5 W's and H of IVF

Who: Dave and I (duh!)

What: IVF aka In Vitro Fertilization; a procedure that involves the retrieval of eggs, collection of sperm, and then placing them together in a laboratory dish to fertilize outside of the body.

Where: The procedures will take place at The Center for Reproductive Endocrinology and Fertility in Spokane. The injections will be done by me on me wherever I happen to be at precisely 7am and 7pm on the days the doses are scheduled.

When: We have already begun the suppression phase of the protocol. The series will continue through the end of June and hopefully result in a pregnancy (or two) by early July.

Why: Basic junior high biology class taught us that in order for a pregnancy to occur, and egg and sperm must hook up. Let’s just say that any biological children of Dave will not be Olympic swimmers. TMI?

How: Okay, down to the nitty gritty. After a multitude of exams, ultrasounds, blood work, and specimen evaluations the protocol that our physician has prepared for us will be in 5 phases.

1. Suppression: The purpose of this phase is to quiet the ovaries and prepare them for stimulation. This is done by taking oral progesterone tablets daily.

2. Stimulation: The purpose of this phase is to stimulate multiple follicles to grow so that they are of optimum size for retrieval. (Follicles are sacs of fluid and typically each one hold and egg.) Stimulation is done by injecting two different hormones twice a day into my abdomen (Yes, that means 4 shots a day). During this phase I will have an ultrasound and blood work every other day to determine my hormone levels (to ensure medication dosages are adequate) and the size of the follicles in my ovaries. We will be starting this phase on June 12th (our 4th Anniversary).

3. Retrieval: Once the doctor determines that the majority of my follicles are of optimal size, I will take a high dose HCG injection and plan on retrieval 36 hours later. The egg retrieval procedure is an ultrasound guided needle aspiration of the follicles from the ovaries. The procedure is performed under anesthesia at The Center. This is tentatively scheduled for June 23rd. It is at this point that Dave gets to participate. On the day of my retrieval, he will supply a specimen of his swimmers. The sample is washed and spun down to separate the highly motile from the ones swimming in circles. Finally, the motile sperm cells are placed in embryo culture medium with the eggs so they can do their business. In the event there are not enough sperm with a sense of direction, the embryologist may perform the ICSI procedure. I’ll give more details later if we have to go that route.

4. Embryo transfer: After all of the mature eggs and sperm hook up they will incubate in a temperature controlled environment to (hopefully) grow into mature embryos. Once we determine how many of the embryos have matured, we will have some difficult decisions to make including how many to place in my uterus and what to do with any “leftovers”. The embryo transfer itself is a relatively minor procedure that occurs 3-5 days after retrieval (tentatively June 28th). Basically, the mature embryos that make the cut are strategically placed in my uterus via a flexible catheter. Then we wait. I will continue one of my twice daily injected hormones to help foster a hospitable environment in my uterus for the embryos.

5. Follow-up: One week after retrieval, I will have estrogen and progesterone levels drawn to double check drug dosages. Two weeks after retrieval I will have my first pregnancy test. If the result is positive, then… well it is positive. If the result is negative, we will double check it again in a few days, if still negative then we start again at square one. Hopefully we won’t have to think about that.

Well… that is it in a nutshell. There is not a lot else we can say other than prayers for strength, courage, and patience are appreciated. As you can imagine, it has been a long road to get to this point and will be even longer until we have a positive pregnancy test. Your posted comments will be greatly appreciated as we endure the nexy few weeks.