Staying Sane as You Begin Your First IVF Cycle

Forty years ago, IVF (in vitro fertilization) was only offered to women with  blocked or absent fallopian tubes. Today, it is utilized by diverse range of individuals and couples for an ever-expanding number of diagnoses, from tubal issues to male factor infertility, endometriosis, unexplained infertility, fertility preservation/egg freezing, PCOS, and the need for genetic testing of embryos to avoid heritable disease like cystic fibrosis or Tay-Sachs. Additionally, it allows gay men to pursue egg donation/gestational surrogacy and for lesbians to pursue reciprocal treatment. 

Although the reason for pursuing IVF may vary, the physical and emotional impacts can be strikingly similar, as the goal to obtain healthy eggs and/or healthy embryos. The  journey to achieve this can present challenges. 

How do you decide if moving on to IVF is the right decision for you?

This decision depends on various factors, including your diagnosis(es). For some, IVF may be your only option for genetic parenthood, such as blocked or absent tubes, severe male factor infertility, or for members of the LGBTQ+ community. Other reasons might be that less intense treatment hasn’t worked for you, the desire to proceed directly to the  treatment with the highest pregnancy rates, or the option of performing pre-implantation genetic testing (PGT).  Ultimately, the decision is yours/yours and your partner’s. While your physician will likely make a recommendation based on your individual situation, you should not proceed with IVF unless you feel confident that it is the right next step for you. 

What Should I/We Expect Physically?

There is no single answer, as various protocols, medications, and approaches depends on your age, your partner’s age, the diagnosis(es), previous medication responsesAMH level, and even how many children you would like to have. For example, if you only want one child, you might be prescribed lower levels of stimulating medications than if you desire a large family. 

Generally, most cycles include some form of suppressing medication in the prior cycle, such as the birth control pill. During the stimulation phase (“stims”), you will likely be instructed to inject yourself once or twice a day with medication, using a small subcutaneous needle (. Another injectable medication might be added after a few days. Some patients feel anxious about the idea of injectable medication, especially those with a needle phobia, which is very common.  If this describes you, consider making an appointment with a mental health professional who has experience treating phobias. You need to decide whether you want to administer the injections yourself, have a partner/family member/friend do them, or hire a nurse.. Most patients quickly get used to self-injections, despite some medications stinging for a few seconds. Putting ice on the skin beforehand can help.  

The next phase includes monitoring, which tends to happen first thing in the morning and includes a blood test and a vaginal ultrasound. Some doctors order them for daily, some for every other day, and some for every third day. In some clinics, physicians do the ultrasound scans and in other clinics, it is done by an ultrasound technician. Ideally, they are scheduled so that you are out of the clinic as efficiently as possible. 

Be aware that starting an IVF cycle doesn’t guarantee the embryo transfer; some cycles may need to be canceled for  various of reasons. However,a cancelled cycle does not mean than a second attempt won’t be successful. For example, if the cycle is cancelled because you don’t develop enough follicles, your physician may simply increase the dose of your stims medication in the next round. 

Once you have several follicles (the dark circles you see on the ultrasound screen) of the right size, you will be scheduled for your trigger shot and retrieval. The trigger shot must to be administered at the exact time specified.  Around 34-36 hours later, you will have the egg retrieval. When you are called into the prep area, you will meet several nurses, the anesthesiologist, and the physician who will be performing your egg retrieval. One of them will start the intravenous (IV)  line  in your hand or arm. While this may sting upon insertion, most people don’t feel it afterward and can move their hand or arm normally.  

The idea of “having surgery” can be intimidating, but the procedure is actually quick and involves no incisions. You will be asleep during the retrieval, and the medication used to induce sleep wears off quickly. You will soon wake up in the recovery room, also known as the PACU (post-anesthesia care unit).  You may feel groggy at first but will gradually  regain full consciousness. 

The nurses will offer you something to eat and drink. If you feel uncomfortable, you can ask for pain medication. Pain levels vary significantly after a retrieval, often depending on the number of eggs retrieved.  Some patients feel well to goout to lunch on the way home, while others may need to take pain medication and rest for the remainder of that day.  

After your retrieval you will learn how many eggs were retrieved. This number can be lower, the same , or higher than you anticipated. Try not to focus too much on the initial count, especially if it is lower than you had hoped, because things can change rapidly in the next few days. You will soon find out how many eggs were mature, how many fertilized, and how many made it to the blastocyst stage. For instance, it is preferable to have 10 eggs retrieved, 8 fertilize, and 6 reach the blastocyst stage, rather than retrieving 20 eggs,having 14 fertilize, butonly 4 reach the blastocyst stage. 

Remember, every case is unique, and you only need one healthy blastocyst to achieve a perfect pregnancy. 

Whenever you have a transfer, whether it is a fresh one five days later or a frozen embryo transfer (FET) months later, it is far easier and less cumbersome than a retrieval cycle. Your physician may or may not prescribe medication for you to take during this period, but the transfer itself is quick, painless, and straightforward. As one of our patients once said, “I walked into the clinic, into the transfer room, pulled down my pants, and five minutes later walked out of the clinic pregnant”!

Throughout the entire process, it is a good idea to note any questions that  come to mind on your phone. This way, the next time you speak or message with your nurse or doctor, you won’t forget anything.

What Should I/We Expect Emotionally?

There is no right or wrong way to cope with an IVF cycle, but the process becomes much easier if you know what to expect and plan ahead to make it as comfortable as possible for you.

First,consider carefully who you want to tell about your journey. While support and encouragement are invaluable, 

be mindful that sharing with many people means you’ll have many inquiries about your progress. You might want to start by informing those who can provide consistent support and expand the circle as you feel more comfortable.

Thinking ahead and managing your expectations can significantly ease the emotional journey of an IVF cycle.

Next, consider the timing of your cycle. For example, if you have a significant work project , family wedding or any other event  where timing is crucial, it might be wise to plan your cycle for the following month . The exact timing of a cycle, can be unpredictable, with the  retrieval potentially occurring earlier or later than anticipated. By choosing a less busy period, you can alleviate stress  and avoid sleepless nights worrying about potential scheduling conflicts on crucial days.

If you have a partner, it is important to talk and plan ahead of time. Do you expect them them to administer your injections? If not, do you want them to be present for every injection? Are there  any plans they need to change to be available for the crucial moments? Discuss who do they want or need to inform and ensure you’re both comfortable with that decision.   This is an excellent time for you both to consider how you you handle challenges, how you function best as a team,  and what your most effective communication strategies. 

Undergoing IVF can feel intimidating- people once regarded it as the “treatment of last resort” leading to significant anxiety at the start of a cycle. However, today, IVF is considered the the “treatment of the best success”. It is natural to feel both anxious and optimistic at the same time. 

Ideas to Help with Anxious Moments During IVF

• Create a Coping List: When you are feeling calm, list all the things that  help you cope when you are feeling jittery. This might include taking a walk, watching a funny movie, talking to your best friend or your mom, journaling, cooking or baking, taking a drive, napping, etc. Sunshine can improve  your so try  to get outside for at least a few minutes each day. If you live in the place with limited sunlight, consider using a light therapy lamps for 15-20 minutes a day while you read or watch TV. 
• Practice Relaxation Techniques:. Use any relaxation thechniques you know, as meditation, hatha yoga, progressive muscle relaxation, body scans, or imagery.  Try to practice these every day, or ideally twice a day. If you are new to these techniques, explore relaxation appslike Calm, or Insight Timer. , Experiment with different techniques, voices, and times, to find what feel most comfortable and are the most effective for you.
• Stay Busy: While unstructured time might sound appealing, it can lead to increased worry about the cycle. Make a list of good distractions to turn to when you start to fret.
• Limit Social Media:This is not the time to see pregnancy announcements, baby bumps, gender reveals, and pictures of first birthday parties. Instead, focus on reliable  resources like Resolve.org and ASRM.org.  Avoid reading about other peoples’ IVF  experiences, as everyone’s journey is different, and hearing that another person has more follicles than you do might feel discouraging.  If reading about success stories is encouraging for you, then go ahead and read them; otherwise, find something else to read.
• Be self-protective during this time.  Do things you enjoy and skip those you don’t. Develop COVID or be exposed to a stomach bug or whatever it takes to get out of any social event you don’t want to go to. 
• Communicate with Your Partner: Understanding that IVF  affects you both differently. For the patient, it is a very physical process- injections, blood tests, scans, etc., there as  the partner might not have it on their mind as much. They could work or golf all day and not think about it once, and you might be thinking about it constantly. That is entirely normal. Don’t expect each other to be experiencing the cycle in the same way. Do think carefully about what you need from them, whether it is daily hugs, time set aside each day to talk about how you are doing, getting educated about the process so you don’t have to explain everything, or simply being your cheerleader during the injections and throughout each day. 

Remember, you’ve got this. You have been so brave and resilient and determined to make this happen. Feeling anxious or discouraged is part of the journey, and there are going to be lots of ups and downs along the way.  Celebrate the ups, and figure out the best way for you to handle the downs. The end result is worth it.