IVF – Priming phase for cycle #1

Bird’s Eye Summary

I have started priming with a bunch of vitamins and hormones for the IVF cycle. After priming, the stimulation phase should begin approximately July 11th, 2019. I will stimulate for around 10 days and then the tentative egg retrieval date is July 22nd, 2019.

Regroup with Dr. G

On June 6th we had a second meeting with Dr. G to go over our results and discuss next steps in a very general way. A lot of patients leave the IVF train at the regroup meeting, either for financial reasons or for medical concerns. So in retrospect, I realize the main reason for this meeting is to get a “go for launch” signal from the patient. In fact, the very first question he asked during the meeting was “So… how are you guys feeling about this whole process?” I misinterpreted this question at the time, and just responded that I was feeling physically fine, and that I was taking my thyroid medication with no discernible reactions (either positive or adverse).

So that was a relatively quick meeting with not a whole lot in the way of new information (the nurses had called us immediately with all our test results during the week prior). Even so, the doctor was a lot more optimistic about my low Antral follicle count than I had anticipated, so that was a relief. Here’s how the math could work out in the follicle to embryo pathway:

So by his estimate, we could potentially get 0 to 2 healthy embryos ready for transfer. Prior to this meeting, I was thinking we almost certainly would need to go through two or three IVF cycles in order to have a good chance at one healthy embryo, so it was good to hear that there’s a significant chance that it will happen on the first try. How wonderful would that be? Then again, zero is also a possibility. I’m an optimist at heart, but I also know on some level that this journey could turn out to be long and arduous. It’s good to be prepared for a less than ideal outcome.

The thing with this numbers game is, it doesn’t matter how healthy you are. No amount of diet and exercise and meditation can counteract the ravages of time on the DNA of the embryos that I have been carrying with me since I was a fetus myself. That clock started the instant I developed a reproductive system, as a 20 week old fetus inside my own mother. In a way, grandmothers carry their own grandchildren, if they have a girl. Wild!

Nurse Consult

On June 10th, 2019 we had our longest appointment ever at the reproductive endocrinologist’s office, this time with our nurse (whose name is also Emily!) She went through a huge binder filled with all the details of the entire IVF process from start to finish. It was an avalanche of information and took two full hours to go over everything. I won’t bore you with the details, but here’s a rundown of some of the topics we discussed:

• Vaccinations recommended during pregnancy (flu and pertussis)
• Health and lifestyle recommendations for male and female
• Risks of twin pregnancies (prematurity, NICU stays, cerebral palsy, and birth defect rates all increase significantly)
• Priming cycle (the month before IVF stimulation)
• IVF stimulation procedure, how to mix and inject the medications
• IVF medications. So many of them! A partial list of what I will be taking: Menopur, Gonal F, Dexamethazone, and Omnitrope. All injections. Fun!
• Supression medications (to prevent premature ovulation): Cetrotide, Ganirelix
• The trigger shot (synthetic hCG that tells your body to ovulate 36 hours later)
• Egg retrieval followed by 48 hours of bed rest (!)
• ICSI (intra-cytoplasmic sperm injection)
• A 15 minute video on genetic screening

Whew. It was a lot of information!

Priming Cycle

Conveniently, the same day of our consult with our nurse, I was on cycle day 1. This meant she was able to draw us up a calendar for the entire retrieval process. It’s hard to express the joy I felt on holding this calendar in my hands – I’d been waiting six months for this! It was finally real. So real in fact, that we were able to go ahead and schedule all our appointments as far out as the day before egg retrieval (that exact day won’t be scheduled until as little as 24 hours in advance, as the number of days of stimulation varies from 9 to 12 days, depending on how the woman’s body responds).

The first part of the calendar is called the “priming” phase. While I don’t need any injections during this phase, I’m actually taking more total meds, if you include the vitamin cocktail they have me on. It seems, to be honest, excessive! But this clinic has one of the highest success rates in the country, and they have their own research arm, so they are up-to-the-minute on all the latest technologies. It’s quite impressive. So I’m fully on board with whatever they think is best, as long as I can at least vaguely understand what each medication is for.

Here’s the full list of what I started taking on cycle day 1, and will continue for the next four weeks: Vitamin E, Vitamin C, Coenzyme Q-10, Levothyroxine (for thyroid), Estradiol, L-Arginine, Progesterone, Myo-Inositol, Fish Oil (DHA), a prenatal vitamin, and my usual Calcium + Vitamin D pill. Oh yeah, and testosterone. Wait, what? Yeah, I was surprised. But apparently there’s been (very) recent research indicating that testosterone administered in the month preceding IVF treatment, especially in women with diminished ovarian reserve (which I have, to a borderline degree at least), can help with follicle development. Who would have suspected? Testosterone is otherwise a very bad thing to have in your system when trying to get pregnant, so timing is certainly critical. I will stop all of these drugs except for my usual prenatal and Calcium+D before stimulation (good thing too, these guys are expensive all together). The technical term for my IVF protocol is the “testosterone antagonist”. There are many different protocols, each of which is indicated for different women depending on age, ovarian reserve, PCOS status and other factors.