Yassy’s note: First step into IVF journey

 

In the previous entry titled “Yassy’s Note:Impossible dream made possible“,I wrote that 12 years ago, I came to the states via marriage and,after spending about 2 years ourselves alone, we started thinking about starting a family. However, doctor has found the toxic fluid for babies in one of the tubes and the other tube was closed , plus I had the wall in heart shaped uterus (bicornate uterus). Therefore, both tubes had to be removed.

 Since my uterus had so little space for the babies to grow, our first doctor told us that our option for our dream of life will be achieved via surrogate program,which runs up 60,000 dollars.

 However, when we went to the fertility clinic to talk about option in detail, we were told that the another doctor could perform the surgery to remove the wall in my uterus so the babies can grow, and that I could carry my own baby via IVF as option.
 
 In the another previous entry titled “Yassy’s Note: One step closer to our IVF journey“,  I wrote that the infertility evaluation process is recommended first before the treatment such as IVF if the couple has attempted to conceive more than a year without success. Then, I have explained what kinds of evaluation tests we went through and how they are performed.

 In this entry, I would like to write about how our very first IVF journey has begun.

Mock Egg transfer/Hsteroscopy..

 After all the evaluation is done, fertility clinic scheduled me for the mock Egg transfer/Hysteroscopy,by which physicians would be able to see the uterine anatomy (condition of the uterine cavity,and where the fallopian tubes enter the uterus.It also tells the physician if there were any adhesion,growth of tissue, fibroid in the uterus), and he/she could plan what technique/tool/method to use as well as the planned location of the embryos; exactly where they would like to place the embryos when the real egg transfer date, to help increase the odds of implantation.The physician would also check your cervix

 It was April 2010. This procedure is often done between day 6-11 of your cycle and,you would feel like pap smear.It is not a painful procedure although since you come with full bladder, it is a little uncomfortable during the procedure.

 The procedure itself is done as following steps.

Often times, the clinic will ask you to call when your cycle has begun;day 1. Then, schedule your mock egg transfer/Hysteroscopy.

 The clinic would ask you to take the antibiotic on the day of mock egg transfer/Hsteroscopy day. At the clinic we went to, they also asked us to take the painkiller such as ibprofen to decrease the cramping one hour before the procedure.

 The procedure itself is done by inserting a speculum into your vagina,and then local anesthetic is injected to numb the cervix. The physician would then gently insert the hysteroscope to look inside the uterus.
 After the procedure is done, you will be asked to rest for 15 minutes in the room.

 The clinic we went to did mock egg transfer when they scheduled me for the hysteroscopy at the same time.

  The mock egg transfer will be done under abdominal ultrasound, and they will check the cervix. This procedure is to simulate the conditions of the embryo transfer.

 The clinic we went to asked me to start drinking water 2 hours prior to the appointment and drink at least 8 cups of water. However, I had long drive to the clinic and it would have been so uncomfortable if I drank that much. Therefore, I simply drank the water just enough to have my bladder full without feeling too full.

  This mock egg transfer/Hysteroscopy procedure were not included in the IVF program,and we had to pay roughly $500 through our insurance company for them.

  When you think about trying IVF program, ask the financial staff as to what are included in the program,what are not included in the program and at the same time, ask your insurance company whether what are not included in the IVF program at your chosen clinic would be covered or not beforehand.

 When everything in the uterus looked ok, they gave us long pages of Treatment agreement sheet,which we had to read it,sign it, date it and one of them had to be notarized and submitted to the office. It was May 2010.

What the treatment agreement basically said was risk and benefit of the treatment such as the fact that the treatment is not something they can guarantee that the treatment will be effective to maintain the pregnancy or the pregnancy will result in the delivery of the healthy,living child.

 Also, it is to allow them to test us, and to remind us that the IVF treatment could result in multiple pregnancy,consequences of multiple pregnancy, Ectopic pregnancy, and could have risk of fertility drugs along with the information what would happen if the doctor thinks pregnancy should be terminated because of the medical reasons.

Another one we received was the statistic information sheet,which we had to read and sign it. Below is the copy of the success rate chart we have received. You can click the image to view the enlarged image.

IVF Success rate chart

In VA, law requires all the physicians who are performing IVF to submit the statistics to patients.Therefore, we had the chart given to us prior to the treatment and know that the chance of the success with IVF that are related to the age,and the cause of infertility.

Interesting thing it said was that, you can call American society for reproductive medicine  to find out the statistics of particular clinic in the states if you wish to find out about it by yourself.

If you would like to know the statistic of your particular fertility clinic’s success rate of IVF treatment, you can call at 205-933-8494 also.

The IVF clinic also submit the statistic data to CDC and  SART (Society for Assisted Reproductive Technologies). These tables are then published and available online to the public. You can click the link here, at the SART website,then, click your state to find out about the success rates at your preferred IVF clinic. Their data format is very easy to read.

How to read the IVF success rate chart..

Donor OVA; Donor egg
ICSI; (ICSI;Intracytoplasmic sperm injection ) is the method where each egg is individually injected with a single sperm using a tiny needle under microscopic guidance in hope of fertilization.
Stimulation; Stimulated IVF program patient number
Retrievals; attempted number of patients who did egg retrieval procedure
Transfer; number of patients whose embryos were transferred
pregnancies; number of pregnancies
Pregnant/stimulation; % of patients who got pregnant after stimulated IVF program

Pregnant/Retrieval; % of patients whose eggs were retrieved and got pregnant

 Pregnant/transfer; % of patients who undergo the embryo transfer and got pregnant

The national infertility association suggests that we should focus on the % of the embryo transfers that resulted in the pregnancy/live birth. The association says that this statistic tells you how many babies were born for each IVF cycle, as opposed to the numbers of babies conceived.

The clinic we went to gave us the data sheet prior to the treatment but the data we got was not that clear if you try to look for the implantation rate that resulted in the live birth but SART got that information and you can find it out very easily. 

For example, looking at the 2012 data submitted to SART via the clinic we went to, 35 years old and younger had 71 embryo transfer,then the percentage of transfer resulted in the live birth was 35.2% (using thawed own eggs). With the fresh egg from their own, 35 years old and younger had 36.4%  of success rate that resulted in live birth.

 Another sheet we got was voice mail consent form, and informed consent for assisted reproduction.
The informed consent for assisted reproduction basically tells you what procedure and steps are involved,what types of medicines are involved for what reasons,as well as other information such as risks to offsprings, risk of multiple pregnancies,Ovarian Hyperstimulation syndrome (OHS),birth defect,legal matters and more. You are to read it and sign it,date it and submit to the clinic.

IVF types and procedure..

At the clinic we went to, they offer two types of treatment when you use your own egg and your husband’s own sperm.

 One is stimulated IVF,which basically use the drug to grew multiple eggs and hoping to have more chance to succeed. The other one was natural cycle,which no drugs are involved to grew multiple eggs and treatment will be done based upon your cycle,using your naturally produced single egg.

 This method would be more natural to the body,I think but downside of it is that you have only one chance and it is only if your egg were present in the ovary and and be ready to be fertilized.

 Both treatment has pro and cons.

 The difference between the natural cycle vs stimulated IVF program is not just about number of eggs and usage of the fertility drugs. The frequency of office visit to be monitored, frequency of blood tests and sonogram will be different as well. Also, the cost for the natural cycle is different from the stimulated IVF program and the clinic we went offered $4,400 for one natural cycle treatment (exclude assisted hatching,blastocyst culture).

 Depending on the treatment you choose, the step is slightly different as well as medications that are given, but generally, IVF treatment with stimulated cycle would go as followings. Since we have tried stimulated IVF program as the first try, I will explain about the stimulated IVF program first in detail.

** You will be given the medication to grew multiple eggs
** Retrieval of the eggs from ovaries
** insemination of eggs with sperm
** culture of any fertilized eggs (embryos)
** transfer of the embryos into the uterus
** medication (hormone) to support the lining of the uterus,to permit the pregnancy and to maintain the pregnancy
** If you used the stimulated IVF, and if you had more embryos that survived 5 days fertilization outside your uterus than you would hope to be transferred to you, you can ask to freeze them for a fee

IVF Medications..

 If you choose the stimulated IVF treatment, you will receive more fertility drugs than you would with natural cycle treatment. Below is the list of typical medication given to you for the IVF treatment.
  • Gonadotropins, or injectable fertility drugs; Follistim, Gonal-F, Bravelle, Menopur

These hormone drugs are to stimulate the ovary in hopes of  encouraging the growth of several eggs over the span of 8 or more days

All injectable fertility drugs have FSH ( follicle stimulating hormone) that will stimulate the growth of the ovarian follicles which contains the eggs, and some of them have LH (Luteinizing hormone) ; that will work with FSH to increase the production of estrogen and growth of the follicles.

The dosage of the drugs,timing of the drugs, timing of the egg retrieval date are unique to the individuals,and it will be determined by your physician in response to the frequent blood tests to check the hormone level as well as the images of the ovaries via ultrasound.

  • Lupron; injectable medication that will prevent a premature LH surge,which could result in the release of the eggs before they are ready to be retrieved. This drugs also be used to start the growth of the follicles or initiate the final stage of egg maturation.
  • HCG (Human chorionic gonadotropin) ;Profast, Novarel, Pregnyl,ovidrel

HCG is a hormone used in IVF to induce the egg to become mature and fertilizable. Physician will tell you the exact timing to receive this medication right before the egg retrieval day.

  • Progesterone, estradiol; hormones normally produced by the ovary after ovulation. After the egg retrieval, since ovaries in some women will not produce the enough level of the hormones for long enough to fully support the pregnancy, physicians would prescribe these hormone.

            Also, supplemental progesterone, and some cases esradiol are given to ensure the enough hormone support of the uterine lining. Progesterone medication is often continued for some weeks after pregnancy has being confirmed.

  • Oral  contraceptive pills; Birth control pills are to be taken for 2-4 weeks before gonadotropin injections are started to suppress the hormone production or to schedule a cycle (when you take birth control pills, it will regulate the cycle and it is much easier for them to give you the best timing possible for the treatment medications)
  • Oral antibiotics; antibiotics are to be taken for a short time during the treatment cycle to reduce the risk of infections associated with egg retrievals, and egg transfer.
  • Baby aspirin; to help keep open the blood vessels in the placenta, to  improve blood flow to the ovary, and prevent the blood clots.It would lead to better stimulation and implantation;giving us healthier eggs and embryos.

With us, our insurance company could cover the stimulated IVF program for up to maximum $10,000 in life time. Therefore, we have chosen the stimulated IVF cycle for the first try.

After all the evaluation, and physician’s consultation on our case, I was asked to start taking the prenatal vitamins besides fertility drugs they would ask me to take.

 The fertility drugs were covered by our insurance company but it was still expensive; $350. Without the insurance, it would have been much more  expensive drugs. If you were thinking of trying IVF, I would recommend to check what are covered,what are not covered by your insurance company beforehand.

And it is good to check to see if your insurance company would cover the certain amount of IVF cost. It was such a big help for us,regardless of the result at the end.

Egg Retrievals..

  After ovaries were stimulated, and produced multiple follicles, next step you would take is egg retrieval.

  Egg retrieval from the ovary is done by ultrasound probe to see the ovaries and the egg containing follicles within the ovaries.

  A long needle would be guided into each follicles and the content will be aspirated. This procedure will be done under the anesthesia. Then, aspirated eggs will be transferred into the lab where they are kept in condition that support their need and growth. Then, eggs and sperms will be placed together in specialized condition, in hopes of fertilization.

 In some case, individual sperm are injected into each egg in a technique called ICSI; Intracytoplasmic sperm injection.

Prior to this egg retrieval procedure,you will be asked to take the antibiotics to reduce the risk of infections. Also,physician may prescribe you to take diazepam to make you relax.

After the egg retrievals..

  The fertilized eggs;embryos are placed in small dishes/tube containing culture medium,which is the special fluid developed to support development of the embryos made to resemble that found in fallopian tubes or uterus. 

 Then, the dishes containing the embryo will be placed into incubators,which control the temperature and atmospheric gasses the embryos experience.

  Then, lab technicians would watch over the embryo’s growth every day. 2 days after the insemination, normal embryos would have 4 cells . Three days after, normally developed embryos would have 8 cells. 5 days after, normally developed embryos would develop into the blastocyst stage here embryos would have more than 8- cells.

 When you get eggs taken for fertilization, not all eggs would fertilized, and not all embryos would develop the same rate or develop normally. At the same time, even if the embryo could develop at the normal rate,it does not mean that the embryos are genetically normal. 

 Embryo transfer..

 After the embryos are kept in the lab being checked for the growth for a certain days (the days kept at the la can vary depending on the clinic you go to), lab technician will select the best embryo from the bunch for the transfer into your uterus.

With the clinic we went to, they kept the fertilized eggs for 5 days to grow, and selected the best one of the bunch and then transferred into my uterus. You will be asked how many embryos you would like to be transferred prior to the procedure. To help curtail the problems of multiple pregnancy, national guideline limits the number of the embryos to be transferred into your uterus depending on your age.

For example, for the 5-6 days old embryos to be transferred, women up to age 35, they recommend to 1 embryo to be transferred, and for the women between 35 to 37,they would recommend 2 embryos to be transferred.

On the day of embryo transfer, the embryo will be placed in placed in the uterus with the thin tube. The physician would use the ultrasound to guide the catheter and select the best spot for the implantation.

You will be asked to arrive with full bladder for this procedure so the uterus will be straighten up and easier for the physician to look the image and guide the catheter into the uterus for the best chance of pregnancy..

In some cases, if you had good fertilized remaining eggs that survived 5 days in the dishes/tube than you would transfer into your uterus, you can freeze the embryos for the later use. The freezing cost was $1,500 per cycle,and annual storage fee per year was $500 at the clinic we went.

Freezing can save your cost,and another fertility drugs to take to stimulate your ovaries again to retrieve the eggs in the future.

That being said, I was informed that the success rate of pregnancy using the frozen embryo is lower at the national level than with fresh embryos.

 After the embryo transfer..

After the embryo transfer, in hopes of successful implantation of the embryo to the lining of the uterus, you would be asked to take hormone medications such as estradiol, and progesterone.

Both hormone medication is given to keep the lining of the uterus thick and gooey so the embryo has more chance to implant.

With naturally conceived situation, ovaries would make adequate level of the hormone, but with IVF treatment, the level of those hormones are not at the favorable level. Therefore, often times progesterone, estradiol will be given to take for 2 to 10 weeks.

Then, you will have 2 weeks to wait till the pregnancy test (blood test), and finally, you will know if you are pregnant or not pregnant then. If you were a pregnant, your physicians will ask you to keep taking the baby aspirin,prenatal supplement and other hormone medication;progesterone and estradiol to maintain the pregnancy.

 The cost for one stimulated IVF program..

 The cost of the treatment is different depending on the clinic you will go to, and the area you are located at. Also,the costs for fertility treatments will vary widely among programs as well. 

 In average, the cost for one IVF cycle with no insurance coverage is approximately $10,000 plus the cost of medications in the Washington, D.C. area.

The clinic we went to included ovarian monitoring with sonograms, blood estrogen and progesterone measurement, egg collection,culture of eggs and embryos, ultrasound guided embryo transfer, anesthesia, supplies, cycle review,facility fees in the single stimulated IVF cycle without insurance coverage.

Medications, prescreening, cryopreservation,ICSI, assisted hatching, culture of eggs, gender selection, storage fees, complication of therapy,pregnancy testing and monitoring were not included in the program above.

What is ICSI..

(ICSI;Intracytoplasmic sperm injection ) is the method where each egg is individually injected with a single sperm using a tiny needle under microscopic guidance in hope of fertilization. The resulting embryo is then cultured similarly to an embryo produced in a non-ICSI IVF treatment.

What is assisted hatching…

 The human embryo hatches out of the eggshell (zona pellucida) at the blastocyst stage of development. Assisted hatching involves making a small hole in the shell that is surrounding the embryo prior to the embryo transfer and help the embryo emerge following its transfer into the uterus after IVF. It is believed that it increases implantation and pregnancy rates.

Just like our insurance company, some insurance companies do cover IVF program. The clinic we went to needed pre-authorization (written form) from the insurance company before starting the program.

What would happen if the IVF cycle has failed?

 The clinic we went to refunded us the fee we did not complete; fee for service. Then, if you wish to continue to try another IVF, you would schedule the appointment for the cycle review.

What would happen if you get pregnant?

 The clinic we went to did not include the office visits,sonogram,monitoring etc after the pregnancy confirmation in the IVF program package deal. The wanted the separate fee of $500.It included all the office visits,blood test,sonogram monitoring etc.. I was being monitored until I was at 6 week pregnant.

 This is how stimulated IVF program is done.

 After we have signed the all necessary paperwork,we were scheduled to visit the office to learn about how to give ourselves shots for fertility drugs, and also we were asked to go to lab to draw blood for the hormone/HIV Hep B Surface AG/Hep C ab test for me. My husband had to get his blood drawn to be tested for HIV,Hep B Surface AG/Hep C ab. These blood test will be required to do every 6 months.

 Now, We were ready to plunge into our first IVF cycle.

 It is best to schedule injection teaching, cycle review about 2 weeks before the estimated cycle day 1 because insurance company’s authorization for the fertility drugs could/would take 2 weeks.

 Unfortunately, our first try did not result in positive result, and it  took us long,long time to finally meet our little son “Liam”, but it was worth waiting for him to arrive in our arms.

 I love him.I love spending a day with our little star “Liam” and enjoy his smile each and every single day.

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Dec 16, 2014 | 0 | IVF

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