What to Expect

If you have made the decision to pursue IVF (or IUI to start) this is what next few months will look like:

DECISION to undergo an IVF treatment, either due to needing a donor (in the case of the woman's age, severe infertility or same sex couples) an infertility diagnosis, or pursuing another avenue in the case of unexplained infertility.

CHOOSING A CLINIC (this is THE most important step. Please see the "Choosing your Clinic" tab on the home page) and contacting them.

PRELIMINARY discussion and tests with a doctor at the clinic. You will most likely be put on a waiting list to have a discussion with the doctor, either over the phone or in person. Once you speak with the doctor, he/she will look over your medical history and possible diagnosis to determine the next step, which is usually a work up on both partners. The clinic will run their own diagnosis tests (a physical exam, blood and sperm analysis) on both partners to determine the cause of infertility that the family physician may have missed, or to confirm any definite reason for infertility already found previously. There is a chance that the tests will uncover the need to perform certain procedures:

PROCEDURES to either reverse infertility or to make an IVF treatment possible or more successful. For the woman, that may mean a polyp or endometriosis removal, hormonal balance discovery and/or treatment (as in a clomid challenge test) or hydrosalpinx removal. There can be some procedures for the males as well. If the male has a sperm count of zero for example, it must be determined if that is due to a blockage or testicular failure. A PESA or MESA or TESE will be performed to determine sperm presence and hopefully, count.
A REGROUP will occur with the physician once every test and procedure is complete to determine the course of treatment or other avenues. If IUI/IVF is the decision, you may be put on a waiting list to begin treatment, with the female calling a certain phone number to report the first day of her period. This is where a waiting period might take place, sometimes up to a few months, depending on the clinic. If you have chosen a clinic with no waiting list, the process is underway and now will unfold very quickly.

DOWN REGULATION AND STIMULATION of the ovaries will take place (unless you chose a 'natural' IVF cycle). This is called "The Protocol" and it can be short or long (two to several weeks), depending on the decision of the doctor. The goal is to always produce the most amount of eggs possible, in hopes of producing a few good quality, viable embryos. Not all eggs will fertilise, not all fertilized eggs will make it to day to 3 or day 5. Several are lost at each step (due to low quality or genetic defectiveness) so the more you have to begin with, the better. Quality is important as well, so please see the tab called "Egg Quality". Before the ovaries are stimulated to produce more than one egg, the entire hormonal system of the woman needs to be shut down. The reason for this, is because the body has several hormonal functions and negative feedback loops to keep the hormonal traffic according to plan and direction. If the ovaries were going to be stimulated by hormones from the outside out of the blue, the body would try to 'correct' the sudden invasion and influx of unexpected hormones. So by shutting the woman's natural cycle down (by down regulating estrogen), the ovarian stimulation process can take place without disruption from the body. An analogy would be a general anaesthetic administered to a patient so an operation can take place without the patient protesting and protecting their body. So something is given to the woman to shutdown her cycle hormones, namely Lupron (which will put the woman into temporary menopause) or a birth control pill. Do not let this concern you. It may sound drastic but this is necessary in order to stimulate the ovaries. Once the process is over, you will be back to normal. When the woman's cycle has been shut down, hormones will be administered to stimulate the ovaries. These hormones are Leutinizing Hormone and Follicle Stimulating Hormone, the two hormones responsible for ovary stimulation and ovulation in our bodies to begin with. Here, they are given at much larger doses. The woman administers these two hormones by injecting them into her belly or thigh fat twice per day. After a few days of this, her ovaries will be monitored by ultrasound, usually everyday for a week. The dosage of the medication may be adjusted according to the growth rate of the follicles on the ovaries and the number of follicles producing eggs. Once the doctor decides that it is time, a trigger shot is given (ovulation will occur 36 hours after the trigger shot) an egg retrieval will be scheduled for 35 hours after the trigger shot, to avoid ovulation prior to the process. It is an egg retrieval, not an egg hunt.

THE EGG RETRIEVAL (ER) is performed under general anaesthetic or sedation. A needle going through your vaginal wall in order to gain access to the ovaries, only to have the follicles be pierced one by one is not something you want to be completely conscious for. It is NOT horrifically painful, but the level of discomfort will be determined by how much sedation they give you. Clinics can be frugal with their sedatives, so be sure to discuss the dosage with your doctor. General anaesthetic, if possible at your clinic, is recommended. This will also keep your stress level down if it is followed by a fresh transfer. The surgeon makes a difference as well. In Calgary, I was only mildly sedated, felt everything and cramped and bled for two days afterwards. In Denver I was completely out for the procedure and when I woke up and continued with my day, I would not know anything had happened. Count on some bleeding (again, depending on the surgeon) and some cramping afterwards, and take the rest of the day off. Following the procedure, an embryologist will come out and let you know how many eggs they retrieved. This should not be a surprise as you would know how many follicles/eggs your doctor was tracking during the ultrasounds. It is possible they will get a few more or less, depending on the maturity and how many they were able to get that the ultrasound did not pick up.

FERTILISATION occurs on the same day as the egg retrieval. While the woman is undergoing the ER, the male partner's sperm is being collected, either via fresh ejaculation or a thawing process if it had been frozen. Fertilization will either take place in a medium in the laboratory, when the sperm is left to fertilize the eggs on their own, or using ICSI (see the 'IVF Treament' tab for more information on ICSI).

OBSERVATION will now take place. The lab will keep in touch with you to let you know how your embryos are doing. Keep in mind that having any embryos in the first place is not a given.

GENETIC TESTING will take place on day 3 or day 5 depending on the testing type and the clinic. Generally speaking, genetic testing does not take place in Canada. See more on the "Genetic Testing" tab.

TRANSFER of the embryos/blastocysts will follow on day 3 or day 5 after the egg retrieval if doing a fresh transfer. Which ones are transferred is decided mostly by the doctor, depending on the number of cells and quality grade. If a frozen transfer is occurring, the ones that were decided on prior and survived the thaw will be transferred into the uterus. The preparation for a fresh transfer hormonally is much less complex than for a frozen transfer. A frozen transfer protocol is longer since the system needs to be shut down again before the appropriate uteral lining hormones are introduced. For a fresh transfer, that was already done for the egg retrieval and now just the uteral lining hormones are introduced just days before the transfer (such as progesterone). The reasoning behind a day 3 or day 5 fresh or frozen transfer for every couple is unique and will be discussed with your doctor.

PREGNANCY test happens 14 days after egg retrieval if it was a fresh transfer, or 9 days after a frozen day 5 transfer. The Beta hcG hormone is the hormone that is picked up in urine on the pregnancy sticks from the drug store, or in our blood during a blood test. The hcG is the hormone that is released when a blastocyst attaches to the lining in the uterus, to prepare the body for pregnancy. It's levels in the body continue to multiply daily until it is detectable. By the time of the pregnancy test, or even a few days earlier, the hormone is detected enough to confirm pregnancy. Detection of the hormone early does not confirm pregnancy. Pregnancy is confirmed once the hcG is over 25 on the prescribed day of the pregnancy test, and doubles or more than double after 48 hours. If pregnancy did not occur, the clinic will instruct you of how to stop taking your hormones.