hi over the next few weeks we are going to walk you through what it means to do
ivf yeah and this week specifically talking about ivf stimulation yeah
so if this is your first time meeting us i'm sarah i am a board-certified ob gyn
and infertility doctor as well as going through ivf myself right now and i'm curt i'm a board
certified pediatrician and expert ivf med shot giver indeed and we are the doctors bjorkman
some of you may know someone who did ivf or you have a friend who's going through it or maybe you
don't know what to expect at all and that is okay yeah we are going to explain all the steps over
the next few weeks as we experience it ourselves so you can know exactly what to expect too yeah
in our infertility basics video um we talked about that initial visit some tests that might be done
as well as some causes of infertility so be sure to check that video out too
so maybe you could start by saying like what actually happens how do you start
ivf okay um usually it starts with two or three weeks of birth control pills
that seems kind of counter-intuitive it does um i know some protocols use other things like
lupron or estrogen pills but frequently birth control pills are help use for two reasons so
one is to help time your cycle and then number two is to make sure that you have a synchronized
cohort of follicles meaning you want the ovary to be quiet when you start you don't want one
of those follicles to be bigger or ahead of the rest when you get started when you're doing ivf
basically your doctor wants to take over what the brain normally does in a regular cycle gotcha okay
so you're on oral contraceptives or birth control pills then what well a day or two after you stop
your birth control pills you may get a little bit of a withdrawal bleed it is around that time that
you go in for a baseline ultrasound and some blood work this is to make sure the lining of
your uterus is nice and thin and we don't see any polyps or fibroids or anything else unexpected
and we also at that time are taking a look at your ovaries to make sure again they're nice and quiet
we don't want any big follicles or cysts gotcha now and then the blood work at this time they're
usually checking things like estrogen and may also check some other hormones things like progesterone
or luteinizing hormone lh correct so after you get the green light that your baseline scan looks good
it is time to start those injectable medications yeah and so we actually have a whole video coming
out i think next week on how to give all of these ivf meds including actual video of us giving
injections sarah giving injections herself and me giving some of those injections to her as well
to kind of be as a refresher to help you feel comfortable kind of giving yourself
an injection at home or if you're a partner giving those for your partner as well yes
once you start the gonadotropins or that stimulation medication
that kind of begins the process of coming in every other day for ultrasounds and some blood work
yeah so what are gonadotropins gonadotropins are the injectable medications that you're
taking during your stimulation so that is fsh and lh so follistim gonal-f menopur etc and these are
just like the hormones that your brain makes every month to stimulate your ovary to make an egg we
are just giving them to you in much higher doses because we are hoping for as many eggs
as we can safely get yeah and so you're taking these meds how long does this take
well it kind of depends on how your ovaries respond you usually come in for transvaginal
ultrasound and the blood work every other day the ultrasound tech measures all of your follicles
each time and we're using that follicle size plus the blood work to help us determine when your
eggs are mature and ready to go generally it is eight to 12 days of those injectable medications
before you're ready okay and so once the eggs are mature so this means they're usually getting
close to that 18 to 19 millimeters in diameter mark that's when it's time for your trigger
shot yes the trigger shot usually lupron or hcg or both signals the final maturation of those eggs
36 hours after the trigger shot your doc will go and get all of those eggs at your retrieval
it is really important to take your trigger shot correctly and at the exact time that your
dog tells you to this is because we know that your body will be ready to ovulate 36 hours
after that trigger shot but of course we don't actually want you to ovulate we want to go and
get the eggs ourselves so retrievals are generally scheduled for 35 to 36 hours after the trigger
i assume if you give the shot too early then there's a risk you might actually ovulate
before they can harvest them right or if you give it too late then there's a chance that
they aren't quite ready to be harvested at the time of your appointment correct
how do patients feel during all of this well um that really varies from person to person the
side effects from these medications can include burning and redness at the injection site you can
be some patients experience a lot of bloating or headaches and stomach pain some breast tenderness
plus you know compounded with all the emotions of going through infertility and this whole ivf
process is somewhat unpredictable you don't have a lot of control over it um and it can just be a lot
for patients are there any like big consequences or potential medical issues what about OHSS what's
that so great um thing to think about one of the risks of doing ivf and ivf stimulation is
something called OHSS or ovarian hyperstimulation syndrome it is one again of the few complications
that can happen um during an ivf stimulation it is usually seen in patients who have a high
ovarian reserve and are younger but we keep our eye on everyone um as they are going through
their cycle so OHSS is when the ovaries kind of go into hyperdrive because of these medications um
that we are giving you you know we want your ovaries to hyper respond but sometimes they
go into overdrive they start pulling fluid into your pelvis and so you can get a lot of fluid in
your abdomen you can get fluid in your lungs your you are at higher risk for blood clots
and it can be really very dangerous it's also very rare because of newer very safe
protocols it develops in less than one percent of patients but if you develop severe bloating nausea
rapid weight gain you aren't peeing as frequently as you normally do and you or
you start feeling short of breath these are all reasons to call your clinic right away
so as you're going through like how can the partner best be involved what should they be doing
well if your clinic allows hopefully your partner can go with you for some of those
follicle tracking scans um most patients do feel pretty comfortable giving themselves
the stimulation meds those gonadotropins um but you some may not and you may need to help
physically give a shot if not giving a shot it's really nice when they get the meds ready or get
the injections drawn up or just set everything out um because it's kind of a process which you'll see
in the med video next week yeah and i think like from the partner standpoint it's good to just
check in and see how your partner is handling everything that's going on emotionally like
there's just a lot that's happening in terms of we've now taken something that was very
not medical and making it medical and something that was very much required to people and kind
of removing some of that two-person interaction and so it's just good as a partner check in on
your person um it's also something that you've really waited for for a long time maybe and then
all of a sudden everything's happening all at once there's appointments every other day
injections in the morning and night and it can just be a lot it's a lot
um also we're thinking about the partner helping usually the daily gonadotropin injections are okay
and patients do themselves but the trigger shot is usually a much bigger needle so your partner
is likely going to be needed for that one so ivf was not something we anticipated
doing but here we are it's been going fine as you can see from some of the other clips
of going in for scans and different things the injections are not as bad as i thought i remember
when as you all may have seen giving myself that first shot i was like oh this isn't that bad and i
remember going into work the next day and telling our pharmacist like oh i didn't even feel it
and she said well yeah it's kind of like injecting a hot dog i thought that was rude um but it was
not incorrect uneventful for you yeah actually it's surprisingly uneventful for the partner i
think it's funny in terms of you know generally like having a baby is very much a team sport
and this like is something that like i could have not been around for any of the stem part and like
it would have just happened so i think it's just a good reminder as the partner to like check in with
your person because even though like i'm really haven't been needed to this point like it's still
we are still a team and making sure there's like still emotions still things like we are trying
to grow our family and so like wanting to just be there and be supportive emotionally even if
there isn't physically a whole lot that i have to do or can do because it's all just kind of a pain
right you have to go to these appointments every day and so you've gotta miss work or go late to
work or do these different things and you have to take a shot at the same time in the morning and
the same time at night and it's all just kind of a pain like you gotta get the needle out you need to
get your alcohol swab out you have to mix up the injection you have to drop the other injection
it's just a process and it gets old you get really good at it um but it's just a lot it is
not the old-fashioned way of making a baby by any means um and so you can't mean it's way less fun
which we've said multiple times so far so that's how stim is going we will keep you updated on
retrieval transfer and all the things and we will see you guys next week bye
we're doctors but not your doctors anything we've
said in this video is for education or entertainment purposes only it is not
medical advice any specific medical questions you have should be directed to your provider