I may not be your fertility doctor, but it doesn’t matter where you live.
If you’re thinking about or actively preparing for In-vitro Fertilization (IVF) then I’m so glad to have you here.
My intention is to help you get ready for IVF — regardless of who your doctor is or where you live. These are the tips you can apply to your situation to take an active role in your fertility care.
Where do you begin?
Step 1: Know Your Diagnosis
What better way to do this than by following the TUSHY method.
Tubes, Uterus, Sperm, Hormones, and Your Genetics.
There’s no such thing as unexplained fertility. You can’t tell me that you’re forty years old and have unexplained fertility. You just told me the reason — your age!
You have to be honest with yourself. You have to do the work (with a doctor) of uncovering your diagnosis. The reason? Once you have a diagnosis then you can do what’s in your control to increase your chances of getting pregnant with your IVF cycle.
And yes, you read that right. Going through an IVF cycle does not guarantee that you’ll become pregnant.
You can only do so much that’s in your control. After that, you have to just “Let it Go”. You can’t fully control the quality of your eggs. Sure you can eat right, take supplements, sleep, and reduce stress. But, at the end of the day, you’re either going to have a good egg and sperm combo or you’re not. To obsess over things you don't have control over, to me, is unhealthy.
That is exactly why I’m doing this show. I want you, and every one of my patients, to go through this preparation list. To do what’s in their control and feel like they have given themselves the best chance at having a baby.
I want you to be able to say, “I’ve done my preparation and I’ll have no regrets about what will happen during the cycle.”
Before you even start your cycle…
Step 2: Assemble your team
Fertility Therapist: Talk to someone about the emotional process. It’s more than just a simple surgery as it has to do with giving love and finding that love back. If you don’t have a fertility therapist then ask your fertility doctor for a referral.
Exercise and Eating: Work on your nutrition. Follow a pro-fertility diet or a Mediterranean diet. Talk to your doctor or a trainer, if you have one, about what the best exercise regimen is for you. Get an individualized plan.
Acupuncture: I don’t acupuncture shame people. I don’t make my patients do it. It is your choice, but I do make people aware of some of the potential benefits. What I can tell you is that my patients that do acupuncture tend to recover better and they feel better during treatment. They have fewer side effects. Whether it improves your egg quality is up for debate. I think anything that makes you feel physically better could improve your egg quality. But at the end of the day having another cheerleader on your squad is a great thing.
Mindfulness and Meditation: There are many great apps out there, find one you like, and do it. Teach yourself mantras like, “I’m going to be a parent”. It’s very important to have a positive mental attitude when you go into your IVF cycle.
Step 3: Be Organized & Keep Track of Your Files
Create a fertility binder. Ask questions and take control of your own health. Know what your protocol will be and why. Get detail from your doctor, record it, and keep track of it. Be part of the plan and discuss your treatment. It should not be a one-sided conversation with your doctor.
Questions to ask your doctor:
What is my follicle count?
How are my estrogen levels rising during the cycle?
Is this what you expect? Are you happy right now?
Every cycle is a learning experience. Whatever happens, it may be something you want to know for a future cycle.
Step 4: Understand Medication Side Effects
For example, if you are put on birth control (what I call, IVF readiness pills) then it would be helpful for you to know that it’s normal to get a period after you take the last pill.
As you take the medications did you know that you can get egg white cervical mucus? That’s exactly the body’s natural response when your estrogen levels go up. That is also what happens when your body’s estrogen levels rise around ovulation. For many of my IVF patients, they freak out because we don’t want them to ovulate, and they think they are. But I’m able to reassure them that this is a normal response to the birth control and not ovulation.
When you see this egg white cervical mucus this is when I want you to stop exercising and to take it easy. This is the time I think I want you to abstain from sex before the egg retrieval.
Ask your doctor these questions. Now that you’re reading this article and watching the show, you know!
Step 5: Understand your semen collection options:
Trust me when I say that you want to avoid a sperm emergency. What do I mean by that? It’s when you are in need of sperm on the day of your egg retrieval and for whatever reason (anxiety likely being the main culprit) ejaculation just can’t happen.
So I ask my patients if they think there may be an issue collecting sperm on the day of the retrieval. If they say yes then I suggest we freeze some sperm. It feels better to have some frozen so that on the day of you have less pressure to produce a sample. You can collect in my office, at your home, or at a hotel room. You have so many options. The time of the semen collection syncs up with the female collection. After the egg retrieval, the male partner will hang out with the female patient for forty-five minutes after the procedure until it’s time to go home.
Sometimes egg retrievals are super early in the morning — 5AM. You need to know what time your retrieval will be. If you’re not a morning person and you or your partner think that may be an issue for sperm collection on-site then plan ahead and freeze some sperm to use.
Step 6: Decide if you are going to do IVF with or without ICSI or PICSI
You guys know this, but every embryo takes an egg and sperm cell. There are different ways of getting the sperm cell with the egg cell. You can take an egg and put 100,000 sperm on top and that’s called micro drop. Or you can take a single sperm and inject into the egg and that’s called ICSI. Sometimes, doing a sperm DNA fragmentation test will help tell you which is the best sperm procedure for you.
PICSI is a way to select higher quality sperm cells for injection into the egg cells.
What happens if you don’t have PICSI and you end up with an embryo that’s not usable? You may be very upset, especially if you weren’t clear on the protocol your doctor was using upfront.
In fact, before any retrieval with a patient, I review the details of what we hope to accomplish and how. I talk about how many eggs I expect to retrieve, how I plan to make embryos, etc.
For example, I may say that we are doing ICSI with PICSI and we’re going to transfer fresh, transfer frozen, do genetic testing, and then get into when I expect to give you updates about your embryos.
I encourage you to ask your doctor.
When can I hear from you again about the fertilization report? When am I going to know about the embryo quality? Who is going to be calling me?
In my office it’s me. I call my patients first thing in the morning.
Step 7: Decide if you will genetically test the embryos
Most of my patients choose to genetically test embryos, but it’s not for everyone. Discuss this with your doctor and make the choice that’s right for you.
If your doctor does genetic testing, will they allow you to transfer mosaic embryos?
Mosaic embryos are embryos that have a potential genetic abnormality but still have a 30–50% chance or more of resulting in a live healthy birth. So talk to a genetic counselor once you get your genetic report and talk in more detail about the mosaic embryos and see if it makes sense for you to transfer them.
However, knowing if your doctor will even transfer a mosaic embryo — yes or no — is really important to understand. Some clinics discard mosaics without leaving a choice for patients to transfer or store them for the future. Some clinics don’t tell patients of any of their embryos are mosaic. You should know about this. I don’t want you to be surprised or feel unprepared.
Step 8: Understand if you will be at risk for OHSS
Take for example you’re doing your egg retrieval and you find out you got 20 eggs. Well, that means you’re at higher risk for OHSS.
Ask your doctor:
Am I at more risk for OHSS?
If so, what will we do about it?
I ask my patients who have 10 more follicles to hydrate with electrolyte-rich fluids (Gatorade, Propel, G2, Drip Drop, Liquid IV powder that you can add to your water). Staying hydrated is really important during and after the egg retrieval.
I also give my patients a medication called bromocriptine every night until their period starts. You can also use a medication called Femera on the day of the trigger shot to reduce estrogen levels. Lastly we don’t use HCG trigger for patients who have a very high risk for OHSS.
These are my tips and tricks so that you stay safe if you’re at risk for OHSS. I encourage you to ask your doctor about them as well.
Once you’ve put in all of the work of retrieving your eggs, then it’s time to prepare for your transfer.
Step 9: Prepare for the transfer
What’s my embryo quality?
What are my chances for pregnancy?
What am I going to do if it doesn’t work?
It’s helpful to talk about these scenarios going in. Let’s say you’re 38 and you want two kids. You had one embryo that’s very strong and one that’s not so strong. You may actually want to consider a second cycle before you transfer. These are the things I talk through with my patients in something called a post IVF consult. We usually do this two weeks after the egg retrieval once we’ve gotten the genetic testing results back.
If you’re planning a fresh transfer (without genetic testing) you still want to have this conversation with your doctor.
What is my embryo quality?
Will I have the chance to meet my family goals if I transfer fresh?
Let’s say you’re 38 today. Two years down the road when you’re 40 you don’t want to look back and have fertility regret.
You don’t want to wish that you had frozen embryos from when you still had healthy eggs. It’s why I believe it’s super important to have this conversation with your doctor before you transfer.
The other thing I do is implantation testing. I think about it as an evite for your embryo transfer party.
These are tests that you do before your transfer. They involve taking medications like progesterone and estrogen and then doing a biopsy on the lining of the uterus. I call it a mock embryo transfer. It allows me to really understand a woman’s cycle and hone in on her transfer protocol. This sets the stage for defining a woman’s window of implantation.
Step 10: Realize that you are now VIP
You are prepared! You’ve filled your brain with information and your heart with positivity and hope!
You are soon to be pregnant with a very important pregnancy (VIP).
You’re used to being checked all of the time, and then you get pregnant and you’re seemingly on your own. It’s normal to feel anxious and worried in the first part of pregnancy.
I check HCG and progesterone levels every couple days, then a week later, and an ultrasound around 6 weeks of pregnancy. I then offer my patients a second ultrasound until they see their OBGYN.
A little bit of TLC is needed sometimes as a fertility patient you’ve been on a long road to get to pregnancy and I want you to feel nurtured and taken care of during the early stage.
Wherever you live and regardless of who you see as your doctor I hope that this information serves as a guide. My goal is to equip you with the right questions to ask so that you can take an active role in your IVF treatment plan.
If you’re curious about something or have a suggested show topic, please send a note to firstname.lastname@example.org or post a comment here.
You can also catch more of me and topics like this through The Egg Whisperer Show. The episodes are live-streamed onYouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!