IVF Overview
Okay I have a ton of notes from the IVF class. Not a lot that I learned new, but things I wanted to make a note of.
What we will need to get done:
- Another SA, this time with Baystate (last time it was through a different lab) (they require this)
- A sonohystogram (? Double-check with the doctor)
- Double-check again that there won’t be problems with my anti-depressants (or at least confirm with them that I DID get approval from my OBGYN in regards to pregnancy)
- Get my protocol from the doctor
Some other random notes I wanted to make:
- they only do the clomid challenge test on patients over 38
- the choice of which brand of FSH used depends mainly on what insurance covers (sure hope mine covers follistim
- the progesterone suppliments will be vaginal unless a need comes up for PIO IM injections (which I am seriously, seriously hoping to avoid!)
- they can freeze sperm ahead of time if you anticipate that there will be an issue, such has performance anxiety or a business trip at the time of ER
- they recommend collecting sperm in the rooms there, as she said, “Sperm don’t like waiting too long”
Numbers and procedures:
- They require a minimum of 4 follicles in order to proceed with the egg retrieval
- A fertilization rate of less than 50% will mean that the next cycle will be with ICSI
- Roughly 75% of eggs fertilize in general (no guarantees though!)
- If there are less than 6 high-grade embryos on day 3 there will be a day 3 transfer; if there are 6 or more high-grade embryos on day three then they’ll want to do a day 5 transfer with whatever embryos make it to blast stage
- In general, 40% of day-3 high grade embryos make it to blast
- After transfer they will freeze whatever high-grade embryos aren’t transfered
- Whatever leftover embryos aren’t high-grade they let develop to see if any make it to blast – roughly 10-15% of these low-grade embies make it to blast (and are subsequently frozen)
- There is of course a monthly storage fee for frozen embryos. No insurance pays for it, except Blue Cross who pays for 2 years! (And Blue Cross is the insurance we’ll likely be switching to in the fall.)
- They recommend taking the day of the transfer off work
- They request any leftover poor-quality embryos for research purposes, but of course you have to give signed consent for that.
- When you do get pregnant you have to decide what to do with the frozen embryos – to save them or destroy them or donate them.
- The live birth rate for IVF as of I think 2004 for my age (24) is around 40-45%. But they said that their current rates are probably closer to 50% of maybe even a little over.
- If you’re transferring 2 blasts there’s a higher rate of twins than with 2 day-3s
- For my age, first IVF, they recommend transferring 1-2 high grade day-3s, 2 lower grade day-3s, or 1 blast
- 70% of embryos survive freezing and thawing
- Implantation rate is a little lower for FET cycles
- They do recommend reducing to twins if higher-order multiples occur, because of the increased risks to babies and mother
So that was that. Den and I had a few discussions afterwards.
First discussion was me asking him about donating our leftovers for research. He said, “Sure.” I said, “Cool.” So that decision’s taken care of.
The next discussion was a bit lengthier. We were talking about how many to transfer. Now we had previously agreed on 2, and I was okay with that… but I didn’t know we’d be even considering a day 5 transfer with blasts. I do know that blasts have a higher chance of sticking, which would make me even more nervous about twins. Am I willing to accept that if that’s what we got? Yes, okay, I’ve come to that conclusion. However I don’t really want to put my hand in the fire, as I told him. Den I think is much more concerned about the rate of failure than the rate of twins. He’d take twins just fine. I’m much more… reserved.
Now I need to make an appointment with my doctor. Or hmm wonder if I should just wait until my pre-op consult, kill two birds with one stone? If they’ll let me do that. Not sure. I do want to keep this ball rolling.
I don’t know if they discussed this in your class, but there is a higher rate of spontaneous identical twinning with blast transfer. Just another data point to consider when deciding how many to transfer. You could transfer only two blastocysts and still end up with higher-order multiples, unfortunately.
She did mention that I think with assisted hatching but not with straight blasts. Eeesh. Definitely only doing one. LOL!
A few things to consider:
I have seen many women who don’t think they need to do ICSI and then they have poor/no fertilization. If you can afford ICSI, I think it is better to do it and not risk a possibly much lower fert rate.
If you are having a lap, I don’t think you should need a sonohystogram. Didn’t you have an HSG? My RE requires that you have an HSG OR SHG within a year prior to the start of an IVF cycle.
As long as you are within 30 minutes of the clinic, you can do the sperm sample at home. It is soooo much easier for the guy. No one likes to do it in a room at the clinic, no matter how good the porn!
I would also take the day of retrieval off work. You really won’t feel like working. They should give you some drugs (in an IV, sorry!) to make you sleepy. The whole puncturing the follicle via the vagina is not alot of fun.
I wouldn’t make any decision about the disposition of any remaining embyos until you have a baby in your arms. I have heard horror stories about people donating their embryos and then having a m/c and having to do a fresh IVF again. FET’s are MUCH easier on you… and you may want another one later on.
At 24, with no uterine issues, I would be praying for twins! Almost all twin pregnancies these days do very well. I wouldn’t hesitate to carry trips either. Have you ever read Jen’s blog at AMAZING TRIPS? Very entertaining!
Good luck
April
No, I’ve never read Amazing Trips, but I’ll go take a look! The thought of triplets outright terrifies me, LOL!
Thanks for all the suggestions! The clinic said they generally don’t do ICSI for first time IVF tries unless there’s a reason to, and insurance is paying for it so I doubt they’d do that. I don’t know. Something to consider bringing up with the doctor.
I did have an HSG and am having a lap, I wasn’t sure about the sonohystogram. They seemed to mention it in addiction to the required HSG. I was confused.
And yeah, I’ll take the day of retrieval off work. Luckily my work is very flexible! It’ll be a lot of days off… but I’ve been doing lots of favors for other people the last few months so I’m saving up goodwill. ;) LOL
As for remaining embryos… I think we’re only currently agreeing to donate the non-freezable leftovers. If we have good quality embryos I think we will probably freeze them even if we get pregnant…. we do want a second child someday, more than likely, and it would make it a lot easier if I had frozen embryos to use instead of having to do another fresh cycle. So we shall see!
Oh, and yeah – twin pregnancies usually do very well nowadays. I know both of my husband’s siblings who had twins had no problems at all (okay, one had to be induced a week or two “early” – but it was not dangerously early). I guess it’s just in my nature to worry. :) I want the very best chance for my child(ren) possible! Even if that means in the end only ending up with one child (if we only get lucky once). Maybe I’d regret that, I dunno.
Wow, I feel like I just took a class myself. So much valuable info! That is so great – is this beginning to feel more real to you now? I would be so excited.
Kudos to you for donating some eggs to research. I think I would do the same thing. Anything to help other people in our position, you know?
Absolutely! I don’t really have moral issues with how my eggs are used (although the thought of another couple being implanted with our embryo kind of weirds me out – I think it’s great for people who can do it, but I don’t think I could do that and always wonder if there are our genes out there somewhere). I really would love to help support research about IVF.
And yeah it’s definitely feeling more real!