Many people think that the embryo transfer is the most stressful part of in vitro fertilization (IVF). But for me, and most of the other women I’ve spoken to, it’s egg retrieval that’s most difficult. Here’s what it’s really like.
Pre-retrieval: Drugs, shots and monitoring
Having your eggs retrieved generally starts with two processes: down-regulation and stimulation. (I say “generally” because some women are never down-regulated.) Let me explain: On a monthly basis, a woman’s body produces certain hormones—more specifically, luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—that trigger the development and subsequent release of one mature egg. Down-regulation suppresses this response so that the development and release of multiple eggs can be controlled.
This process (medication, timing) differs for each woman, depending on why she is seeking fertility assistance. No two treatment plans are alike. But no matter what the treatment plan, all women who undergo IVF need daily blood work and ultrasound monitoring so that their doctors can determine how their eggs are developing and when they should be harvested.
5 things you should know before starting IVF It took several weeks of being on birth control for my body to be in the right state for stimulation. It was only once my doctor confirmed via blood work and ultrasound that I was down-regulated and I told I could start the next step in the IVF process. That’s when my husband and I were brought into the clinic for a stimulation information and training session. My nurse laid out each of the drugs I’d be taking and explained their purpose, and she also showed us how to inject the needles properly into the muscular and fatty parts of my lower back, butt and thigh. Our target practice involved a spongy black box and two stress balls.
To sufficiently stimulate my ovaries, I would need to inject myself with two needles every day and take a variety of pills. As my eggs matured, I’d need to add a third injection. The hormones I was given were chosen specifically for my infertility-related issues (egg quantity). The goal was to generate as many healthy, good-sized eggs as possible. Many of the shots had to be given at the exact same time each morning or evening—even being early or late by an hour could throw my hormonal balance off. It was daunting.
Ari Baratz, a fertility specialist at CReATe Fertility Centre in Toronto, says that most women find the injection part of IVF to be trying. “You go from being a healthy person to being medicalized,” he says. “People are shocked that the drugs have to be taken daily and are time-sensitive and user dependent.”
Since I couldn’t wrap my head around the idea of giving myself a needle, the task was left to my husband. It turned out to be a good decision to have him do it: Not only did he feel more involved in the process but I could also focus on relaxing my muscles while he focused on injecting me correctly. To minimize pain, we’d rotate the injection sites as often as we could. Some friends used ice to numb an area pre-shot, but that didn’t work for me. I found that it helped minimize swelling and bruising if I rubbed the spot right after the injection.
In addition to the needles, I had to visit the clinic for a daily ultrasound and blood work. I’d meet with a nurse who would brief me on how my follicles were developing and whether my treatment plan would need to change to slow or speed up their growth. The process took between 90 minutes and two hours every day.
It took two weeks for my body to produce enough good-sized follicles (18 to 20 millimetres) to warrant retrieval. For me, the goal was to develop and subsequently harvest 12 to 15 of them, but for some women, that number is lower or higher.
Once my blood work and ultrasound showed that I had reached that number, I was told that I’d be given a “trigger shot,” a drug that triggers ovulation and final maturation of the eggs. Once my doctor deemed that it was time via blood work and ultrasound, my nurse gave me the injection and my retrieval was set for 48 hours later.
Though I felt like a walking pincushion by that time and was moderately bruised all over my midsection, I made it through stimulation with minimal side effects, which can include bloating, hot flashes, nausea, blurred vision and headaches.
My husband and I arrived at the clinic early in the morning after a restless night of sleep. Both of us were on edge, unsure of what to expect, despite all of our research. I was so nervous, I could barely keep water down. When we arrived, we were ushered into an area reserved specifically for IVF patients. It looked a lot like a hospital’s emergency department, with little areas separated by semi-sheer blue curtains. The space was way less private than I thought it would be, which made me uncomfortable. I didn’t want others hearing my personal fertility business, and I could clearly hear couples whispering to one another and nurses and doctors explaining procedure outcomes as we passed various “rooms.”
Once we arrived at our corner, I was asked to take off my clothes and jewellery and put on a hospital gown. I was also given Ativan, a drug given to patients as a mild sedative and to reduce anxiety. My doctor reiterated what was about to happen: Using a needle attached to a catheter, he would suction the mature eggs out of each follicle and store them in tubes, where they’d await fertilization by my husband’s sperm. I was hooked up to an IV, which was used to deliver a local anaesthetic, and 30 minutes later I was wheeled into the operating room.
It took about 15 minutes for the 12 mature eggs I had to be retrieved. Afterward, I recovered in my room while my hubby went off to do “his thing.” I was so loopy from all of the drugs that I don’t remember the surgery or him being gone. I don’t even remember my doctor coming in to tell us how the procedure went (well, in our case). We stayed at the clinic for about an hour, at which point we were discharged. Still groggy from the medication, I spent the rest of the day sleeping.
Post-retrieval: Recover and wait
The next day, I woke up feeling perplexed and confused. I had built up egg retrieval to be this big, scary thing (it’s surgery after all!), when the stimulation phase was really the most trying part. The procedure itself was surprisingly quick and painless.
I was told that I might experience a number of side effects, including soreness in the vaginal area, mild cramping and even spotting (which could have lasted several days), but I didn’t notice anything out of the ordinary. In fact, I felt so good that I was up and moving within 48 hours.
Emotionally, though, I wasn’t doing so well. After the retrieval, we were told to expect a 50 percent loss at each growth stage of our blastocysts. (Some people may be presented with different odds—it differs from person to person.) For us, it meant that only 50 percent of the eggs retrieved would fertilize, only 50 percent of our blastocysts would make it to day 3 and only 50 percent of those would make it to day 5/6 and freezing. Fifty percent of those would be deemed normal in genetic testing.
I didn’t like those odds and, as we waited to hear how our blastocysts were doing, I developed a serious case of post-retrieval anxiety. Even though we received a daily status report from our clinic and I knew we were playing the waiting game, it didn’t feel like I had enough support. The only thing that calmed me down was acupuncture and distraction. We were also in the process of moving into a new home, so I was able to push my worries aside and focus on various to-dos.
How I felt is quite common, says Baratz. “From the onset of an IVF cycle to egg retrieval, there is a lot of contact with the medical team,” he says. “It’s quite involved and serious. Then the surgery only takes 10 to 15 minutes. Afterward, you wait to see how things go and you’re expected to go back to your regular life. A lot of people think they’re going to have to deal with negative [physical] side effects, but it’s usually the emotional worries that are most crippling.”
In the end, our procedure was a major success. By day 5/6, our blastocysts had done better than predicted. Of the 12 follicles harvested, eight eggs were fertilized and six made it to day 5/6. Those were sent for genetic testing and three were deemed normal.
Six weeks later, we completed a frozen embryo transfer and, two weeks after that, we found out that I was pregnant. Today, we have a strong, sassy eight-month-old baby girl who was worth every second of pain, poking and prodding in the process.