One of the questions I’ve often been asked, by the friends and family of those undertaking fertility treatments, is: What is IVF?
Huge topic hey?
I am absolutely by no means an expert or a scientist or even have any medical background; I’m merely a person who went through multiple rounds of fertility treatments. But, I’m going to attempt to give this a shot.
It’s going to be very simplistic and, very much, in lay-man’s terms. I’m not going to talk about the multitude of add-ons or additional testing, as there are just far too many to mention and, in all honesty, I’m somewhat ignorant too about all of the options available for the varying range of issues. I’m going to try to keep to the basics of a bog standard, run of the mill, cycle of IVF – if such a thing exists! I know I’m not going to give as much credit to either the wonder that is IVF, or to the women who put themselves through it. However, I’m hugely passionate about breaking the taboos, which surround infertility, and in helping educate others around the enormous topic, and roller-coaster, it is. And so I am going to try. I desperately hope I can do it some justice.
Before I start, I am going to stress that each clinic can, and does, operate differently. Each patient, and situation, is unique and the world of medical science is evolving daily, with new ideas and findings and options, for those of us who need science to intervene in order to have a family. It’s also important to mention, again, that within each procedure, there are many, many differing practices and medications and tweaks, and tests, and add-ons for each individual, pertaining to their, specific, form of infertility. I’m writing, very much, from my own personal experiences based on the treatments I underwent during my battle to conceive.
In Vitro Fertilisation (IVF) & Intracytoplasmic Sperm Injection (ICSI)
Ah yes, IVF, the party in the petri dish, the bringer about of Louise Brown and many other, over five million, in fact, beings into this world. And, in all honesty, it’s probably that end process; the petri dish, that we all know of, but how everything actually gets there is less widely spoken about.
I’m sure we can all pretty much imagine, though perhaps we shouldn’t in too much detail (!) how the sperm joins the party, but what about the eggs? Yes, plural! How come there are so many eggs? Is it always Easter?
The first thing to know about infertility and IVF is that there is no one set route. Finding the right clinic for treatments is a hugely personal fit and it’s not uncommon to change clinics, later on down the line, to try new drugs or practices, or even a new medical team.
So here goes…
IVF and ICSI are, to a point, the same thing. The procedure will, usually, start in the same way, and it’s only upon fertilisation that things change. With IVF the sperm and eggs are thrown together, into that petri-dish, with party hats and chat up lines, looking for the one! With ICSI one sperm is injected directly into one egg; think of it as less of a nightclub at midnight and more of an arranged marriage.
ICSI is usually recommended where male infertility is a factor, when there can be issues with sperm motility (movement and swimming) and / or morphology (appearance and shape).
My rounds of ICSI were completed using, what is known as, the long protocol. This meant that each cycle took circa six to eight weeks from taking the first drug, to finding out whether we were pregnant or not. After the copious amounts of pre-required blood tests and scans and ever-growing mountains of ticking the box paperwork, this began with taking the contraceptive pill, for around ten to fourteen days. Ironic huh? However, it was explained to me that the pill is used to create a starting point for the cycle. During this time, I was subjected to more scans and blood tests before the injecting could begin.
The medication, my clinic favoured, came in the form of two main injections, and I believe this is a pretty common route for a standard round of IVF. I firstly had to inject myself with Buselerin; a drug whose job it is to stop the pituitary gland producing natural reproductive hormones. It basically switches off the ovaries. This stage is often referred to as down regulating, and I had to inject one dose of “downers”, nightly, for seven to ten days before introducing additional hormone injections.
After more scans and blood tests (of course!) and once my clinic were happy I had responded well to the down regulation process, I then introduced the next lot of drugs, follicle stimulating hormones (FSH). These FSH drugs are usually referred to as “stims” and my clinic favoured a drug called Gonal-F. The stimming hormones do the exact opposite of the downers; it’s their responsibility to encourage multiple eggs to grow in one cycle. I injected a clinic agreed dose of stims each night, alongside the downers, for an additional ten to fourteen days, depending on how the eggs (mainly referred to as follicles or follies at this stage) were developing. Which is why the scans and blood tests are important and do happen frequently – we’re all very keen to know what’s going on in there!
No one ever imagines the need for needles and hormones and a whole host of extra people, in order to do something which is meant to be private and romantic and full of the joys of spring. Yet, being infertile is an incredibly invasive, clinical and relentless process. There is absolutely nothing nice about it and it gives a whole new meaning to the phrase “trying to have a baby”. A quick romp, after a nice bottle of wine, would definitely have been my preferred way to conceive!
In reality, I only injected for a few weeks during each cycle, however, it felt endless, the side effects were nasty and the syringes scarily mount up. But, then the vials start to empty and the final jab arrives; an incredibly well-timed “trigger” shot of HCG (synthetic human chorionic gonadotropin) which causes the eggs to stop their maturation and get ready for their release.
It’s time to get those follies.
The ER (Egg Retrieval) or EC (Egg Collection) is an invasive procedure which usually happens under anaesthetic sedation. It involves a thin needle, often attached to a catheter, being passed, by ultrasound guidance, through parts of the body where no lady ever wants a needle to be inserted, and up to the ovaries. The needle then gathers up the eggs.
Meanwhile, my husband had to become acquainted with a cup…
So much of the IVF process is about gearing up for the egg collection and hoping and praying that there will be a good harvest of healthy eggs. What the clinic is looking for, and what everything has been acutely timed around, is this retrieval of mature eggs; eggs that are at the absolute right stage, and size, for fertilisation. Over and under matured eggs cannot be used. This is why the timing is imperative. There’s also a time limit from injecting the trigger to making sure the eggs are retrieved, which is why clinics give very specific times and instructions. It’s all incredibly nerve-wracking.
The joining of the sperm and those precious, hard to make, super expensive eggs will usually happen on the same day as the retrieval. There’s then an anxiously awaited phone call the morning after, informing how many embryos there are. The tough reality of IVF and ICSI is that there are no guarantees fertilisation will happen and, if it does, how many embryos will form from the eggs collected. Our worst cycle created just one embryo and our best, and successful, nine.
It’s mentally and physically brutal.
The Embryo Transfer (ET) & Frozen Embryo Transfer (FET)
After fertilisation, the embryos are assessed, by the embryology team, to determine how well they are progressing. Each embryo is then graded according to its appearance. It’s incredibly difficult to list the various grades of embryos as each clinic can have their own system.
From this point on, over the next few days; it’s all to do with cells.
In short, and very simply, an embryo begins life as a single cell. As it develops, these cells divide and, as a quick rule of thumb, embryos should be around two to four cells, two days after the ER, then around seven to ten cells when it reaches day three, and seventy to one hundred cells when it reaches the blastocyst stage, around five days after fertilisation. Amazing huh?
Clinics, most commonly, perform embryo transfers on either day two to three, post fertilisation, or on day five to six. There are a lot of differing schools of thought over the success of having either a three (3dt) or five day transfer (5dt), yet in most clinics, this isn’t a choice the patient can make; it’s an educated decision made by the embryology team over the number of embryos fertilised and how they are graded and developing.
Transferring the embryo/s in the days directly after the egg retrieval is known as a fresh cycle.
The more eggs collected, during the retrieval, and a higher fertilisation rate, can often lead to “spare” embryos being frozen, or cryopreserved, for a FET (Frozen Embryo Transfer). As the embryos have already been created, FETs tend to be an easier and less medicated, shorter cycle. I certainly found that to be the case for me.
The technology to freeze embryos absolutely blows my mind. My son was frozen, at blastocyst (five day) stage; he was effectively a bunch of cells put on ice and then defrosted. I find it incredibly futuristic, and I’m very much in awe of medical technology and the advances in research and procedures.
Fresh or frozen, the ET (Embryo Transfer, not the kind that phones home) is usually performed in the same way; with the help of a catheter and an uncomfortably full bladder, whilst wearing hospital robes. It’s, yet again, another incredibly clinical procedure. However, we were always able to see, via ultrasound, our embryos being popped back in, and were always given a scan photo, of our very own little cell bundle, in utero. Which, whatever the outcome, was a beautiful sight to see.
And that’s it.
Then the waiting begins to see whether, after everything you’ve put yourself through, the dream of having a child will come true.
IVF is no easy feat. It’s physically and mentally exhausting. It’s addictive. It’s heart-breaking and infertility is incredibly unfair. I’m so proud that my son is the wonderful product of medical science, but I wholeheartedly wish that I’d never had to experience infertility and IVF.
So there you go, the tip of the iceberg and a very simplified version of what happens. I do hope it makes sense and opens the door, a little, for you to understand just some of what takes place.