Posted on 04/06/2018 in Fertility Treatment Options

IVF Cycle: What to Expect During Fertilization and Embryo Transfer?

IVF Cycle: What to Expect During Fertilization and Embryo Transfer?

(1) Egg Retrieval day

One or two days after your trigger shot, you will go to the clinic for your egg retrieval. You have the actual appointment at Fertility Clinic for the egg retrieval procedure [EXACT TIME and DATE]. But get there a little earlier your ‘SCHEDULED’ time, though so you can get in a gown, hooked up to an IVs, and some nausea medication in your system. If you have never been given anti–nausea medications, this time you will get them.

After the meds, the procedure is somehow less intimidating, even if your anxiety is usually at full blast. But it is a SURGERY. The nurse will inject an anesthetic medication into your IV, and you get the lovely falling feeling. They give you the pain medications first. BUT you will feel the pain of the needle going into your ovaries. Despite it won’t last long, it will hurt. After the procedure, you will be lying on a couch going in and out of consciousness. Then you will wake up, you will say something (or many things) to the anesthesiologist and nurses. But you won’t remember it, so don’t worry about that. And ask your doctor 20 times how many eggs they retrieved. While your doctor is busy stabbing your ovaries repetitively with a small needle, your husband will be in the room. Doing his thing.

(2) Fertilization

The Embryologist will take all the eggs retrieved and toss them in a petri dish with your husband’s sperm and let them do their thing. Another option is called intracytoplasmic sperm injection (ICSI), where the Embryologists manually fertilize the eggs with the sperm individually, but it is for extreme cases only. You will know the next morning how many of your eggs have been fertilized correctly.

(3) Not all retrieved eggs can be fertilized

Not all your retrieved eggs will be mature. And fertilization is possible only in case they are mature. For example, out of the 16 collected, only 10 were mature. Out of the 10 mature, only 6 were fertilized properly and are growing. And out of those six, maybe four or three would make it to 5–day blastocyst and maybe none would. If they would all at least make it to day 3, you would have at the least one. And it may happen that none would survive. If any of them made it to day 5, they will set your embryo transfer appointment.

(4) You will have to wait three days

And then you have to wait three days or maybe a bit more. Sometimes you have to wait five or six days. During those days you will might feel confused. ‘What if…’ questions will whirl in your mind. What if all six embryos would be perfect for the embryo transfer? What if three of my embryos are perfect, how should I choose which one should be transferred? What if I do want all three my embryos to be transferred? What if just one would survive? What if I choose the one and then there would be a miscarriage? Maybe two embryos are better? And if none of them would be perfect then what? You will be a real bundle of nerves. Overwhelmed with fear and inspiration.

The good news is, you can do whatever you want during this waiting–time. Sip the mochaccino with almonds and caramel. Have three–hour shopping to upgrade your style. Have a wonderful morning photo session. Do all the things you want. Do all the things that make you less worried. Your tiny embryos are outside of your body and you cannot hurt them. The bad news is, you may not be able to do any of those things because you will be in pain due to the surgery [egg retrieval] you have just undergone.

(5) What to expect after the egg retrieval procedure? 

The whole procedure takes only about 20 minutes, so you will wake up about 30 minutes later in recovery. You won’t be in any pain because they must have given you some good pain medications through the IV. But when the pain medication disappears, you might experience a bit of pain. You feel excessive fatigue, tremendous pressure, and cramps. Post–surgery fatigue may last several days. Your surgery was done three days ago BUT you just feel extraordinarily tired all the time. Post–surgery cramping also is annoying. The day of the egg retrieval, you will experience some intense cramping and abdominal pain. They will give you pain medication, but as each day passes, you will feel the abdominal pain. And you will LOOK 4 or 6 MONTHS PREGNANT. If the medications you had taken and injected to ‘BOOST’ your follicles growth caused some mild Ovarian Hyperstimulation Syndrome, your abdomen will be filled up with fluid. Therefore, you will literally look 6 months pregnant.

(6) Be ready for the PHONE CALL from the embryologist

On day 3, you get a Day 3 growth report, and it’s the scariest and the most exciting phone call of your life. Have a pen and a notebook ready and note down every word the embryologist tells you because you just might forget something essential. The embryologist can tell you how many embryos fair, good, and excellent quality are. The goal is for the embryo(s) to make it to Day 5 (or 6) when they will either transfer it back into your uterus or freeze it for later.

Be ready for one, two, three or more phone calls from the embryologist. If your embryos make it to day 3, or day 5, or day 6, wait for the call from your doctor to schedule the Embryo Transfer procedure.

(7) The embryo transfer can be cancelled completely 

After the egg retrieval is performed, the ovarian follicles, which have been aspirated, can fill up with fluid and form ovarian cysts. The symptoms usually resolve within 1–2 weeks without medical intervention. BUT there is still one but. Sometimes ovarian stimulation causes severe ovarian hyperstimulation. It is characterized by the development of large ovarian cysts and fluid in the abdomen. Surgery may be required to remove the fluid from of the abdomen. In some cases when there is a significant risk for ovarian hyperstimulation, the cycle may be cancelled, or the eggs will be retrieved and any embryos that result may be frozen.

(8) Ovarian Twisting requires surgery

Ovarian Torsion or Ovarian Twisting occurs in less than 1% of all cases but happens. It is characterized by a fluid–filled cyst(s) in the ovary which can cause the ovary to twist on itself. This can decrease the blood supply to the ovary and result in significant lower abdominal pain. Surgery may be required to untwist or possibly remove the ovary.

(9) You will decide how many embryos should be transferred and what should be done with those left

Before the time of the actual embryo transfer, your doctor will review the fertilization results and the development of the embryos. A decision will be made regarding the number of embryos that will be transferred. You will have to sign the papers before the embryo transfer. The questions in these papers vary from clinic to clinic, but there are three most important which remain the same. How many embryos should be transferred? What should be done with those embryos that left? Will you undergo the embryo reduction procedure in case of multiple pregnancy?  

You can ask to transfer two, three or even more embryos. But you should understand the risks which will follow your decision. Increasing the number of embryos transferred will increase the chances of pregnancy. But it will also increase the risk of a multiple pregnancy (twins, triplets, etc.). Remaining embryos that are not transferred will be accurately examined. If they are of suitable quality, they may be frozen, stored and transferred in the future. Alternatively, these ‘extra’ embryos can be discarded.

(10) Embryo Transfer procedure

Excitedly, you will go to your appointment knowing there is a perfect 5–day embryo waiting for you. You will come to the clinic and wait near your doctor’s office for the appointment. You will be asked to drink lots of water because you need a full bladder, so your doctor can see what he/she is doing on ultrasound. You doctor even can show you a picture of your little embryo. It would be one of the most intriguing and beautiful things you have ever seen in your life. You won’t believe that is your future [possible] small bundle only 5 days old now.

You will wait for the Reproductive Embryologist to come and bring your embryo into the room. Finally, the Reproductive Embryologist will come into the room holding a long tube with a plunger at the end. And it will be the time to replace this small embryo–bundle from the tube inside your uterus. The procedure of Embryo Transfer takes only several minutes. It takes all of three minutes to insert a weird kind of catheter, get it to where it needs to be, accurately place your little embryo inside your uterus, and that is all.

Your doctor may give or not give you the pain medications before the Embryo Transfer. This procedure is usually painless and a little uncomfortable. You will have to lie for 30–40 minutes after the embryo implantation to let everything accurately settle. You will want to pee so bad it hurt. In your medical history, your doctor will note down the weird term ‘PUPO’ (pregnant until proven otherwise). In 5 days past the day of the embryo implantation, you will have to do a pregnancy test. If your pregnancy test is positive, there will be nothing left to do but wait for a visible positive ultrasound scan, indicating the heart activity of your little embryo at around 7 weeks.

(11) Sometimes a uterine infection occurs after the embryo transfer 

Very rarely, a uterine infection may occur after the embryo transfer procedure. The most common symptoms associated with uterine infection are pain and fever. If you have a fever, vomiting, abdominal pain or any other symptoms develop following the embryo transfer, you should contact your doctor immediately.

(12) Cryopreservation of the embryos has some risks

There are several techniques for embryo cryopreservation. The methods include ‘slow’, graduated freezing in a computerized setting, and ‘rapid’ freezing methods, called ‘vitrification’. Current techniques deliver a high percentage of viable embryos thawed after cryopreservation. But there can be no certainty that embryos will thaw normally, nor be viable enough to divide and eventually implant in the uterus. Cryopreservation techniques could HURT the middle–quality embryos and increase the risk of developmental abnormalities after the freezing–thawing procedures.

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