In-Vitro Fertilization (IVF): A Step-By-Step Guide from a Fertility Nurse
At RMA of Connecticut, we recognize how stressful it can be to undergo an IVF cycle. While we can’t take the stress away completely, we can give you the tools that you need to tackle this task with a clear head, a sound plan, and the comfort of knowing you have a supportive team rooting for you.
In this post, I’m going to do my best to give you an overview of what to expect in a typical IVF cycle… think of it as a “zoomed out” picture. (Rest assured, your doctor, nurse, and patient navigator will help you “zoom in” on your specifics once you get started.)
Additionally, this IVF breakdown is specific to RMA of Connecticut. If you are cycling with a different clinic, your steps might be slightly different, but will typically follow this outline.
It’s also important to know that at RMA of Connecticut, we equip you with a team of people to personally help you throughout your entire journey. This includes your doctor, nurse, patient navigator, and an insurance & billing advocate. I will reference these members throughout the process as they are relevant.
The best news about having a team? You will never be alone for any of this and will always have a close-knit team (and everyone else at RMA of CT) in your corner.
What is the IVF Process?
1. The Diagnostic Cycle
At a glance:
- Purpose: To determine your specific fertility diagnosis
- What to Expect: 2-3 Office Visits
- Time: 4-6 weeks
The first step is for us to get to know your fertility story. This is called a “diagnostic cycle.” You will be asked to come in 2-3 different times during your menstrual cycle for various blood tests, ultrasounds, and studies. We are assessing how strong and well-functioning your ovaries and reproductive organs are and confirming that you are healthy and fit for pregnancy. Depending on where you are in your menstrual cycle, it can take 4-6 weeks to complete this step.
You’re not alone in this, though. If you have a male partner, we will ask that he come in for a semen analysis and bloodwork as well.
While gathering diagnostic information, we may find something that we want to address before proceeding. For example, you may have a thyroid level that is not ideal for pregnancy or a blood sugar level that is concerning. Often, these are minor things that can be fine-tuned quickly. Other times, we may recommend that you delay trying to get pregnant until your health concerns are addressed.
At this point, you might be thinking that this first step is a lot. A lot of testing, a lot of waiting, a lot of visits… and it is. I understand. But the more prep work we do, the better we can prepare for your cycle. You might also be thinking that this is a lot of time management. Once again, you’re right! But please, don’t worry.
At RMA of CT, we have a unique team-system where you will not only have a doctor, but you’ll have a whole slew of individuals devoted to your success. This team includes a patient navigator who will assist you in the management of your journey, making sure you check off every box along the way. She will be your “go to” person. She will help you schedule appointments, remember appointments, and field your questions when you don’t know who to go to. She is available by phone or email, and you will likely be chatting with her often.
2. The Follow-Up Consultation
At a glance:
- Purpose: To determine your specific cycle protocol
- What to Expect: 1 Office Visit
- Time: 1 Hour
Once you have completed your diagnostic cycle, and we have all of the necessary info, your doctor will sit down with you for a follow-up consultation. Together you will decide if IVF is right for you, and if it is, she/he will customize a protocol. This is a unique, carefully thought out “recipe” (medications and ultrasounds) that is very specific to YOU. You will follow this “recipe” for several weeks, and we will carefully monitor you along the way.
3. Get Organized for Your IVF Cycle
At a glance:
- Purpose: To enter IVF confidently with the necessary tools, expectations, consents, and skills.
- What to Expect: Paperwork, numerous phone calls and/or emails, video modules. The good news? You can do it all from your couch.
- Time: Well, it depends. But it typically takes days or weeks to regulate your natural hormones, sign all your consents, get insurance approval (if using), and watch all your video modules.
Following your IVF consultation, your team will help you get organized for a treatment cycle. In order to proceed with IVF, you will need to…
- Be financially cleared by your Insurance and Billing Advocate
- Complete all consents
- Learn how to mix and administer injections
- Have all the medications necessary to start
At RMA of CT, your nurse will email you a series of online modules to watch. These are mandatory videos that will teach you everything you need to know about IVF at our practice. These videos cover it all – what to expect during treatment, how your body will respond, how to mix your medication, how to correctly give yourself your shots, and what to do should you have an emergency or need assistance when the office is closed. These videos can be watched at your own pace, and in the comfort of your own home. You may find it helpful to have a friend or partner watch them with you, and if you want, you can watch them multiple times. At RMA of CT, we also offer an in-person medication mixing class which we encourage all of our “first-timers” to attend.
Once you have watched each of these videos, you will be prompted to complete your consents. We utilize an electronic signing program which allows you (and any partner) the ability to sign consents electronically and submit. You will NOT be allowed to start treatment without signing those consents. Therefore, we encourage you to complete ALL consents as soon as they are received.
While you are watching your modules and completing your consents, your financial coordinator is hard at work. They have the tricky task of getting insurance companies to approve treatments and medications. They work very closely with you so that you understand what you will have to pay along the way, with no unexpected surprises. Once your financial coordinator is confident that both you and your insurance company are on board, they will give your nurse the “green light” to order your mediations. Medications for IVF are ordered through specialty pharmacies – you can’t just pick them up at your local CVS or Walgreens, unfortunately. If your insurance company is paying for your meds, they will tell us which pharmacy to use.
Meanwhile, your nurse will coach you on how and when to start medication that will appropriately “prep” you for a treatment cycle. Our first goal is to make sure that your naturally occurring hormones don’t interfere with the IVF medications. To achieve this, we will ask that you start birth control pills (during a menses) or estrogen pills (before a menses). Your nurse will instruct you on the appropriate way to do this.
So, to recap the Get-Organized phase: Once you have…
- Been financially cleared
- Completed online modules
- Signed all treatment consents
- Received medications from specialty pharmacy
- And been appropriately prepped with birth control pills or estrogen pills…
YOU ARE READY TO GO!
4. IVF Begins – Follicle Growth Phase
At a glance:
- Purpose: To successfully administer meds and produce as many eggs as possible.
- What to Expect: Daily injections, repeat bloodwork and ultrasounds about every other morning
- Time: 10-12 days
So much build up, all for this!
Your nurse will give you an IVF calendar or IVF “protocol” to follow. It will tell you every single thing you need to do, daily. It starts with when to come in for your first blood test and ultrasound. At this visit, we are ensuring that everything is “quiet.” (In fact, you may hear us call this visit a “suppression” or “baseline” check.) We want to make sure that the lining of your uterus is thin, that your hormone levels are appropriately low, and that there aren’t any sneaky follicles or cysts growing on your ovaries. If all looks good, we will instruct you to start your injections. If something is going on that we were not hoping for, then you will be given an updated plan.
Most women need IVF injections for 10-12 days. The exact amount of time varies from woman to woman, so don’t be alarmed if you need a little less or a little more time. It’s not a race! Your ovaries will tell us when they are ready.
During the time that you are giving yourself shots (or your partner steps in to administer the injections), we will instruct you to come for blood tests and scans regularly… typically every other day. As the follicles on your ovaries grow, we count and measure each one of them.
Count and measure, count and measure, count and measure, until TA DA! Your ovaries have their final say, and you are ready for egg retrieval.
5. IVF Continues – Egg Retrieval
At a glance:
- Purpose: To retrieve as many mature eggs as possible
- What to Expect: Quick procedure under anesthesia, egg count will be known almost immediately afterward
- Time: 2-3 hours
On retrieval day you should expect to be in our Norwalk office for 2 to 3 hours. You will have anesthesia through an IV that will make you sleep comfortably. The procedure typically takes 15 minutes. Once you wake up, we will monitor you for an additional hour.
Before you go home, we will be able to tell you how many eggs were collected. You’ll be instructed to go home and rest. You may still feel crampy, bloated, or tired. Usually Tylenol is sufficient for any discomfort you may experience.
6. IVF Continues – Embryo Development
At a glance:
- Purpose: Create, foster, and monitor embryos
- What to Expect: You will receive multiple updates as fertilization and growth occurs
- Time: 5-7 days
The day after your retrieval a nurse will call to check in with you. She’ll make sure you’re feeling okay, and she will tell you how many of your eggs were successfully fertilized.
From there, you will get regular updates from us until we know how many of your embryos reach the blastocyst stage – which is the stage needed to achieve a pregnancy. At this point, we can either administer a fresh transfer or freeze for a future transfer.
7. IVF Concludes – The Embryo Transfer
At a glance:
- Purpose: To transfer a healthy embryo into the uterus for implantation
- What to Expect: Simple office procedure, you’ll be awake and able to view the entire process
- Time: 2-3 hours total
If your plan is to transfer a fresh blastocyst, it will occur immediately after the embryo development phase. If your plan is to do chromosomal testing, then we will freeze your blastocysts for future use. You might have to take more medication, including a progesterone in oil injection.
The actual procedure itself is painless and easy – a catheter is inserted through the cervix where the embryo will eventually be deposited through. It will rest in the uterus in the perfect spot, ready for implantation. On the day of the transfer, we recommend laser acupuncture before and after the transfer as it has been shown to increase implantation success rates.
8. The Pregnancy Test
At a glance:
- Purpose: To determine if you’re pregnant or not
- What to Expect: Occurs 8-10 days after a transfer, bloodwork and a phone call later in the day
- Time: 1 day
You will come into the office 8-10 days post-transfer for simple bloodwork. Your nurse will call you as soon as results are received to relay that information to you.
Fertility treatment isn’t a perfect science. And, sometimes we have to give you disappointing news along the way; your ovaries may not respond to medications the way that we had hoped, the number of eggs that we get in the operating room may be less than we expected, or your fertilized eggs may not grow to normal blastocysts. If this happens, we realize you may feel sad, disheartened, frustrated, or maybe even angry. Fortunately, this news rarely sneaks up on us, and we will be communicating any concerns along the way. We also have a great team of wellness providers who are available to help you if you feel overwhelmed or need help making decisions and moving forward.
So, yes. IVF treatment can be intense, complicated, and prolonged. But it can also be empowering. Many women feel excited about being proactive and moving forward. We know that a lot of responsibility falls on our patients. We know that you will be rearranging your schedule like an Executive Assistant, mixing medications like a Chemist, and administering injections like a Nurse.
But take a deep breath. We will give you all the tools, skills, and support you need, and you will conquer it with confidence. We are your ultimate fans, and we will root for you as you tackle this journey. Good luck!
But how am I going to pay for IVF?
About Kirsten Hennigan
Kirsten has been a nurse for 18 years. She earned her Bachelor of Science in Nutrition from Cornell University in 1999 and went on to earn both her Bachelor and Master of Science in Nursing from the University of Pennsylvania in 2002. Her entire nursing career has been in women’s health, first as a nurse practitioner in general gynecology in Philadelphia. She moved to London in 2006 and worked as a fertility nurse on Harley Street. After a move to Tokyo and a short stint as a nurse practitioner in Manhattan, she landed at RMA of Connecticut in 2014. Kirsten’s favorite part of working at RMA is helping patients gain trust in us and watching their transition from feeling broken to feeling empowered with options. She feels very privileged to play a part in that transition. The most shocking fact about Kirsten is that she doesn’t watch television. She hears all about different shows during morning monitoring but has never seen a single episode!