FET and me: An Information resource for IVF

You don’t know what you don’t know.

The elusive Egg Retrieval. It’s an exciting time. What led you here is:

1. You either had other fertility treatments that you attempted first (like timed intercourse or IUI), and now you are looking at IVF, OR,
2. You went straight to IVF

A BIG step of the true IVF journey is Egg Retrieval.

A good place to begin for the Egg Retrieval is at CD1 (cycle day 1 of your period). It determines when you come in for your baseline monitoring appointment, which is often the next morning. At this appointment, you have labs drawn and a baseline ultrasound done. Once the doctor has reviewed them, you will be instructed when to start meds and come back in for monitoring. Ask your clinic for a PDF of your protocol so you have a rough outline and understand what to expect. It is important to understand that this is a rough outline and things may vary. It is incredibly hard to plan around this time, and it can get frustrating when trying to plan around it. Booking cancelable flights or trips can be a game changer in terms of stress.

I was shocked when my IVF cycle #1 was CANCELED. I was truly devastated because I didn’t even realize that was even a possibility. Maybe I should have researched it more, or my clinic should have warned me, but either way, it was an emotional punch in the gut that took me days to grieve and recover from. My second cycle ended in 2 viable embryos, which is great. Cancellations are a very normal part of the IVF cycle (egg retrievals, transfer cycles, etc.,). It becomes a delicate ask to balance positive expectations with realistic outcomes. Experience makes things easier, but all to say the whole IVF experience is very challenging.

Some STIM tips:

• “How long from start to finish” – IT DEPENDS. It depends on your cycle and clinic monitoring practices. A fresh transfer seems to be much shorter than a frozen transfer. From my mini pulse IVF cycle CD1 to frozen embryo transfer to the pregnancy test, it was roughly 3 months. In that time span, I had 2.5 weeks of stim meds, the egg retrieval procedure, PGT-A testing of the embryos, cryopreservation of embryos, a mock embryo transfer procedure, a frozen transfer of the embryo, and then a blood pregnancy test in the clinic. Each procedure usually requires days/weeks of medication, for example, an egg retrieval will need weeks of meds and then an embryo transfer requires different meds.
• Cycles can get canceled! Even after you have taken meds for several weeks. Even if you have paid for those meds! It is emotionally tough, physically draining, and financially taxing.
• Not all egg retrieval attempts will retrieve viable eggs, or result in viable embryos. Eggs have to be fertilized, and embryos have to multiple to make blastocysts (essentially, a ball of replicating cells). Things can go wrong during this process.
• Once an embryo becomes a blastocyst, it can be biopsied (for PGT-A and PGT-M) and/or frozen (cryopreserved) for future use.

STIMS (aka ovarian stimulation medications)

• Several different medications may be used during an egg retrieval cycle. It can be a combination of medicines like letrozole, luprolide, Gonal-F, Menopur, cetrotide, birth control, etc,. The mechanism of action of these medications is detailed in the package insert and other online resources.
• The point of these medications is to recruit as many ovarian follicles with eggs inside to retrieve.
• Depending on your infertility diagnosis, you may have a large number of follicles (i.e., polycystic ovarian syndrome/PCOS) or a smaller number (decreased ovarian reserve/DOR). The expected number of follicles for you is something to discuss with your REI.
• Some women are at risk for Ovarian Hypersensitivity Syndrome (OHSS) during stims. This is dependent on your unique diagnosis.
• HOW TO DO SHOTS: CVS Health has the best YouTube videos that use branded medications, and shows you how to prep and inject medication. I found these videos to be the best from what’s available.
• SIDE EFFECTS of meds: All IVF meds, whether you are preparing for an egg retrieval or an embryo transfer, have side effects. Side effects vary from person to person, for example, one person may experience horrible nausea and someone else may have diarrhea. Side effects can range from hot flashes, nausea, diarrhea, bloating, weight gain, emotional changes, fatigue, headaches, and many, many more. You may not experience the same side effects to the same medication every time. If you are worried about a side effect, always reach out to your care team to ask them their guidance regarding side effects, especially after a procedure. From reading reddit and also being an IVF long-hauler myself, it seems that the emotional side effects are not often warned about, but can be very severe and debilitating. Talk to your care team if you are feeling depressed or experiencing emotions that seem unlike you.

After stimulation, you will do your “trigger” injection, and the timing of your egg retrieval will be scheduled to coincide with that.

AFTER the EGG RETRIEVAL

• Your doctor will tell you how many eggs were retrieved in the Egg Retrieval immediately after the procedure. You will be contacted in a few days with the status of the fertilized embryos, per protocol of your clinic.
• If you are doing a fresh transfer, your clinic will give you next steps.
• At days 5, 6, 7, when the embryos become blastocysts and are sent for biopsy and cryo, you should be called with updates.
• At day 7, you could be told the final number of embryos that made it to biopsy. The embryos will then be send for genetic testing.
• PGT-A and PGT-M test results may take 2-4 weeks depending on the genetic testing company.
• Your frozen embryo transfer date will depend on when your next period occurs. By this point, your embryos may be tested and ready to transfer.
• Once you have your results, you should get a report. If you have questions about your test results, or just any questions in general about embryo genetics, you can make an appointment with a genetic counselor. My PGT company offered a free appointment. It was so incredibly helpful. Highly recommend!