Optimal Timing and Duration of IVF Cycle

[Anonymous]

Our course of action has been determined, i.e. we will need to do IVF w/ ICSI. My questions relate to the timing and duration of all aspects of the cycle. Both my husband and I travel quite a bit for work, and between the holidays and some projected travel in the early part of 2011, I’m trying to wrap my hands around the best timing for the procedure from start to finish + sync up with my RE’s schedule (and urologists, too, as we will need to do sperm retrieval). Namely, my questions are:

• Is my natural menstrual cycle irrelevant in that they can manipulate it OR is IVF typically scheduled around your natural cycle date?
• What is the typical length of the injectable phase? It seems like a hassle to have to travel with the drugs, so I’d want to be sure I was home through all of that.
• Were you able to handle the injections yourself or did you find it useful to have your hubby assist?
• How often are you monitored throughout the injectable phase? Is it every day? Every other day?
• After egg retrieval and transfer, how long would you think is best to remain in town after that for monitoring, beta testing, etc?
• Assuming all goes well, and beta numbers are progressing, how much longer and how often do you still need to see your RE before they discharge you to a regular OB-GYN?

I just need to determine how much time I need to block off where I'm in town.

[Anonymous]

I am a veteran of five IVF cycles (and four different protocols), and my advice would be:

*get your out of town obligations out of the way, first
*talk to your RE/nurse about your specific calendar (there are so many different protocols that none of us could tell you what to expect, even if things run according to plan).
*be prepared that all sorts of things happen sometimes to mess up the schedule (e.g. cysts).

*What I can tell you is that birth control pills can be used to better time the beginning of your cycle (but not all women use bcps)
* I've heard of people stimming anywhere from 9 to 14 days...but even before stim, you are in the office for the occasional bloodwork/sono (the regularity will depend on your protocol), and you may be injecting drugs like lupron for several days before you start the stims.
*except for the trigger shot, I could handle the injections on my own, though having hubby around was helpful (but not necessary).
*monitoring during injectible phase will most likely depend on your individual response. Some cycles I was only in 4-5 times overall (from day 1 of stim); other time, after day 5 of stim, I was in every day or every other day. It really depends.
*after egg retrieval -about two weeks in town (though, following transfer, I think most women only go in for a progesterone check once, and then a beta, second beta, etc)
*after a confirmed pregnancy, I think most REs will do a 6 week and an 8 week sono. Things really do taper off at the end, but the lead up to stim through transfer can be really intense.

[Anonymous]

I have done more IVF cycles than I care to share and agree with most of what the PP stated. I travel for work and have also cycled out of town, so can give you some general tips given that you travel.

- Find out what protocol they anticipate using for you and get a cycle calendar from the nurse to help determine what is involved with the protocol and when you will start using stims.
- If you know your cycle length (in general), you can use it to help figure out roughly when you will start meds. Some cycles require use of bcps, lupron, or estrogen before you start stims, while others jump right into use of stims on the 2nd day of your cycle.
- You can still travel while taking bcps, estrogen or lupron as pre-cycle suppression, but definitely plan to be unavailable to travel for about 3 weeks from the time you start your stim medications to cover yourself for monitoring with stimming, egg retreival, and embryo transfer. I always looked at the calendar to figure out when I would start stims and would then block off my calendar for travel.
- I have stimmed anywhere from 8-12 days depending on the protocol. I have gone for monitoring every other day for most of a cycle and every day towards the end, but I have also gone every day of the cycle as well. It all depends on what's going on with your cycle.
- I can do the sub-q (tummy) shots myself, but always wanted DH to do the intra-muscular (IM) shots. Stims are normally sub-q and trigger is IM.
- Travel is possible in the 2ww and even while getting betas. If you can't make it to the RE's office for b/w, you can get a script to have b/w done STAT in another city. Just make sure that the facility doing the b/w really can do it STAT.
- Ultrasounds are usually done at 6 weeks and 8 weeks, though they may have you come in earlier if there is an issue with beta levels (I've had them at 5 weeks) The 8 week u/s is normally the one where they release you to your OB.
- Egg retrieval requires anesthesia. If you are not able to take a day off last minute with no explanation, then plan ahead. I tolerate anesthesia reasonably well and could always join conference calls in the afternoon, but wouldn't make any big decisions that day.
- Embryo transfer requires 24 hours of bedrest. Again, something to plan ahead for if you can't work from home. Also, you can easily have transfer moved from day 3 to day 5 at the last minute, which could disrupt things that you may have scheduled. (or use of a weekend day for bedrest if that's how the calendar falls)
- Expect the unexpected. I have had cycles cancelled, I have had complications, etc. I swear I have seen it all each cycle and then something unexpected happens.

[Anonymous]

If you husband happens to be out of town when you trigger you can also hire someone to come and give you the IM shot. I had considered a nurse only because I was chicken but I got lucky and the IM shot was such a non-event I was glad I hadn't (I literally asked my husband when he was going to start as the needle went in). Husband will also have to be there to produce sample.

[Anonymous]

Lots of good advice here, so I'll try not to repeat. Just a couple of things:

- traveling with injectables isn't so bad. It would be easy to do that esp. if you're in an early lupron phase with limited monitoring at the start of the cycle. Monitoring during the stim part makes this harder. But the actual dealing with the stuff while traveling really isn't bad. (I did most of an FET cycle while in Spain.)

- Depending on how they're planning to retrieve sperm, you might consider doing that ahead of time and freezing the sperm. While it's great to have fresh, if there is ANY risk that they can't get a good sample the first time, you don't want to find that out the day of retrieval. It was very hard to get sperm from my DH and the first try produced nothing, but the second try worked. Luckily we had planned about a week out, so it wasn't too crazy-making to make alternate arrangements. (Though poor DH had quite a recovery from two procedures.) Just talk this through with your urologist and RE to get a sense of their recommendations.

Best wishes to you. It's a lot to jump into, but you'll be feeling like a pro with all of this before you know it. I still remember my own nervousness before that first shot, but it was so smooth and easy, and that calmed my nerves for much of the rest of the cycle.

[Anonymous]

Different poster here. I don't want to hijack this thread, but the PP brought up an interesting point. How many of you out there with ICSI did sperm retrieval same day as egg retrieval? Was this a successful approach for you? What made your RE confident that this would be a viable option as opposed to early retrieval and freezing? How do success rates differ with fresh vs frozen sperm? Thanks.