Guest blog by Jessica Hepburn: The IVF 100m hurdle race
For those who are new or newish to IVF I’m going to outline the key parts of the treatment process so you know what to expect. It’s important to acknowledge that there are a range of different IVF protocols and no two cycles are exactly the same. But there are certain aspects of treatment that are common to everyone and in my book, The Pursuit of Motherhood, I describe these as being like the 100 metre hurdle race but with six huge hurdles instead of ten.
Hurdle 1: Stimulation or how many follicles?
The first hurdle is how your body responds to stimulation. Unless you’re undergoing ‘no drugs’ natural IVF, stimulation involves injecting yourself with hormone drugs. Before I embarked on IVF, I had never injected myself before and the first time is a bit terrifying. The clinic will show you what to do but if the nurses are bit fast and brusque and you’re unclear or worried then do keep asking until you feel sure. But I promise you will quickly get used to it and soon you’ll be shooting up under the desk at work and in public toilets like a regular drug addict! Naturally you would only have one dominant follicle a month which would release one egg, but with IVF you’re trying to develop more follicles so that you can collect more eggs. Ideally what you want is a good number of follicles in both ovaries developing at a similar size, and be warned this will become an emotional obsession. How many follicles? Until that is you go onto the next hurdle.
Hurdle 2: How many eggs?
Soon the number of follicles becomes irrelevant; now the important question is how many eggs? Egg collection is usually done under sedation and doesn’t hurt, in fact if you’re anything like me it will be the best sleep you’ve ever had. Not every follicle will release an egg, and not every egg released will be mature. As soon as I woke up from the anaesthetic, it was always the first question I asked. How many eggs?
Hurdle 3: How many fertilised?
The morning after egg collection is the next hurdle: how many have fertilised? Whether you have conventional IVF (letting egg and sperm do their thing in a petri dish) or ICSI (injecting sperm into egg) you won’t know until 24 hours later whether any of your eggs have fertilised. In IVF it’s rarely, if ever, 100 per cent, which is why you need a good number of follicles and then a good number of high quality eggs in order to increase your chances of success. Today everything that’s happened over the previous two weeks no longer matters. This is now regarded as Day 1; you’re halfway through, just three more hurdles to jump.
Hurdle 4: Days 2 to 5
Over the next few days your embryos begin cell division and all you can do is watch and wait. As each day passes some will progress, others will naturally falter and fail. From Day 2 of your embryos’ life they start to be graded, and this influences the decision as to which ones should be put back when. In the UK, currently, if you’re under thirty you can have one embryo back; under forty, two embryos; and over forty, three embryos. As soon as it becomes clear which embryos are the best your clinic will want to put them back where they belong. If you have produced a small number of eggs, it becomes clear pretty quickly which to put back. If you have produced a larger number and all of them are developing nicely, they are likely to hang on to see which embryos develop into blastocysts. This is the term used for embryo development on Day 5. In theory, an embryo that becomes a blastocyst has the best chance of survival, but the embryos will only be cultured to this stage if there are more than a few good ones of similar quality.
Hurdle 5: the two-week wait
The penultimate hurdle is the dreaded two-week wait: the period between your embryo transfer and pregnancy test (although strictly speaking the two week starts on the day of egg collection). After all the injections, scans, prodding and poking you are left all on your own in charge of your embryos waiting to see whether they will implant and develop. Time becomes interminable. You’ll become hyper-aware of every twinge, or lack of twinge, in your body, oscillating between thinking it’s a good sign, then thinking it’s bad. Every physical movement or negative emotion feels like it might have jeopardised the process. You know that being positive is important, but you also don’t trust yourself to deliver. But remember that wonderful acronym, PUPO – pregnant until proven otherwise. Try to believe it.
Hurdle 6: The pregnancy test
And finally, the test itself when all that stands between you and happiness is a double line. But weirdly having longed for the wait to be over, you may now wish it could continue. After all, there’s no guarantee of a medal at the end of this hurdle race, and to prolong doubt is to prolong hope. I would urge everyone not just do a home pregnancy test but to go into their clinic for a blood test to measure the levels of the pregnancy hormone hcg. It’s hard walking in and then waiting for the result but it’s really important. Even if you’ve been spotting or bleeding and you’re convinced it hasn’t worked. You don’t want to end up like me being rushed into a hospital with an ectopic pregnancy three months after what I thought was an unsuccessful round of IVF. However, hopefully this will not be you. Hopefully your test will be positive. But, a final word of warning, don’t expect the hurdle race to stop. Although I think anyone who has struggled to conceive will relish the thought of morning sickness, your fears that things might go wrong will still be with you, probably right up until you hold a baby in your arms.
Sometimes I do feel a bit guilty outlining these hurdles if you’ve never been through IVF before because in a way the first time you go through it you are blissfully ignorant of what later become emotional obsessions. But I will say this. Nothing that me or anybody can say will stop the obsessions so just accept it and don’t punish yourself for having them. In all my years of obsessing about how many follicles; how many eggs; how many fertilised; the two week wait; and the pregnancy test, none of it really matters because your thoughts don’t directly control what happens. At the end of the day all you need is one good egg and one good sperm.
By Jessica Hepburn, author of The Pursuit of Motherhood.