First the Work of In Vitro Fertilization, then the Wait


Doctor and Stork Blog Series, with book excerpt from IVF patient K.K. Goldberg

Part 2: Your life, like your body, will be stretched to the limit.

Dr. and Stork imageBy day 8 of IVF – which is how you mark time through infertility treatment – my abdomen turned puffy, bruised, and sore. As we drove to our “preop” visit at the clinic, the waistband of my jeans, the pressure of the seatbelt, ached against my swollen organs. The hormones had pushed my follicles to turn up fourteen eggs. I felt like an Easter basket overflowing with fragile cargo, fragile feelings.

We faced Dr. Marion across a desk. Though it was early on a Saturday, she wore a white lab jacket over a skirt, stockings, and heels and talked to us in her standard verbal dash, as if someone had slipped a pinch of cocaine into her coffee. That she spoke one notch more slowly than an auctioneer made her seem smart and devoted to beating even the most urgently ticking biological clock. We’d waited three years to have a baby – why let another hour fritter away? She had a runner’s build, speed in all things, and she’d get us pregnant fast.

“From that bruised melon belly of yours, we’ll probably get eight good eggs, and with some luck, after fertilization, the Darwinian rat race will leave you with about five ass-kicking blastocysts.”

Of course she didn’t say those words exactly, but she did mention “five blasts.” It sounded like a party, or an explosion.

“How do you feel about multiples?” she asked, leaning back to study us.

“Multiples?” I didn’t understand the word in this context, though it would soon come to define my life.

“Twins or triplets.”

Of course, I knew twins often came from IVF but I figured that happened to Brad and Angelina, or J. Lo, people who didn’t have to stand in line at airports or worry about co-pays. Then there was my friend Tina in Vermont, who’d come by her twins naturally. She made her own maple syrup, was handy with an ax, could run in snowshoes. She taught science to eighth-graders. That was the other kind of person who could handle “multiples.”

I loved to nap in the afternoon, read novels at night. Despite all the resting, I rarely felt relaxed or mellow.

Dr. Marion responded, “If you have twins, your life, like your body, will be stretched to the limit. If you have triplets, you’re #$%!.” Of course, what she really said was “The pregnancy could be more difficult, complications more likely. There are higher percentages of miscarriage, prematurity, birth defects.”

-K.K. Goldberg

Dr. Hinckley on helping women cope with the hard work of IVF

The feelings of imminent life change K.K. describes so well above are often quite intimidating. IVF (in vitro fertilization) can be hard work.

The first six or so days of IVF shots will often occur with little mention of your progress. While we often will perform one or two sonograms and a blood test, we still don’t know a lot about how you are responding to the medication. If someone is a high responder or a low responder, we may adjust your dose a bit and see you back two days later to check your progress.

Then from day 7 to 9, you will be scheduled to have a one-on-one visit with the doctor or nurse practitioner. It is at this visit that we can review your response to the medicines and estimate the number (and sometimes quality) of the eggs we will retrieve. We also use this time to review the risks of surgery and talk about the embryo transfer.

Discussing the embryo transfer can be intense. While it may be one of the most emotional conversations of your life – encapsulating all your hopes and dreams of a family with birthdays and first days of school and graduations – it is also very clinical. Not every embryo will become a baby, and often patients will choose to transfer more embryos in the hopes that at least one is normal, able to implant, and be delivered nine months later.

We discuss the possible scenarios, some which are very rare including identical twinning. Ultimately, knowledge is power. We have a handout where we share with patients the risk of twins and triplets and the options should they find themselves in that situation. At RSC, we are committed to helping patients achieve the healthiest pregnancy, and usually this means having one baby at a time.

At the pre-op visit, we also review the risks of surgery. The risks are not high, and the benefits are obvious. Some people would not even call the egg retrieval a surgery and instead refer to it as an ultrasound-guided needle aspiration. However, because there is a small risk of bleeding, infection or needle injury to organs, at RSC we treat this procedure with as much reverence as a major surgery.

You will have an anesthesiologist (physician) at your head monitoring your vital signs and keeping you sleepy. You will not be paralyzed though, and you will be breathing on your own, just sedated so that you don’t feel any discomfort. The harvesting of eggs takes around 20 minutes.

Afterward, you will recover in the recovery room with a family member for about 45 minutes until you feel comfortable and can walk to the restroom to urinate. At the end of a long day, you will be finished with the “work” of IVF, but sometimes the greater challenge is in the “wait.”

Read Doctor and the Stork Blog Series Part 1

Coming up in Part 3, “It takes a village to make a child”