13 Things People Don’t Tell You About IVF
Knowing what truly lies ahead will help you tremendously. Read this before you start.
Having done 9 cycles of IVF (Invitro-Fertilization), I could teach a class on it! I discovered a ton and I want to share it all with you.
When you have your consultation, your doctor will tell you all about the medical, logistical, and procedural aspects of the treatment, but he/she will leave out all of the practical sides that only someone who’s experienced it can tell you.
I’m not going to bore you with medical information your doctor already gave you, or links you’ve likely already researched yourself. I’m going to give you more than that. I’m here to candidly reveal to you some very informative and practical parts of IVF nobody tells you about. Knowing what to expect will help you be prepared, which will put your mind at ease.
1. Insurance May Cover it!
Not knowing any better, I had to pay about $25,000 for my first cycle and a half. I didn’t complete my second cycle because I was not responding to the stimulation medication, so it was prorated.
Wanting to continue with additional cycles, I decided to look into medical insurances that may cover it. Sure enough, I found out that the state I’m living in is mandated to cover it. Not all insurances include it though. I had to research which ones do in my state. There are only a handful of states that offer it, so I strongly advise you to look into your home state before spending a ridiculous amount of money.
Another thing you should be aware of is that even with medical insurance, you will still be required to meet a deductible and out-of-pocket max before the insurance kicks in to cover some or 100% of your treatment. I had to pay around $8000 before mine kicked in.
Also know that no insurance ever covers testing of the embryos (which I discuss more in #11 below).
2. Pre-IVF Testing
Among all the tests that will be administered, before starting you on IVF, one of them will include a Tubal Patency test (‘Water Ultrasound’). This test is run to ensure there are no blockages in your fallopian tubes. This test is very painful; it feels like sharp menstrual cramps and the residual cramps could last hours after the procedure. The silver lining is that the test itself is fairly quick.
3. It Might be Him
Society is quick to assume the woman is the sole contributor to infertility in the relationship. That’s not always the case. In fact, a 2020 medical journal published in the National Center for Biotechnology Information notes that men are the sole contributors of infertility in approximately 30% of the cases, women contribute to 50%, and both genders contribute to about 20%.
But don’t worry, his sperm is one of the first elements that is tested. The basic semen analysis will test for sperm count, shape, and movement. When there have been too many unsuccessful IVF cycles, the fertility doctor may order a more thorough sperm analysis and examination by a urologist.
4. Medications
Before every IVF cycle, they have to prep you by having you take birth control pills. What?! Aren’t we trying to achieve the exact opposite of that? Even though it seems counterintuitive, doctors do this for 2 reasons; first, it helps ‘reset’ your reproductive system to start fresh, and second, it’s for the hospital’s scheduling convenience. It varies by hospital, but they usually dedicate 1 week out of the month for egg retrievals, so they have to sync all of their patients’ menstrual cycles so they’re all ready to go within that 1 week. They control when you get your period which changes from your natural menstrual cycle.
Your doctor will create a protocol specifically for you. He will decide which medications and dosages you will take based on your response. If he sees you’re not responding to the first protocol, he will likely change it until you’re more responsive.
You will have a box of medications you will need to administer at home by injections. You may have some physical side effects such as migraines or you may not. Everyone reacts differently.
5. Appointments
Each cycle of IVF typically lasts between 12–14 days. During that period, you will be administering your shots as directed by your doctor, and you will also have frequent monitoring appointments; sometimes even every other day.
There isn’t much flexibility in choosing the days of your appointments because they’re all based on your lab results and ultrasounds, so timing is critical. You will need to accommodate your monitoring appointments among your work schedule and anything else. On the day of your egg retrieval, you will have to take the entire day off of work because you’ll be heavily sedated and unable to do anything other than rest. The same goes for the embryo transfer.
6. Bloating
Since you will be on so many hormonal medications, expect to be bloated the entire time. This is a typical side effect of high estrogen levels. The bloating won’t stop until you’re off the medications.
7. You Can’t Have Sex
One of the things the stimulation medication helps with besides making you produce more eggs than usual is making those eggs mature to the right size. They can’t retrieve them if they’re too small, and they can’t let them ‘mature’ too much or they won’t fertilize or survive if they do. When your eggs, and hence your ovaries are becoming enlarged, the doctors are concerned that any kind of activity ‘in there’ may pose the risk of ‘ovarian torsion’. This condition basically means your ovaries can get twisted and lose blood flow potentially killing your ovary.
A secondary reason I personally abstained during this time, was to avoid natural pregnancy which is uncontrolled. When the fertility team manages your cycle, the embryologist gets to examine the embryos to determine which are the best quality and the most viable for transfer. You don’t have that control if you’re conceiving on your own. So there’s a risk you may conceive an embryo with genetic abnormalities which results in a baby with disabilities.
The doctor also advises abstaining from sex after your embryo transfer; during your 2-week wait. There are 2 reasons for this. The first is the risk of ovarian torsion due to your ovaries remaining enlarged even after your retrieval and transfer. The second reason is controversial. Some doctors theorize that that pelvic contraction from an orgasm could disrupt an embryo’s ability to properly implant, while other doctors disagree and believe it actually helps the embryo to implant.
8. Exercise
You can’t jump-rope, do strength training, or high-intensity exercises during the 2 weeks of stimulation and the 2-week wait after the transfer for the same first reason you shouldn’t have sex; risk of ovarian torsion.
9. Egg Retrieval
Before my first IVF cycle, I didn’t know the egg retrieval is considered surgery. They sedate you through IV (Intravenous therapy/your vein), but it’s not general anesthesia. They do this for the patient’s comfort during the procedure. The retrieval only takes about 15 mins.
10. Embryos
After your eggs are fertilized with your partner’s sperm, the embryologist monitors the development of them every day. Your fertility specialist will decide if he/she will do a 3-day transfer or a 5-day, but the embryologist will ultimately wait until that last day to grade their quality based on their shape and cell division. This is how they decide which embryos are viable and hence, transferable, and which ones are not. What I didn’t realize is that a ‘high grade’ (or high quality) embryo does not necessarily mean it will implant. The opposite is also true; embryos that are not the highest-rated, oftentimes implant, and result in healthy full-term babies.
11. Genetic Testing of Embryos
Another thing I didn’t realize is that when you pay for your IVF package, it does NOT include PGS (pre-implantation genetic screening) testing of embryos! The grading the embryologist does is the most basic kind of assessment. To find out if your embryos have any genetic abnormalities, you will need to pay an additional $4000 or more for every round of testing regardless of the number of embryos being tested for that one batch. Simply put, from 1 IVF cycle, whether you only have 1 embryo to test or 20, it will cost you the same for each batch that gets tested.
Another major piece of information you need to know is that PGS does NOT screen for all genetic disorders, syndromes, autism, developmental problems, or birth defects. It only tests for the most common chromosomal abnormalities that result in disabilities like Down’s Syndrome among others.
12. Embryo Transfer
On the day of the transfer, they make you drink 32 ounces of water, so you have a full bladder during the procedure. Having a full bladder helps your uterus show up on the screen better so your doctor can accurately place your embryos in the right location.
Even though it only takes about 5 minutes for the actual transfer, it feels like an eternity because you’re trying to not pee on yourself and your doctor as the sonographer is pressing on your bladder with the ultrasound device.
After the doctor places the embryos, he/she has you wait for 5 mins lying down before you can get up to relieve yourself.
13. Post Embryo Transfer
The doctor will place you on bed rest for 2 days and give you instructions; the main one being, don’t lift anything over 5 lbs.
Your doctor will place you on a progesterone oil shot (or inserts) medication used to thicken the lining of your uterus to help promote implantation.
Be prepared to continue this medication for about 10 weeks if you’re pregnant.
I hope you’ve found all of my nuggets of information helpful on your upcoming IVF cycle. I wish you all the best on your fertility journey!
If you have any follow-up questions, please feel free to comment on this article.
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