the process

Today I'm going to describe the IVF process to you. The clinical process. People always ask me how involved IVF is, whether it hurts, and what the time line is like. So, I'm going to lay it out for you.

Spoiler alert/warning: If you don't like talk of periods, shots, general anesthesia, catheters, or a room full of people looking at you naked, this post is not for you.

Also, the following time line always changes. You don't really know when to do what until the day of. This is just my best guess according to past cycles. Also, this is a best case scenario. Since there are so many steps to this process, things can go wrong (and often do) at any point. There are no guarantees that you will make it through any or all of these steps.

Day 1: Period starts.
Day 2: Start birth control (counter-intuitive, I know) - this does something like set your body at "zero" so all your hormones are at baseline when you begin treatment.
Days 3-8: Continue birth control pills.
Day 9: Stop pills.
Day 13: Go into the hospital in the AM for a baseline ultrasound. The baseline ultrasound is an external and an internal ultrasound to make sure everything is normal before getting started (no cysts, etc.). If you've had a baby, you know what an external ultrasound is. With a little imagination, you can probably guess what an internal ultrasound is. It involves a wand. If everything looks normal, the shots begin that evening.
Days 14-17: Shots in the stomach or thighs in the AM & PM. I will not go into too much detail about the shots because it's complicated - only to say that I use a few different medications that stimulate the ovaries to release healthy eggs.
Day 18: Internal ultrasound & blood test. Continue shots in AM & PM. Nurse calls in PM with instructions for what to do next (adjust meds, when to come in again, etc.). Usually she says to come in on Day 20 for another blood test & internal ultrasound.
Day 19: Shots in AM & PM.
Day 20: Internal ultrasound & blood test in AM at hospital. Nurse calls in PM with instructions.
Day 21: Continue giving 3 shots in AM & PM.
Day 22: Internal ultrasound & blood test in AM at hospital. Continue shots in AM & PM. At some point, maybe day 22, maybe later - but let's just say Day 22 - nurse will say to stop meds and will give you a specific time to take a "trigger shot." The trigger shot is taken exactly 36 hours before the egg retrieval is scheduled. It "triggers" ovulation. Eggs must be retrieved right before ovulation. The timing is exact. If they tell you to give yourself the trigger shot at 9:06 PM, your retrieval will be scheduled for exactly 9:06 AM two days later.
Day 23: Do nothing.
Day 24: Retrieval day. Arrive at hospital one hour before procedure. Retrieval takes place with legs in stirrups, under general anesthesia. Sperm is collected simultaneously. Eggs are aspirated with a hollow needle placed in ovaries. Wake up. They tell you how many eggs they retrieved. Go home a couple of hours later. Pain ranges from moderate to extreme. This is the most painful part of the process.
Day 25: Embryologist calls with fertilization report - they tell you how many of the eggs were mature and how many were fertilized. Begin progesterone-in-oil injections in buttocks. These shots go into the muscle and kind of hurt. Continue these injections for two weeks until pregnancy test.
Day 26: Embryologist calls again to tell you the status of embryos - how many cells they have so far. Ideally, by this day, they should have two cells (each cell should double every 24 hours).
Day 27: Hospital calls in AM to tell you what time to come in for transfer of embryos. The hospital gives you a report card for the embryos. It's a somewhat complicated rating system, but every embryo is given a grade. They select the best one(s) for transfer. Transfer occurs, with legs in stirrups above your shoulders, usually with a room full of med students watching on. A tiny catheter is inserted into the vagina and guided to the uterus. The embryos are brought in and squirted into the catheter. They are too small to see, so they put a little air bubble on each side of them so they will know when they come out and where they are positioned. Go home. Wait.
Days 28-40: Wait. Do nothing but daily progesterone injections.
Day 41: Go into hospital for blood pregnancy test.

I'm completely exhausted typing this all out and I can only imagine that you're completely exhausted reading it. And I'm only on Day 6...