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The Journey

The In Vitro Fertilization Journey
by: Susan Wilson
Coordinator University of British Columbia In Vitro Fertilization Program

The Journey Begins

For many couples the most difficult part of in vitro fertilization (IVF) may be the initial decision to undertake treatment. As the process involves physical, psychological, and financial cost, deciding to embark on the "journey" may be a difficult choice to make. At the BC Women's Centre for Reproductive Health IVF Program, the first step for the couple considering IVF is a consultation appointment. During this two hour appointment, the couple will have blood drawn for screening tests including HIV and Hepatitis B and C. Next the couple will have a counselling session with an IVF nurse who will discuss the specifics of an IVF cycle, medication choices, psychological support, and any concerns the couple may have. In addition the couple will consult with an IVF physician. The physician will review and add to the couples's history, make recommendations based on the history, discuss benefits and risks of an IVF cycle, and perform a physical exam on the female partner. Often couples feel overwhelmed with the verbal and written information they receive and are encouraged to telephone with any questions they may have after this appointment. However, receiving the information is valuable for the decision making process.

En Route

When an IVF treatment cycle is booked, the couple receives an information package which includes the first prescription required, consents to review, and information about what to expect during an IVF cycle. Treatment dates are scheduled by an IVF nurse based on the menstrual cycle.

One of the dates generated from the first day of menses is the "start" day of treatment. For some couples starting treatment gives them feelings of excitement and anticipation. For others there are feelings of extreme anxiety. The experienced IVF nurse can often identify when couples are feeling anxious and encourage them to discuss their feelings. Many couples benefit from visiting with the Program's psychological counselor.

Starting treatment involves bloodwork to assess hormone levels, an endovaginal ultrasound, and a nurse visit, where consents are reviewed and signed, the treatment cycle schedule is reviewed and payment collected. If the hormone level is in the desired range, (estradiol < 200 pMOL/L) and the ultrasound results rule out ovarian cysts or anything which may interfere with treatment, then the next step for the couple is to learn self injection. Usually the female partner will opt to learn self injection but on occasion it is the male partner. The injection teaching is done on an individual basis with the IVF nurse who supervises the first injection. Even the most faint hearted person is amazed when they accomplish this feat. Those who really do not feel comfortable with self injection, may have their injections done at the Program.

Once on board with the hormone injections, the couple can settle into the routine of daily injections for the next 3 days which generally do not interfere with individual schedules. But once the monitoring phase begins, life can become hectic. There is bloodwork scheduled almost daily and as the hormone level rises, there are endovaginal ultrasounds to assess follicular growth in the ovaries. When the hormone level is high enough and there are enough follicles of appropriate size, the female partner is scheduled for egg retrieval two days later. It is at this point that the next teaching session takes place with an IVF nurse, to review information pertinent to egg retrieval and embryo transfer and to tour the procedure area.

The Journey Ends

Egg retrieval is a shared experience for the couple. When the couple arrives to the procedure area, the male partner is directed to the semen collection room where he can give his sample. For some men having to perform "on demand" is a source of anxiety but many feel that this is the one time that they are actually participating in the IVF process. After the semen sample is collected, the couple may stay together for the egg retrieval. This is an ultrasound guided procedure, requiring intravenous medication for pain and anxiety control. The couple have their own viewing screen where they may observe the entire process. At the end of the procedure, the couple know how many eggs have been retrieved and after a short period in the recovery area, may go home.

Later that day the eggs are inseminated or injected as predetermined. The following day the eggs are inspected for fertilization and the development of the pre embryos. Embryo transfer usually occurs three days following egg retrieval. This is a procedure very similar to having a Pap test. It involves using a vaginal speculum to visualize the cervix and passing a fine plastic catheter through the cervix and with the syringe attached to the other end of the catheter, the embryos are expelled from the catheter into the uterus. No medication is required for this procedure. It is at this time excess embryos which meet the criteria for freezing may be cryopreserved (frozen) if consent has been given.

The pregnancy test which determines the outcome of the IVF cycle occurs two weeks after embryo replacement. This can be a very difficult time for the couple with every day stretching before them like an eternity. Contact with the Program is encouraged during this period. The IVF nurses and counselor can provide emotional support and guide couples through this anxious time. Negative results bring feelings of grief and loss to the couple. A positive result is not without anxiety, as the outcome of the pregnancy is unknown. The couple is encouraged to have a follow up visit with an IVF physician to review their cycle and determine what their options are for the future if results are negative, or, to discuss pregnancy management and appropriate referrals if the results are positive. Regardless of positive or negative pregnancy results, most couples feel that this was a necessary journey during their experience of infertility.