IVF – a basic guide

IVF – a basic guide

IVF is a complex process that takes months to set up and then weeks/months to execute. If you are new to IVF its very daunting as there seems so much to get your head around and understand. So ive put this together for my non ivf friends and those just starting out.

Easiest way to do this is a timeline:

Within 6 months of starting treatment youll need a number of tests performed on days 2-4 of your menstrual cycle. These tests include:

  • AMH – this looks at your egg reserve
  • FSH
  • LH
  • Oestriodal
  • Prolactin
  • Thyroid stimulating hormone

Youll also need a scan in the same time frame to check you antral follicle count (AFC) this is simply the number of follicles on each ovary before treatment. This number is NOT the number of eggs you will get at collection.

Some clinics also run STI blood tests for HIV and Hep A, B, et all aswell.

The good thing about these results is there is no bad or good. They are simply to help the Doctor prescribe the right stimulation drugs. Do not read too much into these results, you may be above or below average but thats not what is important, what is important is that Dr has the most current info possible in order to stimulate safely.

Its worth noting that many UK clinics see the 1st attempt as a trial run to see how your body responds (even with all the test results Drs have no clue how you as an individual will react) and that is why many 1st cycles fail and drugs are tweeked for the 2nd cycle.

So, now we have all the tests done, what happens next? Well your clinic needs to fit you in. This usually involves calling on day 1 of your cycle and awaiting a call back for availability (and this is why i dont cycle in the UK – the waiting lists are absurd at some clinics) 

Once accepted, youll be given a drug teach appointment. If cycling abroad you dont get this but there are loads of youtube videos that you can watch!! 

Ive only ever done short protocol on a fresh cycle (fresh means eggs are collected and replaced in same cycle) so im going to focus on short protocol.

Short Protocol

Period starts = day 1. If your period arrives after midday the NEXT day is CD1.

Day 2 = stimulation medications start (usually gonal f or menopur)

Days 3 – 6 = stimulation meds

Day 7 = add in medication to STOP ovulation (dont want all those eggs being let loose) and its usually Cetrotide.

In the UK you will be monitored via bloods and scans but nothing really starts happening until the 2nd week.

The scans are to look at FOLLICLE development…they will be counted and measured. Usually they need to be around 18mm to be considered ready for collection. During this time, your stimulation meds can be adjusted accordingly during monitoring.

Once the follicles are ready youll be given a trigger or hatching shot. It basically tells your body its ok to ovulate in the next 36hrs. When you take the trigger Egg Collection will be EXACTLY 36 hours later.

The day after trigger is a DRUG FREE day, woohoo!!! Its the only one in the cycle mind, but its welcome as youll be quite battered and bruised.

Egg Collection

This is a medical procedure and the majority of clinics sedate you meaning nil by mouth from midnight the night before. Its light sedation but youll not remember the procedure which is nice…plus the after affects are funny (see ‘Time for a laugh’ for details)

During the procedure the Dr will aspirate your ovaries. Remember not every follicle will contain an egg.

After collection IVF/ICSI or IMSI will be performed

IVF – the sperm and eggs are placed in a petri dish and left overnight to fertilise

ICSI – used when sperm count is low or of low quality. An embryogist looks through a microscope, physically selects the best looking sperm and injects it into an egg (its actually a lot more complex than thar but unless you are a science geek like me, its probably not of interest) 

IMSI – very similar to ICSI but with a stronger lens in the microscope i believe. 

Embryo Development

Over the coming days the embryos will be placed in an incubator and cultured in a medium. The embryologists check the embryos daily to monitor cell division and growth. During this time some embryos are likely to arrescyc

During this time you will be prepping your body for transfer. You will most definitely be given pessaries, waxy bullets containing progesterone that is inserted vaginally or anally. You may also be given estrogen support to thicken your lining, antibiotics, steroids etc. All clinic and protocol dependent. 

Embryo Transfer 

This can take place 2, 3 or 5 days after collection. It all depends on the number of embryos and the quality. Only with high numbers will most clinics go to day 5 development. There isnt a best day for transfer. Pregnancies can happen from any day transfer 

It is thought that by day 5 only the strongest will have survived when there is a high number of embryos making selection for transfer easier

Embryo Transfer

Ita basically a smear with a full bladder. Uncomfy but not painful. The full bladder is for the sonagram thats performed during the procedure. It allows the Dr to see inside your uterus and place your embryos in the best spot. If youre lucky youll see a flash on the screen as your embryos are transferred by catheter. And thats it. You are pregnany until proven otherwise! On a short protocol the time taken matches your menstrual cycle so its all done in 4 weeks and that includes the 2 week wait.

2 week wait

I wont lie, its mental torture. You analyse every twinge, sneeze, cramp wondering what it means. There is no cure, just keep as distracted as possible until test day. Im not an early tester and would recommend you dont test until 9dp5dt (9 days past a 5 day transfer) or 11dp3dt or 12dp2dt as then the result will be accurate. I usually break at 11dp5dt as my clinic’s OTD (Official Test Date) is 12dp5dt.

Fingers crossed youll get a positive result but remember IVF isnt a gurantee, even if youve had children tradtionally before. Even when everything is text book, once transferred its all in natures hands and it can still fail (which has happened to me more than once) 

Embryo Grading

MEANS NOTHING!!! Its something the embryologists use to classify embryos but a high grade embryo doesnt mean a baby, nor does low grade mean a negative result. Its just luck at that point to be honest.

Ive only outlined a basic ivf cycle, these days there are loads of extras you can opt for and ill discuss the ones im going for in more detail in future blogs.

I hope that helps give an idea of whats involved but feel free to ask me specifics and ill do my best to answer them. Also feel free to share with family and friends so they have an idea if whats happening when and then hopefully they wont ask lots of questions whilst you cycle.

Love, Little Miss PMA xxx


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