Lets talk about drugs.
No, not the fun ones.
Fertility drugs.
Firstly, let me say, I really hope if you’re going to undergo any type of fertility treatment that you don’t have an aversion to doctors or needles and that you are comfortable to regularly strip to the waist in front of random strangers…
Anyway. Drugs.
First stop on your fertility journey might be Clomid. Or ‘the mad pills’ as people call them. Clomid is often used during IUI (inter uterine insemination) or so that a clinic knows you are probably ovulating. As with all other treatments there will be regular scans to track your progress until follicles are big enough for you to give yourself a trigger shot – probably Ovitrelle – and either return to hospital for IUI – basically making sure the little swimmers get UP there at the right time, or take part in some couples DIY at home within 36 hours.
So why are Clomid pills ‘the mad pills’? Well, for many women the mood swings are horrific, along with nausea, breast tenderness, headache etc. On the plus side, you normally only have to take them for a few days, they are tablets and so in theory its not that disruptive. The other side effect of Clomid is often… twins… :O
An aside: if you’re trying to get pregnant be aware that some fertility drugs will provide a ‘false positive’ for up to 14 days after use. This is certainly the case with Ovitrelle which is prescribed as a drug which will make you ovulate within 36hours. There is nothing quite like peeing on a stick (POAS), having a positive result, only to then believe yourself to have had a chemical pregnancy (basically one where your period comes as normal but you got a positive result, often called a missed miscarriage). Unfortunately, not all clinics make you aware of this fact (or that certain drugs need to be kept in the fridge!) so, forewarned is forearmed.
So, anyway, clomid hasn’t worked. Boo. This might mean the next step in your journey is IVF. This is when the serious drugs come out.
If you’re undertaking normal IVF, the beginning of the process starts with ‘down-regulation’ – basically turning everything ‘off’ and putting your body into a sort of mini-menopause. (you can imagine this is a merry-go-round of fun)
After doing this for a couple of weeks – ‘doing this’ can mean pills, injections, suppositories and combinations of all these! – you will move onto stimulating your body to produce as many eggs as possible through injecting daily with stimulants to encourage this. As I said in a previous blog, normally your ovaries produce 1 egg per month. Several follicles start the ‘race’ until gradually your body focuses on producing one to be released (generally anyway!). With normal IVF, the drugs keep ALL these follicles growing.
As a reminder, your ovary is the size of a walnut. A full sized follicle (20-25mm) is the size of a grape. Having more than a couple of grapes in your ovary can start to become quite painful. Often in normal IVF you will have up to 20-30 follicles with 10-20 eggs harvested on egg collection day. Not only does this make your ovaries very sore, it can also cause ovarian hyperstimulation syndrome (OHSS) which can lead to serious problems. Additionally, as your ovaries float they can also twist with this many follicles in them and cut off the blood supply (I like to imagine internal testicles twisting… not really, but ouch). I have seen some people report having over 70 eggs harvested in one cycle though…OMG, I can’t even… agh!
Finally, your body tends to only produce one egg a month normally because it identifies the one which has the best chance of fertilisation (in the magic 12-24 hours an egg is viable for once released). From growing as many follicles as possible it can often be the case that a large portion of the eventual harvested eggs are either not mature enough to be fertilised, or not really viable and so die off during the 3-5 day waiting period post fertilisation.
Its also true that no matter what type of IVF you go through, you may have nothing to show for it in the end. Either your eggs might be too immature, might not fertilise, might not get to blastocyst stage or might not implant when transferred back. This is why the live birth rate (frankly the only rate that matters at a clinic imho) is the important one to look at.
Anyway, so, you’ve encouraged all your follicles to grow and now you are going for egg collection. A few days before additional medications will be added to your regime to help the egg mature. Then 36hours before you will inject an ovulation hormone to make it easier to collect the eggs. Exactly 36hours later you will have your eggs harvested.
As an aside – this is as fun as it sounds…
Egg harvesting generally takes place with sedation and painkillers (and drifting off is frankly the best part of the whole process). The doctors will warn you of the possibilities of perforated bowels (!) before you sign a consent form to go ahead.
Afterwards you get some time off the drugs though right? Sorry, no, you will be given more drugs. Antibiotics and, if they are planning to put blasts straight back in, some form of progesterone. Probably vaginal suppositories, possibly more injections. At this point your vagina will probably be wondering what it ever did to offend you so much. Things will likely be sore and crampy (massive understatement), and you might feel like you have boulders in your bowels (mmm).
You will take the same drugs until transfer 3-5 days later and then for 2 weeks after that until your pregnancy test. If its positive you have to take them until week 12 of your pregnancy by which point the fetus should be producing enough itself to sustain the pregnancy. This is needed as progesterone is normally released as the corpus luteum releases the egg, but in IVF that doesn’t happen.
Frankly by this point, if you’re not pregnant the thought of going through all this again isn’t that appealing, but still we do, over and over and over again, some people for years…
As an additional shout-out, egg donors undergo these processes in order to help other women get pregnant. That is a LOT of shit to put your body through for someone else (who you probably don’t know), and is often why they used to insist women had completed their families first before doing it. These days though donors often undergo milder forms of IVF which works with your natural cycle instead of undergoing down regulation. They are still bloody rockstars though as any form of IVF sucks.
So, enjoy the drugs…? (well, the sedation bit is nice at least…)