The IVF Protocol (And Other Paperwork)

Protocol, such an official term. What’s a protocol, you ask? The actual format differs from clinic to clinic, but at ACRM it’s basically a very detailed, day-by-day task list to get you from the start of your IVF cycle, through stimulation meds to the egg retrieval phase of IVF. (After egg retrieval, you receive an additional set of protocols to get you through embryo transfer and the beta pregnancy test.)

The protocol includes things you should be doing (i.e. scheduling a financial consult, paying your fees), to things you should be taking (i.e. birth control, baby aspirin, stim meds, trigger shots, etc.). It’s immersive and overwhelming. It was my IVF Bible for the weeks before egg retrieval – I literally referred to it several times a day and had copies on both my phone and work computer, as well as the master in my IVF binder. (More on the binder in a later post!)

My protocol was delivered through email by Katrina, my ACRM nurse, along with about 10,000 other documents to read, review, and sign. Just kidding, only 7. Here’s a list:

  1. My IVF protocol
  2. My medication list (the fertility drug list: Follistim, Menopur, Cetrotide, Novarel, Lupron, Progesterone… and the list goes on)
  3. Injection training instructions – 15 pages!! I videotaped myself scrolling through it to Snapchat a friend… maybe I’ll post it someday!
  4. More injection training instructions
  5. Injection training consent form – just to say you’ve read the instructions and all is crystal clear (ha, ha)
  6. “One Baby at a Time is Best” consent form – this is to agree to transfer in only one embryo at a time to minimize risks that come from a multiple pregnancy
  7. Disposition of embryos consent form – this one was very interesting, and deserves its own post. The question was, should we be able to freeze any embryos during the IVF process, what do we plan to do with them in the event of divorce or one/both of our deaths?
  8. IVF process and risks informed consent form

Did I already mention that this was overwhelming, AND exciting!? I remember being in a work meeting when I received these eight attachments in two emails, back-to-back… and it felt like the world stopped for a second. I thought, “Ahh! This is it!” … and proceeded to end the meeting as quickly as possible so that I could peruse the documents to my heart’s content.

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IVF For Beginners

I walked into IVF knowing the bare minimum about how the treatment process worked. I hardly Googled it. I’m not sure if I was depressed, overwhelmed, or just over it… probably some of each. But I put one foot in front of the other and followed ACRM’s instructions to call on Day 1 of my next cycle.

Day 1 was over a weekend, so the following Monday, I received an email from Katrina, my ACRM nurse, letting me know next steps:

  1. I was to start back on birth control pills for 11 days. (This quiets the hormone-makers in the brain so that your cycle can be fully controlled by the clinic/IVF meds)
  2. I was to set up a financial consultation to discuss IVF costs and payment. (ACRM expects upfront payment for the balance not covered by insurance)
  3. I was to schedule an HSG and trial transfer appointment, and initial bloodwork. Joe had an initial bloodwork appointment as well. (This HSG/trial transfer deal deserves a post of its own, but essentially the point is to 1) look at your uterus and ovaries with a small camera to make sure everything is good, no blockages or lining troubles and 2) make sure that there’s no funny zigs or zags on the way to your uterus that could cause issues during embryo transfer time)
  4. I was to sit tight and wait until the full IVF “protocol” was sent over in a few days. (Ah, the protocol. More on that later.)

After getting these initial instructions, I was definitely excited. It felt like things were happening. Like we were moving forward with a really good option, and a great medical support team. (I also like instructions and to-do lists, so that helped :-)) I couldn’t wait to get started for real.

Embryo Transfer Day!

I popped my Estrace, Xanax, and Advil, I grabbed my water bottle, and we headed to the doctor’s office. After the requisite bloodwork, Joe and I made our way to the OR. The nurse greeted us, walked us through the post-transfer do’s and don’ts, and asked us to change into our his-and-hers OR clothes. After waiting a few minutes, I was led into the back for a quick ultrasound to check if my bladder was full. (A full bladder pushes the uterus down for better visibility on ultrasound, and also helps the doctor insert the catheter more easily for embryo transfer.) Even though I had already guzzled about 60 ounces of water, my bladder was nowhere near full. So, back to the pre-op room for more water, and waiting. They tried again. Still not ready. I felt like a failure! I apologized profusely to the nurse, and she kindly said, “Don’t worry – bladders can be funny! We just need to wait a little longer.”

So we waited. Finally, around 11am, we were both led back to the OR to get the party started. I definitely had to pee by then. 🙂

It all happened so fast, but here’s what I remember. I was in the same room for the egg retrieval. Dr. Keenan, who was on deck for my transfer, had previously did my trial transfer (and several ultrasounds/at least one IUI), which reassured me a lot. The nurse placed my legs in the maximum security straps, and the team started to get the equipment ready. Joe took a seat to my left, next to my head. Dr. Keenan called the embryologist over, whose name is Dr. Steven Johnson but introduced himself as Steve. Nicest guy ever. He gave us the embryo update:

Retrieved: 10
Fertilized: 8
Arrested: 2
Transferring today: 1
Still in development for potential freezing: 5

5! Wow!! I was ecstatic to hear that news. I felt so good, and so hopeful that our cycle had produced at least 6 embryos. Six pre-babies! I was happy.

Dr. Johnson then showed us a photo of the embryo that they were transferring in that day. He said it was a perfect embryo… “textbook.” He went back to the adjoining lab and started to get the embryo prepared for transfer, while Dr. Keenan placed the speculum and catheter in position. After a few minutes, I heard Dr. Keenan say, “Steve, we’re ready,” and then the transfer process began. Joe put his hand on my shoulder. Though I couldn’t see much of the transfer on-screen, I watched the doctors watch the screen intently to place the embryo in the exact right place in my uterus.

It’s hard to describe what I was thinking in these 5 minutes. It was stunning. It felt like the miracles of science and love, coming together. I listened to the classical music faintly playing. I sent good vibes to the little embryo making its way to its home. I prayed that this was our baby. Tears slid down the corners of my eyes at the weight of the moment.

All at once, it was complete. The next part was a blur. The nurse sat me up gently, and showed me an ultrasound capture of the embryo. It’s just a little flash of light that wasn’t there before. But it’s almost a baby.

 

 

Waiting For ET: Worse Than The 2WW?

I started this blog last Sunday, in the throes of anxiety between egg retrieval and embryo transfer for my first IVF cycle. Since then, I’ve been trying to describe our infertility struggles from the beginning of the story. But for today’s post, we have to fast forward to the present time, because I just went through the embryo transfer yesterday! I promise we’ll get back to chronological order after this (can’t skip posts on the stim injections, trigger shots, and egg retrieval, after all), but I want to tell you about yesterday’s experience while it was still fresh (there’s a joke in here somewhere…) in my mind.

I was scheduled to have the embryo transfer 5 days after my egg retrieval last Thursday. The five days between egg retrieval and embryo transfer were quite possible the most anxiety-ridden days of this whole treatment process. Some people say that the 2WW with IVF cycles is not as bad, because it’s only ~10 days in reality, but they aren’t counting those 5 days before the transfer! The 5DW should be a thing.

Here’s how they went for me:

On Friday, the embryologist called to let me know that out of 10 retrieved eggs, 8 of them fertilized normally. I thought this was great news! On Saturday and Sunday, I drowned in anxiety, apprehension, and the gut-wrenching fear of the unknown. How were the 8 fertilized eggs doing doing? Would we have any embryos at all to transfer? Would they call us right away with bad news? On Monday, the nurse called to confirm my 9:30 appointment on Tuesday for the embryo transfer. I asked her if she had an updated status on the embryos, but she didn’t… she explained that they still had to develop a full day before they were able to evaluate them for transfer. This made sense, but didn’t help my anxiety. Was there one viable embryo? Were there more? The nurse simply reminded me to drink a ton of water, arrive with a full bladder, and take Xanax and ibuprofen in the morning as prescribed.

The night before the embryo transfer felt a little like Christmas Eve. I was rife with anticipation and thought I’d never be able to get to sleep. I’ve been having problems sleeping in general. I assume it’s from the stress of infertility treatment, but work takes its toll, too. I’ve also been waking up a lot in the middle of the night to use the bathroom. (Thanks, progesterone.) But the next morning, I woke up feeling surprisingly well-rested. In equal parts fear and excitement, I got ready for transfer day at ACRM.