At our fertility clinic, anyone thinking of/planning to undergo IVF is required to attend an IVF session. It was scheduled for 2 hour, 45 minutes, but only lasted 2 hours. Originally, I expected it to be us and 2-3 other couples. Then I learned that it would be approximately 75 people. I was a bit floored by that because they run these sessions every 2 weeks and when we booked ours we had to book 2 months in advance because that was the first availability. I live in a big city, one of the biggest in Canada, but I was still shocked by the number of people looking into IVF. I was also kinda surprised about the number of younger couples. Even though I know that infertility affects young couples too (obviously!), I expected that most of those couples found success in other treatments rather than needing to turn to IVF.
To start, one of the 6 REs at the clinic gave a talk on the process, success rates, risks, etc. Given all the research I’ve done and what our RE already told us, most of it was review. I took a few notes though and thought I’d share them because they may be of interest to others as well. I learned that sperm has no influence on the embryo until day 3. So if there’s an issue with the sperm, you wouldn’t know it right away. That’s one reason why waiting until day 5 (if possible) to transfer can make a difference. At my clinic, their general rule is to transfer two embryos if you’re doing a day 3 transfer and only one if you’re doing a day 5. They stressed that their goal is a healthy singleton birth because even though twins seems like a really cute idea and a way of getting the most “bang for your buck”, it is still considered a pregnancy complication. And there’s the possibility that embryos could split, so if you transferred 2 hoping for twins, you might end up with triplets or quads. The average number of eggs retrieved is 12 and they aim for 10-12. It’s common to not get an egg from every follicle though and some eggs won’t be mature, so they often stim you for more knowing that there will be natural attrition. Once the eggs have been retrieved and combined with the sperm, they check on fertilization 18 hours later and then the embryologist will call with a report. Something else that was really interesting is that there’s a new test called the Harmony test. Apparently it’s only been available in Canada for 2 weeks (longer in the US). It’s a non-invasive alternative to amniocentesis. Since the amnio can cause miscarriage, many people opt not to risk it (and some people just don’t want to know if there’s a problem – something I can identify with). Now, with the Harmony test, you take a blood sample from the mom. They have discovered that enough cells from the baby transfer to the mom’s blood to get a conclusive result for chromosomal disorders (e.g., Down Syndrome). Although other prenatal tests are covered under the Canadian health care system, this one is not. It’s $800.
The doctor spoke for an hour and then we heard from a pharmacist (there’s an onsite pharmacy at the clinic), psychologist (a counseling session is included in the fees for IVF), and nurse. At first I expected the pharmacy would have pricey meds since they specialize in fertilization and people would be more likely to go there for ease, but it turns out they offer better prices (and we were welcomed to call around). The reason why they can do this is because, unlike most pharmacies that do not stock fertility medications, they order large quantities which reduces the cost to them. Also, because they have longstanding relationships with the drug companies, they sometimes get deals, which they pass on to the patients. They will also teach you how to inject, free of charge, if you order from them. They will teach you if you order elsewhere, but then there’s a fee. They will even courier meds to out of town patients with no courier fees for the patient. The pharmacist encouraged us to submit all meds to our insurance company even if our plan says no fertility medications (like ours). She said that not all of the medications are specifically fertility meds so some would be covered.
As for the psychologist, I’m a bit of a harsh critic being a psychologist myself. She seemed a little “fluffy” for my liking, but her talk made me cry regardless because it made me reflect on all the feelings I’ve been experiencing and I also reflected on what J has been experiencing. Once the tears stopped, I couldn’t stop them. I wasn’t sobbing but my cheeks were soaked. I was trying to wipe at my eyes without being obvious. Kinda embarrassing because I don’t think others were crying (but I didn’t look since I wanted to avoid having people notice I was). Anyway, the psychologist said a few things I’ve already heard/thought of, but it was nice to hear them from someone else and to know that most others in the room could probably relate. She pointed out that research shows that the stress of infertility is akin to the stress associated with the death of a loved one or being diagnosed with a terminal illness. A big difference though is that the stress of infertility is typically not visible and many people keep their experiences private. One in six couples in Canada will experience infertility. So it’s not rare, yet we don’t talk about it much as a society, so people feel isolated. The grief model has been found to be the best model to describe the experience, but people find it harder to share this kind of grief. In my own experience, it makes it harder because many people (i.e., those who haven’t dealt with infertility) do not recognize it as a grief experience. I have felt grief each failed cycle because there was a build up of hope only to be crushed by despair when pregnancy didn’t happen. And I have truly grieved, but then it starts again and a new grief cycle begins.
The nurse spoke last. She said that the first day of monitoring (blood work) takes place on day 4 of stims. Blood work and ultrasound also take place on Days 7 and 10 (and possibly more). At our clinic, blood work is done on a first come first serve basis. They start at 7:45 am and the doors open at 7:30, but people are often lined up outside of the clinic before the doors even open. Pregnancy tests (beta) are usually done 16 days after the egg transfer. That seemed late to me because I have read 11 days later for those who do day 3 transfer and 9 days later for those who do day 5 transfer. Something that was definitely new and important to learn was that when the nurse calls to offer you treatment, if you accept that verbal acceptance is the start of your IVF cycle. Payment is due the following week and if you agreed impulsively only to realize 5 minutes later that you won’t be available that cycle, you’re charged a $750 cancellation fee. So you’d better be sure when you say yes! Luckily, you can ask to call them back so you can check your schedule and with your partner, and if you’re not available due to prior commitments, you can request a specific month. She said a lot of teachers request the summer.