In vitro fertilisation (IVF), words to strike fear into the bravest hearts. But, what does it mean and how can you navigate the process?
IVF is a medical technique used for couples experiencing a variety of infertility problems—in particular, male factor problems, endometriosis, advanced maternal age or blocked or damaged fallopian tubes.
Here is an explanation of the process:
Before you begin
Before you start, the doctor will complete a thorough diagnostic and treat you and your partner for any conditions that might compromise your fertility (including medical conditions like auto-immune problems or elevated sugar levels, lifestyle issues like a high BMI, smoking or excessive alcohol intake, and emotional conditions like stress).
If the doctor diagnoses IVF as a solution for your fertility problems, you and your partner will need to assess the cost and emotional challenges of the process and decide if it is right for you to go ahead.
The IVF process
If you choose to begin IVF, the doctor will determine which programme is best for you (either short course or long course IVF—these differ in duration but contain many of the same elements).
The clinic staff will then create a detailed, patient-specific programme for you which usually includes the following stages:
1. First Scan
IVF begins with a scan to establish the state of the lining of your uterus.
2. Hormone injections
If the doctor is happy with the results of the scan, you will begin hormone injections.
These can be self-administered but if the thought of injecting yourself is stressful, ask your partner for help or visit your clinic or pharmacy daily and request that the nurse does them for you.
Typically, there are two sets of injections and the timing of administering them depends on your programme. They are:
- A GnRH Antagonist which is given subcutaneously. This injection is designed to take control of your cycle, suppress the release of the body’s hormones and prevent premature ovulation.There are very few related side effects but some women do report headaches and hot flushes.
- A FSH or FSH/LH injection, given subcutaneously or intramuscularly. This is designed to hyperstimulate the follicles in the ovaries to produce as many eggs as possible. You may feel bloated and uncomfortable so try to drink lots of water.
3. Follicle scan
After five days of the FSH or FSH/LH injections, the clinic will scan you to determine the number and size of the egg follicles.
Usually the follicles are small at the first scan. If so, you will continue hormone injections and scans until the biggest follicle reaches 18mm or more in size.
4. Ovulation injection
This injection(which can again be self-administered) is usually given at a specific time in the evening.
Egg retrieval will then take place 38 hours after the ovulation injection—about eight hours before the egg is due to be released from the ovary.
The clinic will tell you what time to check into the clinic for the egg retrieval.
The procedure is only about 15 to 20 minutes but takes place under strong sedation, so plan to take the day off work.
The doctor will retrieve the eggs and your partner will produce a sperm sample to fertilise the eggs. When I woke up from the procedure, the number of our eggs was written on my hand (clinics know that women need details and their partners are often bad at remembering or communicating them).
This can be an emotional day because your hopes and expectations are linked to the number of eggs and how mature they are.
Ask your partner to drive you home and be available to support you if the news is bad.
6. Embryo fertilisation (naturally or through ICSI)
Once the eggs are retrieved, the laboratory scientist will place them in a dish along with the sperm. The dish is put in an incubator where fertilisation occurs.
If necessary (usually when there is male infertility or when fertilisation has failed to occur or has occurred abnormally in the past), the lab will use ICSI (intracytoplasmic sperm injection) to fertilise the eggs. During ICSI, the lab will select and then inject a single sperm into a single mature egg.
7. Embryo development (the waiting period)
The clinic will decide when to do the embryo transfer (either on day three or five after aspiration). In the period between aspiration and transfer you will phone the clinic every day to get an update on the growth of your embryos.
This can be a very stressful time, especially if the embryos are poor quality. Remember that stress at this point can no longer affect your embryo quality but it can impact negatively on your experience of IVF as well as your emotional preparedness for the embryo transfer and early pregnancy.
If you are feeling overwhelmed, it is best to seek some help.
8. Embryo transfer
The clinic will schedule a time for the embryo transfer. This is a minor procedure, not requiring an anaesthetic.
Before transfer, the clinic will talk about the number and quality of embryos and give you a more accurate estimate of the likely success of the procedure.
Depending on the quality of the embryos, this may be an emotional and challenging day but do try to stay hopeful.
9. Waiting stage
Following the transfer, you will be given medication to maintain a healthy uterine lining which will result in heightened emotions and symptoms that resemble pregnancy.
Symptoms can include; tender breasts, bloating and frequent urination. This is a period of high stress where emotions can vacillate wildly from hope and optimism to despair.
Try to keep busy and not attempt anything too physically or emotionally strenuous during this time.
10. Pregnancy test
This takes place 11 days after the transfer. The clinic will perform a blood test and then communicate the results.
If the test is positive (and I sincerely hope it will be), you will continue on your medicine and return to the clinic for regular scans. Many clinics will continue to care for you through the first trimester following which you can see an obstetrician.
A negative result can be devastating though. It is common to go through all of the stages of grieving: shock, disbelief, numbness, anger, depression and lots of “why” questions. This is normal but friends and family may not understand so it may be a good time to seek external help (especially if you find that you cannot move on).
Hard as it is, it is also important to speak to your doctor about factors that may have contributed to the failure,as well as next steps.
Having a plan can make the difference between depression and continued hope.
IVF is expensive – leading clinics quote between R35 000 and R50 000 per IVF cycle depending on the procedures used (this excludes medication).
Although semi-government hospitals offering IVF may be cheaper, you will still need to budget for it or obtain IVF-specific finance (speak to your clinic about options).
South African medical aids don’t fund IVF but pressure groups continue to lobby them so watch this space.
2. Your emotions
IVF is very stressful. Be sure to set up a good support structure and if necessary seek professional help to cope with it successfully.
3. Readying yourself
Prepare well. Infertility experts understand that a large number of factors contribute to a couple’s success with IVF. Try to make any necessary health, psychological and lifestyle-related changes prior to the treatment to maximise your chances of success.