First Week of IVF Treatment Cycle: What to Expect? What You Won’t Be Told About That?

Infertility is exhausting physically, emotionally, and mentally. It tends to get a bit uncomfortable and you could begin to feel agony because of all those injections, meds, IVs, blood draws, doctor visits, etc. If you have already experienced all these things, you know what I am talking about. Or if your OB/GYN recommended you schedule an appointment with the respected reproductive endocrinologist to talk about your situation, you should know that you won’t be told many things.

Before you start your first IVF Treatment cycle, I would like you to go through some topics. Because when you know what to expect you are psychologically ready to experience all that things. You are not so scared of everything that you should go through. You just say ‘YES’ or say ‘I want to look through the other options’ without annoyance, anger, frustration, or nervous tension. You have the choice. Remember this vital rule. The choise is yours. You may agree with the proposed Treatment Options, Treatment Plan, medical tests, meds, and so on, and you may disagree. And you have the rights to disagree.

Wondering what to expect? Or just want to complete the official part of the IVF Treatment cycle and get started? Before you say: ‘Yes, I will do that because you are respected specialist and I trust you’, and sign the papers, I would like you, and I encourage you ‘TO GLANCE INSIDE’ the First Weeks of IVF Treatment Cycle (based on real experience), and ‘INVESTIGATE’ What You Won’t Be Told by the Doctors About That. 

1. You may need more than one consultation and more than one Infertility Specialist

If you glanced three times to reread the above–written line, YES, you will have to do that. You will have to schedule the consultations with infertility specialists. Because infertility can be a great challenge to accurately diagnose. There is no gold standard for an accurate diagnosing of infertility. Even if you were diagnosed ‘Infertility’ by your OB/GYN, this diagnosis must be verified.

You have probably already had some initial testing done through your OB/GYN, and maybe you have done a few rounds of Clomid [the medication that helps boost your FSH – the hormone that grows your follicles], with no success. Therefore, you will have to schedule the consultation with Infertility Specialist. Usually, the first consultation you schedule is with Reproductive Endocrinologist [OB/GYN]. 

But in several cases to diagnose infertility, you may need more than one consultation and more than one Infertility Specialist. Note down the other Infertility Specialists you may consult with: Reproductive Immunologist, Reproductive OB/GYN, and Reproductive Surgeon [OB/GYN or/and Urologist]. 

What to expect from the consultations:

The Reproductive Specialist will inclusively review your medical history from your OB/GYN, [from the other Infertility Specialists], and your husband’s Semen Analysis [including your husband’s medical history from his andrologist to exclude the male factor infertility or to confirm it]. 

The Reproductive Specialist will represent and explain you the different Treatment Options. Infertility Specialist will also discuss with you all possible Treatment Option in your case. The doctor will tell you transparently about the pros and cons of every Treatment Option you can choose and make the recommendations for your next steps.

Any Treatment Option includes medical screening for Infertility and Infertility Testing. Not only for you but also for your husband. Infertility Specialist will discuss with you these procedures.

Infertility Specialist will run more blood work, to take a deeper look at your hormones, like Thyroid (TSH, T3 & T4), Prolactin, Estrogen, Progesterone, AMH.

Reproductive Endocrinologist [Endocrinologist/GYN, OB/GYN, Surgeon] may do another transvaginal ultrasound and may schedule additional transvaginal ultrasounds on a specific day of your cycle

Transvaginal ultrasound enables the accurate visualization of your ovaries. The benefit of the Reproductive Endocrinologist [Endocrinologist/GYN, OB/GYN, Surgeon] is that they can typically do this right away, and do it themselves, versus having to schedule a separate appointment with a separate tech. They look at your ovaries, sometimes on a specific day of your cycle, to see if there are follicles growing, and your uterus to see if your lining is thickening to accept a fertilized oocyte, and to generally make sure everything looks how it is supposed to look. They will count how many potential eggs you have on the left and on the right ovary. If you have low egg reserve and they see 10 potential eggs, they will be amazed because aren’t expecting to see so many.

Schedule an HSG (Hysterosalpingogram)

You will have to do this before starting with any Treatment, to make sure that your Fallopian tubes aren’t blocked and investigate whether the shape of your uterine cavity is normal. Basically, they shoot some dye into your uterus while watching on an X–ray to make sure the dye spills out of your Fallopian tubes. You will see different horror description versions this test if you Google it, so don't get worked up. Yes, it hurts. But it only hurts for a maximum of 10 seconds. Literally, 10 seconds and it is completely over. When you schedule this, ask about taking ibuprofen before the test.

Fertility Specialist must disclose all the information you need. And you must ask him/her questions

I strongly recommend you include these challenging questions that would never ask at the start of your journey. These questions will show you the doctor’s experience. They are vital to be asked.

1. What data exists to back up what you are recommending?
2. What tests are not necessary but just recommended?
3. What flexible Treatment Plans can you propose me?
4. What can be changed in my Treatment Plan?
5. What side effects these medications have?
6. What will be if I refuse to do that? Do you have the alternatives for this test?
7. What is different now to lead you to believe the procedure will work this time?
8. What tests have we not considered even if they don’t seem to be obvious ones?
9. What will we do differently next time should the procedure fail?
10. Does your office have any early/late hours for scans and blood work?
11. Do you have your nurses team or your assistants? If you are not in the office, who is responsible for everything?
12. Do you have weekend hours?
13. Do you have an after–hours phone line?
14. What are you not telling me?

Print at least ten copies of your question list. Take your question list every time you have the consultation with the doctor. You will be amazed how this question list ‘DOES ITS JOB’. Keep it as your secret. Anytime you want to compare different versions of answers from different specialists, different Treatment Plans, different Treatment Protocols, even your tests with different results, just scan them through. Caught the idea?

You should discuss with Fertility Specialist the Treatment Plan and make a draft of your Treatment Protocol. 

Ask Reproductive Endocrinologist to create the document version, a printed one. Because when everything is written, it is easier to track the consequences of the Treatment, cross unnecessary tests, and correct the meds. just imagine what happens if you don’t have your printed version, or your doctor has it, but you don’t have the copy. In the first case, it is impossible to remember what you need to do, which meds you need to take, what are the pills and what are the injections and so on. Or, the second version, you call your doctor: ‘Hello, Doctor Williams, what should I take today, and is there my ultrasound scheduled for today at 02.00 P.M. or 04.00 P.M., can you just glance through my Treatment Plan?’ Want to be involved in such a situation? Neither do I.

2. You will start feeling ‘A two–legged pill’ or/and ‘A two–legged syringe’

If you are a needlephobic person, you will start feeling ‘A two–legged syringe’ in a week.

The first line of Treatment with your fertility doctor (Reproductive Endocrinologist) usually is an oral medication called ‘Femara’ along with FSH injectables. Usually, these injectible medications are Gonal–F and Menopur. The FSH is Follicle Stimulating Hormone – self–explanatory, it is the hormone that stimulates (or grows) your follicles.

You and your husband will go in for your baseline appointment to learn how to give you injections into your stomach. Why should you inject needles into the stomach? Surely, to get those potential eggs big and strong. Gonal–F comes in pen and you just need to dial up 225 and inject it into your stomach. It is easy.

Menopur is a completely different story. It comes in glass vials and needs to be snapped open. It is dangerous and hard to do because while trying to open a vial, you may cut your fingers open and bleed for a very long time. That is why you need some solid medical gloves to open them, so you are not worried about getting hurt. After you open this vial, you have to mix the solution with 3 other small bottles. It sounds easy, but the first three times it will be hard to mix those solutions.

3. Second ultrasound monitoring and finally a trigger shot

You will have your second ultrasound monitoring to see how your follicles are growing and how many of them are still an average size. If the Reproductive Endocrinologist decides to “boost” those average–sized follicles, you will do more injections to “boost” them. Your doctor can also add a new injectable to the mix. And he/she will schedule the next ultrasound monitoring for the second week of your Treatment.

Surely, the first thing you wont be told is that your first weeks of IVF Treatment cycle are really exhausting. Because everything is weird. Everything is quite scary. Change is constant. Nurses, blood tests, painful IVs, fertility meds, external ultrasounds, scans, even surgeries… And you must know what to expect. But everything is for the best! so put those fears aside.