Hi @solanks Very happy to share - I have spent hours researching and reading about IVF to try and inform our choices. I hope some of it will be helpful.
I agree 12 IUIs is a lot to demand! Very few people are going to be able to afford that - if you have that kind of money you’re probably going to head to IVF much sooner than after 12 failed attempts! The cynic in me says it’s just an intentional obstacle to block same sex couples from accessing it. I’ll be very interested to hear the outcome of your letter!
IVF:
First I had a baseline scan to check my follicle count (AFC) - they look at your ovaries and count the number of visible follicles. This is used as an indicator of how many eggs might be collectable. I also had bloods taken to check my Anti-Mullerian Hormone (AMH), which is used as an indicator of how many eggs you have remaining. Both of these came back as pretty good for my age.
There are different IVF protocols, depending on your baseline state, some may be more appropriate than others.
”Mild” protocol IVF is being promoted by a lot of private clinics and this is what we did this time. This protocol involves using your own menstrual cycle in which you stimulate the already dominant follicles using follicle stimulating hormone. I injected this once daily from day two of my cycle (day 1 is classed as the first day you bleed in full flow).
While doing the stimulation they scan you every other day to check the growth of the follicles. They also take bloods regularly to monitor your oestrogen levels. As the follicles grow they secrete more oestrogen and if this gets too high it can force your body to ovulate (which means they can’t collect the eggs!) and it is also associated with ovarian hyper stimulation syndrome which can make you very poorly.
(Women with PCOS are at higher risk of this, as they have large numbers of follicles which is why a “mild cycle” with less stimulant drugs is often suggested for them.)
I don’t have PCOS but I do have quite a polycystic pattern and my oestrogen was quite high during my cycle, and even though I wasn’t on a high dose of the stimulant drug they actually dropped the dosage halfway through.
once the follicles get above a certain size/blood work indicates high oestrogen you then introduce a second injection which prevents ovulation. Mine was called cetrotide.
i think I did 6 days of stimulation injections with the latter 4 of those days including the second injection to prevent ovulation. I then did a “trigger” injection on day 7 which is to mature the eggs and induce ovulation. This is very carefully timed to be done 36 hours before the egg collection procedure.
egg collection was done by a consultant under sedation. I got one hit of drugs that made me high as a kite (quite fun) followed by another that put me to sleep. Wasn’t aware of anything at all! Woke up 20 mins later with a sharp period type pain in my uterus/ovary region. Was fully awake and walking out of the clinic 40 mins later. Was a bit sore for 24-36 hours post egg collection - easily managed with paracetamol.
they introduced the sperm to my eggs that day. Out of 8 eggs, 5 fertilised. They like to try to grow them to 5 day blastocysts if they can. This is because at day 5 they can see more in more detail which embryos are developing well, but they can also do 3 day transfers if there aren’t many to choose from. Lots of clinics “grade” embryos based on how nice they look under a microscope. This can be helpful to a point, but should also be taken with a massive pinch of salt, as the appearance of the embryo doesn’t tell you anything about the genetics of it. The Duff is a really good website that has a very detailed post about embryo grading.
assuming you are doing the embryo transfer in the same cycle, you go back at either day 3 or day 5 to have it put back in. This feels like a 20 minute smear test with a semi-full bladder: they thread a catheter through your cervix with the help of a speculum. It’s no fun but again can be managed!
At this time you are also on some form of progesterone support (either injections or vaginal pessaries or suppositories). This is because in a normal cycle the ruptured follicle post ovulation becomes a corpus luteum, which secretes progesterone to support implantation until the placenta is mature enough to take over. When you have your eggs collected that’s all been disrupted so you need to be on a replacement.
once the embryo is in, it’s the TWW (though this is often 10-11 days in IVF because the embryo is already 3-5days old when it goes in).
Costs:
this cost us £2750 (meds, bloods, monitoring scans) + £990 (years storage for embryos) + ~£1300 for sperm and shipping
the following two embryo transfers were medicated and cost £2300 each; this cost seems pretty standard across the sector.
all in all this probably equates to the cost of 4-5 failed IUIs.
This is less than a lot of IVF because we were with a clinic who have nurses lead their clinics, but who consult regularly with the consultants. It was also because I was on a drug called Bemfola which is cheaper than other stim drugs such as gonal F (thought research shows that bemfola is almost as effective as gonal F in terms of the number of eggs it helps produce).
a mild cycle under the sister clinic of my current one, which is consultant led with more expensive meds, would have been around £6500 plus cost of
donor sperm. I think this is more in line with the cost of more traditional long cycle IVF.
down sides of short protocol is that you get fewer eggs which can mean fewer embryos, though not always!
my understanding of long protocol IVF involves a period of “down regulation”. This is where you take a medication to suppress your natural menstrual cycle for a few weeks. This means that your ovaries are sort of “flat” without the natural dominant follicles. When you start stimulation you then have the chance to grow the follicles more evenly, and this can lead to more eggs and the possibility of more embryos.
as I’ve said unfortunately I’ve not had success and we have decisions to make on our next move, so ivf is still a gamble! But when we weighed up the cost to risk of failure ratio, we felt it was a gamble worth taking. It’s not paid off for us this time, but I do know people for whom it has worked wonderfully.
I really hope this is helpful! Sorry it’s so long, and I hope it’s not telling you loads of stuff you already know.