Details of the Procedures

Along with myself, I am sure you have had a few questions about what all these procedures mean, what they do, and the details. I wasn’t sure where to find the best descriptions, but of course about.com had the best details. Of course for each fertility clinic, numbers may look a little different. I feel though, that each step is explained in detail and I would say this is how we experienced the process thus far. If you have ANY questions, do not hesitate to ask! The whole reason we are so open about this process is because we know there are MANY others walking the path we are – whether using a gestational carrier or not. For some of you this may be boring, and I understand that. There are just so many intricate parts to the process that it’s hard to keep them all straight. There are steps that occur before this, but I thought I would update everyone on the last week or so. My comments are in italics.

Final Oocyte Maturation (aka hcg shot) – this is the shot that I had administered on the side of the highway.

The next step in your IVF treatment is triggering the oocytes to go through the last stage of maturation, before they can be retrieved. This last growth is triggered with human chorionic gonadotropin (hCG). Brand names for this include Ovidrel, Novarel (the one I took) and Pregnyl.
Timing this shot is vital. If it’s given too early, the eggs will not have matured enough. If given too late, the eggs may be “too old” and won’t fertilize properly. The daily ultrasounds at the end of the last step are meant to time this trigger shot just right (that is why I was going in for ultrasounds everyday except Sunday for awhile there). Usually, the hCG injection is given when four or more follicles have grown to be 18 to 20mm in size and your estradiol levels are greater than 2,000pg/ML.
This shot is typically a one-time injection (yeah!). The timing of the shot will be based both on your ultrasounds and blood work and when your clinic schedules your retrieval.

Egg Retrieval

About 34 to 36 hours (mine was 35 1/2 hours) after you receive the hCG shot, the egg retrieval will take place. It’s normal to be nervous about the procedure, but most women go through it without much trouble or pain.
Before the retrieval, an anesthesiologist will give you some medication intravenously to help you feel relaxed and pain free. Usually, a light sedative is used, which will make you “sleep” through the procedure (unfortunately I didn’t sleep through most of it and felt the needles). This isn’t the same as general anesthesia, which is used during surgery. Side effects and complications are less common.
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle in to the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.
The number of oocytes retrieved varies but can usually be estimated before retrieval via ultrasound. The average number of oocytes is 8 to 15 (I had 8, with one immature), with more than 95% of patients having at least one oocyte retrieved.
After the retrieval procedure, you’ll be kept for a few hours to make sure all is well. Light spotting is common, as well as lower abdominal cramping (I feel incredibly bloated and crampy now, but am hopeful it will end soon! Nurse today said it is normal), but most feel better in a day or so after the procedure. You’ll also be told to watch for signs of ovarian hyperstimulation syndrome, a side effect from fertility drug use during IVF treatment in 10% of patients.

Egg Fertilization

While you’re at home recovering from the retrieval, the follicles that were aspirated will be searched for oocytes, or eggs. Not every follicle will contain an oocyte.
Once the oocytes are found, they’ll be evaluated by the embryologist. If the eggs are overly mature, fertilization may not be successful. If they are not mature enough, the embryology lab may be able to stimulate them to maturity in the lab.
Fertilization of the oocytes must happen within 12 to 24 hours. Your partner will likely provide a semen sample the same morning you have the retrieval. The stress of the day can make it difficult for some, and so just in case, your partner may provide a semen sample for backup earlier in the cycle, which can be frozen until the day of the retrieval.
Once the semen sample is ready, it’ll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best looking sperm,” placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.
With the exception of severe male infertility, 70% of the oocytes will become fertilized. In the case of severe male infertility, ICSI (pronounced ick-see) may be used to fertilize the eggs, instead of simply placing them in a culture dish (we did ICSI – not because of fertility issues, but with using a carrier, they recommend this process – we found it well worth it considering the cost of having to repeat the whole medication process again). With ICSI, the embryologist will choose a healthy-looking sperm and inseminate the oocyte with the sperm using a special thin needle.

THIS IS WHERE WE ARE AT – THIS PROCEDURE IS HAPPENING ON SATURDAY
Embryo Transfer
About three to five days after the retrieval (two days in our case), the fertilized eggs will be transferred. The procedure for embryo transfer is just like IUI treatment. You won’t need anesthesia.
During the embryo transfer, a thin tube, or catheter, will be passed through your cervix. You may experience very light cramping but nothing more than that. Through the catheter, they will transfer the embryos, along with a small amount of fluid.
The number of embryos transferred will depend on the quality of the embryos and previous discussion with your doctor. Depending on your age, anywhere from two to five embryos may be transferred. Recent studies have shown success with just one embryo transferred. Speak to your doctor to find out if this may apply to you.
After the transfer, you’ll stay lying down for a couple hours (bring a book) and then head home.
If there are “extra” high-quality embryos left over, you may be able to freeze them. This is called “embryo cryopreservation.” They can be used later if this cycle isn’t successful, or they can be donated.

Two-ish Week Wait
On or after the day of your retrieval, and before the embryo transfer, you’ll start giving yourself progesterone supplements (this is what Brenda is doing). Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil.
Besides the progesterone, there really isn’t much going on for the next two weeks.
All you can do is wait the two weeks and see if pregnancy takes place. (In our case, it’s about a 12 day wait – it’ll be a long 10 days, but we both plan to try to stay busy)

Again, if any of you have any questions, just comment or send me an email!