IVF - Can you walk me through the steps?

[skyblu]

Hi ladies,

My best friend is dealing with infertility and just started her IVF "process". If it makes a difference, her husband's sperm count is very low and her Fallopian tubes are blocked, so they're doing IVF as opposed to IUI.

She's confused and doesn't always know what things are called or exactly what they do, and her husband is very private and doesn't want anyone to know they're doing it (IVF). So, he doesn't know that I know.

What I'd like to do is to better understand the entire process so when my friend tells me about it (she calls me frequently to vent, discuss, etc.), I don't feel so lost. Also, so I can help her ask questions of her doctors so she can understand what's going on with her body! I'm in a health profession and this makes her think I have all the answers! My job or my current school do not deal with this in the least (I'm an EMT and taking science classes in order to start PA school in the Fall), but I am a lot more knowledgeable about anatomy and physiology than she is, so she asks me lots of questions.

So far, I know they had originally put her on the Pill (sounds counter-intuitive!), then a few days before AF was due, she started injecting herself with something. She doesn't know what it's called or what it does. Oy!

Then, once her period started, she had to call her doctor so they could "switch her medicine." Again, she cannot be more specific than this.

Sometime this month (her AF just started a couple of days ago), they'll retrieve her eggs, then fertilize them and put the embryo(s) back (sorry, don't know what this part is called).

So, here are my questions:
1) What are these "medicines" she is injecting? I'm thinking that the pre-AF one was to maybe stimulate more egg production (she doesn't have a problem ovulating), and the during- and post-AF one is progesterone to thicken the uterine walls and improve the odds of implantation?

2) What's the timeline for the whole thing?

3) What are the odds of implantation the first time around?

4) (and most important) How can I best support her through this? She's completely unprepared for the IVF not working the first time around. Should I gently remind her it may not? Or do I let her be 100% convinced, and then watch her heart break if it doesn't work?

Thank you all in advance, and sorry this ended up as such a long post!

[skyblu]

Hi ladies,

My best friend is dealing with infertility and just started her IVF "process". If it makes a difference, her husband's sperm count is very low and her Fallopian tubes are blocked, so they're doing IVF as opposed to IUI.

She's confused and doesn't always know what things are called or exactly what they do, and her husband is very private and doesn't want anyone to know they're doing it (IVF). So, he doesn't know that I know.

What I'd like to do is to better understand the entire process so when my friend tells me about it (she calls me frequently to vent, discuss, etc.), I don't feel so lost. Also, so I can help her ask questions of her doctors so she can understand what's going on with her body! I'm in a health profession and this makes her think I have all the answers! My job or my current school do not deal with this in the least (I'm an EMT and taking science classes in order to start PA school in the Fall), but I am a lot more knowledgeable about anatomy and physiology than she is, so she asks me lots of questions.

So far, I know they had originally put her on the Pill (sounds counter-intuitive!), then a few days before AF was due, she started injecting herself with something. She doesn't know what it's called or what it does. Oy!

Then, once her period started, she had to call her doctor so they could "switch her medicine." Again, she cannot be more specific than this.

Sometime this month (her AF just started a couple of days ago), they'll retrieve her eggs, then fertilize them and put the embryo(s) back (sorry, don't know what this part is called).

So, here are my questions:
1) What are these "medicines" she is injecting? I'm thinking that the pre-AF one was to maybe stimulate more egg production (she doesn't have a problem ovulating), and the during- and post-AF one is progesterone to thicken the uterine walls and improve the odds of implantation?

2) What's the timeline for the whole thing?

3) What are the odds of implantation the first time around?

4) (and most important) How can I best support her through this? She's completely unprepared for the IVF not working the first time around. Should I gently remind her it may not? Or do I let her be 100% convinced, and then watch her heart break if it doesn't work?

Thank you all in advance, and sorry this ended up as such a long post!

[CapeCod04]

I'll try to answer your questions based on my own IVF experiences.

1. What are these "medicines" she is injecting? She's likely starting with a hormone (known as stims) that will stimulate follicle production. They (doctors) want you to produce a lot of eggs. That gives them more to harvest and fertilize. She is likely being monitored very closely to watch her hormone levels, the number of follicles and the size of them. She may also be taking a drug to prevent ovulation. After retrieval, she may begin taking progesterone through injection - known on here as PIO - for progesterone in oil. This is to promote a healthy uterine lining - a nice soft landing place for the egg.

2. What's the timeline for the whole thing? That varies by person. For me, a cycle would start with a week or two on the pill. Then about 3 days after I stopped the pill, I would start the stims. The target was 10 days of stims, I went longer twice, shorter once. When they decide your follicles are ripe, you stop the stims, the next day you take a shot to finish the maturation process - it's taken about 36 hours before the retrieval. So - basically a day and a half after that shot, you go in for retrieval. Eggs are fertilized and then put back, usually 3 to 5 days later. At my clinic, you go back for the pregnancy test 2 weeks after the retrieval.

3. What are the odds of implantation the first time around? - totally depends on the individual - how old are they, what is their diagnosis, etc.

4. How can I best support her through this? She's completely unprepared for the IVF not working the first time around. Should I gently remind her it may not? Or do I let her be 100% convinced, and then watch her heart break if it doesn't work? I think you are making a great start - trying to understand what she is going through. Understand that the stims will cause her hormones to go wild. Picture PMS on overdrive! So - be understanding of that. It's not physically the most comfortable thing, especially as you get close to retrieval. Plan any activities accordingly. Lastly, just listen, let her talk it out.

Good luck to your friend - she's lucky to have someone who cares so much!

[Astro]

Hi Skyblu

The pre-aunt flo med is probably Lupron. It is used to supress the ovaries, make them all nice and quiet. When she got aunt-flo, she probably went in for baseline ultrasound (check ovaries are quiet, no cycsts, uterine lining, etc) and bloodwork. After that, she starts stims. The meds can be different, but some of the more common are follistim and repronex. She'll take lupron (half dose) in the morning with follistim, then the repronex at night. During this, the lupron helps keep her ovaries from releasing any eggs while the follicles (containing eggs) keep growing. She'll be watched closely to make sure she's responding appropriately and meds adjusted as needed. During this time, she can ask about her follicle numbers and sizes. It can range from 2-30+ follicles that may eventually reach 16-24 mm in size. At that time, she'll give herself the trigger shot, and they'll harvest the eggs in the next day or two.

That's the short story. You can also get a lot more information from the IVF boards. They're very welcoming and don't mind answering a 1000 different questions. :)

[eponymous]

Edited to remove confidential information

[Scooter]

I can't imagine going through infertility treatments, especially IVF, without having any idea about the process. It would just be so confusing and isolating, and unless you know what is going on you really aren't able to be a good consumer. I had an appointment with my RE to get ready to start IVF, and one of my questions for her was what she thought my % chance was. I can't imagine already being on stims and not even having a realistic idea of the outcome. :( It's a real set-up for heartbreak. Especially when she can't be a good consumer and find out if she's being treated well for her diagnosis or anything like that. Then again she may not want to know anything, some people feel more comfortable blindly trusting their Drs.

I think as a friend one thing you could do is let her know she can ask her Dr for his/her opinion on what her chances are. And each clinic has yearly stats--you should be able to see what their success rates are in the different areas (fertilization rates, singletons vs multiples, successful pregnancies, etc). She can ask them about this information.

Just because her DH doesn't want to let people know about it IRL (which is really too bad, because you need a lot of support going through this) doesn't mean she can't get support. There are plenty of internet sites that offer support and information. There's always CC and the IVF thread here, and there's www.ivfconnections.com which is packed with info. It has info on tons of clinics (maybe hers is on there!), book lists, and extensive bulletin boards. (E.g. there are entire forums for: male factor, tubal infertility, IVF by location, 2ww, financial issues, etc.)

[eponymous]

Edited to remove confidential information

[Suzlywoozly]

Come on over to the IVF board and if you read through a couple of pages, I know that some of us have posted our protocol.

Your friend's RE should give her some type of protocol describing what to expect and what all the meds are for and their side effects.

I'll give you what my protocol was....

8/4/05 First day of my period

8/5/05 Start birth control pills

8/25/05 Pre-lupron sonogram (makes sure there are no cysts and that the ovaries are "quiet"); Start the lupron injections (1 at night).

8/28/05 Stop taking the birth control pills
After stopping pills, wait for period to start...

9/1/05 Baseline sonogram and E2 bloodtest

9/3/05 Start taking baby asprin & follistim injections (225iu). Continue lupron injections but a lower dose

9/7/05 Sonogram and E2 bloodtest (check to see if foliicles are growing)

9/9/05 " "

9/10/05 " "; Follistim is decreased to 150iu.

9/11/05 " "; Stop follistim and lupron injections; Start taking Estrace tablets (estrogen), Doxycycline (antibiotic) and Medrol (controls inflammation). Give ovidrel injection at the exact time as directed by doctor. Ovidrel makes the follicles ready for retrieval. Dh started antibiotic to make sure sperm is "clean" for fresh semen sample on the day of retrieval.

9/13/05 Egg retrieval (21 retrieved); Had hespan infusion since so many eggs were retieved (helps prevents OHSS); Start the progesterone injections; Continue on medrol, doxycycline, estrace and baby asprin. Dh takes last antibiotic pill. After ER, need to rest at home and limit activity.

9/14/05 Doctor called to give fertilization report (16 fertilized)

9/16/05 Doctor calls to tell you whether embryo transfer will be that day (day 3) or if the embryos/blastocysts are good quality they will wait until day five to transfer them (14 made it to blastocysts).

9/18/05 Embryo transfer (2 blast tranferred); if any the remaining embryos are frozen (12 frozen...2 didn't survive). After ET, need to rest at home and no activity for 36 hours)

9/18/05 - 9/26/05 Continue on baby asprin, estrace and progesterone injections

9/27/05 Bloodwork (pregnancy test)

cont...

[Suzlywoozly]

cont...

*Lupron supresses the hormone production and allows for improved stimulation of the ovaries.

*Follistim is what stimulates the ovaries to produce lots of follicles (eggs).

*HCG/Ovidrel is the "trigger shot" that matures the eggs and prepares teh mature follicles for ovulation.

*Progesterone assists in making the uterine lining making it "plush" for implantation and maintaining early pregnancy.

*Estrace is estrogen replacement therapy.

*Baby asprin is given to optimize blood flow to the uterus and prevents micro clots.

I hope that gives you some info to understand what your friend will be going through. That is really thoughtful of you to take interest and try to understand what she is going through. IVF has probably been the hardest thing I have ever gone through in my life. The emotional, physical and financial aspects can be very stressful not only on your friend, but on her DH. The best advice I can give you is to listen to her and let her vent. My friends outside the "infertile" world were not very supportive and understanding of what I was going through. Don't make comments like telling her to relax or that it will happen (or that it might not happen). It is the last thing an infertile person wants to hear! Just listen to her, let you know you support her and that you are there for her. The heart break will be awful if they find out that they were unsuccessful. I cried for days and it still makes me tear up just thinking about it. She will probably wonder if she did something wrong or try to figure out what went wrong. I wish her all the best of luck!:)

Sorry my posts were so long!

[skyblu]

Thank you all so much! Your erplies are very helpful!

I think message boards would be a great way for her to get the support she needs, anonymously. But she says it's too confusing and overwhelming. She has me even do simple Google searches for her, she's not too computer oriented.

Her DH is very private about everything, but this is ridiculous! She asked him "for permission" to tell me (and just me) so she could get support from a female friend who'd been pregnant and given birth (my son is 8), but he claims he can never know if "the information" will get out. He feels very emasculated by the male factor, and thinks he's "less of a man" for it, so he's afraid people will ask why they need IVF (I guess he's the opposite of the men in the study mentioned, because he blames it all on himself). Would people ever really be that rude to ask why? I guess they could be, but there's always a polite put-off like "Our doctors agree that it'd be nearly impossible for us to get pg naturally, so we've decided to go the IVF route." What's there to ask? And if someone does, you can always say, "I'd rather not discuss the particulars." No?

Anyway, her Dh is really a good guy, and part of him feels he is all the support she needs. He doesn't need support, he thinks, so he doesn't understand why she might.

A very delicate situation, for sure.

As far as the possibility of it not working, I think you all are right, I won't bring it up unless she does. Part of me thought it might be a good thing. The background on that is that I have a chronic illness and, while I appreciate people who try to cheer me up, after a while it gets quite uncomfortable and annoying when people say, "I'm sure you'll be okay! You can beat this! I know it!". Um, well, I'm glad *you* are sure, because I sure as heck am not. And what am I gonna say, every time, "No, I probably won't?" So in my situation, I do appreciate the rare friend who says, "This sucks. Do you have a plan for what happens if it doesn't go away?" But the more I think about it, the more I think you all are right and the same would not necessarily be true in her situation.

Wow, I've spilled my guts here! :p Thanks again for all the input!

[Scooter]

Skyblu, I don't know anything about that study that was mentioned above; what I know is from my experience with friends, on the boards, and from reading books on coping with infertility. But to me, the results of that one study are not representative of the men's reactions to MFI (male factor infertility). It seems like they either are in denial about it and want to pretend the couple isn't infertile (it's too threatening to their self-identity) or they learn to accept it and in the process feel totally emasculated, like your friend's DH. I have to say that if he doesn't think he needs support about infertility, the chances are he's still in some phase of denial about it all. And your friend may well be, too.

I have to dissent about not talking to her about the IVF results. At least approaching the subject with her to let her know what her options are, as far as getting that info I mentioned from the Dr. Plus, she should have gotten a packet of info that explained some of the process from her Dr--has she looked at that? Give her info about INCIID (http://www.inciid.org/) ("inside") and Resolve (www.resolve.org), two great sources of national support & info. Resolve offers group therapy or support meetings, which her DH may feel more comfortable with because they're not people they know personally.

You can always print out some info to help her start to figure out all of this, since it alone can be so overwhelming, emotions & money aside. Some links to look at to see if she may be interested ina ny of it:

Demystifying Infertility:Infertility Myths and Facts (http://www.resolve.org/site/PageServer?pagename=cop_demis_home)
THE SECRET OF INFERTILITY: When to Tell, Who to Tell, and How to Tell (http://www.resolve.org/site/PageServer?pagename=cop_tainf_tsoi)
Is a Support Group Right for Me? (http://www.resolve.org/site/PageServer?pagename=cop_arsg_sgrfm)
fertility basics (http://www.idreamofbaby.com/fertility.php)
What is IVF? (http://sharedjourney.com/ivf/what_is.html) (lots of links to describe breifly, basically each thing, good intro to the info)
Plus the 1st page of the SAI (http://www.constantchatter.com/showthread.php?t=13442) thread has a lot of book recs and info links. If forums are too overwhelming for her, a good book would be great.

[kat]

Would people ever really be that rude to ask why? I guess they could be, but there's always a polite put-off like "Our doctors agree that it'd be nearly impossible for us to get pg naturally, so we've decided to go the IVF route." What's there to ask? And if someone does, you can always say, "I'd rather not discuss the particulars." No?


There is absolutely no reason for them to "tell" anyone that they did IVF (or are doing IVF). If they decide they're close enough to tell someone (like you), then they can, as you suggest, say "I'd rather not discuss the particulars."

BTW, there are also books available on IVF. I know I read one in Barnes & Noble when I was going through the process.....so if she's not computer literate, she can still get the information.

[Suzlywoozly]

I replied to you over in the Family Planning Group post...

[skyblu]

Thank you all again so much for sharing your own experiences, advice, and information. I really appreciate all your help!

[skyblu]

Thanks, guys! Suzly, your timeline and meds list ROCK, thank you!!!!

[jennylou]

Moving this to the family planning section, instead of the groups section.:)

ETA - Two threads merged on same topic.