IUI vs. IVF

I knew that by deciding to write and publish a blog about my struggles to conceive, I was definitely putting myself out there. Naked, in a sense. I choose to divulge things that most people remain private about. However, I have found a certain peace by creating this blog...a certain level of understanding that I share with many of the women that read my blog or vise versa. This blog is a place for me to not only document my journey for my own benefit, but a way for me to share my journey with those close to me. That is why I will document my IVF process in great detail here for my friends and family, and other women going through IVF or thinking about it. Hopefully, my account of this cycle will help people to better understand the emotional, financial and physical commitment an IVF cycle truly presents to the couple.

Today, I will share information about the basic steps involved in an IVF cycle. The information below has been gathered from several sources.

What is IVF (in vitro fertilization)?

There are basically five steps in the IVF and embryo transfer process which include the following (from the American Pregnancy Association):
1. Monitor and stimulate the development of healthy egg(s) in the ovaries.
2. Collect the eggs.
3. Secure the sperm.
4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
5. Transfer embryos into the uterus.

Prior to step 1, my husband and I have to complete blood tests (mandatory HIV and chromosomal panels) and another semen analysis. We have completed the bloodwork, and are looking to make an appointment to complete the semen analysis this week. Also, prior to starting the fertility meds, I will be on birth control beginning this Tuesday. (I'm not sure for how long, but given my proposed egg retrieval scheduled for the week of December 12, I can only assume, at this point, that I will not be on birth control much longer than 3 weeks. I believe I will find out more tomorrow when the nurse calls me.)

Step 1: Fertility medications are prescribed to control the timing of the egg ripening and to increase the chance of collecting multiple eggs during one of the woman's cycles. This is often referred to as ovulation induction. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Egg development is monitored using ultrasound to examine the ovaries and blood test samples to check hormone levels.

I will be using several medications to achieve this step. Menopur is a highly purified preparation of naturally derived gonadotropins, called hMG. Menopur contains equal amounts of 2 kinds of hormonal activity: follicle-stimulating hormone (FSH), which helps stimulate egg production; and luteinizing hormone (LH), which helps the eggs mature and release (ovulate). Bravelle is a highly purified preparation of human follicle FSH and 2% luteinizing hormone (LH) activity. Ganirelix is an injectable gonadotropin-releasing hormone antagonist (GnRH antagonist). It is primarily used in assisted reproduction to control ovulation. The drug works by blocking the action of GnRH upon the pituitary, thus rapidly suppressing the production and action of LH and FSH. Finally, I will use Ovidrel to give the eggs a final boost to mature and prepare for ovulation, which will NOT occur as the doctor will go in prior to ovulation to remove my eggs via an Egg Retrieval (ER).

When the follicles are mature (determined by ultrasound measurements of follicle size and hormone measurements (estradiol levels - E2 - via bloodwork), the egg aspiration procedure is done to take the eggs out. About 15 to 20 mm diameter is generally consider a "mature" follicle.

Step 2: The eggs are retrieved through a surgical procedure which uses ultrasound imaging to guide a hollow needle through the pelvic cavity. Sedation and local anesthesia are provided to remove any discomfort that might be experienced. The eggs are removed from the ovaries using the hollow needle, which is called follicular aspiration. Some women may experience cramping on the day of retrieval, which usually subsides the following day; however, a feeling of fullness or pressure may last for several weeks following the procedure.

For a video of an egg retrieval, go HERE

Step 3: Sperm is obtained and prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are placed in incubators located in the laboratory which enables fertilization to occur. In some cases where fertilization is suspected to be low, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman's uterus anywhere from one to six days later, but most commonly it occurs between two to three days following egg retrieval. My clinic does 3 and 5 day transfers. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos (for us, 2 is the magic number) are suspended in fluid and gently placed through a catheter into the womb. This process is often guided by ultrasound. The procedure is usually painless, but some women experience mild cramping.

For a video of an embryo transfer, go HERE

After the transfer, I will be started on Progesterone in Oil shots. PIO injections are given in the rear. Progesterone is a type of female hormone. This medication is similar to the progesterone that your body naturally makes. It is given to replace the hormone when your body is not making enough of it. Progesterone is needed to increase the receptivity of the endometrium for implantation of an embryo and is used as part of assisted reproductive technology (ART).

These steps are followed by rest and lots of waiting. Bloodwork will follow about 2 weeks later to see if pregnancy has been achieved.

How is this different from IUI (intrauterine insemination)? For my IUI cycles, I used injectable meds (Bravelle and Menopur) to stimulate follicle growth, and then would use Ovidrel to force ovulation. 36 hours later, I would take my husband's sample to the clinic with me, where they would wash and process it. Then, using a catheter threaded through my cervix, they would inject the sperm directly into my uterus. The main difference is that in IUI, they do not remove the female's eggs. Because I have tubal factor infertility (I have only one tube due to multiple ectopic pregnancies, and the health of my remaining tube may be compromised), IVF is our best chance. There is still a slight risk of ectopic pregnancy with IVF (approximately 1-3%), but it is minute compared to the chance during a natural or IUI cycle where the egg and sperm fertilize in the fallopian tube. IVF bypasses the tube, however, sometimes the embryo can "float" up into the tube after the transfer.

The information above was gathered from the American Pregnancy Association, as well as from information I have been provided by my particular clinic. I have been at the Buffalo Infertility and IVF Associates since July 2009. Initially, I was seen by Dr. Sperrazza. For my IVF, I will be seen by Dr. Sullivan and Dr. Crickard.

As I mentioned above, I will continue to document my journey. I hope that sharing my journey can one day help someone else. I follow several blogs, and have been touched by each person's individual story and journey. It is reassuring to know I am not the first (nor will I be the last) person to go through infertility and come out the other side OK!