Monday, 31 March 2014

A day by day guide to IVF - Pre-retrieval.

A lady asked for a breakdown on a message board, so I thought I'd post my response here as well. The bottom line is that every IVF cycle is different - clinic to clinic, woman to woman, and cycle to cycle.  Here is the general schedule of events, based on my two IVF rounds:

Once you have the green light from your clinic (which involved endless testing, some quite invasive and uncomfortable, and may have taken months), then you wait for a new cycle to begin. This is the down regulation part of the cycle, and involves roughly 3 weeks of birth control pills. There is a fair bit of flexibility in this portion, but mine always started with blood tests and ultrasound on day 3, and starting pills that night. On the 18th day of taking pills, I had another ultrasound to make sure the pills were doing their job of "quiet ovaries and thin lining", which they were, so then with some flexibility the decision is made as to when to stop the pills. There is some unpredictability as to when bleeding will occur after stopping pills, so I was more involved in my second cycle planning dates with my clinic, based entirely on my first cycle. Symptoms of pills are much more pronounced when you just take it one cycle after 10 years off, and they suck. For me, it's headaches & irritability. No wonder I didn't have any long-term relationships when I was young and on the pill, makes me wonder why I was on it in the first place ;)

Cycle 2, again, on day 3 go for blood tests and ultrasound. this day 3, coming off the pill, I was not as actively bleeding when I went for my ultrasound, which is pretty awkward for me but old hat to them. It's not something you think about until you're standing in the change room, sheet wrapped around you like a skirt, hoping you don't start bleeding down your leg while you wait for them to call you in. Oh, and internal ultrasounds (aka vaginal ultrasounds) are sometimes uncomfortable, sometimes not, and you get used to them. I've had days when I was quite tender and it's very uncomfortable, but other days when it was fine. During my first cycle I got more tender as the days went on. During my second cycle I was tender on the left only two occasions early on, but then it got better. On the basis of this day's "monitoring", the decision is usually made to start injections. This day 3 now becomes day 1 of injections.

You're left alone to inject yourself daily until day 5 (of injections), when you return for monitoring. At this point, estradiol is starting to get pretty high so this is when I start leaking extreme amounts of cervical fluid. This is also the day when, depending on monitoring results, a GnRH antagonist is added to the injection routine, to prevent the high estradiol from prompting a lutenizing hormone surge. It was at this point in my second round that we discovered I was responding a bit slower than the first time, so I knew my perfectly planned schedule was in jeopardy. I was a day behind at this point.

Day 8 (of injections), more monitoring. After this point, it really could go day by day. This is also when my boobs became really sore. On my first round, growth was progressing nicely and they had me back on day 10, when I was instructed to take a partial dose of injections at my usual time, my trigger injection at a specific later time, and given the appointment time for my retrieval. On my second round, I was back on day 10, 12, and finally on day 13 they said I was ready to go. My schedule wasn't completely shot, in fact it worked out pretty well for the most part.

My clinic requires you to take 7-10 days off work after retrieval, and 14 days restricted activity, so put your feet up and relax!

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