The IVF Journey | Part Two: Pre-Treatment Screenings and Preparations

This article is the second a part of our IVF collection. Read half one right here.

In vitro fertilization (IVF) is a sort of assisted reproductive know-how (ART) that entails utilizing a mix of reproductive medicines and surgical procedures to assist sperm fertilize an egg outdoors of the uterus; “in vitro” means outdoors the physique. After fertilization, embryos are then positioned immediately right into a affected person’s uterus for potential conception.

IVF is mostly recommended for folks with nonfunctional or lacking fallopian tubes and companions with poor sperm high quality. But different circumstances can result in somebody selecting assisted copy, together with age, well being points (resembling endometriosis), unexplained infertility, and as a method for same-sex {couples} to expertise being pregnant and parenthood.

Before IVF therapy begins, sufferers will usually endure a fundamental infertility analysis that entails a collection of checks, screenings, and conversations with their supplier. For a greater understanding of what to anticipate previous to the primary therapy, we related with fertility specialists Banafsheh Kashani, MD, FACOG, reproductive endocrinology and infertility specialist in Orange County, California, and Jordan Rush, MD, an OB-GYN at Northside Women’s Specialists in Atlanta, Georgia and fellow with the National Institutes of Health, Endocrinology Diabetes & Metabolism on the following steps of the IVF journey.

Screenings and Tests 

In vitro fertilization is an concerned course of even earlier than the precise first step of therapy (ovarian stimulation) happens. From evaluating egg amount to analyzing semen to testing for infectious ailments, there’s no scarcity of prep that comes with preparing for IVF to start, however in keeping with the specialists, the payoff is useful.

“Pre-screening assessments are done to ensure that patients undergoing fertility treatments can receive the most optimized treatment protocol specific to their diagnosis. It is recommended that all these preimplantation assessments be completed before starting treatment,” says Dr. Kashani. “For example, if a partner has not yet completed a semen analysis, it would not be advisable to start treatments without this information, in the event that the sperm counts are too low to qualify for an intrauterine insemination.”

A affected person’s reproductive endocrinologist (REI), additionally known as a fertility specialist, performs the excellent analysis and helps information choices on which checks are applicable. While these deciding components are distinctive to each affected person, these are the frequent pre-screenings and checks to anticipate:

Semen evaluation

A semen evaluation is commonly the first step in IVF screening as a result of it’s non-invasive and can inform suppliers an ideal deal concerning the high quality, exercise (motility), and quantity of a associate or donor’s sperm. One motive for conception points is semen abnormality, and this evaluation helps decide the probability that the sperm may cause a being pregnant.

Ovarian reserve testing

Ovarian reserve testing makes use of a mix of blood checks and a vaginal ultrasound to find out the variety of eggs (follicles) that stay in a affected person’s ovaries, as egg rely is a robust predictor of fertility therapy success. This testing may also rule out potential hormonal imbalances that may impression the affected person’s menstrual cycle.

Infectious illness screening

Just as pregnant persons are suggested to check for sure ailments earlier than start, the identical suggestions apply to sufferers and their companions going by fertility therapy.

“Tests for HIV, syphilis, hepatitis A and B, gonorrhea, and chlamydia are performed on the patient and their partner or sperm donor, as well as an egg donor or surrogate, if applicable,” says Dr. Rush.

Certain ailments like chlamydia and gonorrhea can cause pelvic an infection and tubal harm and should be handled with antibiotics earlier than sufferers and their companions can start therapy.

Uterine examination

During this examination, a supplier will look at the within lining of a affected person’s uterus to test if it’s wholesome. This examination may involve a sonohysterography (the place fluid is injected by the cervix into the uterus) and an ultrasound to research photographs of the uterine cavity. Another choice (although extra invasive) is performing a hysteroscopy, wherein a skinny, lighted telescope is inserted into the uterus and used to look at the uterine partitions.

Pelvic ultrasound

If not accomplished beforehand, Dr. Rush notes {that a} pelvic ultrasound can also be carried out throughout this time.

“A pelvic ultrasound to evaluate uterine anatomy is also necessary prior to embryo transfer to make sure the uterine cavity is normal and there are no uterine anomalies, fibroids, or polyps that may affect embryo transfer.”

Practice (mock) embryo switch

Dr. Kashani explains that there are two situations that individuals discuss with as a “mock embryo transfer.” These trial transfers are used to make sure sufferers and suppliers optimize effectivity on the day of the particular embryo switch.

“One [scenario] is the method of going by an tried embryo switch process the place a catheter is superior into the cervix (the slender tunnel or passageway into the uterus). This is to ‘map’ the pathway into the uterus to see if it’s a ‘straight path’ or if there are any twists and turns that may make it tougher to carry out the embryo switch. The embryo switch day is such a giant day that it’s best to be ready and have a trial run.

“Alternatively, people reference ‘mock embryo transfer cycles.’ This is when you take hormones that would be used for an embryo transfer cycle, and then test the uterine receptivity to ensure that the protocol of hormones used is appropriate and does not need to be adjusted. This is to help achieve a more personalized embryo transfer and optimize success rates.”

Note {that a} lower than “straight” uterus, resembling a tilted or retroverted uterus, doesn’t have an effect on a affected person’s likelihood of profitable implantation or being pregnant, although it’s useful for medical doctors to know what to anticipate earlier than handing the dear cargo of an embryo.

Dr. Rush provides that the mock process additionally permits the doctor to guage the perfect measurement catheter to make use of prematurely, in addition to optimum placement within the uterine cavity for the embryo.

Questions to Cover With Your Provider

Prepping for IVF comes with many queries and considerations. These advised questions from the Mayo Clinic can assist sufferers make vital issues and decide what must be mentioned additional with their associate or supplier.

How many embryos might be transferred?

Age can have an effect on the variety of fertilized eggs a supplier will switch. Since the speed of implantation is decrease for older ladies, a health care provider might switch extra embryos for a better likelihood of a profitable being pregnant. In women beneath the age of 35, usually not more than two embryos are transferred at a time. Using a solo embryo may be thought of if the affected person is decided to be a very good candidate primarily based on prognosis. For ladies 35 to 39, a complete of as much as three embryos is really useful for every switch, and the variety of embryos used can proceed to extend with age.

What is the coverage regarding additional embryos?

There are choices for sufferers with leftover embryos, together with freezing and storing the embryos for future use, donating unused frozen embryos to a different couple or analysis facility, or discarding the unused embryos. Having entry to frozen embryos can reduce the prices of future IVF cycles, although sufferers might want to think about facility and storage charges.

What are the possibilities/dangers of a a number of being pregnant?

The odds of getting a a number of gestation being pregnant by IVF are roughly 30% on common throughout all age teams. In comparability, twins naturally occur in about one in 250 pregnancies, triplets in about one in 10,000 pregnancies, and quadruplets in about one in 700,000 pregnancies.

A a number of being pregnant poses potential risks to each the birthing father or mother and unborn infants, together with hypertension, start defects, and preterm start. Partners ought to talk about how they may deal with a a number of being pregnant, in addition to plans for parenting multiple little one sooner or later.

What are the potential issues related to utilizing donor eggs, sperm, or embryos, or a gestational service?

While all sufferers hope for a clean expertise, it’s nonetheless crucial to know the emotional trials and authorized ramifications surrounding utilizing donors. A skilled counselor with expertise in donor points—resembling a gestational service encountering well being issues from the being pregnant or wanting to maintain the baby after start—can assist sufferers navigate the spectrum of potentialities (ask your supplier for a trusted suggestion). In addition, if utilizing a gestational service, an lawyer could also be wanted to help companions in changing into authorized parents of an implanted embryo.

According to Dr. Rush, utilizing donors in IVF can include potential well being issues for the start father or mother. “There is some data that shows patients using donor eggs have higher rates of pregnancy complications, including hypertension. [Additionally], sperm donation may create psychological issues and unforeseen genetic diseases; of course, this also applies to egg and embryo donation.”

How to Prepare at Home

There’s lots a affected person can do outdoors of the clinic to enhance their probabilities of fertility.

Body

“It’s best to prep your body about one to two months before starting IVF,” says Dr. Kashani.  “Ideally, try to follow a Mediterranean diet which includes foods such as fish, avocado, olive oil, and vegetables. Additionally, antioxidants are great, and these can be found in blueberries, pomegranates, and acai. You can also take CoEnzyme Q10, which is a supplement that is an antioxidant and can help optimize egg quality.”

She additionally states that caffeine consumption must be minimized, and alcohol and sweetened drinks must be averted previous to an IVF cycle.

Dr. Rush provides that journey to any nation or area with an elevated danger of buying sure infectious ailments must be averted, as this might impression or delay fertility therapy.

Mind

Finding methods to attenuate stress earlier than and throughout therapy is a vital precedence, says Dr. Kashani. “A moderate amount of physical activity and stress-reducing exercises such as yoga are great. Stress can negatively affect the response to the hormones used for fertility treatments, and therefore you should try to plan your treatment cycle at a time that is not very stressful at work or home. In addition, sleep is also critical, and having regular sleep cycles can benefit your fertility and response to the hormones used for fertility treatments.”

Minimizing stress is tough in the perfect of circumstances, however particularly troublesome in a state of affairs involving infertility with such excessive stakes. Walking, journaling, spending time outdoor, gardening, studying, and even intentional deep respiratory are all methods to assist cut back stress.

Dr. Kashani additionally encourages sufferers to refill on being pregnant checks earlier than the IVF course of will get going, particularly ones that ship fast outcomes. “First Response Early Result Pregnancy Tests are a great option as users can get results six days sooner rather than waiting to see if a period is missed, helping to reduce the stress of waiting.”

Wallet

Perhaps probably the most daunting components in IVF prep is the cost of treatment. A single IVF cycle can vary from $15,000 to $30,000, relying on the affected person’s particular person wants. While these numbers are intimidating, each Dr. Rush and Dr. Kashani say there are monetary help assets to contemplate.

“There are many grants available that can be used towards treatment,” claims Dr. Kashani. “Additionally, [patients can] contact their clinic’s financial team to determine if there are any payment or funding programs/loans available to use for IVF treatments. Patients can also contact their employer’s human resources department to see if they have any options for fertility benefits for treatments. Sometimes, [employers] can consider adding on this benefit for employees.”

Dr. Rush recommends that sufferers additionally try RESOLVE, a nationwide group that serves as an umbrella useful resource for buying data on monetary assist for infertility therapy, together with insurance coverage protection, scholarships, financing alternatives, army personnel choices, and extra.

Relationships

Undergoing in vitro is usually a making an attempt time, and sufferers and their companions might really feel a variety of feelings all through the method. Establishing good communication forward of time will show to be a vital software that may assist companions specific their feelings and really feel understood and supported throughout therapy.

“It is beneficial for couples to be open and honest with each other about what they are comfortable with in terms of treatment, as having a unified view on treatment goals is very important” explains Dr. Kashani. “Also, I advise partners to be supportive of one another and understand that fertility treatments and hormones can cause irritability and mood swings. It’s important to be patient with one another and know that there will be ups and downs.”

For some {couples}, the stress of therapy might require skilled psychological assist to get by it, and companions ought to have a plan for looking for these assets if wanted.

“Infertility can put a lot of stress on a relationship and when couples are unsuccessful in becoming pregnant, often the relationship encounters severe difficulties,” says Dr. Rush. “Most fertility centers offer psychological support to couples undergoing fertility treatment as it impacts the couple [in many ways].”

Finding Support Before Your First IVF Appointment

IVF presents obstacles distinctive to every particular person. Patients ought to search the assist they want at any time with out judgment—and hopefully, achieve some solidarity alongside the way in which.

“Trying to conceive—especially through IVF—can feel isolating and leave people scratching their heads, and unfortunately, there is no one-size-fits-all approach,” says Lauren Berson, founder and CEO of Conceive, a digital well being firm altering fertility outcomes by individualized knowledgeable steerage, tailor-made fertility plans, and communal assist teams.

“If you map out the IVF affected person’s journey, it’s arguably probably the most advanced well being care journeys that essentially requires extremely individualized steerage. On common, a affected person sees three to 5 specialists and does a number of therapies and checks. And present assist from Google rabbit holes renders conflicting recommendation—as do completely different medical doctors, spurring sufferers to surprise if they need to get a second or third opinion.

“Fertility clinics offer expert guidance, but it’s not in their business model to recognize the power of community. With only 1,800 reproductive endocrinologists in the country, many clinics also have long waiting lists. And even when you have care, it’s challenging to get your questions answered with the sense of urgency you need.”

Berson’s personal multi-year journey by infertility, emotions of isolation, stigma, and disgrace, together with a scarcity of trusted assets within the IVF area, led her to discovered Conceive.

“While we serve members going through all kinds of fertility journeys, we find many come to Conceive when they’re undergoing IVF—often because they can’t find the support and information they need elsewhere,” explains Berson. “In vitro fertilization is a highly technical process with lots of things to interpret, and [our team] can be their second set of eyes, their gut-check, and the support system that helps them learn, and ultimately get results.”

And in terms of these outcomes, Berson says her crew’s efforts are working. A 2021 closed beta check revealed that 27% of their members uncovered new diagnoses, 64% turned pregnant, and 90% of members felt supported of their journey, which Berson says is a driving power in her work.

“We want to do [the hard work] for our members—bringing them the community, support, and trusted resources, so all they have to do is focus on taking care of themselves.”

No matter the place sufferers discover group throughout their IVF journey, the vital factor is to not undergo this difficult and emotional course of alone, and to know they deserve assist each step of the way in which.