keep in mind that the original dosages could change. You may start off taking low dosages of certain meds, and your doctor may instruct you to begin taking higher and higher dosages. Also, if your follicles are slow to grow (like mine), you may end up taking all your meds for longer than the doctor originally anticipated. I had to take Ganirelix for one day more than we thought I would, and I had to take Follistim and Menopur FIVE more days than we thought I would. Not only does this push the timeline back, it also means you have to purchase refills of your medications. In our case, this almost doubled the original price of our meds. I say all of this to warn you that, the price you pay initially for the meds may be just the tip of the iceberg. Be prepared to have to order and pay for more meds before its all said and done! (Click here for some ideas on ways to save money on IVF)
12) By day eight of my shots, my stomach was feeling pretty full and uncomfortable. By the time day ten rolled around I was in total discomfort all day. My stomach was bloated and full (because my ovaries were so big), and my back hurt pretty badly too. The pain was nothing to write home about, but definitely noticeable enough to be a distraction.
13) Also by day eight of the shots, I was going into the doctors office daily for ultrasound and bloodwork. Since every person is different, you may not require such careful monitoring, but if you have PCOS, chances are that you will be required to go in often. Due to PCOS, we may already have many follicles, so we are easy targets for overstimulation. Frequent monitoring allows the doctor to catch this and adjust meds accordingly, before it becomes serious.
14) Do not plan any trips during the IVF. You will have lots of meds to take, and you will likely have very frequent doctors visits. Even a beach trip would probably be more stressful than its worth.
15) Instead of trips, plan some quality of life moments with your husband: a picnic, a walk at the park, dinner and a movie together, bowling. Plan a few fun things to do that will help you cherish this time, and be able to look back on it with fondness. If you are on as tight of a budget as we were, this may require LOTS of creativity, which makes it even more fun. All of our quality of life moments were either free, almost free, or things we needed to do anyway (like both of us going to the grocery store together instead of me going alone). All of our quality of life moments were precious.
16) You may want to consider going easy on the exercise the week of the egg retrieval. Since by day seven and eight of the shots, my stomach was beginning to feel bloated and uncomfortable, I did not do any exercise at all (unless you count legs up the wall yoga pose as exercise, which is just pathetic). Day seven was also the day I added Ganirelix to the shot regimen. I noticed that it made me soooo tired. In light of this, I was not motivated to exercise at all. By day nine I was feeling lazy and gross, so I walked about three miles. It was uncomfortable, and I noticed that I walked more slowly than normal. Afterward I felt totally wiped out. Even though I drank plenty of water throughout my walk, I felt dizzy and headachy for quite a while after. This may be a non-issue for those of you who are in better shape than I am, but you still may want to be aware that your body is tired, and busy doing other things. After my day nine experience, I decided to only walk about for about thirty minutes at a time, and to do so at a very comfortable pace. Do exercise when you can, but dont push yourself, and do not be hard on yourself if you do not feel up to exercising. Apart from a couple good walks, my stomach was really too swollen for me to do much.
17) Expect to gain a little weight. You may not gain any, but I did. (Ive actually gained a significant amount of weight since we started fertility treatments a year and a half ago). A lot of my weight gain during IVF was from ovarian hyper-stimulation, which is not a common side effect of IVF. If you do not become hyper-stimulated, you should not gain as much weight as I did during IVF, but I know even slight weight gain can be depressing if you dont prepare for it mentally, so just know that its a possibility!
18) You will be at the doctors office SO MUCH, so you will probably figure out on your own what makes those visits as relaxing and enjoyable for you as possible. But for me, it helped taking a book. My doctor and nurses were great, and I rarely had long waits, but always had several small waits (in the ultrasound room, in the lab for bloodwork, in the consult room for my chat with the nurse). All these small waits add up, and a book helped me stay relaxed. Another thing that helped me was wearing skirts or dresses to my appointments. This way, I did not have to get completely undressed for the ultrasounds. All I had to do was lift my skirt up. It helped me feel safer, and much more modest!
19) Since you will be spending so much time at the doctor, and since giving the shots takes a lot of emotional energy, spending lots of time cooking throughout the week of the egg retrieval is probably the last thing you will feel like doing. I spent about three hours in the kitchen on Sunday, prepping food for the rest of the week. I baked lots of chicken, roasted plenty of veggies, made a big batch of brown rice and steel cut oats, chopped raw fruits and veggies, made a loaf of bread (here is my favorite grain free/gluten free bread recipe), packed my husbands school lunches and snacks, etc. Even if this is something you do not normally do, I highly recommend it the week leading up to the retrieval.
20) The IVF process is going to be hard. Pick at least one, dear friend to confide in. Do not be afraid to share your struggles, apprehensions, excitement, and experiences with her. But try not to get get frustrated if she cannot relate to or understand you. Unless she has been there, there is just no way for her to get it, no matter how much she loves you and wants to.
21) If there are any home improvement or DIY projects that have been burning on your heart, do them before your transfer if possible. After your transfer, it will be natural for you to be incredibly cautious regarding physical activity, exposure to any chemicals or fumes that could cause harm or stress to your embryos, etc. I had been wanting to paint a frame in our upstairs hallway for months, and finally did so prior to our transfer. I also painted our dining room before our transfer. SO GLAD I did. If you are not able to get around to any of the projects on your to do list prior to the transfer, then make sure to wrap your mind around the fact that you will need to put these things off until you are much farther in your pregnancy.
22) You can also use the time before your transfer to start involving your husband in household chores that he may not be used to performing. After the transfer, you will want to avoid chores that involve heavy lifting, and any strong/toxic chemicals and cleaners. Let him help you with the housework so that after the transfer, and throughout nine months of pregnancy, he can be a help to you around the house.
23) The needle for the progesterone injections is pretty large, but the shots do not hurt. I actually think they hurt less than any of the other injections. They do make you hip/behind area a little sore and lumpy (read more about that here), and mine bruised pretty badly. But the actual shot itself is not as big of a deal as the needle might lead you to believe! I will say that, in addition to its other side-effects, I think the progesterone made me hungry. (Click here to read about other side-effects you may experience with Progesterone.)
24) If you are prescribed estrogen patches (I was prescribed Vivelle Dots), you will want to be aware that pulling them off your skin hurts like all get out. I was unprepared for this. Those suckers are sticky! And thats great, because you do not have to worry about them coming off once they are on. This allows you to completely forget about them during the day. But pulling them off hurts, and they leave sticky residue on the skin. Lemon juice is helpful in getting that residue off.
25) Make sure that, on the day of your transfer, you put the estrogen patches on your lower back instead of on your stomach (which is where you will normally put them). Having them on your stomach will interfere with the ultrasound, and you certainly dont want that!
*** A reader brought up another thing that should have been on this list originally:
If you are doing a frozen embryo transfer, there is a chance that your embryo(s) may not survive the thawing process. I was terrified of this prospect, and when the embryologist came to show me the picture of BOTH our little embries, I felt such a wonderful sense of relief wash over me. I had tried for weeks to mentally prepare myself for the possibility of one or both of our embryos not making it through the thawing process. So be aware that this is a possibility, and try to brace yourself as best you can (if that’s even possible!)
26) Although I highly recommend NOT planning any trips during your IVF cycle, if you do decide to go out of town, make sure that you have plenty of refills for all of your meds! Most of the medications are things that you cant simply have called in to a local Walgreens. The last thing you want is the stress of being away from home and running out of something as crucial as Progesterone (or any of the other meds, for that matter.)
27) If you would like to plan an IVF trip, or if you must travel somewhere, you may want to consider scheduling your trip during your two-week wait. Yes, it will be a hassle to pack up your meds, but it is do-able at this point in the cycle as long as you plan ahead and have plenty of medication, needles, someone to give you the shots, etc. Scheduling your trip during the two-week wait may help those long, slow weeks go by a little faster. Just make the trip as low-key as possible!
28) Your doctor and nurses will urge you not to take a home pregnancy test after your transfer. They will tell you to wait for you beta test at their office. If waiting does more harm for you than good (for instance, if it is incredibly stress-producing), then you may want to consider taking a home pregnancy test on your own prior to going in for blood work. Ive heard women say that doing this gave them more of a sense of control, as opposed to feeling like they were just waiting. If you decide to take a test on your own, make sure to use your first morning urine, and to take the results with a grain of salt. Also bear in mind that if you had a fresh transfer after a retrieval that included an hCG trigger shot, you will need to wait at least ten days before taking a home pregnancy test; otherwise, you run the risk if getting a false positive due to the hCG from the trigger shot that may still be in your bloodstream. (Here is what’s going on in your body in the first several days after your transfer.)
29) Another way to help you get through the two-week wait is to make a two-week wait to do list. And then, of course, complete each item you included on the list. Ive had many two-week waits, and once I started making to do lists, it helped the weeks go by a little faster, and it helped me feel more purposeful, as opposed to feeling helpless, antsy, and completely nuts. Your list could include things like: go for a stroll at the park, call a friend that you have not spoken to in a while, try a new recipe, sleep in, etc. You should put things on the list that are enjoyable rather than stressful. You can also make the two-week wait a time of productivity by making an effort to eat a proper pregnancy diet. This will help you feel more in control while you are waiting. (Click here for more tips for the two-week wait.)
30) Plan an event for the night that you find out the results of your blood pregnancy test. Commit to keeping the plans whether the result of the pregnancy test is positive or negative. This event can either be a celebration of your good news, or it can be your way of resolving not to let the bad news defeat or define you.
***If you become hyper-stimulated, or are in the IVF process now and think there is a possibility you might be becoming hyper-stimulated, please email me. This can change the game completely depending on how severe your case is! It definitely threw a wrench into our IVF cycle, and it would have been great to know a little more about what I was up against ahead of time!*** (Click here and here for more info on hyper stimulation.)
Just know now that, from the beginning of this process all the way to the end, you will not feel like yourself in any way, shape, or form. For starters, you will feel out of whack physically. You will feel tired on some days, edgy and antsy on others, achy, bloated and fat even this list could continue on and on.
And while its true that if youve been trudging through infertility, youve probably already felt emotional and overwhelmed, the emotions that accompany IVF are totally unique. The day you start your IVF cycle, something changes. For me, the emotions I experienced with IVF were far different even from the emotions I experienced with each of our three IUIs, and vastly different from my more natural cycles when we were trying to conceive. They are truly indescribable, and nearly impossible to prepare for.
You will be distracted, and focused constantly on your IVF cycle. You will loose your water bottle, your cell phone, your car keys, your purse, and your temper. You will forget things that used to seem commonplace. In short, you will feel like you are losing your mind.
So give yourself grace during this time. But also give grace to those around you. You are right when you feel like they do not understand what you are going through and what you are feeling. They probably cannot relate. They may say the wrong things. Even your husband may sometimes seem like he is not as involved or invested as you. Give everyone in your life grace anyway. Believe me, you will want them to do the same for you.
I read something recently: “Stop being afraid of what could go wrong and think of what could go right.” It is easy to be overwhelmed with both anxiety and hope throughout the IVF process. You are spending so much money on something that has just as great a chance of not working as it has of working. That alone is terrifying. Then toss in the emotional and physical toll that an IVF cycle takes on the body, mind, and spirit… It is easy to dwell on the negative. But we also have hope.
We always have hope. And that is a beautiful thing to focus on. The “what could go right,” is worth the risk. It’s worth the discomfort, the emotional roller coasters, the dwindling savings accounts, the tear-filled nights, the shots, and even the weight gain.
After a year and a half of fertility treatments, we finally found out that we are pregnant, through IVF! My second blood test is scheduled for this morning, and I can’t wait to share the results! Although I am terrified, I am believing for good news!
If you are someone who has gone through IVF already, I would love to hear what your experience was like!