Switching to IVF questions

[Stringy]

I'm hoping a few people here might have some experiences you could share with me.

I've had 9 IUI's now. Thats a whole big waste of money and time and heartache. DW and I have talked about switching it up to IVF, and because our insurance will cover most of it (not sure about the meds) - but doesn't cover all these vials of sperm we keep blowing through, it may be the better financial choice too.  She's left it up to me, its my body.  I'm nervous mostly about the shots, and about time off from work and some planned getaways. So far I've done trigger shots and they seem to be NBD, but I realize this will bring more.  But I'm also thinking about timing...

So, this TWW will be up on memorial day.  If I want to do IVF the next cycle, what do I need to do to prep now? (call my doctor, yes) Is it even possible or will I have to sit out a cycle?  We have a weekend away planned about 13 days after memorial day - I usually don't ovulate until 15-20 days - but do you require more monitoring since you are using more meds?  What's the worst part or the whole process?

Pretty much give me your IVF 101, please.

A gif for your time

[mahler5]

I think they put L on meds on her CD3 or CD4 to get her ready for Egg retrieval. I can't remember when the shots started but I think by the 5th or 6th cycle day. They did put us on Birth control pills to line up our cycles. And I think they occasionally do that to delay cycle day 1 ( which would be the first day without the pills) for scheduling purposes.

My point being you might need to take the cycle off if you are going to be out of town or they might be able to delay your cycle a few days with BCPs. It also seemed like the Egg Retriecal was not on cycle day 14 like an IUI but a little later, like maybe CD17.

She had a lot of subquetaneous shots, so just in the fatty skin of her abdomen and only a few IM shots.

However, you will probably have to do IM progesterone shots leading up to the ER and after ET. I do one every other night. But if you are used to the trigger shots it shouldn't be that big of a deal.

I would call your office and tell them what you are thinking so you can get in for a consultation. The process always seems to take longer than expected , at least with our RE office.

That's great insurance will cover most of it. Our procedure was around $8,500 but meds for the ER and first ET were $4000. Meds for our FET this cycle are about $250, so additional cycles (if you need it) won't be as expensive med wise. Our FETs are $2,000. Our insurance doesn't cover shit.

I hope this cycle is the one!! Waiting sucks.

[mahler5]

Monitoring

I think this varies as my RE doesn't seem to monitor as much. I think L had 2 or 3 ultrasounds leading up to the ER and one or two lab draws. Maybe somebody else has a better idea. But it seems like a weekend away when you are planning it would be ok. As long as you don't mind bringing all your meds and supplies with you

[healz413]

IVF is exciting and terrifying and time-intensive and overwhelming and, often, people's best shot at getting pregnant.

Here are my basic thoughts--yes, it's expensive (although less so for you-- yay!) and time-intensive, but it's kind of like combining 5-30 IUIs into one (depending on how many eggs you get). If you look at it that way, it's not so bad.

As for protocols and calendars, they totally vary. In most cases, though, REs will want to do something the previous cycle (birth control pills, lupron, etc.) so it is definitely important to talk to your RE as soon as possible to see what they would want your timeline to look like.

As for number of appointments in the IVF cycle itself (not counting appointments the cycle before for lupron, BCPs, saline sonogram), our cycles looked something like this:



Day 2 or 3: transvaginal ultrasound and blood work, start stimming drugs

Day 5 or 6: transvaginal ultrasound and blood work to see if drugs need to be adjusted

Day 8 or 9: transvaginal ultrasound and blood work to see if drugs need to be adjusted and to get an initial sense of when retrieval will be

Day 10 or 11 or 12 (depending on previous results): transvaginal ultrasound and blood work

Everyone 1-2 days after that: transvaginal ultrasound and blood work to pinpoint when retrieval should be.

Retrieval is usually between days 12 and 16 depending on how slow or fast your growth is.

Then, if you're doing a fresh transfer, you will transfer 3 or 5 or 6 days after that.

If your partner cannot give you the injections, you will need to also go in every morning to get a nurse to give them to you. However, most people who aren't super squeamish can give the injections just fine.

I would recommend planning to take the full day off of work for the retrieval and also for the transfer. The retrieval time off is a medical necessity. The transfer day off is more about convenience, nesting, being with your partner, etc.

[Stringy]

So, what i've been doing for my last 3 IUI's isn't all that different than what you describe healz413,. The number of monitoring u/s has varied, but one cycle I went in 4 days in a row for blood work. This one I only went in for one monitoring check in.

I assumed some time off for the ER would be part of it.

I'd be super happy to have a nurse give me shots. I don't like the idea of my wife doing it. I can do some, but the trigger one is small and easy (so far). I was very squeamish about blood and shots prior to TTC.

As for the cycle before, that would be this one (hopefully) so I was on clomid and a trigger and progesterone. I had a saline sono a few months ago.

Ok, I guess I should just call. I always feel so pessimistic calling during a TWW, and its hard to get the doctor (vs a nurse) on the phone sometimes.

Thanks everyone - add more if anyone has anything else!

[cetcar]

(I'll give my 0.02, and CAR may add to it when she gets the chance)

Our experience with IVF is a little different, and we're still in the process of it, but we've learned a decent amount by going through it and asking lots of questions.

Our cycle started as a medicated IUI, so it was CD 3 work- bloodwork and u/s, and then on day 4 CAR started the gonal injections daily. The dose would be higher and for more days potentially if the cycle was intended to be an IVF from the start. She was worried about the injections, but found that the gonal was really easy to use (small needle), and didn't hurt if you use ice for a min or two to numb the skin.

Once we converted to the IVF protocol, there were a couple injections to postpone ovulation, and then finally the trigger, but CAR did them herself (with ice) and was ok. If you respond well, you may be sore from your ovaries being big, but that's kind of a good thing/bad thing situation.

The actual retrieval was quick- 20 mins, and you're asleep for it. I won't lie, CAR was in some discomfort afterward, but felt better the next day. However, because of her over response, she did get some early onset OHSS that lasted several days and just started to fade at the time of our 6 day transfer. Not debilitating, she could go on with life, but definitely uncomfortable. However, this, as well as her late onset OHSS (worse) was due in part to her over response to the meds, which probably correlated to her very high (off the chart) AMH and follicle count, so she's a bit atypical. Your doctor can tell you more about what you personally could expect.

As far as how long you'd need to plan ahead if you're doing IVF, each clinic seems to have their own thing. Since you've been doing IUIs and they've been working with you they may be able to go right to it, but I do think they prefer to have 2 cycles to prep you. I'm thinking of doing a freeze-all cycle later this summer since I'm not getting any younger (and putting all the medical expenses in one year has tax benefits for us), and our clinic said they'd want to put me on BCP for the cycle before the intended IVF.

Overall, yes, it's a big difference from IUI- much more involved, but the success rate is a lot higher (our Dr claims he's 80-90% with good responders). For most people the issue is cost, but if it's covered.... Plus, you have the possibility of having embryos left over for future transfer.

One bit of advice I do have is to ask about the lab they use and what their rates are and what processes they offer. There are big differences in success rates lab to lab.

Not sure if that answers any of your questions....but...feel free to ask more

[kh826]

So, I am very much team IVF when it financially and emotionally makes sense (for reasons already mentioned), and I won't rehash what other's have already said, but I will share my own experience for you to add to your info arsenal...

So, healz413 is right - protocols can vary a lot, and that will determine the amount of time an IVF cycle will take. My fresh IVF cycle took about 8 weeks from start to finish. First I went on BCPs for 21 days and started Lupron injections (sub-q in your thigh - definitely not a big deal) to overlap with the BCPs. Once I completed the 21 days of BCPs, I stopped them and waited to get a light period. After my period came I had a baseline at day 3, stayed on the Lupron and started stimming (those are the injections in your abdomen). I stimmed for about 14 days in total (some stim longer, some stim less - depends how you respond and if they need to adjust your meds). I had monitoring visits with blood work and u/s every 2-3 days while I was stimming. Once I was deemed "ready" we triggered and retrieval was 36 hours later. Then transfer was 5 days after that. So all in all it was just about 2 months from the day I started BCPs until the embryo transfer. They refer to my protocol as the "Long Lupron Protocol." There are other protocols that are a bit shorter. Your RE can guide you on what is best for you, however, it is my understanding that there is some flexibility around the amount of time that you stay on BCPs, so if you need to stay on them a few days more to delay the next steps of your cycle due to travel, etc. - I think that is doable. Or you could also delay stimming by a few days while still on Lupron. So there can be some flexibility on terms of schedules. Once you start stimming though, you are pretty much tied to your RE's office until egg retrieval.

The shots are truly no big deal in my opinion, and I was really nervous about them at first. Like everything else in TTC, it something you get used to and then just becomes part of your normal routine.

The fact that you have insurance coverage for IVF is AMAZING! We have paid our RE many, many, many dollars between our IUIs, our fresh IVF and our FET. Seriously, she could buy a lovely new car.

There is a lot to know about IVF, and many of us here who have been there done that... so please do not hesitate to ask a million questions.

Good luck!

[kh826]

Things that I forgot:

* With my fresh cycle I took a total of 3 days off. Day of Egg retrieval, day after egg retrieval and day after transfer (transfer was on a Sunday, so I was already off for the day of transfer). With my FET, I took off the day of the transfer, but not the day after. Some clinics will recommend modified bed rest for 24 or 48 hours, but as long as you take it as easy as you are able to immediately following, you should be just fine. Going to work the day after a transfer (unless you are digging trenches) is really fine.

* I also personally think that recovery from egg retrieval was not a big deal. I know other folks who have had different experiences, but for me I felt a little sore but mostly fine by later that same day. I tend to have a high threshold for pain just generally speaking, but I didn't even take advil or the like following my retrieval.

* Most clinics offer an IVF orientation class that you can take at the start of your cycle. Our class was in the evening (required no time off from work) and they even had dinner for us. The Dr who led the class walked us through the entire process, showed us videos and then took questions from the group. There were 4 other couples in our group. We learned a lot. If your clinic offers that, I would recommend it.

[officerofthelaw]

Here is my experience and hopefully it helps. Our fertility was not covered at all so I did a lot of research to find ways to save money.
First off if I knew that the very first IVF would work, I would have skipped the 9 IUI's.

For medication, if it is not covered there is a company called Compassionate Care and they give an awesome discount for the meds through Freedom Pharmacy. It's a form that you will fill out online at Compassionate Care and they will base your discount off your income. We got 50% off all our fertility meds. Secondly, some people donate their leftover meds. I donated mine and the woman I donated them to just found out she was pregnant today and it was her first IVF. I only took one day off of work and that was the day of the egg retrieval because you will feel a little bloated. The shots were really easy. They went in my stomach and didn't bother me at all. I hope this helps, I know the heartache. Good luck and if you have anymore questions feel free to ask!

[Stringy]

Thanks you guys - this is super helpful.

cetcar what do you mean about the lab? I ask because I *think* they do things in house? So do you mean the embryology lab and related processes?

[karlamo]

Stringy, I hope all of these comments are useless to you because you're already pregnant!

But if you do need to do IVF, my advice is wait till after vacation at least the stimming part. If you need to suppress your cycle maybe you can do that on vacation.
When it comes to stimming you have no idea how you're body will respond or how much monitoring you'll need. It truly varies. My wife stimmed for 13 days, me 7.
Our clinic doesn't do classes, instead you'll meet with your dr and they will pick 1 of 3 IVF protocols for you based on what they think you need. They're the antagonist protocol, long lupron, and micro flare. We researched them before our apt so we knew what the dr was talking about and recommending for us. We're type A like that.

They put the order in for the meds from a local fertility pharmacy in Beverly. They will deliver to your door. They come with easy to follow instructions on how to give the shots and you can watch videos on their website too. The shots never bothered us probably because we were so desperate for a kid I would have injected it into my eye if I needed to!

I know it may be hard to wait another month when you've already waited this long. After our 12 IUI, we had a trip to Hawaii planned that we didn't want to go on. I actually broke down crying in my dr's office saying I wanted to skip the trip and move into IVF that month. She was wonderful and said NO, you need this trip, take a break from all of this.

Good luck and if you have anymore questions just ask. I'm assuming you're doing IVF at the same clinic as you're at now.
Oh and one more thing, they do monitoring at their satellite offices but all ER and ET they do at the Dedham office. They're done early morning.

[cetcar]

May 14, 2015 12:52:51 GMT -5 Stringy said:

Thanks you guys - this is super helpful.

cetcar what do you mean about the lab? I ask because I *think* they do things in house? So do you mean the embryology lab and related processes?

Okay, this may be way more detail than you're looking for at this stage, but given what our last month has been like, I've been all research all the time on IVF.  Especially since we didn't know we were doing it, so we never got a consultation or info session on it.

Yep, and ours does it 'in house' as well.  Technically, I think it runs as a different business, but it's really the same clinic.  The 'surgery center' where they do the ERs, all more involved procedures (CAR's fluid drain yesterday was there), and the embryology lab, are downstairs, and the fertility clinic for the consults and IUIs and such are upstairs.  The lab that did our PGS was affiliated, but not the same as the embryology lab.

Doing some research from published success rates (for us clinics- www.sart.org/find_frm.html), there are differences between clinics/labs.  Obviously, it's highly dependant on their patient age, etc., but you may want to ask a few things up front so you're prepared- how often do they do 2, 3 day, 5 day, etc transfers?  Do they usually have good rates of blasts lasting to day 5 or 6?  What is their freezing procedure?  Thaw success rates? Storage fees? Do they offer elective PGD/PGS, and what are their rates of elective single transfer?  What is their standard of care- ICSI? Assisted hatching?

Your clinic may have an info sheet or such that could answer most all of these things in one go, since they're common questions, and most deal with their standard procedure.

 

[Stringy]

May 14, 2015 13:09:22 GMT -5 karlamo said:

Stringy, I hope all of these comments are useless to you because you're already pregnant!

But if you do need to do IVF, my advice is wait till after vacation at least the stimming part. If you need to suppress your cycle maybe you can do that on vacation.
When it comes to stimming you have no idea how you're body will respond or how much monitoring you'll need. It truly varies. My wife stimmed for 13 days, me 7.
Our clinic doesn't do classes, instead you'll meet with your dr and they will pick 1 of 3 IVF protocols for you based on what they think you need. They're the antagonist protocol, long lupron, and micro flare. We researched them before our apt so we knew what the dr was talking about and recommending for us. We're type A like that.

They put the order in for the meds from a local fertility pharmacy in Beverly. They will deliver to your door. They come with easy to follow instructions on how to give the shots and you can watch videos on their website too. The shots never bothered us probably because we were so desperate for a kid I would have injected it into my eye if I needed to!

I know it may be hard to wait another month when you've already waited this long. After our 12 IUI, we had a trip to Hawaii planned that we didn't want to go on. I actually broke down crying in my dr's office saying I wanted to skip the trip and move into IVF that month. She was wonderful and said NO, you need this trip, take a break from all of this.

Good luck and if you have anymore questions just ask. I'm assuming you're doing IVF at the same clinic as you're at now.
Oh and one more thing, they do monitoring at their satellite offices but all ER and ET they do at the Dedham office. They're done early morning.

Ooh thanks - good to know the 3 protocols, I will also pre-research.  I've had the meds delivered already (trigger and progesterone) so I've done that - and the IUI's are in dedham too so I'm already used to going there (plus things keep happening on weekends so I'm there anyway).

The June trip is just a weekend and local (one of the islands) - and so if I have to come or go early its not too big of a deal. PLus its free.

But then of course in july and august we have weeks at the beach with each of our families. Also possible to come home for things as needed, but I don't want to be stressing over feeling crappy there, nor do I want to wait until September. Hopefully your first line will be true and this is just speculation.

[Stringy]

May 14, 2015 13:16:31 GMT -5 cetcar said:

May 14, 2015 12:52:51 GMT -5 Stringy said:

Thanks you guys - this is super helpful.

cetcar what do you mean about the lab? I ask because I *think* they do things in house? So do you mean the embryology lab and related processes?

Okay, this may be way more detail than you're looking for at this stage, but given what our last month has been like, I've been all research all the time on IVF.  Especially since we didn't know we were doing it, so we never got a consultation or info session on it.

Yep, and ours does it 'in house' as well.  Technically, I think it runs as a different business, but it's really the same clinic.  The 'surgery center' where they do the ERs, all more involved procedures (CAR's fluid drain yesterday was there), and the embryology lab, are downstairs, and the fertility clinic for the consults and IUIs and such are upstairs.  The lab that did our PGS was affiliated, but not the same as the embryology lab.

Doing some research from published success rates (for us clinics- www.sart.org/find_frm.html), there are differences between clinics/labs.  Obviously, it's highly dependant on their patient age, etc., but you may want to ask a few things up front so you're prepared- how often do they do 2, 3 day, 5 day, etc transfers?  Do they usually have good rates of blasts lasting to day 5 or 6?  What is their freezing procedure?  Thaw success rates? Storage fees? Do they offer elective PGD/PGS, and what are their rates of elective single transfer?  What is their standard of care- ICSI? Assisted hatching?

Your clinic may have an info sheet or such that could answer most all of these things in one go, since they're common questions, and most deal with their standard procedure.

 

So I have looked up my clinics stats on SART before - but it wasn't until after we were using them for IUI. So, here's my question which you may not have an answer to. What makes the differences in success rates? I know sometimes its the population they serve (what issues their patients come in with) - but other than that, is it skills in the lab? Unknown? Different tools and techniques? Like wouldn't blasts lasting to day 5 or 6 be mostly an indication of the health of the cells? I suppose it should have something to do with the environment too.  Since I am already using this office and so far have no major complaints, I am not looking to change. I'm pretty sure their rates were a little lower than another big clinic around here - but what can/should I do about it?

[RM80]

I won't rehash all that's been said, but give my opinion on a few of your questions:

1. Appointments seemed like a lot to us, about every 2-3 days we were in there, so depending on the convenience of your office location (ours was an hour away, so round trip was 3 hrs just to get an u/s) it can be a lot.

2. The shots prior to retrieval weren't bad, basically the same level of 'pain' as the trigger. All small needles & totally doable. I did the first few for my wife and after that she did them herself, she preferred to be in control! POI on the other hand- was rough. I know some people can give them to themselves, but I couldn't reach that far around my A**! My wife had to give those. I survived them, they weren't great, but once you get over the fear, its not too bad.

3. Depending on your testing you've already done, you might not need to skip a cycle (unless you want to), but really only your RE or nurse can tell you that. I say call now to ask & get on the schedule if you need a meeting! Better to call with a BPF later and say never mind!!

4. Worst part for us: the outlay of loads of cash and no take home baby. This isn't that common, but it was our reality.

I so hope this is your cycle and you won't need this, but I totally get wanting to be ready to move on too.

[cetcar]

May 14, 2015 13:44:06 GMT -5 Stringy said:

May 14, 2015 13:16:31 GMT -5 cetcar said:

 

So I have looked up my clinics stats on SART before - but it wasn't until after we were using them for IUI. So, here's my question which you may not have an answer to. What makes the differences in success rates? I know sometimes its the population they serve (what issues their patients come in with) - but other than that, is it skills in the lab? Unknown? Different tools and techniques? Like wouldn't blasts lasting to day 5 or 6 be mostly an indication of the health of the cells? I suppose it should have something to do with the environment too.  Since I am already using this office and so far have no major complaints, I am not looking to change. I'm pretty sure their rates were a little lower than another big clinic around here - but what can/should I do about it?

It's true that the SART figures aren't really a true comparison since things may be reported differently, but you can tell from them what type of protocol they generally do- like the ICSI or PGD percentages.  Also looking at numbers of patients, etc, can help.  There likely are skill level/tech level differences place to place but I doubt it's something you would be able to ask and get a solid answer on.  Really though, if you're liking your clinic, then just learning as much about what they do and can offer and making a plan with your doctor is the most important thing-ask lots of questions, and be your own advocate through the process.  We also live in a place where there are a lot of potential options of clinics, but we didn't shop around based on figures, per se.

Yes, if possible based on your fertilization numbers, a 5 day transfer is a good option. It more closely matches the time frame when an embryo would normally reach the uterus and be ready to implant.  A 3 day embryo put back is still too 'young' as it naturally should still be in the tubes. I'm not sure how much it varies currently place to place, but there are different types of culture and whatnot that may be more or less effective in growing embryos to the blast or hatched stage. As I understand it, a 3 day embryo and a 5 day embryo need different nutrients and chemicals to keep growing. A big limitation of IVF over the years has been the ability to keep them developing long enough to be able to see which ones are better than others, or to have a high enough confidence rate to be able to offer a single transfer with good results.   

Without PGS done, our clinic pushes for a double transfer, even if the embryos are high quality.  The science is just simply that not all 5 day blasts, no matter what they look like, will end up genetically viable.  We had 13 of our 14 mature eggs make it to day 5, and 9 were 'normal.'  We really wrestled with whether or not to do the PGS.  It's a decent chunk of money, and it's strange to know the sex of the embryos, but our doctor stressed doing it (we think in part it helps his success rate, our place has the highest rate of PGD I've seen on SART, but also the highest birth rate...no clue if it's the cause or not though).  In the end we did it because we had a good number, and it was nice to know also that our frozen embryos were all technically viable.  

Sorry, once again for the un-asked-for detail level.... but....I'm a researcher.  Being the non-carrying partner has kicked this personality trait into overdrive the last few weeks.

[Stringy]

Oh trust me cetcar- I over researched everything when my wife was pregnant. Drove us both nuts! Haha. Thanks for the info. I like lots of info.

[karlamo]

Stringy, if you're looking for more research I suggest reading the book IVF by Rebecca Matthews PHD. She does an amazing job explaing IVF, testing, picking a good embrology lab to work with etc.

We read it after our first IVF failed and like RM80 mentioned we were not prepared for that reality. Our WTF appt with our RE went to a whole new level after reading her book.

It's a short easy read so you can read it in a few days or during one of your MOTN wakings:)

ETA:  I have referred 2 other lesbian couples to our clinic after they both had 12+ failed IUI's and both are now parenting so I believe you are in excellent hands over there!

ETAA:  I should have received a discount on my FET for all the referrals I do for them.  Moka should have been 1/2 price!

[mariahacevedo]

[Stringy]

Is this spam?

[Stringy]

Only asking cuz of the link.

[wittyandwaiting]

Aug 18, 2015 19:33:58 GMT -5 Stringy said:

Only asking cuz of the link.

I'm scared to click the link.

[crazyaunt84]

I wouldn't click it...it goes to something called "ilex medical products". Probably no good.

[kh826]

If it looks like spam, and smells like spam, 'Tis spam! Ugh!

[crazyaunt84]

[jgy]

I didn't even see a link but the post made me ragey anyway.

[crazyaunt84]

LOL - thanks NariaDreaming 

[Stringy]

Aug 19, 2015 9:17:38 GMT -5 crazyaunt84 said:

LOL - thanks NariaDreaming 

Lol - did someone page her or do you regularly search for the word "spam" Naria?

[wittyandwaiting]

I flagged it.

Thanks NariaDreaming!

[Stringy]

Aug 19, 2015 11:49:18 GMT -5 wittyandwaiting said:

I flagged it.

Thanks NariaDreaming!

Oh yea, that flagging stuff. Thanks Witty!