- IVF or see what happens?
- The older a couple becomes the sooner Assited Reproductive Technologies (ART) or In Vitro Fertilization (IVF) should be considered. My girlfriend cautioned me not to wait too long so we started looking for help after 6 months of trying. In our situation we knew after the vasectomy reversal surgery didn't work that IVF was the only way to have children of our own.
- IVF now or when?
- What no one really talks about is how long IVF can take to get basic answers. The first appointment is a consult, ultrasound and labs. It costs under $400, BUT one clinic had a 5 month waiting list. Then the HSG (Hysterosalpingography) test- The doctor injects dye into the uterus and fallopian tubes, looking for a mechanical reason that pregnancy is not occuring. Some women naturally get pregnant after having this done. And yes all these have to be timed with your cycle, which adds 2-4 months to your timeline.
- Genetic test or no genetic test?
- Many clinics do this for the couple in advance of treatments. Somehow we missed this. Genetic testing is interesting. One can receive a lot of information and has to decide what, if anything, to do with it. In hindsight, we may have strongly considered this. Genetic testing can identify if either partner is a carrier for genetic disorders. And it all comes down to probability. For example, if I am a recessive carrier but hubby is not; our child may be a carrier but will not have the genetic disorder expressed. Alternatively, if we are both carriers; 1/4 that the child will have the disorder, 1/2 that the child will become a carrier without having the disorder, 1/4 that the child will not have any of the genes. Long story short we did not do this part.
- There is also genetic testing of embryos. This we did for 3 of our embryos. The embryology team can mature the embryo to 4 or 5 days. Not all will survive. At 4-5 days the embryo cells have differentiated into the placental side and the baby side. The team biopsies a few cells from the placental side and sends them to a lab. At the lab they check the chromosomes for completeness. This means things like Down's Syndrome and gender can be detected but the breast cancer gene can not.
- Embryo testing is a good option when you have 4-8 embryos in a cycle. More than 8 and it can be cost prohibitive. Less than 4 and you may risk losing embryos that would have been successul in the transfer.
Embryos - Freeze or grow?
- We chose to freeze 3 of our embryos without growing them out and testing them. This was our choice for Cycle 3 when we had 1 embryo and Cycle 5 when we had 2 embryos on day 1. On cycle 4 we had 5 embryos and chose to grow them.
- Ultimately, we deferred to our fertility doc. This part is hugely a statistics and financial decision.
Transfer - 1 or 2?
- How many embryos a woman transfers at one time depends on age, prior success with transfer and number of embryos. There are probably other factors but those are the big ones that are influencing my decision. IVF is far more successful than it used to be. For women over 30 the risks of complications with a multiple pregnancy is much higher. Instead of having a situation where "selective fetal reduction" is recommended, we will do 1 embryo transfer.
- In the cases where women have had unsuccessful transfers the IVF doctor may recommend transferring more than 1 embryo. We have a friend who did not get pregnant with 2 or 3 transfers. On the final transfer, she had 2 embryos transferred. One became her son and the other did not implant.
Transfer - now or later?
- This decision depends on so much. My short answer- if you know you have a super stressful season upcoming-wait. If you are healthy, even if young, go for it!
- Last year we chose to do everything as soon as we could. During my first egg retrieval cycle my father in law was hospitalized and then on hospice. During my first transfer we had to close several of my father in law's companies. It was incredibly stressful. And ultimately not successful.
- This year we chose to plan our IVF schedule for when I could take the extra time off work to rest and get my body ready. We started my first of three 2023 retrievals in Febrary and are only getting to my transfer in October. I waited to recover from the hustle and bustle of year end. I waited to recover from the egg retrievals and to get through taxes (extension deadlines). It was the best decision, although difficult.