What is IVF? (and ICSI)

You can have both God & Fertility treatment – Noni Martins

IVF seems to be this big secret that is only shared in the TTC community and the information never gets passed down and across to people outside of the TTC community. Almost everyone I have spoken to either has no idea what IVF is or has serious misconceptions about what it actually is. This is compounded in the African community which means people end up saying really irrelevant things to myself or my husband because they just don’t know anything. My mum, being a nurse, has been so keen to absorb everything about the process and I have enjoyed ‘schooling’ her on this because it is really fascinating and wonderful just what science can do for humanity. So this offering is really to explain the IVF process in simple language (where possible) and I hope you will learn something from this post. We are still learning and still discovering and still being wowed by the possibilities that science has to offer. As I mentioned in a previous post, we will NOT be blogging about our IVF journey in real-time and we will not be sharing the success/failure of our process until we feel ready to do so. I am however going to write this post from my own understanding of the IVF process as pertaining to our situation. This does not mean any or all of this has happened, I am just explaining it the way it was explained to us by our nurses.

So what is IVF? IVF stands for in-vitro-fertilisation which basically means fertilisation ‘in glass’. It is a method of assisted reproduction where a man’s sperm and a woman’s egg are combined in a laboratory dish, where fertilisation is expected to occur. For a couple with a male-factor or male infertility, there is a slight variation to this part called ICSI which stands for intracytoplasmic sperm injection. Treatment will be exactly the same as with IVF. The only difference is that instead of mixing the sperm with the eggs and leaving them to fertilise, a skilled embryologist (embryo specialist) will inject a single sperm into each egg. This maximises the chance of fertilisation taking place as it bypasses any potential problems the sperm will have in getting inside the egg – (Via HFEA). Once the referral has been made by your GP/specialist to a fertility clinic and all the paperwork has been completed and processed (please see our fertility timeline so far), IVF starts off with a consultation with a head nurse who will go through the forms you have filled in, confirm details, take more signatures and give you an overview of what lies ahead. At this consultation, you are advised to notify the clinic on the first day of your normal period which will set the date for the whole process to kick off. Everyone’s IVF journey is very different and some people (like me) have a short protocol IVF and others, a long protocol IVF – I still don’t know what the difference is but click the link for information on the long protocol. In my situation, because my AMH is very high, there are concerns that I may have an excessive response to the stimulation, something called Ovarian Hyperstimulation Syndrome – OHSS (more below). Anytime there is such a concern, the short protocol is applied.

So on day 1 of your period, you ring the clinic and they book you in for a drug appointment which is basically to talk through all the drugs you will be administering for that round of IVF and the nurse teaches you how to do the injections because they are slightly different depending on what you are having. Sorry, before your drug appointment, the clinic writes to you with an invoice for the medication – you pay for your medication even for an NHS funded cycle. I opted for the NHS prescription pre-payment certificate which works out cheaper and it cost me £30 for 3 months and I can get as many prescriptions as I want, even non-IVF-related ones. My drugs would have cost me £50 and If I needed more for whatever reason I would be required to pay more so I would highly recommend the pre-payment certificate for anyone doing IVF via NHS (or anyone who has to pay for repeat prescriptions generally!) At the same drug appointment you are given dates of when to start the medication and when to come back in for transvaginal scans – this is how they check progress, internally! The real IVF starts when you go home and map out your life for the next 4-6 weeks and start your medication – I will share my self-made colourful IVF calendar, which I am very proud of, at a later date!

Our protocol will follow the general timeframe below but as with all things IVF, this can change and vary quite a bit depending on how one responds to treatment:

  • Day 1 – 10 – Take Norethisterone 3x a times a day with food – this is a pill to induce a withdrawal bleed to thin the uterus lining
  • Day 11 – 15 – Withdrawal bleed – the shedding of the uterus lining
  • Day 16 – Transvaginal scan to confirm uterus lining is thinned
  • Day 16 – 25 – Bemfola stimulation injections x1 every evening
  • Day 21 – Transvaginal scan to check the progress of the follicles
  • Day 21 – 25 – Cetrotide stimulation injection x1 every morning
  • Day 25 – Transvaginal scan to check number and size of follicles
  • Day 26 – Trigger injection to mature the eggs (must wait to be notified by the nurses what time to take it!)
  • 36 hours later – Egg collection under general anaesthetic – this is when ICSI for us will take place, fertilising the egg and sperm in a laboratory dish
  • Between 3-5 days after egg collection – transfer of 1 embryo into the womb.
  • 2 weeks after Transfer – pregnancy test at the clinic

On paper, the process seems quite quick but as I said, things can vary with IVF and sometimes there can be delays in terms of how you are meant to respond to treatment and how you actually respond to treatment. For example, you might not have your withdrawal bleed within the 5 days after Norethisterone. Or in a much less preferable situation, you could have Ovarian Hyperstimulation Syndrome which puts a pause on the entire process. Because my AMH is high, it is likely that I could get OHSS which is when the ovaries develop too many follicles as an over-response to the medication. When this happens, fluid from the blood vessels may leak into your abdomen and in some cases into the space around the heart and lungs. The kidneys and liver may also be affected, but this is usually mild and will settle without medical intervention. Approximately a third of patients will have mild symptoms, with only 2-8% of patients needing medical intervention (via NHS). They warned me about the risks related to OHSS and made it very clear that I should let them know if I start to get any symptoms. They stressed even more that if do end up over-stimulating – that is, 19 follicles or more of 11mm plus in size, the transfer would be cancelled, the embryos would be frozen (FET) and I would have to wait 6 weeks before the process continues. Not ideal but they need to make sure that my body is fit enough to hold and carry the baby for the 9months.

This is one IVF cycle in a nutshell from start to finish but like I said can be different from one couple to another. If a cycle is unsuccessful, the clinic will do some investigating into potential reasons why and any information from this will be taken into consideration for the next attempt. If you have any embryos remaining which were frozen from the first round of stimulations, you do not have to go through the stimulation process again and you can just have another transfer at a suitable time when the uterus lining has been thickened again ready to receive an embryo. An interesting little fact I almost forgot to mention is that my clinic uses Embryo glue when they do transfers; EmbryoGlue is a medium developed to closely resemble the environment in the uterus at the time of implantation. It is not a glue in the common sense, but acts as an adhesive by increasing the chance of implantation of the embryo to the uterus. The embryos are placed in the solution and allowed to soak in it for a fixed duration of time prior to the transfer (via NHS). However, like most things in the IVF world, (and as you will see when I share information from the Fertility Festival which I attended), there if a conflicting body of evidence about it’s effectiveness and further research is required. I think it’s still cool though! Ha. Another thing to mention, is the success rates of IVF as they are not as high as everyone thinks. How successful IVF will be depends on the woman’s age and the cause of infertility. The below percentages show the average chance of a birth from IVF treatment. These figures are for women using their own eggs and their partner’s sperm and use the per embryo transferred measure (via HFEA).

  • under 35: 29%
  • 35-37: 23%
  • 38-39: 15%
  • 40-42: 9%
  • 43-44: 3%
  • over 44: 2%.

 For context I thought it might be worth sharing our journey so far minus the IVF bit (click here) – just to show a timeline of things and potentially for anyone looking to go down this route, to show how long it can take. I think we are very fortunate living up North because there was no waiting list for our referral and so everything has moved quite fast. Just after the new year, I had a bit of a meltdown when it started to hit me that we are ACTUALLY having IVF, it wasn’t hypothetical anymore and I just started getting really anxious to the point where I was struggling to sleep. At the time I did not have any of the information above and so I think it was just the enormity of the unknown and feeling so in the dark about what was to come. I sat down with my husband and told him how I was feeling and he did a mixture of comforting me but also scaremongering because in his mind it was better that I was prepared for a bad experience but we obviously hope for an okay experience _ I was going to say ‘good’ experience but I think that is asking for a lot! It’s very hard to tell what IVF is going to be like until you start going through it… it does not matter how much reading you do, how much information they give you, how many youtube videos you watch, you can never know how YOU are going to be, how YOU are going to experience it, it is such an individual journey and I cannot tell you how grateful I am to be doing it with someone else. I personally would not be able to do this without my husband and our life experiences have been so instrumental in our coping mechanisms because we accept things for what they are and work on solutions and being informed rather than dwelling on outcomes, which are often out of our control.

I hope this has been useful to some of you and an interesting read for the rest of you. I am more than happy to answer any specific questions in my DMs and I am always happy to chat, especially about this so honestly feel free 🙂

love & light

Noni x

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