The Birds and the Bees for IVF
Here’s the part of the birds-and-bees convo that usually gets skipped over but would be helpful for about 17% of the population who are experiencing infertility. When a couple really loves one another and can’t seem to make a baby, that’s where IVF comes in. The IVF process is two parts: first, you have to create an embryo, and next you have to transfer it.
First up: egg retrieval (what is technically the “IVF cycle”).
In a perfect world, you have to do none of this. In the imperfect world of fertility treatments, ideally you do this first part just once. You get pumped full of hormones that help your body create many more eggs than it would naturally produce (instead of 1-2, I created 31!). That way, you can have multiple embryos to be able to create your family.
Here’s how that worked for me — and, though I haven’t done the research on the averages (because I’ve been too busy researching everything else about this process), how it works for most women I know. There’s something called the “IVF waterfall” that might just ruin the beauty of actual waterfalls for you forever. It’s the term used for the cascading effect that happens from egg retrieval to embryo creation because women’s health hasn’t been studied enough for doctors to know how to do this better.
Before we look at the process, you should know that IVF clinics typically recommend you have 3 embryos per baby that you’d like to bring home. That’s because most women need to have multiple transfers (the first 1-2 often do not work). So for 2 kids, 6 embryos are the recommended minimum.
You should also know that at every step of the process, people experience about a 50% drop off in what is considered viable to move on to the next step.
What that looked like for me:
10 days of hormone injections to make my body create multiple follicles (the parts of the ovaries that produce eggs).
1 surgery to retrieve 31 eggs.
Of those 31 eggs retrieved…just 15 eggs matured.
Of those 15 eggs that matured…only 8 fertilized.
Of the 8 that fertilized…(luckily) 6 made it to day 5 blastocysts, which means they are embryos ready to transfer.
And by the way, 31 eggs is a LOT. Most women get closer to 10-20, often leading to even worse waterfall outcomes. And some women get just a handful and have to undergo multiple IVF cycles just to get a single viable embryo.
According to the Society for Assisted Reproductive Technology, these are the most common medications used during an IVF cycle (this first part). The descriptions are my own — in plain English because I’ve read enough to know it’s annoying (and sometimes a huge impedient) to have to translate medical language on top of everything else you’re going through.
Gonadotropin releasing hormone: a subcutaneous injection that indirectly stimulates the ovaries to prepare them to work harder
Gonadotropins: a subcutaneous injection that directly stimulates the ovaries to produce multiple follicles where eggs will grow
Human chorionic gonadotropin: a subcutaneous injection that makes eggs mature and ready to harvest
That’s the first part, the IVF cycle.
Next up: embryo transfer.
This is the part where the embryo is implanted into the uterus to hopefully stick around and grow into a baby. I say “hopefully” because that’s all we really have to go on here.
If I sound a bit jaded, that’s because I’ve had 3 embryos not stick and zero answers as to why. Multiple doctors have told me that it’s “bad luck” and I have an official diagnosis of “unexplained infertility.” If that’s all we have to go on for one of the most precious, invasive, and expensive treatments that women experience in the year 2023, it’s clear to me that science is woefully behind.
But back to the actual science we do know.
An embryo transfer requires tricking your body into thinking it is pregnant. Since it’s not, it won’t know to produce the vital levels of hormones required to carry a baby: estrogen and progesterone. The mother’s body produces these hormones for about the first trimester, at which time the placenta is large enough to take over and produce these for the rest of the pregnancy.
So how to trick the body into doing this? More hormone injections. Specifically: subcutaneous (under the skin) estrogen injections and intramuscular (into the muscle) progesterone injections. I wasn’t able to find a thorough common list of medications for embryo transfer because the types, amounts, length of time, and more can vary from person to person.
According to the American Pregnancy Association, the following embryo transfer medications are often used:
Lupron: a subcutaneous injection used to prevent ovulation
Medrol: a daily steroid to help with embryo implantation
From my own experience (and many other women I’ve talked to), the list goes on. In addition to estrogen and progesterone, my embryo transfer medications included:
Heparin: a blood thinner used to treat blot clotting disorders, one of the most common causes of miscarriages (Get yourself a simple blood test to check for this, ladies!)
Baby Aspirin: a daily dose to support the Heparin
Lupron: a subcutaneous injection used to prevent ovulation
Prednisone: a daily steroid to help with embryo implantation
Platelet Rich Plasma: a uterine injection to help with uterine lining growth
Viagra: a daily dose to support uterine lining growth
Typically, these medications are taken throughout the first trimester or about 91 days. Depending on your diagnoses, some may be taken longer (like Prednisone) and some may be taken throughout the full pregnancy (like Heparin and baby Aspirin).
Last but not least, there are the vitamins and supplements. I won’t bore you with the full list of the dozen or so that I take (do your research and ask your doctor because every person is different). Just know that you need a good prenatal vitamin, which is probably not one that’s being hawked by influencers.
So, there you have it. How IVF babies are made. It’s not quite as romantic as the traditional birds-and-bees talk, but I hope it helps someone out there!