Guest blogger Julie says everything she needs to know she learned at the IVF Clinic.
1. Silence is golden
If you're embarking on your first cycle, you're probably feeling a great deal of optimism, and it's natural to want to share your excitement and hope with the people you love. Resist -- or at least be extremely selective.
My first time around, I told absolutely everyone -- family, friends, co-workers, casual acquaintances, the guy who changes the oil in my car. When that cycle failed, I regretted it. I'd raved about how good our chances were, and how sure I was that we'd succeed. I hadn't imagined how awkward and painful it would be to spread the news that it hadn't. (The boys down in the lube pit were perfectly sympathetic when I broke it to them 3,000 miles later, but our relationship was never the same after that.) Your cycle doesn't have to be a secret, but discretion might serve you better than widespread disclosure.
2. Don't put all your eggs (and sperm) in one basket
Don't count on your first cycle working. Sure, it could; plenty of people hit the jackpot on IVF #1. Statistically speaking, however, it's likely that you'll need more than one try, and it's best to be prepared for that from the very outset.
Our doctor encouraged us to think of our first cycle in terms of a diagnostic run, a chance to see how my body would respond to the drugs, and how our embryos would develop in the dish, giving us information that would help optimize any further treatment if necessary. This excellent advice helped us face a bad outcome without destroying our future hopes. So when you're making a treatment plan, save enough money, time, and stamina for a second cycle, and perhaps beyond. There's no down side to being prepared. And, hey, maybe you will hit the jackpot. After all, you can't win if you don't play.
3. Make a plan
All told, we attempted eight IVF cycles. Some failures were more devastating than others. (Some merely felt like having a piano dropped on me from the upper stories of a tall building, while others felt like...well, a whole lot of pianos.) The most upsetting were the ones when I didn't know what our next step would be.
I have found that it helps immensely to have a plan, any plan. If you're the methodical type, you might sketch out a detailed flow chart. If you're someone who prefers to feel your way as you go along, your plan might be as simple as promising yourself you won't give up. If you recognize you're approaching your limit with IVF, you might begin making inquiries about adoption, or you might start pricing two-seater sportscars -- screw the minivan. And if you're like me, your plan might sound a little like this: "Drunken bender. Two-day hangover. Let air out of doctor's tires. Get a second opinion."
4. Be flexible (you'll be more comfortable in the stirrups)
That plan we talked about? Forget it. Or at least be ready to change it if your heart tells you it's the right thing to do. When we first started IVF, I had some embarrassingly firm ideas about what I would and wouldn't do. (A sample: "I can't imagine doing more than three cycles. After all, we're not desperate." Line forms here to smack me upside the head.) As we progressed through treatment, I repeatedly found my convictions wavering. "If this doesn't work, we'll take a break," my husband and I promised each other before our second cycle. But when I got pregnant and then miscarried, I was hurting so badly that I couldn't bear not to try again as soon as my doctor allowed. "I don't want to try donor eggs," I said, an opinion I scrapped quite cheerfully once my ovaries had refused to respond for the third cycle in a row.
That's not to say you shouldn't have limits. Just don't be afraid to question those limits as the situation changes. Be flexible. If nothing else, it'll help you duck when someone wants to smack you upside the head.
5. Everyone's an expert
Did you know the woman who cuts your hair is a board-certified authority in reproductive medicine? And that your brother-in-law has a degree in counseling, specializing in couples facing infertility? When you're trying to conceive, everyone's an expert. This is especially annoying once you've graduated to advanced techniques like IVF. It's infuriating when well-meaning people offer suggestions you abandoned years before -- you don't make it all the way to IVF without knowing which tab fits neatly into which slot, if you know what I mean. Yet the unsolicited advice keeps coming. "Have you tried Robitussin?" "Take a vacation!"
I've learned to my disgust that there's simply no stopping it. But I've also come to accept that the majority of it is given with the best of intentions. That doesn't make it any less irritating, but it does keep me from demanding to see my hairdresser's credentials and reporting her to the state medical licensing board. Usually.
6. It's not over till the Russian coach cries
It's tempting to think of each stage in an IVF cycle -- suppression, stimulation, retrieval, fertilization, and transfer -- as a separate event. Say, like Olympic gymnastics. Surely if you stick the landing off the vault, and keep those pixie toes pointed on the floor exercise, and balance that beam with nary a bobble, all while keeping your leotard from creeping up where it doesn't belong, you'll win the all-around gold, right? But Bela Karolyi weeps. Success at any one stage is just that: success at one stage. It doesn't necessarily predict a positive outcome. Even perfect-looking cycles fail, after all, for reasons our doctors don't always understand.
Happily, the converse is also true. Barring complete failure at any one stage -- no eggs retrieved, no fertilization, no embryos to transfer -- there is still some hope for pregnancy. Wonky cycles can work, and do. I've had to relearn this lesson every time. It's hard not to lose hope when you have only three mature eggs, or only one embryo to transfer, and equally difficult not to get overconfident halfway through the cycle. But the only sure indication won't come until after transfer. Now smile pretty and stretch: the East German judge is watching.
7. It's beyond your control
I would bet cold American cash that the distinguished innovators of IVF once put their heads together and asked each other, "How can we engineer this process to make sure it drives control freaks absolutely outpatient insane?" And then they had a good laugh and probably a few beers. Well played, gentlemen.
If you have even the slightest inclination to obsess, IVF will amplify that into full-blown mania. At every stage you'll be given numbers, statistics, and new terminology that will send you scurrying to Google, PubMed, and your best friends on the Internet. You'll scrutinize every measurement, second-guess every dosage, and barrage your doctors with e-mail asking, "Was my endometrium 7.6 or 7.5 mm? I need to put it into my Excel spreadsheet." Mastering all this information won't make your cycle work, of course. To a control freak, that's bad news. The good news, though, is that as long as you take your medications as directed and follow your doctor's instructions -- which you will, you big freak -- there's not much you can do to make your cycle fail. (Trust me, that is good news.)
8. Welcome to the two-week wait, where nothing means anything
Congratulations! You've made it through stimulation, retrieval, and transfer. Now how are you feeling? Bloated? Weird cramping...you know, down there? Tender breasts? Tired? Moody? Bizarre constellation of pimples that looks a little like Ursa Major? Oh, you're totally pregnant. Except, uh, maybe you're not. I had all those feelings after my first two IVFs, and I was, indeed, pregnant. So I was thrilled when I felt the same way after my third IVF -- This is what pregnancy feels like, I thought, dreamily admiring the star-studded belt of Orion that stretched across my forehead.
No: that is what progesterone felt like. Any IVF cycle will involve progesterone supplementation due to the way the process compromises our ability to make it naturally. And any time you introduce large amounts of progesterone into a woman's body, she's probably going to feel pregnant, even when she's not. I did, and I wasn't. Unfortunately, you can't trust any "symptoms." It's impossible to resist looking for signs of pregnancy during the two-week wait. But when your body's natural patterns have been so thoroughly manipulated -- when you're jacked up on hormones and hope -- you just can't count on that epic constipation actually meaning anything.
9. Trust me, I'm a doctor (or at least his worst nightmare)
On the one hand, your doctor is well educated, experienced, competent, and compassionate. On the other hand, no one cares whether you get pregnant nearly as much as you do. Even as I say this, I'm feeling a surge of sympathy for those poor physicians whose patients show up at consultations with reams of printouts from Internet message boards, aggressive suggestions about protocols, and detailed questions about experimental techniques currently performed only by a single maverick doctor who locks the doors and hides under his desk when the CDC comes calling. But I'm going to say it anyway: We are our own best advocates, and we owe it to ourselves to do a decent job of it.
It took me a long time and a lot of failed cycles to see myself as an equal partner in my own treatment, and to stop caring very much whether my doctors found me easy to work with. Now I ask those questions, request those tests, and suggest those bizarre new protocols without a hint of self-consciousness. After all, our doctors' job is to get us pregnant, and our job is to remind them that we expect them to do it.
10. Relax! Think positive! Or don't. See if I care.
I thought my first IVF cycle would work. It didn't. I thought my second would work. It didn't. After that, all bets were off. Forget relaxation, positive thinking, or happy visualization. I eagerly embraced the power of negative thinking. "Good luck," the nurse would say at transfer, and I would snort so rudely that my embryos would tremble in their dish. With an attitude like mine, no wonder they wouldn't implant.
Some would say that if you're not relaxed or positive, of course you won't get pregnant. To them I give an even ruder snort. Even if there were any credible evidence that women who were more relaxed had higher pregnancy rates after IVF -- I wouldn't know; when I see "relax" in a headline, my head explodes before I can ever read any farther -- the proposition makes no sense. Infertility and the need for treatment are the cause of our stress, not the other way around. IVF has taught me that women with stinky attitudes get pregnant all the time. If feeling pessimistic helps you manage your own expectations, you snort as loud as you need to. You and I will make it a duet.