Today we had an all-morning appointment they call their “IVF Orientation” at the fertility center.
They told us they had reviewed the hysterosalpingogram results done earlier this year at a different provider and said they looked fine as well as Molly’s Day 3 labs and overall ovaries/uterus ultrasound done 10 days ago. This morning they again did a brief ultrasound for a quick look at Molly’s ovaries and uterus, and again noted the one 15 mm paratubal cyst on the right that has caused confusion in the past. They did a “trial transfer” to make sure things would be straight forward in the actual procedure, and apparently it was “easy” (for the doctors, at least). They also performed a saline infusion sonohysterogram to examine the inside of the uterine cavity, and everything looked great there, too (though Molly said it wasn’t exactly the most delightful experience).
We then met with the reproductive endocrinologist and resident again and discussed the best IVF plan for us. As at the recent consultation, we decided on a single 5-day embryo (blastocyst) transfer, which should give about a 60% chance of pregnancy and a 2-3% chance of twins. The RE also said that they can re-freeze the same vial of sperm they use so running out of vials when using IVF shouldn’t be a problem.
We also met with the nurse to learn how to draw up and administer the various medications involved in the IVF cycle. Wow, there are a lot! The list includes:
- Ciprofloxacin x 10 days, which can be completed anytime before the retrieval
- Lupron (leuprolide acetate), subcutaneous shot every morning until the retrieval, to prevent the endogenous production of FSH and LH and to prevent ovulation from occuring
- Follistim (follicle stimulating hormone, FSH), subcutaneous shot every evening until the evening of the trigger shot, to stimulate the development of egg-containing follicles on the ovaries
- Novarel (human chorionic gonadotropin, HCG), intramuscular shot as the trigger shot (about 35 hours before the retrieval), to cause final maturation of the eggs prior to retrieval
- Doxycycline x 5 days, as a preventative measure around the time of the retrival
- Medrol (methylprednisolone) x 5 days, as a preventative measure around the time of the retrieval, to assist with embryo pre-implantation
- Progesterone, intramuscular shot every evening starting the day of the retrieval and continuing until the pregnancy test (and until 12 weeks of pregnancy if pregnant), to establish, support, and maintain pregnancy
- Estrogen patches, changed every other day, starting the day after the retrieval and continuing until the pregnancy test (and until 10.5 weeks of pregnancy if pregnant), to support pregnancy
The nurse drew up an example mock calendar for all of these medications, but the exact timing of most of them will depend on when Cycle Day 1 next occurs. Going into this appointment, we assumed that we’d have to wait until after the next cycle to get started, but then we learned that you actually start the first medication (Lupron) on Day 21 of a cycle. Because we’re not yet there, that means we can start sooner than we had anticipated! As long as we can get the medications in the next 7 days, we should be good to go and start right away! We can also use the same pharmacy that we used to purchase the gonadotropins in the past so hopefully that will make it easier and faster, too.
The last meeting during the orientation was with the financial administrator for the fertility center. We considered the “money back guarantee” where you pay a substantially higher price upfront, then get (most of) your money back should it not work, but we decided against it, because that option still costs more than just paying for one fresh cycle plus one frozen cycle by themselves; if the chance of pregnancy really is about 60%, with the chance of pregnancy for a frozen cycle theoretically being even higher if we had to do one, then hopefully we made the right choice. We did opt for the “package deal,” which results in a slightly lower overall cost but does require full payment upfront. However, none of the “packages” include costs of the medications or anesthesia for the retrieval. As long as we can get the medications in time, we’ll send a check later next week.
And so this next adventure finally begins…