As my pregnancy approaches the
middle of my 2nd trimester, I’m finally feeling ready to share my
IVF experience with those curious, as well as those interested in learning what
they should expect as they embark on a similar journey.
I must say, invitro
fertilization (IVF) is not an easy process. Scientific discoveries and medical
breakthroughs have improved the results and the methods used; but hormonal
treatment is still a harsh aspect of this procedure. So expect quite a few ups
and downs (especially when it comes to your mood). The side effects – including
increased cancer risk – need to also be given proper consideration. I heard and
read some women struggled with weight gain, among other things, during the
treatment. Personally, I only experienced bloating, mild mood swings, general
discomfort and accentuated fatigue.
But
I should point out that the dosage of medication my body responded well to was
fairly low compared to most women undergoing this treatment. Age, physical
health, medical history and other such aspects factor heavily into your
doctor’s decision regarding the type and amount of medication you’ll be given.
The length of your treatment will be determined by your specific blood test
results. So take my numbers purely as an example.
Ok; now that I gave you the
“scary’, let me tell you why I’m such a huge fan of IVF.
On the bright side of things is
the fact that you get to literally see your kid grow from a 5-6 day blastocyst,
to a 2 week embryo and later a fetus. So, if all goes well, you can say you’ve
witness the miracle of evolution in the making; the transformation from a few
cells to a fully developed human being. It truly is one of the most moving and
incredible journeys a mom could ever be a part of!
And when I say “see it”, I mean
literally see it. You get lab photos of the cells created from your eggs and
the donor sperm, you see the embryo being placed, in real time, inside of your
uterus; then you get sonograms of the embryo and finally, ultrasounds as the
embryo becomes a fetus, and later a baby.
So I’d say, this is by far the
most immersing experience an excited expecting parent could wish for.
My other argument “pro IVF” is
the genetic aspect. I honestly believe that in the future IVF will be the only
recommended way to conceive a baby. I say this because, as you can read in my
treatment, despite the fact that I’m a healthy woman and the father’s sperm underwent
genetic testing which it passed with flying colors, I still had a 3 out of 4
chance of having a miscarriage or giving birth to a baby with a
genetic/chromosomal disorder. PGD (Preimplantation genetic diagnosis) can save you and your child a lot
of heartache in the long run and I wholeheartedly recommend spending the extra
money and time.
And since we got
to the money question; I can give you some estimates for informational
purposes.
These are the approximate prices in Massachusetts (at FCNE, but it’s
comparable to Boston IVF and other well known providers) as of 2015-2016:
- Regular Intrauterine insemination (IUI) is about $500 +
donor sperm + medication (if you do a medicated cycle) + ultrasounds.
Downsides: you most likely will have to repeat the IUI several times before you
succeed.
- Simple IVF: $7,500 + donor sperm + medication + 3-4
ultrasounds and doctor visits that are done before and after the actual paid
treatment (all the other sonograms taken during the treatment period are
included in the quoted price).
- IVF with PGD: $13,500 + $950 (for a genetic test
performed on your blood; not covered by insurance) + donor sperm + medication +
3-4 ultrasounds and doctor visits that are done before and after the actual
paid treatment (all the other sonograms taken during the treatment period are
included in the quoted price). Ask about this, as I had the surprise of being
billed additional money for “pre-treatment” consultation, ultrasounds and blood
work as well as a couple of follow-up visits that I thought were part of the
treatment. Also, if you do PGD/PGS you will have to see a “genetic counselor”
who, generally, does not accept insurance (go figure!) and charges anywhere
between $90-$150 – cash only. I personally found that visit useless; didn’t get
any info that I hadn’t already read online. So I basically paid for them to
write a letter to my doctor saying that I received genetic counseling.
My IVF
treatment
This treatment was tailored to me, according to my
needs, based on regular ultrasound and blood test results. It is not intended
to be a recipe for anyone else’s use. I’m
just providing it so you can get an idea of how intense it is and how much precision
and dedication it requires.
My side effects were minor during the actual treatment.
Mostly fatigue, light headaches, some nausea and mild bloating. I must say, my
regular “period headaches” (I get them pretty bad on a regular cycle) were
actually a lot less intense during the treatment and absent while I was on
estrogen.
There were a couple of days when I did feel down and
depressed. I remember one morning I woke up crying for no reason at all and a
few minutes later I was laughing at the fact that I’ve been crying for no
reason. So, yes, hormonal treatment will provoke mood swings. But, overall, I
could keep mine under control. They did not affect my work or much else. I did
reduce my social life to a minimum anyway, since I did feel drained of energy
and the daily treatment kept me on a tight schedule.
The week before my egg retrieval was the worse up to
that point. But that is also because I had 33
eggs that were extracted. Which is a lot, especially for a 38 year old
woman. Out of those, 19 fertilized and
only 4 made it to day 5. Upon PGS, only 1 out of the 4 blastocysts was a “perfect” embryo (genetically speaking).
The other 3 had chromosomal abnormalities, which meant they would not develop
properly and could result in a miscarriage or malformation.
My recuperation after the egg retrieval was lengthy. There
was an additional complication, as I sustained a serious external skin burn on
the lower left side of my abdomen from the heat pack they used while I was
under anesthesia.
The embryo transfer was not eventful. The prep time
was much longer than the actual procedure, and waiting with a full bladder was
not fun. Other than that… it’s easy-peas compared to the rest of the treatment.
I recommend lots of rest after the transfer and keep your feet warm (worked for
me! LOL. But... not sure how “scientific” that is). Fatigue will increase as your body is
going through the implantation and pre-pregnancy stages while you are on the progesterone.
By the way, I opted for vaginal progesterone, rather than injections (since I
had nobody to help with the progesterone injections). It’s messy, but a lot
less painful – if what I read about the injections is correct.
But, back to the process. I made my decision to
forward with exploring IVF in December 2015. I asked my PCP, at my regular
check-up, for a referral. And I was scheduled for an initial visit with a
fertility doctor at the beginning of January. During this visit, I got a rough
overview of the process, the various options and the financial aspects for each
option. I decided on IVF and my next doctor visit was planned for Jan 28th,
at FCNE. We kind of went over the same details on Jan 28th (and,
honestly, that was a bit sketchy to me, since I was billed for both
consultations but found them redundant).
January 28, 2016
Good evening Denisa,
I understand that you have met with Dr. ***** and
discussed pursuing an IVF cycle with PGS. In order for FCNE to contact the
reference laboratory (Good Start Genetics) with the request for PGS we need to
obtain your consent forms. We utilize a service called Docusign which lets you
sign documents with an electronic signature. It’s safe, secure, and legally
binding.
After all of your evaluations testing is complete and
you have another follow up with Dr. ***** we will send you the necessary
consents for the PGS process.
The PGS process is as follows: The day after the Egg
Retrieval our lab will determine that normal fertilization occurred and there
are embryos. The lab at FCNE will perform a biopsy of each viable embryo on day
5. The lab will asses any remaining embryos on day 6 and if any un-biopsied
embryos meet criteria those will also be biopsied & added to the group.
From there your embryos will be frozen & stored at FCNE. The biopsies will
be sent to Good Start Genetics for analysis. The results will be available
approximately 7-10 days after Good Start Genetics receives them.
Dr. ***** will contact you once we have the results to
inform you. If the results are acceptable for your criteria you will then
discuss the frozen embryo cycle. You will then meet with your doctor to discuss
the Frozen Embryo Transfer (FET) Cycle. If you have any questions, please feel
free to contact me.
Letter from Good Start Genetics:
Your doctor has referred you to Good Start Genetics to
learn more about Preimplantation Genetic Screening (PGS) with EmbryVu. The
purpose of Preimplantation Genetic Screening (PGS) is to screen embryos created
through in vitro fertilization (IVF) for numerical chromosome abnormalities
prior to implantation. IVF with PGS allows physicians to select embryos
predicted to be free of a numerical chromosomal abnormality for transfer into
the uterus, which increases the chances of achieving a successful pregnancy.
The results of this testing are typically available
7-10 days after Good Start Genetics receives the samples. The information you
receive from PGS can help you and your doctor plan for your future frozen
embryo transfer, so it is important that the testing is accurate. For all tests
we perform, Good Start Genetics uses highly accurate technologies, giving you
and your doctor confidence in your PGS test results.
In order to move forward with PGS, you must speak with
a genetic counselor about the PGS process and acknowledge your understanding of
the benefits and limitations of PGS by signing the Informed Consent document.
Good Start Genetics
February 11, 2016
I understand you met with Dr. ***** today and
discussed moving forward with your IVF treatment with PGS. I have sent you the
necessary consent forms through docusign to be signed. Please reference the
previous message you received on 1/28/16 regarding the PGS process and working
with Good Start Genetics.
February 16, 2016
Your upcoming IVF cycle has been approved and your
medications have been ordered through Cigna specialty pharmacy. Please call
Cigna to arrange for delivery of your medications asap.
Once you have a scheduled medication delivery date and
your donor sperm has been received from the Cryobank we will give you a birth
control pill stop date.
Please continue to take ACTIVE birth control pills (do
not take the inactive sugar pills).
The following medications have been ordered for you:
-Follistim 600iu pens x 6 pens with 1 refill
-Cetrotide 0.25mg x 8 with 1 refill
-Menopur 75iu vials x 14 with 1 refill
-Novarel x 1 with 0 refills
-Needles & syringes
February 19, 2016
The lab has received your vial of donor sperm.
Your results have been reviewed and your instructions
are as follows:
Please take your last active birth control pill today.
Please return for blood work and ultrasound on TUESDAY
2/23 in BRAINTREE between 7-7:45 am
February 23, 2016
Good afternoon Denisa
Your results have been reviewed and your instructions
are as follows:
Starting tonight take 200 IU of Gonal-F Pen every
night subcutaneously on 2/23, 2/24 & 2/25
• Please attach a needle to the Gonal-F pen and dial
the Gonal-F Pen to your desired dose. Push the plunger to administer the dose.
After completing the injection, view the medication window to ensure that the
pen dial is registered at zero. If a number other than zero appears in the
window this is the total number of units not administered and would need to be
dialed on another Gonal-F pen and injected.
Return for blood on 2/26 in Braintree between 7a-745a
Today your estradiol level is 279. Your results have
been reviewed and your instructions are as follows:
Starting TONIGHT begin to take 75 IU of Menopur every
night subcutaneously on 2/26 and 2/27
INSTRUCTIONS:
• Take the ordered number of vial(s) of powder from
the box of medication. Take 1 vial of the diluent (liquid) from the box.
• Use the 3cc 21G 1½” syringe & needle to
reconstitute your medication.
• Draw up 1cc (ml) of diluent. Slowly inject the
diluent into the vial of medication. Gently rotate the vial to mix the powder.
Do not shake. Once dissolved, draw the 1cc (ml) mixture into the syringe.
• If you have been instructed to take more than 75 IU
of Menopur, inject the mixture into the next vial of medication.
• Draw up this mixture.
• Switch to the 30G ½” needle tip and inject
subcutaneously.
Starting tonight DECREASE to take 150 IU of Gonal-F
Pen every night subcutaneously on 2/26 and 2/27
INSTRUCTIONS:
• Please attach a needle to the Gonal-F pen and dial
the Gonal-F Pen to your desired dose. Push the plunger to administer the dose.
After completing the injection, view the medication window to ensure that the
pen dial is registered at zero. If a number other than zero appears in the
window this is the total number of units not administered and would need to be
dialed on another Gonal-F pen and injected.
Please return for blood work and ultrasound on SUNDAY
2/28 in READING between 6:30-7:45 am
Today your Estradiol level is 932 & your largest
follicle is 10.5mm. Your results have been reviewed and your instructions are
as follows:
CONTINUE to take 150 IU of Follistim Pen every night
subcutaneously 2/28, 2/29 & 3/1
CONTINUE to take 75 IU of Menopur every night
subcutaneously 2/28, 2/29 & 3/1
STARTING TONIGHT take 0.25 mg of Cetrotide every night
subcutaneously 2/28, 2/29 & 3/1
INSTRUCTIONS:
• Mix one (1) 0.25mg powder of Cetrotide with the
syringe containing diluent. Once dissolved, change the needle tip to a 27G ½”
needle tip and inject subcutaneously.
Return for blood and ultrasound on 3/2 in BRAINTREE
between 7-7:45am
March 2, 2016
Today your estradiol is 2135 and your largest follicle
is 14 mm. Your results have been reviewed and your instructions are as follows:
Take 0.25 mg of Cetrotide 0.25mg tonight
subcutaneously
DECREASE FOLLISTIM to take 100 IU of Follistim Pen
tonight subcutaneously
Take 75 IU of Menopur tonight subcutaneously
Return for blood and ultrasound on 3/3 in BRAINTREE 7
- 745 AM
March 3, 2016
Good afternoon Denisa. Your results have been reviewed
and your instructions are as follows:
Take 10000 IU of hCG 10,000IU (Novarel, chorionic
gonadatropin) tonight intramuscularly
INSTRUCTIONS:
• Stop your Follistim, Menopur, and Cetrotide.
Take hCG (Novarel, human Chorionic Gonadatropin) 5 K
IU as an intramuscular injection tonight @ 8:30 PM.
Use the 3cc 22 G 1½” syringe & needle to
reconstitute your medication. Draw up 2cc (mL) of diluent. Slowly inject the
diluent into the vial of medication (powder). Gently rotate the vial to mix the
powder. Do not shake. Once dissolved, draw ONLY 1cc (mL) of mixture into the
syringe and switch to a new 22 G 1½” needle tip and inject intramuscularly.
(therefore, you will have 1 cc of unused medicine left in the vial)
TONIGHT begin to take DOSTINEX (cabergoline) 1 pill
everynight at bedtime for 7 nights.
• HAVE NOTHING TO EAT OR DRINK AFTER MIDNIGHT 12 AM
DAY OF EGG RETRIEVAL INCLUDING GUM AND BREATH MINTS.
No makeup, jewelry, contacts, perfume or powder. Bring
a photo ID and insurance card to appointment.
You will need to have a responsible ride home.
Please report to FCNE Reading Suite 205 on SATURDAY @
7:45 AM.
You may also watch some instructional videos at
Freedom MedTEACH.
March 6, 2016
Yesterday you had 33 eggs retrieved, 22 were mature
and inseminated with sperm/had ICSI. Today 19 have fertilized so you have 19
embryos today!
We will update you on 3/11 to let you know how many
embryos were able to be biopsied and frozen. We will then update you again once
we have the PGS results back from Good Start Genetics which can take 10-14 days
from when the samples are sent out.
March 11, 2016
Our lab was able to biopsy 4 of your embryos. The
embryos have been frozen and the biopsy samples will be sent to GSG. Please
expect these results by approximately 3/23/16. FCNE will contact you once we
receive the results.
March 19, 2016
I understand Dr. ***** spoke with you this morning
regarding your PGS results.
I have called a prescription for birth control pills
to your local pharmacy. Please call the care team with your cycle day 1 to start
the birth control pills.
Please call reception on Monday at extension 600 to
schedule your follow up with Dr. *****.
March 31, 2016
Good afternoon Denisa,
Your results have been reviewed and your instructions
are as follows:
Your upcoming FET cycle has been approved and your
medications has been ordered through Cigna.
Please call Cigna to arrange delivery of your
medications
Please call with your next cycle day 1 to start your
FET cycle
The following medications have been ordered for you:
-Estrace 2mg tablets x 80 tabs with 5 refills
-Crinone 8% vaginal gel x 60 with 5 refills
-Zpack x 1 with 0 refills
You may also watch some instructional videos at
Freedom MedTEACH.
April 9, 2016
Good morning Denisa,
Your results have been reviewed and your instructions
are as follows:
I got your voicemail that today was CD1!
Return to our READING office for blood and ultrasound
tomorrow 4/10 between 6:30am-7:45am to start your FET cycle.
April 10, 2016
Good morning Denisa,
Your results have been reviewed and your instructions
are as follows:
Starting today 4/10 begin to take 2 mg of Estrace
twice per day orally
Return to our Braintree office for blood and
ultrasound on 4/23 between 7-7:45am
April 23, 2016
Today your endometrial thickness is 6.4 mm which is
not quite the 7 mm we need to schedule your embryo transfer. Your results have
been reviewed and your instructions are as follows:
INCREASE the Estrace to take 2 mg of Estrace THREE
times per day orally
STARTING TODAY take 2 mg of Estrace twice per day
VAGINALLY. Simply insert the estrace tablets into your vagina as far back as
you can comfortably.
Return for blood and ultrasound on 4/27 in BRAINTREE 7
- 745 AM
April 27, 2016
Today your endometrial thickness is 6.7 mm almost
there but not quite 7 mm.
Continue to take the estrace to take 2 mg of Estrace
THREE times per day orally and take 2 mg of Estrace twice per day VAGINALLY.
Simply insert the estrace tablets into your vagina as far back as you can
comfortably.
Return for blood and ultrasound on 4/29 in BRAINTREE 7
- 745 AM
April 29, 2016
Today your endometrial thickness is 7.2 mm which is
perfect !!. Your results have been reviewed and your instructions are as
follows:
Continue to take the estrace 2 mg THREE times per day
orally and take 2 mg of Estrace twice per day vaginally
Please take Azythromycin 5 Day Dose pack orally for 5
days starting TODAY
STARTING TOMORROW take 1 applicator of Crinone 8%
Vaginal Gel twice per day vaginally. Do NOT take the Crinone the morning of the
Embryo Transfer until you go home after the transfer
May 2, 2016
We would like you to come in a little earlier for your
embryo transfer on Wednesday. Please be here @ 10:15 AM with a full bladder.
May 16, 2016
Your HCG level today is 1249, which is a great rise!!!
Your results have been reviewed and your instructions
are as follows:
DECREASE your dose of Estrace to take 2 mg twice per
day orally
Continue to take 1 applicator of Crinone 8% Vaginal Gel
twice per day vaginally
Return for blood on 5/23 in Braintree between 7a-745a
Please return to Reading suite 205 for your Embryo
Transfer (ET) @ 11 AM on 5/4/16
Please have a full bladder, drink 1 liter of water 1
hour prior to your appointment, and do not urinate. Also, continue your
medications as previously instructed. Please bring your photo ID and insurance
card.
May 23, 2016
Your HCG level today is 22,454 which is a great
rise!!!
Continue to take Estrace 2 mg twice per day orally.
Continue to take 1 applicator of Crinone 8% Vaginal Gel twice per day vaginally
Return to our READING office on 6/1 @ 8:30am for your
OB ultrasound
Congratulations!!!
