IVF Cycle: What to Expect During Testing and Ovarian Stimulation?

1. Tests, Tests, Tests

The first appointments with the Reproductive Endocrinologist will be unbelievably overwhelming. They will be inspiring and even thrilling. So many wonderful options and you have the choice. Surely, there are so many various Treatment Options and Treatment Protocols. Some of them are even flexible. You will discuss everything with your doctor, including medications you need and listed further testing to undergo.

Any Infertility Treatment option starts with Testing and Screening. Doctors don’t tell you that infertility testing is a long, emotional, exhaustive, and sometimes, physically painful process. And they don’t tell you how many tests are there. They disclose this information step-by-step. Just Two tests, after that oops! three more. A ‘little’ surprise from the medical team especially done for you. Special Gift ‘From heart to heart’.

Hysterosalpingogram, Sonohysterogram, Hysteroscopy (HSC), and other testing and screening.

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 try to avoid it. 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.

Sonohysterogram (contrast sonography)

An ultrasound scan where they inject dye into your uterus and to check whether your Fallopian tubes are blocked or not. When the uterus is filled with contrast fluid, ultrasound images are made of the inside of the uterus and the uterine lining. If the test is being done to access your Fallopian tubes, then fluid containing bubbles is placed inside the uterus through the tube. The bubbles make the fluid easier to see. The pathway of the fluid through the Fallopian tubes is noted on ultrasound scans. Painful [your eyes are literally filled with tears], and totally unexpected [as your glittering tears flow down your cheeks]. There’s a reason they advise you to take ibuprofen before this procedure. Do it.

Hysteroscopy (HSC)

Between days 6 – 10 of your cycle, your doctor will perform a hysteroscopy. She will insert a small camera into your uterus and then fill your uterus with saline to inflate it, so she can look around, and make sure there are no polyps, fibroids, or scarring. When you schedule this, ask about taking Ibuprofen or Valium before the test.

2. External ultrasounds

There will too many external ultrasounds. Transvaginal ultrasounds will be scheduled on specific days of your cycle. If you have never seen a vaginal ultrasound wand, it’s about ten inches long. The obstetrician covers it in a rubber glove, put on some lubricant, and then it is inside you. 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. You may have even three internal exams in one day — and sometimes it is painful enough to make fresh tears stream down your face and onto your incredibly flattering hospital gown.

3. Blood tests, Blood tests, Blood tests.

More blood work than you have ever imagined. Guess whose blood will be taken? Yes, Yours. They are measuring your hormonal levels, investigating your blood type and your Rh, looking for infectious diseases since they are going to be messing with your DNA in the laboratory. And if you are needle-phobic? IVF will make you not only extremely nervous but a real bundle of nerves. Because your blood samples are taken nearly every time, you have an appointment with your doctor. If you have very sensitive blood vessels or veins which roll, and you always get stuck multiple times don't freak out, you will be attended by the best professionals.

There is only one Fertility Clinic where needle–free testing is performed. Boston IVF Fertility Centers have Needle–Free Monitoring Test, which replaces the necessity for daily blood draws by monitoring estrogen levels using a simple saliva sample. It is the only fertility center in the world to offer this cutting–edge fertility monitoring test, which dramatically reduces the stress associated with Fertility Testing.

4. Paperwork, Paperwork, Paperwork

You will sign thousands of documents. Sometimes your indignation will be unmanageable. So many forms and you must fill in all of them. IUI Consent Forms, IVF Consent Forms, Egg Freezing Consent Forms, Laboratory Consent Forms, Diagnostic and Surgical Documents, Legal Disclaimer Consent Forms. And you will answer a lot of really hard questions. Would you like to cryopreserve all viable embryos or to discard all viable embryos that are not transferred to the uterus at the conclusion of the IVF cycle? What should be done if you get pregnant with multiples? Do you want to perform the Embryo Reduction? What happens to your embryos if you die? If your partner dies? If you both die? What if you move out of the country? You won’t sue the clinic if you don’t get pregnant, right?

5. What? A ‘MOCK TRANSFER’? What is it? Really? When should it be done? Any ideas? 

Embryo Transfer is a blind procedure and some difficulties can unexpectedly arise. Therefore, many IVF programs perform a ‘mock’ Embryo Transfer prior to the Treatment cycle to determine the most suitable catheter and technique for actual Embryo Transfer. Moreover, as the uterus is mobile, its direction may vary on the day of the Embryo Transfer from what it was during the mock Embryo Transfer. Performing Mock Embryo Transfer immediately before the real transfer can show these problems.

In the middle of your cycle, your doctor will do a Mock Embryo Transfer. It is a trial of the actual Embryo Transfer. The actual Embryo Transfer requires taking the embryos into a catheter and then transferring them to the uterus via the cervix. This procedure is more complicated than it appears. It’s not enough to just drop those tiny embryos anywhere inside the uterus. There is an ideal area in your uterus where they should be accurately placed.

Mock Embryo Transfer is done to collect valuable information for when the actual Embryo Transfer takes place. Knowing the length of the uterine cavity, its orientation and, how easy it is to pass the endocervical canal should help your doctor in doing an easy Embryo Transfer when the time comes. This information allows your doctor to determine the best route to place the embryo within your uterus. It is also used to assess for unexpected difficulties such as undetected fibroids, scar tissue on the cervix, or any other problem that may make actual Embryo Transfer complicated.

Your doctor takes a catheter and essentially pretends to transfer an embryo into your uterus, while a nurse does an ultrasound and takes pictures to see where she is going. She will take measurements, and basically make himself/herself a little ‘map’ of your uterus, so when he/she has got your precious tiny embryo or embryos, he/she knows exactly where to go, and can be in and out. You should have a full bladder for this procedure.

6. Ovarian Stimulation SHOTS and more SHOTS...

Wait for another period. Once it starts, you will start 10 days of birth control pills. After that they will be shots after shots. You will do a medical training session with the nurse. Because you are essentially going to be a nurse by the end of this cycle. It is a joke really. Because you will do your own tummy shots.

On day 15, you will start ‘Menopur’ and FSH injections. Yep, two shots a day. Every single day. The FSH is to grow the follicles, and the ‘Menopur’ is to mature them. You will do this for about 10–12 days. Throughout all these injections, you will go to your Reproductive Endocrinologist every other day for external ultrasound scans to monitor your follicle growth and blood work to check your estrogen levels. Your arms will be black and dark–blue colored by the end of the month from all the blood draws from your veins, so at least you will have that to show for it.

7. Mood swings, Cramping, Bloating and Cysts

Cramping. You are basically going to have one cactus (if only one your ovary cramps) or two cacti where your ovaries once were (if both your ovaries cramp). Your ovaries will be literally HEAVY and will HURT.

Mood swings. Anger, annoyance, anxiety, indignation, irritation. Because the meds change your hormone levels, you will experience the mood swings.

Bloating. Remember that you are injecting yourself with all the hormones? Bloating is one of the side effects.

Ovarian cysts. After every cycle using IVF injectable meds, you may have cysts on one or both ovaries.

8. Trigger Shot

About 6–7 days in, when your follicles start to mature, you’ll add in yet another daily injection of ‘Ganirelix’. This is to prevent you from ovulating on your own. Once your follicles are mature, you will do a trigger shot. There are two different options here, either ‘Lupron’ or ‘HCG’. If your Estrogen levels have been trending up too high, then you will be at risk for a condition called ‘Ovarian Hyper Stimulation Syndrome’ (OHSS). It is caused by HCG interacting with all the excess estrogen. So, if your Estrogen levels are too high, your Reproductive Endocrinologist will probably recommend a ‘Lupron’ trigger instead of the usual ‘HCG’ trigger.