IVF Procedure: A Personal Step by Step Guide on the IVF Process
There is an increasing number of individuals seeking in vitro fertilization (IVF) as a solution to fertility issues. Being tested for infertility and deciding on various treatment options like IVF can be a daunting and unpleasant task.
Therefore, I would like to share my personal experience of the IVF process to help eliminate some of the anxieties and uncertainties relating to this particular fertility treatment option. There are generally two types of IVF protocols offered at the hospital that I was at — long protocol and short protocol. I have experienced both of these procedures and have included an explanation of the process and my tips below.
This is my personal experience with a specific hospital, so please consult your doctor for more specific instructions to find the appropriate treatment plan for your condition.
How to Prepare for an IVF Procedure
You need time to prepare your body for the IVF procedure as you want to be able to produce the best quality eggs and sperms to increase your chance of success. Three months before the procedure, you should start your preparations such as exercising and taking vitamins or herbal supplements.
Personally, I am a strong believer in Traditional Chinese Medicine (TCM), and I found the book below extremely helpful in teaching me how to take care of myself and prepping for the IVF procedure. The book has a section where you can do a simple self-evaluation by reviewing your symptoms (e.g., dark clots in your period or menstrual cycles that are shorter than the typical 28 days) to identify the potential deficiencies in your body such as kidney deficiency or blood stasis.
Once you have identified the potential problems, the book provides extensive advice on the things you can do, such as acupressure on specific points of the body and nutritional changes, to heal your body and improve fertility.
One thing about this book, though, is that you do need a lot of patience to read it as there is a ton of information. However, the author does provide some suggestions for what chapters are essential. I would suggest getting a hardcopy of the book so you can bookmark important points and easily cross-reference different sections. For example, Chapter 7 has diagrams of the different acupressure points mentioned all throughout the book, so a hardcopy allows quick referencing.
Dr. Randine Lewis is an experienced Western and Chinese physician specializing in gynecological problems. Her book provides extensive knowledge on how to improve your health and prepare your body for pregnancy using Traditional Chinese Medicine (TCM).
What Are the Steps of In Vitro Fertilization?
Both long and short protocol IVF procedures generally include the following steps:
- Egg stimulation: synthetic fertility injections that can be self-administered.
- Egg retrieval: a short operation to remove egg follicles.
- Fertilization and embryo transfer: a mild procedure to place the fertilized embryo in your body.
- Pregnancy blood test: the final step in confirming a successful conception.
My Schedule for Long Protocol IVF Procedure
My Schedule for Short Protocol IVF Procedure
Step 1: Egg Stimulation (Injections)
This part of the process is where the injections occur and typically last about a couple of weeks, depending on the type of IVF protocol you are in. The injections work to stimulate many egg follicles to grow during the IVF cycle (a normal cycle would usually only have one follicle). The goal is to get as many egg follicles to grow to the minimal size of 10mm to be suitable for egg retrieval. Different hospitals may aim for different sizes, but for my procedure, 10mm was the target. The dose of egg-stimulating drugs will be adjusted accordingly to ensure a healthy response as well as to avoid overstimulation, which can lead to ovarian hyperstimulation syndrome (OHSS). In this condition, too many egg follicles are stimulated, leading to bloating and pain in the abdomen.
At this stage, you would need to have several rounds of ultrasounds, sometimes on consecutive days, to monitor the growth of the egg follicles. It can be pretty time consuming and, in my opinion, quite stressful as you go through the anxiety of hearing the doctor's evaluation of each ultrasound to determine if things are progressing as planned. If the egg stimulation is not up to standard (e.g., not enough egg follicles meet the required size), the IVF cycle could be canceled and all the preparation and efforts would go to waste.
Tips for Self-Administered IVF Injections
- When wiping the injection site with an alcohol swab before an injection, don't over apply the alcohol if you have sensitive skin. Just simply wipe a small area of the skin you want to inject and use a cotton swab soaked with cool water to wipe off any excess alcohol after the shot. If you apply too much alcohol or leave it on the skin for too long, you may develop rashes, which is what happened to me. Rashes make it even harder to inject because they can develop into ugly scars or markings that harden the skin.
- The nurse who taught me how to self-administer the injections suggested that I alternate between the left and right side of the abdomen each day so I can allow more time for the tissues at the injection sites to heal.
- Based on my personal experience, I also recommend that you don't space the injections too far apart as there are many injections to be completed and you want to ensure there are enough available injection sites. I find that the area where I inject myself tends to be a little harder after the injection and needs a day or two to soften up. If I reuse the injection site too soon or use the area near it when it is still hard or tender, it tends to be more painful.
- If the hospital did not provide you with a sharps disposal bin, keep your used injections in a plastic box and bring it to the hospital for proper disposal when you're done.
Are IVF Injections Painful?
I didn't experience many side effects of the fertility drugs. The only issue I had was the bloated feeling I had in my abdomen, which was expected considering that I had 17 and 19 egg follicles retrieved during my first and second IVF cycles respectively. The bloated feeling caused quite a bit of discomfort towards the end of the stimulation phase but there was no severe pain. I felt immediate relief after the egg retrieval process.
The stimulation phase of the IVF cycle was the most painful for me because of the multiple injections. I was required to inject myself 1–2 times daily in the lower abdomen area (where there is usually a layer of fat) and it was quite challenging to find a suitable injection site which I had yet to use towards the end of the stimulation phase.
The Fertility Medications I Was PrescribedClick thumbnail to view full-size
How to Use a Puregon Pen for IVF Injections
Step 2: Egg Retrieval (Operation)
When there are enough egg follicles meeting the required minimum size, your doctor will schedule the egg retrieval procedure. Egg retrieval usually only involves sedation and not full anesthesia. You can find out what is the difference here but basically, sedation is considered a lighter sleep where you are not completely unconscious, unlike full anesthesia. I did not require ventilation when I was under sedation. It just felt like I went into a deep sleep and did not feel anything that happened around me.
Egg retrieval is considered a day surgery, so I was not required to stay overnight in the hospital. The procedure was done through the vagina, so no incisions on the surface of the body were required. It only took about half an hour, and I was under observation for about an hour, after which I was allowed to go home. All in all, the whole process took about half a day. The hospital required a family member to be present before I could be released as patients are generally still groggy or weak after sedation. I also experienced some bad cramps that same day but was back to normal and functional by the next day.
Step 3: Fertilization and Embryo Transfer
On the day of the egg retrieval, the male partner will also be asked to donate his sperm sample. Once both the egg and sperm are available, they will evaluate the quality of the samples and perform the fertilization in the lab. There are generally two ways fertilization can be done. One is placing the sperm and egg in an incubator and waiting for them to come together. Another way is through an intracytoplasmic sperm injection (ICSI). The clinic explained that this is done in some situations such as low sperm quality (e.g., low sperm count, low sperm mobility). After the egg develops into an embryo, the next step is the embryo transfer.
The embryo transfer is a relatively easy procedure. To me, it’s somewhat like a Pap smear. You lie on a chair with your legs open, and the doctor will use an instrument to clamp open your vagina and insert some kind of tubing which helps to guide the injected embryo or blastocyst to the uterus. The procedure is guided by ultrasound and takes only a couple of minutes. I did not experience any pain from it.
After the embryo transfer, I was given progesterone to ensure that my body could support the potential pregnancy (e.g., ensure uterine lining remains thick). The medication I used was Crinone, which is a vaginal progesterone gel. The gel is inserted daily into the vagina by a pre-filled applicator, which is basically a plastic pump. Crinone is easy to apply, but it can be quite disgusting since clumps of gel which have accumulated inside can come out as discharge and sometimes it’s black in color. However, it is definitely a better alternative to progesterone injections.
As explained by my doctor, there are two types of embryo transfer—a Day 3 embryo transfer and a Day 5 blastocyst transfer. I find that the video below provides a great explanation on the difference between the two types of transfers.
Difference Between Embryo Transfers
Tips for an Embryo Transfer Procedure
For some reason, I was required to have a full bladder during the embryo transfer. My guess is that having a full bladder allows the doctor to have a better view of the uterus on the ultrasound. The clinic advised me to drink plenty of water at home before arriving at the clinic and to avoid using the toilet until after the procedure.
However, I have a small bladder and during my first embryo transfer, I couldn't wait until after the transfer. I used the toilet while waiting for my appointment, not realizing I was the next patient in line. I tried to drink lots of water to compensate for my toilet run but was told that my bladder was not full enough and I had to wait another 40 minutes while they attended another patient.
So my advice is to ask your clinic's receptionist for the approximate waiting time and don't try to drink a gallon of water at once—instead, bring a bottle of water and drink it slowly on your way to the clinic.
Step 4: Pregnancy Blood Test
After the embryo transfer, it’s pretty much a waiting game. A hCG beta blood test is usually scheduled about two weeks after the transfer to confirm whether you are pregnant.
In my opinion, this is actually the hardest part of the process because you will be fretting about every little symptom and wondering what it means. I spent a lot of hours worrying, doing endless online searches and surfing online forums to try and get a glimpse of what’s to come.
I would highly recommend that you plan something to occupy yourself like going on a relaxing holiday or even working at this period of time. Bed rest is not necessary after the embryo transfer, in fact, some online searches discourage it. You can go back to your normal routine after the transfer, but I personally don’t think you should do anything too strenuous.