Fitting Fertility Treatment Into Your Life: What To Expect In the Quest To Be Expecting
All patients gearing up to start fertility treatment share common concerns about the impact it may have on their daily routine, work schedule, and whether the time commitment required to cycle will warrant explaining their treatment journey to friends and family. Knowing what to expect before starting treatment can greatly reduce the anxiety and stress surrounding the process. Most patients are surprised to hear that undergoing treatments (ie. IVF) doesn’t mean they will need to have significant time off of work. To clear up these types of common misconceptions, I put together this quick overview of the typical treatment timeline, the frequency of required in-person visits, and required downtime surrounding specific procedures. Please keep in mind that these points are pertinent to where and how I practice, as a NYC based fertility doctor. It is important to ask your fertility doctor for their take on this as you plan and prepare to begin treatment.
Please leave a comment below if you have any specific questions about the expected schedule and time commitment associated with particular types of treatments or procedures!
INTRAUTERINE INSEMINATION (IUI)
Typical # of visits needed to clinic: 3 (Day ~3, ~12, ~13)
IUI is a 5 minute long procedure that is done in the clinic setting. It involves using a speculum to identify the cervix and inserting a long, flexible, thin catheter through the cervix so that sperm can be injected at the top of the uterus. This procedure is usually done mid-cycle, ideally 1-2 days prior to ovulation. IUI is done either before natural ovulation or during a medicated cycle. The workflow of an IUI cycle is as follows:
-Day 2-5 of menses: Blood work to confirm all hormones (estrogen and progesterone) are ‘baseline’ (to confirm you are not in the middle of an ovulation, or post-ovulation) and to rule out an inadvertent pregnancy (blood tests are more sensitive at picking up very early pregnancy compared to at home urine pregnancy tests). If labs look good and the plan is to use medication to induce ovulation, or potentially release more than 1 egg, medications such as clomid or letrozole can start for 5 days. This blood test can be done at any outside lab and is not required to be done at the clinic.
-Day 3 to 7/Day 5 to 9: Clomid or Letrozole pills are taken daily for 5 days total – this can be done on your own, and does not require coming into the clinic.
-You will need to be available sometime between Day ~10 to 14 have a pelvic ultrasound +/- blood work to check on whether you responded to the medication/are ready to ovulate. Depending on when you normally ovulate and personal characteristics (ie. ovarian reserve), your doctor will decide which cycle day to bring you in for your mid-cycle ultrasound to confirm that you responded to the medication. If there is a large, mature follicle (at least 18mm in size), a trigger shot is administered to prompt ovulation within a 2 day window.
-IUI is done 24 hours (if trigger taken in the morning) or 36 hours post trigger shot (if taken at night): If your partner cannot be there due to travel, work etc – you can, ahead of time, have him freeze a sample of sperm with the clinic, to be used at time of insemination.
-The Two Week Wait: Post IUI, you will wait 2 weeks to get the results of the cycle. If the pregnancy test is positive, you will not get a period and you will come in for blood work to check your pregnancy hormone levels (bHCG and progesterone). If they are confirmed positive, you will be asked to recheck your bloodwork 2-3 days later to ensure the bHCG level is rising. If rising appropriately, your next visit would be for the first pregnancy ultrasound (along with bloodwork) about 1 week later. From there, I typically will do a pregnancy scan every week for an additional 1-2 weeks and then discharge patients to their OB for routine prenatal care.
**Potential added time: If you do not respond to the medications and you are not ready to ovulate and be scheduled for the IUI, it is possible you will just need more time and to be reassessed with another follow up scan after 2-3 more days. It is also possible that one would be asked to take another round of clomid/letrozole right then and there, in an effort to get the ovaries to respond.
IN VITRO FERTILIZATION (IVF)
Egg Retrieval Cycle
This is the most demanding type of treatment, when it comes to needing to be in close proximity to a fertility clinic and to clear 2 weeks in your schedule to be available and flexible. The injectable medications for an egg retrieval cycle are usually given for 8-12 days (depending on how long it takes the ovaries to respond), starting on day 2-3 of the period, or ~4 days after stopping birth control pills. The birth control pill holds your cycle at day 3 hormonally, allowing for flexibility of scheduling when the ~2 week stimulation and retrieval process happens. During the injections, you will be asked to come in for ~5-6 clinic visits for both blood work and ultrasound to gauge your response to treatment. These are typically early morning visits that can be done outside of normal work/school hours. The clinic will call with same day results (usually) and give instructions on what to do for the next few days, until the next monitoring visit. At the start, these visits occur every 2-3 days, and then consecutive days, until deemed ready for egg retrieval. On the last day of shots, you will take a final set of medications called a ‘trigger shot’ which will preceed the egg retrieval by ~36 hours. Egg retrievals typically happen in the morning and are scheduled in a very rigid, inflexible fashion. Once you take that trigger shot, your retrieval time is set. The day of the egg retrieval is the one day you should plan to take off from school/work/life. You will likely feel groggy and out of it due to the anesthesia (which is light sedation), and may have some cramping and bloating – so it’s best to give yourself that day to recuperate.
Embryo Transfer Cycle
The embryo transfer cycle tends to be less demanding than the egg retrieval cycle. It usually consists of 3-4 visits total:
- Baseline visit – day 2-3 of the cycle or ~4 days post stopping the birth control pill. A transvaginal ultrasound and blood work is done to see if you are truly at the baseline of the hormonal cycle, before tracking the cycle or starting estrogen to thicken the lining.
- Mid-cycle ultrasound- the timing of this is somewhat flexible. It is scheduled to ensure that the lining is thick enough to proceed with the embryo transfer. Once this is achieved, we can plan out when to do the transfer – it will be scheduled after a specific number of days of progesterone is administered. Progesterone can be administered as pills (oral and/or vaginal pills taken 2-3 times throughout the day) or intramuscular injections (once a day dosing).
- Most clinics will check on the lining with a transvaginal ultrasound and blood work right before the transfer (1-3 days in advance). This is to ensure there are no issues that would warrant cancellation of the transfer (ie. fluid in lining, extremely low progesterone levels). It is rare to find a problem – but when we do, it is worth cancelling and starting over to make sure we get it right!
- The embryo transfer. This is done without anesthesia and is generally non-painful. It involves coming into the office with a full bladder (or drinking lots of water once you arrive). And about 30-60 minutes after checking in, we perform a speculum exam and transfer the embryo under ultrasound guidance. This is done in the operating room as it is in close proximity to the lab, where the embryo was thawed. Post transfer, you will be able to go home right away and can get back to your life! You will get instructions specific to your case, on what activities are ok vs. restricted post transfer.
Regardless of what type of treatment you are embarking on, it will involve some level of ‘monitoring’, where you come in for a transvaginal ultrasound, bloodwork, or both. Monitoring visits are generally always in the morning and should be short, efficient visits. Additionally, they can be done at outside clinics, if you must travel during a treatment cycle. In general, you will always need to be near your clinic for major procedures such as an egg retrieval or embryo transfer. I have had many international patients who will prepare for a transfer or egg retrieval elsewhere and then fly into NYC for their procedure.
If you are concerned about how to make room in your life for fertility treatment, here’s my advice:
- Speak with your doctor and voice your concerns. Your care team can help to spell out the tentative dates and help you to figure out whether you need to manipulate your cycle timing using birth control and how to best schedule work events, trips etc. so they do not result in a conflict.
- Consider sharing your treatment plans with friends, family, and even coworkers you trust and feel comfortable with. If you can be open about it, it will remove that element of stress from an already intense process. Of course, if you do not feel comfortable discussing your treatment, you should rest assured that undergoing even the most demanding treatments can be pulled off in a subtle and discreet way.
- When all else fails, you could aim for the second half of the IVF cycle to fall during a week of vacation from work or school, to minimize the stress associated with trying to juggle it all.
Good luck! You’ve got this!!!