Over and over, I hear from patients they wish their IVF clinic had given them a better overview of the IVF process and what they are getting into. It can take multiple cycles, meaning months or years of experience and a lot of money before patients gain an understanding of the process and to start to advocate for themselves. Grain Fertility is built to help fertility patients become better advocates for their own care and empower them throughout their journey. However, in order to do this, it is important to know what the IVF process looks like for most patients. Grain Fertility is proud to provide this IVF treatment overview to help make IVF patients more prepared for their journey.
Trying To Conceive: Before the IVF Journey Begins
By the time someone is referred to a reproductive endocrinologist (RE) and told they will need fertility treatment to try to successfully have a child, odds are they have been struggling for months or years before this, many times without anyone knowing.
Infertility is defined clinically as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse, or after 6 months if the woman is older than 35 years of age and traditionally doctors and insurers require patients meet this definition before moving to an RE for fertility work. However, there are exceptions to this, such as someone who has infertility caused by a cancer diagnosis and treatment or other diseases such as sickle cell, same-sex couples, and single parents by choice.
Once someone is referred to a fertility clinic, the care team will work to try to identify the cause of the infertility in hopes of best identifying the best form of treatment. Different treatments can include simple lifestyle changes or prescribing medications, surgeries to an underlying cause, or different forms of assisted reproductive technology (ART) such as intrauterine insemination (IUI), In Vitro Fertilization (IVF), or third-party reproduction options like surrogacy. It is important to know that different forms of treatment have different treatment impacts and processes, but every diagnosis and treatment absolutely has some impact on a person’s ability to work and deal with their fertility issues.
IVF Overview: The Phases of Infertility Treatment
A normal IVF cycle can last four to six weeks, including the time before egg retrieval, when a person takes fertility medication, until they’re tested for pregnancy. There are several major phases someone undergoing IVF goes through and these are the stimulation phase, the retrieval/ fertilization phase, and the transfer phase. Below, you can see a sample schedule and hypothetical process for a 32 year old IVF patient, created by the amazing team over at FertilityIQ, who provide fertility and menopause education for millions of people.
As you can see, the IVF process is not guaranteed to work for every patient every time. In fact, there are a number of factors that determine your success including. your age, medical background, and the cause of infertility. The Centers for Disease Control (CDC) created a simple IVF success estimator tool, available at https://www.cdc.gov/art/ivf-success-estimator/index.html to help patients know their chances. There are also commercial tools available through clinics, including an AI based tool developed by the team at Univfy. It is important that before you start any cycles, you have a clear understanding of your chances. Too often patients are told that it will not be a problem getting pregnant, setting patients up for incredible disappointment if the cycle does not lead to a pregnancy.
1) The Stimulation Phase
During the stimulation phase, a person takes injectable hormone medications to encourage the entire group of that cycle’s eggs to mature simultaneously and fully. The goal is to retrieve as many eggs as possible for fertilization. The type, dosage and frequency of medications prescribed will be tailored to the individual based on their medical history, age, AMH (anti-mullerian hormone) level and response to ovarian stimulation during previous IVF cycles (if applicable).
This process is intense, consisting of medication taken at specific times daily through shots, orally, and/or vaginal application and monitoring appointments every few days that require blood work and/or ultrasounds to monitor progress.
Once the care team decides someone is ready and your (two or more) follicles will have grown to a certain size (18 mm or greater), the patient is ready for the trigger shot. The patient is instructed to take a trigger shot that must be given 36 hours before the scheduled egg retrieval time. While there is a little wiggle room, the timing is critical to ensuring your retrieval timing.
2) The Retrieval/ Fertilization Phase
36 hours after the trigger shot is when the eggs are collected and those that are mature or the patient does not want frozen are fertilized using sperm. As the chart above shows, about 70% of eggs fertilized should be expected to fertilize successfully, so to many patients, banking as many mature eggs as possible is very important. Producing a lower number of mature eggs can be very hard on a patient because they know it decreases their chances of success. Over the next 5 to 6 days, the fertilized eggs are monitored by embryologists and trained staff to track development of viable blastocysts. Embryologist Alease Daniel has written up a fantastic overview of what happens during this 6 day window.
This is a very stressful time for IVF patients, as only about 50% of the fertilized eggs should be expected to become viable blastocysts, but it is not uncommon for results lower than this, especially for people with undiagnosed issues with their eggs or sperm.
Depending on the patient's readiness for IVF, including how well their uterus has responded to stimulation, the remaining blastocysts are kept fresh and prepared for transfer or are frozen and saved for a frozen embryo transfer at a later date.
3) The Transfer Phase
For weeks before the targeted transfer date (if there are viable blastocysts available), patients are taking additional medications and attending monitoring appointments to prep the uterus for implantation using IVF. Patients and their care team decide whether they should proceed with a fresh embryo transfer or freeze the blastocysts and try a frozen embryo transfer at a later date when the uterus is better prepared to accept the transfer. The day of a transfer is relatively easy medically, but one of the more stressful days for a patient. The IVF procedure takes less than 10 minutes but it kicks off what is known colloquially as the Two Week Wait (TWW), where the patient nervously waits 10 to 14 days before their doctor administers a blood test to see if they are pregnant. During the TWW, patients continue all assigned medications until they are told to stop.
At this point, hopefully the patient is pregnant where their RE clinic will continue to monitor and treat until 12 weeks, when the patient graduates and is referred back to their OB-GYN for prenatal treatment and monitoring. However, it often takes more than 1 cycle for a successful pregnancy and the patient’s medical history and age are major determinants of how many cycles it may take to get pregnant. Data from the Society for Assisted Reproductive Technology (SART) on success rates for IVF stated that for women under 35, the percentage of live births using the patient's own eggs for a singleton (one child) is 51%.For women ages 35-37, the IVF success rate is 38.3% for live births using the patient’s own eggs for a singleton (one child) birth. At ages 38-40, the percentage drops to 25.1%, and for 41-42, it is 12.7%. For women older than 42, the IVF success rate is 4.1% for a singleton birth using the patient's eggs, according to SART.
Throughout this four to six week period, someone average multiple appointments per week, be taking multiple medications orally, vaginally and through shots that can cause a tenderness and pain at shot injection sites, mild bloating and cramping, breast tenderness, spotting, constipation, mood swings due to changing hormone levels, anxiety, possible depression, and other symptoms.
Hopefully this overview provides some information to newer IVF patients. In a future post, we will provide you will detailed ways Grain Fertility can help you throughout each of these phases of the IVF process, giving you a blueprint for success and making your IVF cycles a little easier.