Big question here. And one I can't really answer definitively as we are still months away from beginning the process. But in an attempt to sort of "let you in" on what we foresee the steps being, let me shed some light on what a round of IVF might be like for this "first cycle" couple...
1st Appointment - Fortunately for us, the doctors we are working with already have full access to our past medical history. Both infertility-wise and otherwise. They will have a preliminary knowledge of what they're "up against" before we ever step foot in their office. This is the appointment where we will talk to them about our hopes and intentions, discuss options, ask questions, etc. We've already got a pretty extensive list of questions to ask! We will also meet with people in the financial department of OU Infertility to talk with them about what our insurance may or may not cover. We will most likely be sent for blood work at this appointment. Then I will be scheduled to have some or all of the following procedures within the following 2-4 weeks:
HSG (Hysterosalpingogram) - This is a procedure that I've had done before. They inject dye into your uterus and fallopian tubes to see if your tubes are blocked and/or if there is any scar tissue or other damage. This procedure also helps the doctors note the size, shape, and placement of your uterus. When I had one done in November of 2010, everything was seemingly normal. Barring any unforeseen complications that have arisen in the last 3 1/2 years, I'm assuming this test will once again be normal.
Hysteroscopy and/or Laparoscopy - This is where they put a tiny little camera right into my uterus or abdomen to check for fibroids, endometriosis, blocked tubes, and/or other abnormalities. Usually if they see something during this exam they go right ahead and remove the fibroids or scar tissue that might be blocking the tubes or otherwise hindering a successful conception/pregnancy. I'm not gonna lie...it's *this* procedure that scares me some. Because it's the procedure that could uncover things that could prevent both IVF *and* our chances of ever conceiving. Yep...I get anxiety just thinking about it...
Semen Analysis - Just what it sounds like. Jonathan gives a sample, they put the little guys under a microscope, they give them a score. Simple as that. This is another test we've had done before and should return normal again.
Sonogram - To check my endometrium (the lining of my uterus) and my ovaries for cysts or abnormalities. I'm a pro at this procedure since I've had more of them than I can even remember. Thankfully, unless something drastic has happened since March 2013, this reading should be normal.
Mock Transfer - This is new to me, but I think it's pretty cool (even if the procedure itself harkens to a bad experience I had in March 2013 with an endometrial biopsy...eesh...). Basically the doctor is going to perform the IVF transfer procedure right up until the point of actually transferring the fertilized eggs into my uterus. Why? Because every woman is different and they have to make sure they are using the right size and length of catheter. Also they want to make sure they are able to place the fertilized eggs in the most optimal place in my uterus for implantation. This procedure is done while the doctor looks at an ultrasound image to make sure everything is just perfect for when it's time to transfer those Womack Embabies for real...
Hormone Testing - There are a few tests that have never been run on me during fertility treatments. Why? I have no idea. There's a possibility, though, that the OU doctors might want a clear(er) picture of my hormone levels throughout a natural cycle. We will be seeing them right in the middle of a natural cycle, so they may want to see how my body is producing estrogen, progesterone, FSH (follicular stimulation hormone...the hormone that tells your body to produce eggs), LH (lutenizing hormone...the hormone that tells your ovaries to release the egg(s)), etc. These are just simple blood tests, but some have to be checked on precise days in your cycle. We will be seeing them on or around Day 18 of my natural cycle, so who knows where these evaluations may or may not fit in...
Then starts the fun part (please read the sarcasm there) ;). We have no idea what the exact timeline for this will be (we are hoping a transfer date sometime between August 1st and September 10th will be possible), but here are the steps we will likely be taking between the evaluation stage and the actual transfer:
Step 1 - 2 weeks of birth control. Ew. I'm not a fan. But hopefully it will be 2 weeks of yuck in exchange for years of awesome, so I'll do it. There's a chance I may not have to do this since I've got a normal cycle going now, but we also don't want to take any unnecessary chances if we don't have to.
Step 2 - Sometime around the middle of the cycle I will begin taking Lupron injections daily which will suppress my natural ovulation.
Step 3 - "Stimming". This is a term used in the IVF world for stimulating your ovaries to produce lots of eggs. At the start of my next "cycle" I will take daily injections to make my ovaries mass produce. I will take these injections for anywhere from 7-10 days.
Step 4 - Ovidrel (which I've taken before). This is an injectable drug that stimulates your eggs to mature before "release". In our case, the doc will be going in to get those mature eggs before my body releases them naturally.
Step 5 - Retrieval. This is done under general anesthesia like an outpatient surgery. This is when they will use a needle through a speculum to poke through the walls of my lady parts and retrieve all my tiny little mature eggs. Then those little eggs go straight to a petri dish and into an incubator to await their "knights in shining armor". During retrieval they will take as many eggs as they see and are able to get to. So it can be anywhere from around 15 all the way to 35+.
Step 6 - Jonathan gives the docs a "sample" and his soldiers are then deployed into that fateful petri dish with "marching orders" to "attack the hill". We will get daily phone calls about how many eggs were fertilized and how our embabies are growing for the next 3-5 days.
Step 7 - On Day 3 or 5 after retrieval and fertilization our embryos will be "graded" (exactly like they grade chicken eggs actually...AA, AB, BB, etc.). The highest graded embryos are slated for transfer and/or cryogenic freezing. On Day 5 I will go into the office and they will put our Womack Embabies (1 or 2...hopefully we have 2 good ones) into my uterus in the same way that they did the mock transfer in the beginning. This is done without anesthesia but I will likely be given something to relax me (i.e. Valium or the like) so that I don't get too tense and cause my uterus to contract which could hinder our chances of a good transfer and hopefully implantation.
Step 8 - 2WW (Two Week Wait). This is only about 9 days after the transfer happens rather than 2 full weeks, but I'm told this feels like an eternity. It is during these 9 days that we will need some SERIOUS distractions and encouragement. Say prayers for me, yes, but mostly Jonathan during this time. Because I will likely be a basket case...
Step 9 - Beta pregnancy test. I can take a home pregnancy test if I want to (who am I kidding?? I will probably take several...), but no matter what I will go in 9-11 DPT (days past transfer) and they will draw blood to check my hCG (human chorionic gonadotropin...the pregnancy hormone) levels. If they are rising, I am pregnant!
Step 10 - I will continue working with the OU Infertility docs until around week 8 when a heartbeat (or heartbeats!) are confirmed via ultrasound. I will then be released to my regular Ob/Gyn for the remainder of the pregnancy.
Whew! Did you follow all that?? Me neither. :) It's pretty confusing and overwhelming. Thankfully we have some pretty wonderful people in our lives that are A) Praying for peace for us, and/or B) Helping to talk us through this process because they've "been there done that". It will never cease to blow my mind how God has orchestrated this whole endeavor. He made our paths cross with people 10+ years ago, and then now today they are people helping us along this bumpy road to parenthood...
We are so blessed and quite anxious to get this party started man!
If you'd like some video footage about the process of IVF from "the lab"'s perspective, I found this video which is actually pretty incredible. I think it's amazing even if it wasn't done in petri dishes in a lab. How cool is it that these microscopic cells grow into humans??? Mind blown y'all...
Showed it to Jonathan and this was his response:
Did you just get goosebumps??? Me too... :)