“I have so many questions!”

The day came for our IVF consultation, you know the procedure that “grows babies in a petri dish”, yep that one. You may remember how setting up this appointment went from my last post. I was fully prepared with a list of 46 questions backed by hours and hours of research during the six days from our fifth IUI failure leading up to this day. Much like during my research for our initial consultation, I wasn’t able to find a clear answer regarding what to expect from an IVF consultation but I assumed it would strictly be a conversation, however, I recommend asking your clinic if you are unsure.

J left his office early that day so we could meet at home and to pack the car for a vacation as soon as our appointment was over. We were the last appointment of the day, so we were greeted by Krissy’s smiling face telling me there was no need to check-in and that it would just be a minute before Crystal was ready for us. Without barely having time to sit down, out came Crystal ready for us and pointing into the vitals room. Naturally, I questioned the need for my vitals and she explained they needed to be taken as we were started a new treatment. Okay, fine, I gave in. She took my blood pressure which was through the roof as usual, 158/103, so she retested it and got a reading of 139/101 – better but still high. Then it was time for me to get on the scale as I lost the bartering battle of telling her my weight this time. In true Kate fashion, I rolled my eyes are her and she responded with “Out of all of our patients, you’re the only one who rolls their eyes at me,” to which I told her was strictly out of love!

Once we were through with my vitals, yes, only mine again, we headed down the hall to Dr. F’s office. He greeted us with a big smile saying “I know you don’t want to be here, but at least there is no exam!” Valid point. I then went to explain my hatred by saying “It’s not you, I love you. I just hate exams of all types. But I do love seeing you.” ……. too much?? Probably! He replied by saying that he enjoys seeing us too and he appreciates us coming back as his patients as he knows there are always other options. However, none of the other options are ones that we would consider. (Ex: choosing a new RE in the FIRM, switching to a new clinic, adoption or fostering.)

Dr. F said we could do this appointment one of two ways. Option 1: let him get into the process and procedures involved and ask questions at the end. Option 2: ask my questions first and then have him fill in with other information that may have been missed. He went with the first option as we both knew he would likely answer many of our questions during his explanation. And we wanted the whole picture from beginning to end, so I tried my best not to interrupt him. I won’t go into every painful (literally) detail, but I will give you an overview.

He answered several questions right away: he said we would be doing the antagonist protocol and it would take about three months from my first birth control pill to the day of our beta blood test. He explained that I would take birth control for three weeks starting on CD2 of my upcoming cycle (this appointment was on CD4 so we had already missed the window for that cycle). During the time on birth control I would have a saline infusion sonohysterography (SIS) to look for any cysts, fibroids or polyps that may be in the way. Soon after completing my birth control pills, I will start my next cycle in mid-December (based off our calculations), and on CD2 I will start with daily injections, aka stims, and appointments (appointments could be every other day, that is to be determined). After 10 to 12 days of stims, it will finally be retrieval day followed by three days of bed rest. Then we will take the month of January off to give my body a rest, but as soon as I start my cycle in February, I will start another 10 days of stims in preparation of a fresh embryo transfer or FET. Now, all of this is subject to change depending on my cycles and how I am responding to everything. We were also warned that depending on how things fall during the holidays, I could be put on birth control for a second month, pushing everything out and making our timeline four months instead of three, but we are hoping that doesn’t happen!

During our conversation, Dr. F went into all of the technical terms and gave us a ton of “what if” scenarios so we are fully prepared should he or my body throw us any curveballs. Dr. F could tell I was getting overwhelmed so he asked if we wanted to go through our questions. “UM, I thought you’d never ask” came blurting out of my mouth! So here comes the part you’ve been waiting for (if you too are about to start the IVF process)… our questions! I broke out our questions into five topics, this way I wasn’t all over the place and knew all of the questions we had for each part of our discussion. The items with a * are answered below at the bottom of this post. I purposely kept them separate so you can easily copy all of my questions if you’d like!

General Questions
1. What do you think are our chances for success?*
2. Do you feel we will have success with our first round?
3. What is the FIRM’s success rate?
4. Which IVF program do you recommend? (the FIRM has several options)*
5. What does the average cycle look like?
6. Will we do a fresh or frozen transfer? (answered above)
7. What is the estimated timeline for my next cycle? (answered above)
8. Will I be doing Down-Regulation?
9. Do you recommend ICSI?*
10. Do you recommend Assisted Hatching?*
11. What do we do with remaining embryos?*
12. What would cause a canceled cycle, retrieval or transfer?*
13. Have you seen success with lower grade embryos?
14. What kind of pain and recovery can I expect?
15. How common is OHSS?
16. What is the risk of multiples?
17. Do I stay on all of my current medications and supplements? Anything to add?*
18. Do we have any restrictions on sex, exercise or travel?*
19. How should we prepare ourselves health-wise and physically for IVF?
20. Will Dr. F be the one doing my retrieval and transfer?
21. Will we only have to go through one retrieval?*
Medication Questions
1. What medications should I expect to use? Oral, injectables, vaginal suppositories?*
2. Are we allowed to order medications from oversees to save some of the cost?
3. What is the best time to do injections?
4. Are all shots subcue or intramuscular?
5. Will we be given lessons on mixing and administering the injections?*
1. How many monitoring appointments should we expect? How many will be bloodwork vs. ultrasound?*
3. Are all appointments done at the main office?
4. Is bloodwork done inside the office or through an outside lab?
5. After a transfer, what is the appointment schedule like?
Retrieval and Transfer Questions
1. How many eggs do you hope to retrieve?*
2. Do you take all follicles even if they don’t look mature?
3. What percent of eggs typically make it to maturation? Fertilization? Freezing?
4. What is the process for watching the fertilized eggs grow?*
5. How long does a retrieval take? How long can I expect to be under?
6. What is a transfer like? How long will it take?
7. How many embryos do you recommend transferring?*
8. Is Jeremy allowed in the room for either?*
Testing Questions
1. Do you recommend PGS?*
2. Do you recommend any other tests? (Any other type of HSG, Genetic Testing.)*
3. Will you do a Mock Transfer or ERA (endometrial receptivity analysis) on me?
4. Are there any tests that Jeremy should have done?
Billing Questions
1. What is the cost breakdown and what is included in the cycle?
2. Do we pay upfront? Medications too?
3. Does the FIRM offer in-house financing or partner with a financial institution?

General Answers
1. What do you think are our chances for success?
– Success rates average about 53% for patients that undergo IVF.
4. Which IVF program do you recommend?
– Based on our infertility diagnosis and our younger ages (29 and 30), the Single IVF Cycle is recommended for us.
9. Do you recommend ICSI?
– Due to our male factor infertility, yes.
10. Do you recommend Assisted Hatching?
– No, this is typically needed in women over age 35.
11. What do we do with remaining embryos?
– Most couples freeze them until they are ready to go through another transfer. When our family is complete, we can decide on donating, doing embryo adoption or discarding them.
12. What would cause a canceled cycle, retrieval or transfer?
– he biggest reason a cycle would be canceled would be due to a low response to the medications such as not producing enough eggs or having issues with my lining.
17. Do I stay on all of my current medications and supplements? Is there anything I should add?
– Stay on everything, absolutely no herbal supplements (teas) or antihistamines.
18. Do we have any restrictions on sex, exercise or travel?
– Due to every or every other day monitoring, travel during the stim cycle isn’t recommended. Walking and swimming are the only totally safe exercises (recommended by the FIRM), and sex is okay up to a few days before retrieval and transfer.
21. Will we only have to go through one retrieval?
– Hopefully! The idea is to only go through one retrieval as that is the hardest (and most expensive) part of IVF. It is all dependent on how many eggs are retrieved and fertilized.
Medication Answers
1. What medications should I expect to use? Oral, injectables, vaginal suppositories?
– Mostly injectables, and one vaginal suppository. Orals will only be birth control and an antibiotic prior to retrieval.
5. Will we be given lessons on mixing and administering the injections?
– Yes!
Appointment Answers
1. How many monitoring appointments should we expect? How many will be bloodwork vs. ultrasound?
– We are planning on everyday monitoring through stims, but know that it could likely only be every other or every three days.
Retrieval and Transfer Answers
1. How many eggs do you hope to retrieve?
– Ideally 16 to 18. Fingers crossed!
4. What is the process for watching the fertilized eggs grow? How often are they checked on?
– The embryologist will check on them days 3, 5 and 7 (if doing PGS). The amount of checking is limited due to keeping the tanks at an optimal environment for the little babies to grow.
7. How many embryos do you recommend transferring?
– A singleton (one) under the age of 35. Two is the maximum limit due to the risk of multiples. With transferring a singleton, there is still a great possibility that it splits and becomes twins.
8. Is Jeremy allowed in the room for either?
– Retrieval – no, it is a sterile surgical suite and he will be doing his part at the same time. Transfer – yes, thank goodness!
Testing Answers
1. Do you recommend PGS?
– PGS is completely up to us, a lot of couples decide against it for moral or religious reasons. Dr. F can’t tell us one way or the other if we should do it or not unless any other test came back with a reason to do so.
2. Do you recommend any other tests?
– Yes, the first step will be having some of my levels retested from last year (HIV and Hepatitis as we are starting a new type of treatment and all boxes need to be checked; my A1C due to my insulin resistance; my thyroid; and my AMH). We also will start with an optional genetic blood test, J was so kind in offering to go first. (I’ll do an entire post on this test once we have our results.)

After an hour and a half, we left there totally overwhelmed with information overload, so our annual vacation to Disney’s Food and Wine Festival was just what we needed. Dr. F even told us we could “live it up” for those five days and have a few glasses of wine. Reminder: all of the information above is dependent on everything going as planned. We, of course, will be optimistic that all will go smoothly and according to plan, but we wouldn’t be surprised if life threw us a curveball.