IVF Answers

Today was the big appointment! We left this morning anxious and excited and came home a bit overwhelmed and emotional. I keep forgetting that every step we have is like this: overwhelming and emotional. Our appointment was great, though. We were able to meet with one of the main OB/GYN Nurse Practitioners at the clinic, and I love her. She had been one of the few gals who did all of my ultrasounds and even IUIs there. Kind and patient, she explained to us what our next steps are.

She was on the same page with us as for not wanting to do anymore IUIs (we've done five) and skip to IVF. She recognized that even though my fallopian tubes appear to be open, we have no way of knowing the extent of the damage which is in those tubes. The little "hairs" (cilia) that pull the egg along to get fertilized--if that is happening--may themselves be damaged.

This bit of info was a strong confirmation for me to hear. I'm not sure if I shared on this blog but in August of 2011, Rob and I went to see a new fertility specialist, mainly to get a second opinion on our whole situation. He was great and spent at least a half an hour with us just talking about our entire journey. He said that he felt we had done everything "correctly," all of the steps there are available to do, and his guess was that the problem lay in my fallopian tubes. Incidentally, he also knew my doctor and the clinic, and said that would the place he would have recommended, the only other being a referral to Stanford.

Back to the appointment today. There were four main things we wanted to discuss:

1. Am I still a good candidate for IVF, and if so, what are the chances of conceiving?
2. What are the steps of IVF?
3. What is a cost estimate of the whole thing?
4. What about our own ethical and religious beliefs, specifically concerning the embryos?

Am I still a good candidate for IVF, and if so, what are the chances of conceiving?

I am most likely still a good candidate based mainly on my and my husband's age, health, and medical situation. Rob needs another analysis done, and I have to do three tests again, two that check all sorts of hormone levels, and one that gives a clear picture of the state of my uterus. This one is like the HSG I did a couple of years ago, which basically is an x-ray of the uterus and tubes. This new one, called an SIS, focuses on the uterus, though, and gives a clearer assessment of the health and shape of my uterus. This is better if you're not as concerned about the tubes, which at this point, we're not! Read about the procedures for and differences between the HSG and SIS here. 

The chances with IVF sky-rocket compare to those they gave me with IUI. A textbook answer is at least a 30% chance of conceiving, but the NP told me it is more like 50% if one embryo is placed, and 65% if two embryos are placed inside the uterus. These statistics are based on a blastocyst stage embryo transfer, which is an embryo that is five days old instead of three. (More on that in the next section.) I was on Cloud Nine when I heard these stats!

What are the steps of IVF?

Any research will tell you there are four steps: Stimulation, Monitoring, and Triggering; Egg Retrieval; Fertilization; and Embryo Transfer. Our NP broke them up in different ways, though, so I'm going to use what she said:

1. Suppression: This is the first step in the process, and it definitely feels like you're headed in the wrong direction. Before any stimulation of the follicles occur, you are put on birth control to encourage suppression of the follicles. This is because each month, there is always one follicle (potentially mature egg) that is a little bigger and that sucks all the follicle-stimulating hormone (FSH) the body produces. We want all the follicles to be the same size when starting so that more than one will get to grow because of the FSH.
2. Stimulation: After a cycle of birth control, you are ready to begin the real process! Follicles are stimulated by injecting FSH into the body. This is something our bodies produce naturally each cycle, but we want more than one mature egg. Naturally, just like in a normal situation, eggs may "die" or fertilization may not occur, so the goal is to get a good number of mature eggs. This step also includes a medication that triggers ovulation. Timing is everything, whether fertilization is occurring inside or outside of a clinic! This "trigger shot," as it's called, ensures when the woman ovulates. Once ovulation has been triggered, it's time for egg retrieval.
3. Retrieval and Fertilization: Because IVF means that an egg and a sperm are coming together outside the body, the egg has to be retrieved. In the case of IVF, there are multiple eggs being retrieved. Now, we can't see eggs -- they are smaller than a single piece of dust. Basically, the fluid from the follicle (which we can see in an ultrasound) is withdrawn and examined. At that point, the embryologist can see if the egg was retrieved, its size, and even its health! This is done one-by-one with the embryologist examining each bit of fluid and ultimately each egg. The woman, by the way, is completely sedated, so she doesn't feel any pain and often doesn't remember anything. The eggs are then placed in an incubator. Within a couple of hours, the eggs are fertilized using the cleaned sperm sample. 
4. Embryo Transfer: The fertilized eggs, now embryos, "grow" for a few days. A typical IVF places three-day-old embryos in the uterus, but it is possible--and higher success rates come--from giving the embryos a couple more days to grow. At five to seven days after fertilization, the embryo is called a blastocyst. All kinds of factors may go into whether a three-day-old or five-day-old embryo is placed inside the uterus, but the NP definitely favored the five-day-old guys. The main reason is there is a higher chance of implantation and survival, as well as a better way to control the chance of multiples. In typical IVF, more embryos are placed inside the uterus, but with the blastocyst embryo transfer, only two are placed inside the uterus. The transfer is straight-forward: the embryos are placed inside the uterus at the appropriate time, and the woman is on bed-rest for 24 hours. Fourteen days after the transfer, a blood test lets everyone know whether the IVF was successful...and hopefully it was!

What is the cost estimate?

I won't go into the breakdown, but if you would like it for your own knowledge and benefit, please ask me. Basically from initial visit to pregnancy test a couple is looking at anywhere from 12,000 - 15,000 dollars at our clinic. This includes all the ultrasounds, doctor visits, tests, medications, hospitalizations, sedation, embryologist fees, clinic fees, lab fees, doctor fees...you name it. There is the slightest of chance that our insurance may pick up some of the non-fertility labs, but I don't like to count on them. They haven't helped much in the past.

When I looked into this a couple of years ago, the cost alone sent me running. But now--especially after multiple IUIs and many dollars poured into this--my view on it is simple: it is worth it. If it works, and we have a baby, it is worth it. If it doesn't work, and we don't have a baby, it would still have been worth trying because the potential is so wonderful. Plus, I always like to tote that this cost is less than what most people our age are spending on cars...and we don't have a new car and would gladly go without in order to have a baby.

Although the clinic doesn't offer financing, they do have a few companies that they recommend, so we will research that if needed.

What about our own ethical and religious beliefs?

This ethical issue is so huge that entire books have been written on the topic. What we believe is this: Life occurs at fertilization. Those embryos are not little cells that we view lightly; we believe they are life, and we will treat them as such. This means that we will limit the eggs fertilized and ensure--to the best of our ability--that the embryos have the best possible chance of survival.

I won't lie, friends. This is tough for us. This was the hardest part of our appointment today. We were honest with the nurse, though, and she assured us that they act based on our beliefs. I'm not going to go into too much detail yet because Robby and I need to formulate this together. There are many different opinions, even among Christians (perhaps more among Christians!), and we plan to continue with prayer and counsel. We already have our key beliefs which will be the foundation; there are just some other trickier situations that may arise.

I had picked up a small book a few months back published by Bethany Christian Services. It is called Christians and IVF: Wise Choices and Life-Affirming Options. It has been very helpful! I would encourage everyone to read this as IVF and other forms of AI are part of our culture today. 

Robby also reminded me that this is not our first choice as the way to have a baby. How we wish we could be "normal" and get pregnant on our own! But this is where we are, and every step of our journey has been drenched not only in tears, but in prayer, as well. 

The Big Question

As I shared the Cliffs Notes version of this with my mom this morning, she was of course concerned with the big question. When will this happen for us???

We chose not to rush into the next IVF cycle that the doctor is performing, which is in November. (To which my mom responded with a sigh.) This is, as I've already said, huge. No rushing is necessary! The following IVF cycle will be in January, so our plan, our tentative plan, that is, would be to begin our cycle at the beginning of the new year. This gives us time to get all of our labs done and discuss the outcome of each, budget the cost, and spend lots of time together in prayer.

We are excited, friends! We are also overwhelmed and a bit terrified. We desperately need your love, support, and prayers. Thank you for caring enough to read this long thing and stay updated on this huge step in our journey!