We are so excited for you as you begin your in-vitro fertilization (IVF) journey. Why excited? Because IVF has impressive success rates compared to other modes of treatment, and it clearly shows your commitment to your future family.
Just as you have a commitment to your goals, we at Illume Fertility have a commitment to you. We want you to be as prepared as possible for your IVF journey, whether it’s with our team or another fertility clinic, which is why we created this informative guide to IVF and all the side effects you may experience along the way.
Here, we explain the different stages of the IVF process and give you an idea of what to expect for each.
Stage 1: Suppression (Pause and Prepare)
What happens?
In this first step, our goal is to calm the ovaries, usually by using oral contraceptives (OCs). In a normal menstrual cycle, follicles (fluid-filled sacs that hold the eggs) grow at different rates. Some slower, some faster. Their size corresponds with their maturity, and ultimately, one dominant follicle will win out. We don’t really want this to happen during IVF.
Instead, we want all the eggs to reach maturity at around the same time, resulting in a higher egg yield during retrieval. Taking OCs prior to your cycle-start can pause follicular growth at a small size so that when injections start (see the next stage), the follicles all start at a similar size and grow together.
Suppression Side Effects:
Overall, the side effects are mild if noticeable at all. They can include:
- Spotting
- Breast tenderness
- Nausea
- Mood changes
Stage 2: Stimulation
The next step is the injection phase. You’ve heard about it and aren’t looking forward to it. It’s okay – we get it. Let’s break it all down and understand what you can expect.
What happens?
First off, why injections? Why can’t we just take more pills? Unfortunately, at this point, oral medications alone are not strong enough. In order to make a group of follicles “players” for that month, meaning they have reached maturity and have the ability to be fertilized, we have to be more aggressive. (Some follicles may remain small, and that’s normal. They will still be retrieved, but it’s unlikely that they are mature enough to respond to sperm.)
Let’s pause a second… a question I commonly get asked at this point is if we are “using up more eggs from my egg supply” by stimulating the ovaries.
“Are you tapping into my egg reserve to get more eggs this month?” The short answer is no.
A certain group of eggs are chosen by your body that month and there’s nothing we can do about that. This group of eggs, called a cohort, are removed from your total egg supply with the hopes that one will become dominant and the others will just stop growing and get reabsorbed by the body. That’s what happens when you cycle naturally. You would “spend” that same number of eggs that month whether going through IVF or not.
In IVF, though, the daily stimulation injections salvage the remaining eggs in that month’s cohort that would normally get reabsorbed. Now, a bunch of dominant follicles can be made (instead of just one) and are available to be retrieved and fertilized.
What to expect when you’re injecting? Injections need to be administered on a daily basis and around the same time (within a two-hour window) in order to mimic how the body would normally produce the hormones that cause follicular growth (FSH and LH). You can choose what time period (in the evening) works for you. If you pick a window between 6-8 pm, for example, you should try to stick to this as much as possible, but it doesn’t need to be followed so precisely as to disrupt your life.
For example, you are leaving for dinner at 6 pm and won’t be home until 8. You don’t need to bring your meds with you and inject them in the bathroom, you can take them a little early or a little late that day, then get back on track the next day.
Eggs are microscopic and, as previously stated, they live in fluid-filled sacs called follicles. Measuring the diameter of the follicles in the morning is an indirect measurement of the maturity of the eggs. Most women take 8-10 days of medications before their lead follicles (remember, they usually grow at different paces) are ready to be “triggered,” that is to be given the medication that causes the final maturity of the eggs and helps them release from the follicular walls in preparation for ovulation.
We see you often during this time so that we can decide the best day for you to take your trigger shot. Most women will come into the office for “morning monitoring” about 5-7 times for blood tests (that measure the amount of estrogen which reflects follicular growth and health, and progesterone, which is indicative of ovulation) and ultrasounds.
Stimulation Side Effects:
During this phase, your side effects may become increasingly more noticeable as you reach the egg retrieval.
- Headaches
- Hot flashes
- Nausea
- Bloating
- Bruising at the injection site
- Breast tenderness
Stage 3: The Egg Retrieval
What happens?
The third step is the procedure called an Egg Retrieval (done under anesthesia) where the eggs are removed from the follicles. Since we can’t see the actual eggs, we will puncture each follicle (that’s why you have anesthesia) and withdraw the follicular fluid, which then gets emptied into a dish for the embryologist to view under the microscope. He/she counts the number of eggs and prepares them to be mixed with sperm.
Whether or not they responded well to stimulation and the trigger shot and are perfectly mature is determined the following day, along with how many of them fertilized. Eggs that are pre- or post-mature are still collected and counted but are not in the proper stage of cell division to respond to sperm, so they do not fertilize.
Due to the multiple vaginal and ovarian punctures, it is normal to feel sore and have some spotting after retrieval. Think of the ovaries as being swollen, bruised, and needing to heal. After you bang your knee, for example, it might take the bruise a few days to appear and will be sore for those days until it resolves. Accordingly, many women feel worse the first few days after retrieval than they feel on the day of it, some reporting menstrual-type cramping, while others have bloating and abdominal discomfort.
After about 5-7 days, the ovaries go back to their original size and most people feel better at that point. As with any surgery, there are the rare risks of bleeding and infection, so we will ask you to tell us if you feel worse than described above, such as a hard abdomen, intense abdominal pain or bleeding, or if you have a fever.
We also want to know if you have symptoms of excess fluid collection, such as a drastic weight change or an increase in abdominal circumference. This might not be related to the surgery at all, but a sign of a rare event called ovarian hyperstimulation syndrome (OHSS). You recall that I used the word stimulation was the first stage of an IVF cycle, and some amount of hyperstimulation is needed in order to make many mature follicles and not just one.
When OHSS occurs, though, the body responds rapidly to the stimulating medications, and the consequences of this are a result of fluid collecting in the body in certain spaces that are usually hollow, such as the abdomen or beneath the lungs. So, symptoms that reflect this, like an increased abdominal circumference and difficulty breathing, should be reported to us quickly to optimize the management of this syndrome.
Egg Retrieval Side Effects:
Remember, an egg retrieval is a surgery and you will be under anesthesia. That comes with its own set of side effects. For most women, these are mild and go away within a couple of days after the procedure.
- Soreness
- Spotting
- Constipation
- Bloating
- Cramping
- Fatigue
- Nausea
- Vomiting (anesthesia side effect)
- More severe and highly rare: rapid weight gain, increased abdominal circumference, and difficulty breathing (please call you doctor if these rarer symptoms occur as these could be a sign of OHSS)
Stage 4: The Embryo Transfer
What happens?
An embryo transfer is the procedure during which either fresh or thawed blastocysts are placed in the uterus. The transfer process will look similar for either fresh or frozen, but the lead up is different.
There are many reasons to freeze your embryos before a transfer. For instance, if you are having PGS done on the embryos (Pre-implantation Genetic Screening), we will freeze your embryos in order to wait for the results and then transfer them back in a later cycle. Another reason to freeze would be if you are diagnosed with OHSS (see indicators above) so we can let your body heal prior to attempting pregnancy. Additionally, as previously discussed, the stimulating medications generate many mature follicles, which can cause your body to make elevated levels of progesterone.
In a natural menstrual cycle, there is only a short period of time that the uterus is receptive to a blastocyst, and elevated levels of progesterone can close or advance this window, decreasing your chances of implantation. In this case, we can set you up for a frozen embryo transfer cycle where we can make sure your uterine lining is ideal before we transfer the embryos back.
But maybe you don’t fall into any of those categories and instead, you’re ready for a fresh embryo transfer. This would happen within a week of your egg retrieval!
Either way, fresh or frozen, we need to assure that the uterus is hormonally ready to receive the embryos. We do this by having you administer estrogen and progesterone, which are administered daily and are oral, vaginal, and/or intramuscular injections. Believe me, we have tried to not give you any more injections, but the research still tells us that, at this point, injecting progesterone is the best option. The good news is that you don’t need to come in for blood tests until the pregnancy test, so your veins get a break (at your gluteal muscle’s expense).
The embryo transfer is done in the same OR where you had the retrieval, but this time no anesthesia is required. We ask that you have a full bladder at the time of the transfer for two reasons. One is that a full bladder helps us see when we use an abdominal ultrasound probe to confirm the placement of the embryos in the uterus. The other is that a full bladder straightens out the natural curve of the cervical canal, making the passage of the transfer catheter (with your fragile embryo(s) inside it) easier.
After transfer, you will sit for 20 minutes before you are discharged that day. Many people ask if they need to be on bedrest after that. There is not a lot of research that is done in this area, so no easy answer, but of the studies that have been done, there is no benefit to going on bedrest after transfer. We do, though, ask that you do not do any heavy exercise or lifting for the next few days, because we want you to feel confident that you have created the best uterine environment to allow implantation to take place. So if you forget, and lift something heavy once or twice, it is ok, you didn’t ruin your chances at pregnancy that month.
The pregnancy test is scheduled for approximately 9-10 days after your transfer. It will feel like the longest 9-10 days of your life. Here is what works during this time: distraction and self-compassion. Allowing yourself to feel whatever you are feeling, maybe it’s nervousness, maybe a lack of control…etc. Here is what doesn’t work: Trying to find out early, so that you can mentally prepare yourself for either outcome.
The only way to really know if you are pregnant is by a blood test on your scheduled day. Urine tests can give false positive or negative results, depending on timing and the test, so our policy is to only rely on a blood test. After the pregnancy test, the next steps depend on your results. If you are pregnant, we monitor you closely until your first appointment with your OB/GYN. If you are not pregnant, we usually have many other options for you to proceed with a subsequent cycle.
Embryo Transfer Side Effects:
The side effects of administering progesterone and estrogen can often feel like early pregnancy and are typically mild. The embryo transfer procedure has little to no side effects other than pregnancy!
- Breast tenderness
- Bloating
- Cramping
- Constipation
- Fatigue
- Bruising at the injection site
What is a Severe IVF Side Effect, and When is it Time to Call a Doctor?
Side effects can be very personal, so we always would rather you contact us if you are not sure whether something that you’re experiencing is “normal” or not. Here are a few of the infrequent, but more concerning, side effects that we would like to know about as soon as possible:
- Shortness of breath
- Urination that has reduced or stopped
- Calf or chest pains
- Abdominal bloating or distention that is severe or is continuing and not resolving over time
- Heavy bleeding, saturating >1 pad/hour
- Fever >101°
Feeling Ready For Your IVF Journey Now?
We understand - it’s a lot to take in!
IVF is a physical, emotional, and mental commitment that takes much of your time and energy (if not all of it). Not only do you have to worry about the logistics of financing and medications, you have to deal with the physical kickbacks like fatigue, nausea, and breast tenderness, just to name a few.
We are here to help you know exactly what’s going on with your body at every step of the process so that you never feel alone. Take the steps now to mentally prepare so that whatever happens with your body, no matter what you’re feeling, you know what is normal or what isn’t. Good luck on your IVF journey, and thank you for allowing us to participate in your care.
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