What You Need To Know Before You Start IVF
So you are starting IVF, what do you really need to know?
After months of trying, doctors visits, reading books and late night google sessions you finally are wrapping your head around IVF treatment. You and your partner are on the same page to get your family going and feel ready.
Great!
There is so much to consider, so much information overload and a few things I wish I knew before starting my IVF journey.
IVF is not a guarantee
There I said it.
There is the elephant in the room and its big and scary and sad. To go through the process is tough enough to go through it and not gain your desired outcome is heart wrenching.
I believe it’s best to be as realistic as possible, understand the worst and hope for the best.
IVF has a 30% success rate that means 70% failure rate. Each cause of infertility has slightly different success rates so it is important that you discuss your particular chances with your physician.
You should discuss with your partner what your plan is moving forward if you are not successful. These will likely be long conversations but they need to happen before you are pumped full of hormones and suffering a loss.
When will you say when?
Is it an amount of trials? An age? Will you consider surrogate? What are your thoughts on adoption? Fostering? Moving forward without children?
Back to the positive. Each round of IVF is about 30% successful so the more rounds the better your chances. However that leads me to the next thing you need to know.
IVF is expensive
Each full round of IVF can cost between $11,000- $30,000 depending on medications and procedures needed. Cost vary by state and by individual clinics. Insurance often does not cover IVF or at least not in full.
Most states do not require insurance companies to cover IVF placing higher financial burden or the patients. There are 17 states that do have laws around insurance companies covering or offering coverage for at least part of the process. Check to see if your state is on the list.
See if your state requires insurance companies to offer coverage
Talk to your insurance company before you start IVF. What do they cover and what providers do they work with?
Talk with your clinic about pricing and shop around. Yes, you are a consumer here, don’t feel that you have to stay at any one place. Your clinic should be up front about there costs and discuss their financing options with you before you start any procedure.
The expensive and relatively low success rate can lead to strain in your relationship.
It is easy to get swept up in the excitement and the future planning of what you ultimately want which is why it is vital to your relationship to talk about all expectations and planning before hand. You need to make sure you and your partner our on the same page, or at least have an understanding about where each of you stand, regarding next steps if IVF isn’t successful and a financial plan.
Either topic alone is enough to send even the most loving of couples into states of resentment and relationships can’t survive there. Financial problems and irreconcilable differences are common reasons for diverse, combat it early with frequent honest conversations. If you are feeling strain seek out couples therapy before problems escalate.
IVF is hard on your partner too.
It may feel like the majority of the burden is falling on the women trying to conceive, regardless of the reason for infertility. That is because she is the one undergoing most of the treatment, procedures, injections and hopefully carrying the embryo.
Keep in mind that while yes it is very hard on you, it is also hard for your partner too.
They might not be going through physical treatments or changes but their hopes and dreams are also on the line and they likely feel helpless in the process. Keep that in mind to help you both move forward with all your difficult conversations with a bit more compassion.
Speaking of hard on you…
You will look and feel pregnant throughout your IVF journey
Oh the cruel irony of it all. Because of all the hormones you likely will notice bloating, especially prior to egg retrieval. I looked very similar prior to and up to a week after my egg retrieval as I did at 3-4 months pregnant. The same is true, although to a lesser extent, at the start of each frozen cycle.
Not only can you look pregnant but you can feel pregnant too. The increased bloating can be generally uncomfortable. The hormones mimic pregnancy and you can get all the lovely early pregnancy signs with it including sore breast, headaches, cravings, increased urination frequency, mood changes. Hormones affecting mood on top of an already stressful situation is a recipe for out burst.
Drinking plenty of water and continue to move your body toPr help ease some of the side effects. Always discuss starting a new exercise program with your physician first but if nothing else adding some walking into your day will be helpful both physically and mentally.
There are times you can not exercise
Prior to and about 2 weeks after egg retrieval you will be asked to avoid exercising especially anything high impact such as running.
Talk to your doctor about your typical work outs and activity level prior to starting IVF. As hard as it might be please do listen to this recommendation of not working out after egg retrieval. Your ovaries are very swollen, and fingers crossed producing tons of viable follicles, when preparing for and just after egg retrieval so there is a risk of ovarian torsion.
Ovarian torsion is when your ovaries get tangled in the ligaments supporting them. It is uncommon but can be devastating. If you are having trouble conceiving the last thing you want is another barrier. Discuss this with you doctor and listen to their advice.
No one really knows if you can exercise throughout the rest of your IVF cycles
Not sure if there is anything more frustrating then inconclusive advice but here it is. With the exception of egg retrieval, exercise is not fully off limits during IVF but is not always encouraged either. The exercises you typically do might need to be modified or if you are too sedentary you might be encouraged to start gentle movement or a walking program. Talk to your physician because each doctor has their own protocols and theories.
The reason for your infertility and typical activity levels may also impact if you can exercise and what types of exercises you can do or should avoid.
The fact that there were not clear cut rules or guide lines for exercise drove me a little crazy.
Generally though it is not advised to start anything new or super high intensity like marathon training or training for your next cross fit games.
Keep in mind though movement is medicine, there are so many benefits both physically and mentally so find something that feels good that you, and your doctor are comfortable with.
Personally for me yoga was a constant throughout my IVF processes, except during egg retrieval of course. It felt good to continue with my normal routine and helped my sanity. I trialed running (treadmill only) and lifting during some of my IVF cycles and took breaks during others. Whether I worked out of not did not seem to be relevant for my success or failures.
Try to block out the noise.
Over thinking my workouts, or lack there of, was only one of many ways I would get into my head.
It is so easy to reexamine every move you make during the process. As if you aren’t in your head enough, friends family and neighbors are all willing to join you there.
You will hear a lot of “advice” when going through IVF. Change your diet, just relax, go on a vacation and you’ll get pregnant, it is because you run too much, it’s because you aren’t active enough the list goes on of what others feel it necessary to tell you. It’s hard not to let it sink in, try not to. Easier said then done I know.
Try to figure out what might help before starting the process. Journaling, meditation, solo walks, gentle workouts, yoga, and seeking out therapy are all great ways to work on processing your emotions and blocking out the external.
Everyone you know will be pregnant.
Seriously when going through IVF it felt like everyone I knew, heck even celebrities were becoming pregnant. I’m not sure if it was just the stage of life my friends and I were in or if my attention was just drawn to it more.
Whatever the case it felt like I was constantly getting notifications or calls and messages of people expecting. Whatever emotions come up around this are OK and allowed. It is normal to feel resentment or pings of jealousy. Allow those feels but try not to wallow there.
IVF can be a long game. You don’t want to be miserable the whole time. Try your best to find ways to rejoice with your friends and loved ones. It can be seriously hard to find ways to be happy for others who seem to be (so easily) getting what you want. Remember that two things can be true: you can be heartbroken that you are not pregnant yet AND genuinely happy for your friend.
Acupuncture is a great complimentary modality to IVF
Ah I loved my acupuncture sessions, and my acupuncturist! That was my hour of me time, my self care and my assist throughout the process. For me it was what helped me stay out of my head, block out the noise, ease medication side effects and find some peace in the process. Acupuncture has been shown to have positive outcomes during the IVF process.
Check with your clinic as some offer acupuncture appointments day of transfer. For each transfer I did a pre and post session as well as regular visits to my own acupuncturist. Many insurance companies are also covering portions of sessions so be sure to check with your insurer on that as well.
Sex and IVF don’t mix
Forget everything you learned about becoming pregnant.
Once you are on the road to IVF conceiving becomes asexual. There are seriously long stretches when you will be advised not to have intercourse.
If you were trying naturally for a while and sex started to become clinical, it might be a welcomed break for you both however it could end up being another relationship stressor. I recommend open honest communication.
IVF will rule your schedule
Timing is everything with IVF. You will need to clear your schedule. I am generally a planner, this was tough. Blood work is performed almost daily and ultra sounds often. When everything looks just right it is go time. There is no real planning and no wiggle room.
Fortunately, I was doing home care during most of my cycles. I was able to work my schedule around my appointments and get it all done.
Not only will each cycle control your schedule but so will the time between trials. It can start to feel like your life is on hold and revolving around visit after visit.
Yay you have embryos! Now what?!
Discuss genetic testing prior to freezing embryos.
Genetic testing wasn’t recommended for me initially. It is often recommended with repeat fail rates and increased maternal age or a known history. You need to thaw eggs and then re-freeze for testing. This is expensive and there is a high risk of destroying the embryo in the process.
It can leave you with a tough decision. Risk losing your embryos and a lot of money to know which of the remaining will actually be viable or try to work with what you have and perhaps wait and lose precious time and possibly have to do another round of egg retrieval.
Lets say IVF was a success, awesome! What are your plans for the remaining embryos?
This is a conversation you need to have with your partner and clinic early on. How many children are you aiming for? How many times are you willing or able to go through IVF? How long does your clinic hold onto frozen embryos? How much does it cost to keep them there each year after the hold time expires? If you have remaining embryos will you donate them to another family or science or just dispose of them?
These questions still make my head hurt and send me in a spiral. You don’t have to have all the answers when you start but you do need to start the conversation.
Fresh or Frozen?
My first attempt failed. It was a fresh embryo, rated well, and for some reason I thought it was superior. I was disappointed. The good news is there doesn’t seem to be a significant difference in fresh or frozen.
IVF injections. It is all about location, location, location
Afraid of needles? Don’t worry it isn’t that bad, really. I found that changing up the location of my injections was really helpful. I would alternate left and right side of my body. I did all the subcutaneous injections myself. Those are the smaller ones, just under the skin. Those really were not painful but sometimes the medications would sting, ice helped.
I did not attempt any of the inter-muscular ones myself. I will be honest they were not fun. Do your best to avoid the area near your sacrum. There are a lot of tight ligaments and nerves in the area and it is more uncomfortable than your outer and lower buttock. You can only change location so many times.
Ice before hand and try your best to relax, a tense butt does not make for easy injection, yikes!
You will only be implanting one embryo at a time
I have seen the reality shows of moms of large numbers of multiples. IVF leading to 5, 6, 7 even 8 babies at once! I want to be a mother so badly but the thought of multiples was beyond overwhelming. I expressed my concern and was relieved when talking with my physician. They will only attempt one transfer at a time. This was a relief but I wanted to ensure success. The risk out weigh the benefits. At the very most they will do two if you are over a certain age and if there are other criteria that are met. Discuss this with your physician before hand, understand their practices and their why.
Day of IVF transfer check the pipette!
Reclined back, feet in stir-ups I watched the screen intently. You can see a little sparkle on screen when the embryo is inserted, or when you think it is. My physician had me hang out there as they went back to the lab to check the pipette. My embryo was still inside, stuck to the wall of the pipette. This is rare but it happened to me twice! Your clinic should be checking without you asking however you are always your best advocate. Speak up and make sure they check the pipette! I’m so glad they did because one of those sticky buggers was my son!
The 2 week wait feels like an eternity
There is so much lead up and build up to transfer day. You will be buzzing with excitement and anticipation. That buzzing will likely continue for the next two weeks. That is the amount of time you need to wait for your pregnancy test. You will likely feel pregnant. Remember what I said before of looking and feeling pregnant? Yup, it will continue as you wait those two weeks.
There is no benefit to testing early. Put those home pregnancy test away and do your best to keep your mind busy on anything else.
IVF is a risk factor for PPD
After all the struggles and months to years of waiting you finally have your baby. You would think you will be ecstatic and you will be but you may also experience PPD (post-partum depression.) While PPD is always a risk you might be at a slightly higher risk after IVF treatments. In the Journal of Midwifery and Women’s Health PPD risk is closer to 25 percent up from 11-20 percent. Talk to your OBG or Midwife about all your risk factors during your pregnancy.
You are not alone
Infertility and your IVF journey might seem like a long lonely road but you are not a lone in that.
According to the CDC about 1 in 5 women of reproductive years have trouble getting pregnant after a year of attempting and 1 in 4 have difficulty carrying to term.
Talk to your friends. You might be surprised who else is silently struggling. If you are uncomfortable discussing with friends or family as your clinic for information on their support group. I found the more comfortable I became talking about it the more normal it felt to me.
Knowing What I Know of IVF
Deciding to start IVF is not an easy decision. There are so many factors to consider. This list is not a deterrent, but a realistic look at what is involved in the IVF process. Knowledge is powerful. The more prepared we are for a journey the better.
Knowing what I have learned throughout the years of undergoing IVF treatment would not have changed my decision. I wish you the best along your IVF journey.