In Vitro 101

In the past several months people have asked us a lot of practical questions about our experience with in vitro. Most people want to know what it is, how it works, etc., so I've decided to dedicate this post to help answer some of those questions in basic layman's terms (because honestly that's all I really know anyways!).

PREFACE: I am not a doctor, a nurse or anything close to that! This is my attempt at an overview of my personal experience. It's kind of long, so read on only if you're interested. I highly understand that to some this is just too much information!

The Basics
In Vitro Fertilization (IVF) at its core is the process of fertilizing a woman's eggs with the man's goods outside of the woman's womb (for some reason I feel weird saying the "s" word on my blog!). IVF is considered one of the most involved and complicated fertility treatments available to couples, and it is also the most expensive. Most of the time couples will try other alternatives that are less involved (and cheaper), such as hormone therapies and/or intrauterine insemination (IUI - also known as artificial insemination), before they opt for IVF.

Why IVF for us?
Our infertility is male factor infertility (due to Colin's cancer treatments), and we are working with a limited number of goods! We have more than enough for IVF, but we are well short of the amount needed for artificial insemination. Having a child through pregnancy has been a dream of mine since long before I ever knew Colin. The decision to move forward with IVF is not one that we take lightly. We spent an extensive amount of time in prayer before ever starting anything. In addition, we've been practically preparing (saving, researching, meeting with doctors, having prescreens and tests, and saving more!) for a couple of years now. We have peace that God has opened every door for us to move forward with this. We are prayerfully relying and depending upon His wisdom for every step and decision in this process.

Our IVF Process
The IVF process has five phases/steps: Suppression, Stimulation, Egg Retrieval, Fertilization, and Embryo Transfer.

Suppression
The goal of the suppression phase is to shut down (or suppress) my ovaries. This is typically achieved by some combination of the birth control pill and hormone injections (in my case, Lupron). My nurse explained it to me like this, they want to shut down my ovaries so that they can build them back up their way. I just completed three weeks on the birth control pill and will add a Lupron injection twice a day starting tomorrow.

Stimulation
The goal of this phase is to stimulate my ovaries to produce multiple eggs. The average woman releases one egg each month. My doctor wants to see lots of eggs - at least 6-8 but he would be happiest with 10-20 eggs. This process is achieved through adding some additional hormone injections to my daily meds (in my case, Follistim and Menopur). This phase will last ten days for me, and most days will involve five injections - two Lupron injections, two injections of Follistim and one injection of Menopur. During this phase I will go to the doctor every 2-3 days for an ultrasound and blood work to monitor my progress and to make sure they time the egg retrieval just right.

Egg Retrieval
The egg retrieval procedure is highly timed. It must occur before my body naturally ovulates because once ovulation occurs it is impossible to retrieve the eggs and the cycle is ruined. This is an outpatient procedure with light general anesthetic (similar to when you have your wisdom teeth removed or a colonoscopy - I will be asleep, but not so far under that I can't breath on my own). The doctor will take a needle, guided by an ultrasound, up to my ovaries. The eggs will still be living inside follicles (healthy cysts) on my ovaries, and the doctor will use the needle to extract the egg and fluid from inside each follicle.

Fertilization
Once the eggs have been extracted, they are kept in a very controlled environment. Some of the eggs will be immature and will die, and others will be strong and mature and ready for fertilization. Fertilization takes place on the same day as egg retrieval for me. There are two primary ways to fertilize the egg. In the most basic technique, the eggs and the man goods are placed in a dish together at the lab, and, well, may the best man win! The other technique is called ICSI (short for a big long name!). In ICSI a single male good is injected directly into an egg using a needle under a microscope. Because this is more involved than the first fertilization technique, it does cost more money, but it helps achieve fertilization that may not otherwise be possible. Our situation is one that will require ICSI.

Embryo Transfer
The fertilized eggs, or embryos, are watched for 3-5 days (some will naturally miscarry during this time). During the waiting period, I will cease my other medications and begin daily progesterone injections, which will strengthen my womb. At the end of the 3-5 day waiting period, I will return to the doctor for the embryo transfer procedure. I have been told this procedure is quick and not too painful (no anesthetics needed). The doctor will use an ultrasound to help guide a catheter into my womb, and the embryos will be sent down the catheter and placed near the top of the womb. The progesterone injections coupled with a few oral drugs that I will be taking are supposed to make my womb prime for implantation and embryo development. After the transfer, we will have to wait a few weeks to learn if we are pregnant.

Whew! That's a lot to process. It seems awfully tedious as I was typing it out. The beautiful thing is that God is showing me that this process is no less His miracle than a "natural" conception. There are no words to express our gratitude and thankfulness that options exist for couples like us. Although this is an extremely grueling process at times (both physically and emotionally), we recognize how blessed we are: 1) that this option is even out there, 2) that we have been blessed with the financial means to afford it, and 3) that God has strategically placed us amidst an unbelievable support team - not just our doctor/nurses, but our family, friends and church body.

I hope this helps you understand the process a little better. If you have any follow-up questions, feel free to leave them in a comment below.

I will post an update to the progress of my latest cycle, along with prayer requests, later this week.

Love to you all!