What Is the IVF Process Like?
What is In Vitro Fertilization (IVF)?
Simply put, IVF involves cultivating and then extracting eggs from a woman, injecting them with sperm in a lab, and either after fertilization and testing, or just after fertilization, putting them back in a woman's uterus with the hopes that embryo will grow into a full term pregnancy.
Why Go Through IVF?
Seeing as IVF is so uniquely time consuming, expensive, inconvenient, and sometimes uncomfortable, why go through it?
You REALLY want children that are biologically yours, or at the very least must have the option to have children who are biologically yours someday.
You don’t have periods, so getting pregnant naturally would be a bit… difficult.
You have tried to get pregnant naturally with no success, plus also tried other things interventions, such as egg stimulating medications (e.g. Clomid) combined with regular ultrasounds at a fertility clinic to ensure both adequate egg supply and perfect timing of intercourse, and still you do not get pregnant.
One of various fertility troubleshooting exams you have gone through (a HSG, in which they take a closer look at your fallopian tubes, blood tests looking for markers of your egg supply, etc.) indicates that you may have trouble getting pregnant naturally.
Given your age and the number of children you want, you realize that you had better bank normal eggs or fertilized embryos now to (1) ensure you can have all the kids you want despite age constraints, (2) avoid higher cost and less efficacious fertility treatments later in life, and (3) reduce your odds of birth defects and other problems with your kids, which increase with both male and female participants’ ages.
You want to spare your children form the uniquely humiliating knowledge that they were created by two disgusting humans slapping their genitals together.
Seeing as I personally check all the boxes above, IVF was the obvious answer. Whether it is for you depends on not only these factors, but also your budget and willingness to undergo the treatment itself.
Why are you interested in IVF?
How much does IFV Cost in the US?
Based on our research, each round of egg cultivation, extraction, and fertilization in the US costs between $8,000 and $15,000. This does not include the necessary medications, which cost between $3,000 and $5,000 per round.
PGS testing, the process of testing embryos to determine gender and how likely they are to make it to a full term pregnancy, costs another $2,300 (or much more, depending on how many embryos ultimately get sent in for testing).
Fresh or frozen embryo transfers (the process of transferring the fertilized embryo into a uterus) cost another $3,000 to $5,000.
The vast majority of US health insurance plans do not cover IVF.
In other countries, IVF and IVF medications cost significantly less. My husband and I do not have the liberty to just move to places like Spain to see this treatment, so instead we lived on a shoestring budget for what we called “The Year of the Harvest” in which pretty much all our disposable income went toward banking fertilized and PGS tested embryos.
What Is the Follicle Stimulation Process Like?
The entire egg cultivation and extraction process seems to take 13 to 20 days or so. It begins with the creation of birth control, the kickoff of a period, and a visit to your IVF clinic for a baseline appointment in which you get bloodwork done and have a transvaginal ultrasound, in which they shove a wand where you would expect and have a look at your uterus, uterine lining, and ovaries, and follicles.
Depending on your results, a couple days later or so, you will begin stimulation medication. This usually involves two injections daily to start; one in the morning and one in the evening. Common medications prescribed are Follistim, Bravelle, Gonal-F, and Menopur.
A few days into this stimulation process, your IVF clinic will soon demand that you come into their office daily or every other day as they monitor your hormone levels and follicle growth. These visits always involve bloodwork and a transvaginal ultrasound. Their purpose is to determine how to adjust your stimulation medication to ensure you get an optimal number of follicles growing while also reducing your odds of getting complications from all this stimulation (specifically, Ovarian Hyperstimulation Syndrome).
Once your biggest follicles reach a certain size, your doctor will work a third injection into your daily mix: An “antagonist” like Cetrotide, which will help to prevent you from ovulating before your egg extraction surgery. You will continue with these three injections and regular tedious doctor visits for several days leading up to your trigger shot and surgery.
How Bad Are All These Needles and Meds?
Being rather needle phobic, I came into this process extremely worried about all this blood work and all three injections. Having now gone through the egg extraction process five times, they do not phase me, so a nice side effect of the this process is it can help you get over your silly fear of needles. Yay!
About out those needles: All but one (that of the HCG trigger shot) are super tiny and you will find yourself becoming accustomed to injecting yourself surprisingly quickly. All but the HCG shot goes into your lower abdomen, so all you have to do is pinch up a bunch of skin and jab that gushy blob with the needle and inject, all the while digging your fingernails into your skin, and you will be too busy feeling your fingernails to really feel that needle.
Some common follicle stimulation injections are a hassle in that you have to assemble syringes and mix the medication before injecting. Others, like Gonal-F, come in a preloaded pen (the end of which is twisted to establish dosage) on which you stick a disposable needle to inject yourself in a very simple and no-hassle fashion. I LOVE Gonal-F!
The only needle that really gets me is the one for HCG shots. This one needs to go into your backside, directly opposite your hip bone on the upper part of your butt check. The needle, especially in comparison to the other needles you work with for stimulation, looks HUGE. More daunting still, you have to shove THE WHOLE THING IN, pull the plunger back a bit to make sure you do not pull up blood, and if blood does come up, you have to start all over again.
The first time I gave myself this injection (typically, a friend or spouse is supposed to help you do this, but like hell am I going to trust someone else with a needle that size around me without me being heavily sedated), I called my IVF office several times crying because I was sure that I, being in the underweight end of the spectrum, would just hit my hip bone with the needle.
That said, it turns out that area of our bodies is not particularly nerve heavy. The shot can leave a bit of soreness, but as you are fumbling, twisted around, and actually administering the injection, it is not so bad.
As for the medication side effects: Honestly, I did not notice anything, mood wise. I always struggle with the weak, embarrassing moods that result from being human, and my moods did not seem any more horrible than they always are. If you are worried about the meds making you bonkers, I would say: Expect to go bonkers, but more because you have to fit constant doctor visits into your schedule and less because you are being pumped full of powerful hormones.
What is the Ovulation Trigger Process Like?
Once your fertility doctor has decided that an optimal proportion of your growing follicles are at the right size, they will order you to take a trigger shot at a very specific time (e.g. 8:30pm, or 10:30pm).
This shot may be straight HCG, like Pregnyl, or a mix of HCG and Lupron, or maybe just Lupron, or maybe something else entirely. The purpose of this injection is to trigger ovulation--the release of your eggs--so that when you go into surgery 36 hours later, your surgeon can easily extract those eggs.
You will visit your IVF clinic for blood work the next morning. The purpose of this visit is to ensure your dosage the previous night was sufficient to actually trigger your ovulation for the following day’s surgery. A few hours after you leave the office, they should call you to either let you know you’re good to go for the next day’s surgery, or you need to dose with something more.
The day before your surgery, you may also get a call from your anesthesiologist, who will ask a series of routine questions to ensure they properly care for you during the next day’s surgery.
You will be told to have nothing to eat and drink after midnight leading up to your surgery. Take this rule very seriously, but also do not set yourself up for loads of uncomfortable IV jabs on the day of surgery by showing up dehydrated (a mistake I made on Surgery One). What I did for Surgeries Two through Five was set an alarm for 11:50pm the night before, drink so much water I thought I would be sick, and spend most of the night urinating just to be sure I would not be actively de
What is the Egg Extraction Surgery Like?
On the day of your surgery, you will arrive at your IVF clinic at the designated time and be prepped for surgery by a nurse. This typically involves:
Getting a finger prick hemoglobin test (PRO TIP! Ask the nurse if she could take a drip from your IV instead to avoid this extra prick).
Emptying your bladder (Remember my tip about drinking loads of water right before midnight).
Changing into paper surgery gowns.
If you will be fertilizing your eggs from this round with a husband or sperm donor who will be leaving his sample that day (rather than providing a frozen, banked sample), the office will also inform this esteemed gentleman on how and where to provide his sample.
You will then be taken into the surgery room, have various tubes and heart monitors applied to you, have your IVs put in, have your legs strapped into place, and meet your anesthesiologist.
The liquid that at least my anesthesiologists use to put me down stings a bit. I started complaining about that in surgeries Three, Four, and Five, which lead to them putting in something like Novocain first, which took the bite away. You might consider doing this too.
You will likely not remember the anesthesiologist putting you under. On Surgery Five, I asked my anesthesiologist to tell me when he started mixing the sedation medication into my IV so I could count up and see how long I lasted, and while I do not remember counting, I was told I made it to seve.
You will likely wake up feeling some uncomfortable cramping, which makes sense seeing as a surgeon just finished sticking a needle attached to a catheter through your vaginal wall and sucking out a bunch of eggs. Sometimes, I felt OK and a couple of extra strength Tylenol pills did the trick to get me back on my feet and back to the office. A couple of times, my post surgery pain was so bad I could not think straight, which lead to my husband freaking out and demanding more powerful pain medication, which was eventually (though quite hesitantly, given the opioid epidemic) administered, and that did the trick to get me back to work at the office.
They say that you should take a day to rest after surgery and “not make any major decisions,” but let’s face it: If you can afford to get IVF in the US, chances are you have a demanding job and cannot just take time off willy nilly, meaning you will really need to be in the office the same day as your surgery.
For the most part, I had no trouble with this. Only on one occasion did I vomit five times throughout the day after surgery (and this was just one out of five post-surgery experiences), and on only one of those five vomiting occasions did I almost vomit on a client. You should be just fine, too—and if your surgery falls on a weekend day, rejoice! You can likely work from home instead!
What is Recovery from Surgery (and Ovarian Hyperstimulation Syndrome) Like?
Ovarian hyperstimulation syndrome is, in most cases, the most common complication resulting from the follicle stimulation and egg extraction process. Simply put, it involves a “perfect storm” (as my doctor puts it) of hormones causing an uncomfortable accumulation of liquid in your abdominal area.
I suffered from a moderate to severe case of ovarian hyperstimulation syndrome after my first round of stimulation and extraction. It is difficult for me to report accurately on the symptoms, as it turns out that I also had walking pneumonia during that entire stimulation and extraction process. The pneumonia blossomed right after surgery, getting so bad that I could barely walk. While I probably would have been hospitalized in the US, I had flown to Peru the day after my first surgery for work, so I ultimately self medicated with… a perhaps unwise mix of antibiotics that, while handling the pneumonia, also lead to an extremely trippy night of bad dreams and plenty of projectile vomiting the next day (including a uniquely watery display at the office, in front of my coworkers).
I’ll do my best to parse out the symptoms associated with pneumonia and suboptimal mixing of powerful antibiotics from the symptoms associated with pneumonia, so I can describe more or less what it’s like.
The first thing you will notice is significant abdominal bloating. Consider this practice for getting pregnant. Your pants will not fit. Your shifts will not fit. Your jackets will not fit.
You will also experience significant weight gain. I gained about 13 pounds in total in water, which does not sound like a lot, but because I am on the thin side, it really felt like I was being suffocated from the inside.
All the liquid puts pressure on your intestines and stomach, making eating… not so appealing. I found the only thing that really felt good to eat at that time was ramen. When you get ovarian hyperstimulation syndrome, there is not really much to do aside from religiously hydrate, which is not tempting when you already feel stuffed to the gills with water and bloat. Still, hydrate you must.
This formation of liquid in your abdomen—known in other medical spheres as ascites—is not something that happens only to women going through ovarian hyperstimulation. In fact, I had come into close contact with this condition one year before experiencing it myself as my mother suffered from it while slowly losing a battle against ovarian cancer.
Having witnessed my mother’s experience with ascites, I know what one does when the ascites become unbearable: If the condition is short-term and acute (like it is with ovarian hyperstimulation syndrome), one can go in for an outpatient surgery to have some of the liquid drained. If the condition is long-term and chronic, like it was for my mother, you can install a port enabling you to drain that liquid from your abdomen yourself using a series of bags and tubes. If you are merely experiencing abdominal liquid buildup as a result of ovarian hyperstimulation syndrome, you will not be getting a port installed. Really, even in a pretty bad scenario, you will look horrendous for a ten day period and feel awful. That is worth your ensuring you have healthy children, which presumably is a core part of your life lan.
To be honest, dealing with ascites one year exactly after my mother’s passing, and coming to learn tangibly, intimately, one of the many symptoms from which she suffered in her final days, was extremely distressing—certainly more distressing than the symptoms themselves.
That said, there are things you can do to avoid this complication. For Founds Two through Five, my IVF doctor prescribed Cabergoline and instructed me to take it for ten days, starting the night of the trigger shot. Since working Cabergoline into my regimen, I have only experienced super moderate ovarian hyperstimulation syndrome: Nothing to write home about.
Some doctors (though to my understanding, this process is considered antiquated) also advise “coasting” before extraction—letting a few more days pass and estrogen levels to go down a bit before triggering ovulation. This process can certainly help reduce the risk of hyperstimulation, but it can also lead to the loss of some prime follicles (due to waiting too long), and I personally would much rather spend a week uncomfortable bloated and distended than spend approximately $15,000 for a failed procedure or a less productive harvest.
How Many Healthy Embryos Typically Result from Stimulation and Egg Extraction?
Doctors typically say their goal is to get one to three healthy embryos from any given stimulation and extraction period. Studies I have reviewed are all over the place on this subject.
In my first and worst harvest, I got just one healthy embryo. In my most productive harvest, I got eight. This is all to say it is really difficult to know how well any given session will work out.
Here are my full stats:
- Batch 1: 17 in total extracted, 11 mature eggs (65%), 9 normal fertilizations (82%), 3 embryos sent (33%), one viable embryo (33%): 1 male.
- Batch 2: 33 in total extracted, 23 mature eggs (70%), 16 normal fertilizations (70%), 9 embryos sent (56%), 8 viable embryos (89%): 7 male, 1 female.
- Batch 3: 26 in total extracted, 17 mature eggs (65%), 11 normal fertilizations (64%), 5 embryos sent (46%), 5 viable embryos (100%): 3 male, 2 female.
- Batch 4: 44 in total extracted, 29 mature eggs (66%), 21 normal fertilizations (72%), 7 embryos sent (33%), 5 viable embryos (71%): 2 male, 3 female.
- Batch 5: 47 in total extracted, 32 mature eggs (68%), 24 normal fertilizations (75%), 11 embryos sent (46%), 7 viable embryos (64%): 5 male, 2 female
Keep in mind that I went through this process at age 30. While I have plenty of other things wrong with me, ovarian reserves was not one of them. So consider these results to possibly be typical for a slightly underweight 30-year-old with high ovarian reserves and a fairly healthy diet + daily cardiovascular exercise, plus no smoking (ever) and no drinking (during each extraction process).
As you can see from my personal stats, it is not exactly safe to have, say, 47 eggs extracted (just for egg banking) and think: Great! I can just save this until I’m ready to choose a spouse / sperm donor and start a family. You could get loads of eggs and only have a small proportion of those in the end be viable
How Can I Ensure I Get As Many Healthy Eggs / Embryos As Possible?
Do Not Put Off This Process
The younger you are when you do this, the more eggs you are likely to get. Those eggs are also likely to be of higher quality.
Take Omega 3 and 6 Fatty Acid Supplements
Good question! After the embryologist accused my dear, darling eggs of being “funky” and “granular” after my first extraction, I asked my nurse what I should be doing to improve egg quality. She recommended Omega 3 and 6 Fatty Acid supplements, which I have since been taking twice daily. In addition to (maybe) helping with egg quality, these supplements have lots of other supposed benefits, such as improved cognitive function, so I am all for them!
Do Not Get Sick or Schedule a Harvest Month During a Time of Year When You Regularly Get Sick
While the doctors and nurses said that my having pneumonia should not have affected the quality of my eggs, I am almost certain it did. It makes sense to me and my husband that the body would have means of “shutting down” reproductive function / quality when it is sick, both because energy is being directed elsewhere and because we doubt that, evolutionarily speaking, early hominids that for whatever reason were SUPER FERTILE while also sick probably did not survive and reproduce at as high of rates as their fellow females who shut reproduction down or sabotaged follicle/egg quality while sick. Pregnancy is risky enough as it is; we cannot imagine the human body being encouraged, through evolution, to develop anything that helped reproduction in sick women.
This is a long-winded way of saying: Don’t get sick while going through one of these rounds. Avoid travel (which I did not do during my first session). Don’t schedule the round right after a stressful trip or holiday (which I did during my first session). Don’t push through long hours at work despite feeling sick (which I did during my first session). Don’t have a stiff upper lip and work through sickness and discomfort (which I did during my first session).
Avoid Stress and Rigorous Exercise
Stress seems to hurt everything, so it goes without saying that while going through this procedure, you ought to do everything you can to be uniquely unburdened. While you likely cannot evade all of life’s stressors every time you do this, at least don’t make egg extraction months the same months you also try to take on new challenges and confrontations.
My nurses also advised me to avoid any extreme running, exercise, or stretching that might “knock loose a follicle.” While I do not know if this actually happens, I kept my exercise to walking and had no problems.
I hope this overview has been helpful to you. If you’re nervous, hang in there! What probably scares you the most about the IFV process is the needles and surgery. In the end, those are the least painful elements of the process after the (1) incredibly high cost and (2) time-consuming, tedious activities. If your circumstances suggest that IFV is your best option, I absolutely recommend you got for it with abandon. In your science driven family planning and all other things, I wish you all the best.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.