Tips from Former Patients

A Girlfriend’s Advice to In Vitro Fertilization Patients

IVF Tips from Amy J. and Friends

Before starting your in vitro fertilization (IVF) cycle…

 

  • You will be required to attend a training class taught by staff of the Bennett Fertility Institute. Be sure to take detailed notes and ask lots of questions – this is a great opportunity to get a feel for what you will be experiencing over the coming weeks.
  • You should have an initial consultation with a nurse at our fertility clinic. You will discuss what will happen starting on your in vitro fertilization (IVF) cycle day. Be sure to take notes here as well. You will be told to call Bennett Fertility to confirm when you do actually start your period, officially marking the first day (Day 1) of your IVF cycle.
  • Because you will be on birth control pills, you should know the date of your IVF Cycle’s Day. It is VERY helpful to create an individualized calendar specifically for your IVF schedule. It’s a good idea to include your Cycle Day, shot schedules, doctor appointments, and estimated time frames for your retrieval and transfer procedures. This will help you clear your schedule around the estimated days of the retrieval and transfer.

After starting your IVF Cycle…

  • KEEP A RUNNING CALENDAR OR JOURNAL and record what you actually did (shots, doctor appointments, blood work, etc.) or what you experienced that day (side effects, misc.). You will be amazed at how quickly all these details start blurring together in your memory. This record will come in handy both during and after your IVF treatment, regardless of the outcome.
  • TAKE NOTES! We’ve said it several times, but we can’t say it enough. Each time you return to see your doctor or go to Bennett, be sure to bring a small notepad and record all instructions (even the simple ones) that are being given to you. With so many medications, dosages, injection techniques, and appointments to remember, your brain will not retain details as well as it normally does.
  • PAMPER YOURSELF! Depending on your experience leading up to the IVF process, you may be fairly emotionally drained when you get to this point. Just remember that you need to take care of yourself…the more relaxed and positive you can be about this process, the better! Foot rubs, pedicures, massages, short weekend getaways, frequent movie/date nights may all be great ways to relax and take short mental breaks!
  • If he’s willing, HAVE YOUR HUSBAND BE YOUR PRIMARY SHOT-GIVER. It is nice to allow him to be involved in the process, and it is a great way to take a little anxiety off of you! However, be ready with a backup shot-giver, either yourself or a friend, so you’ll be prepared if he is not available.
  • SET AN ALARM: Going through an IVF treatment, you’ll find that you have a lot on your mind and will probably be somewhat scatterbrained. It is very important that you remember to take all of your shots on the days prescribed, and at the prescribed time. To help remind you of this, many people have found it helpful to set an alarm on their watch, cell phone, or PDA as a reminder that it’s “shot time.”
  • ADJUSTING SHOT TIMES WITH NURSE: The instructions from Bennett state that Lupron shots should be given at 8 p.m., and that other shots should be given 12 or 24 hours following. If you and/or your shot-giver are consistently away from home at 8 p.m., talk to the nurse about adjusting the shot schedule to a little earlier or later in the evening. The most important factor is giving your shots at the same time every day, and the nurses may allow you to adjust the shot time to better fit your schedule.
  • USING AN ICE PACK: Some patients find the shots fairly painful, while others tolerate them without many problems. With exception to the Progesterone shots, it can be helpful to apply an ice pack to your stomach prior to administering subcutaneous (sub-Q) shots (i.e., Lupron, FSH such as Follistim or Gonal-F, and hMG such as Repronex). Patients have found it helpful to apply ice for five to seven minutes just before giving the shots, and have experienced little to no discomfort from the shots when doing so.
  • PINCHING SKIN: The nurses will demonstrate how to administer each type of shot, and most recommend grabbing and/or pinching the skin around the shot area while giving subcutaneous shots. This method has worked well for most patients. However, some patients have experienced less pain by NOT pinching the skin during shots, and instead stretching the skin tight while giving injections.
  • RASH / SKIN IRRITATIONS: Subcutaneous shots given in the stomach can sometimes cause red welts and irritation around the shot area. This redness may improve after a couple of days, but if you experience significant problems and discomfort, call the Bennett nurses. They may recommend that you begin giving the shots as intramuscular (IM) injections.
  • CORTISONE CREAM/BAND-AIDS: If you do experience some redness on your stomach from the shots, try applying some topical cortisone cream to the area. Some patients have also seen vast improvement in skin irritation when they apply very large bandages over the irritated area. This can prevent further irritation by protecting the skin from rubbing against your clothing.
  • GIVE SHOTS ON CARPETED FLOORING: A few patients have learned this lesson the hard way! If you happen to drop your vial of medication onto a hard tile floor as you are filling the syringe, you will likely break the vile and lose the entire dosage late in the evening when it will be hard to replace. If this happens, immediately page a Bennett nurse. Pager numbers are available on the answering machine when calling the Bennett Fertility Institute main number (405) 949-6060.
  • TRAVELING WITH SHOTS: If you have to be “on the road” while you’re giving shots, there are a few things to remember:
    • Bring a small ice chest to transport your medications that need to be refrigerated.
    • If booking a hotel room, look for a room with a refrigerator.
    • Pack plenty of extra syringes and alcohol wipes… Be prepared for the unexpected.
  • HAPPY-FACE HIPS: The trigger shot and progesterone shots are both to be injected intramuscular, (IM) into the hips. There is a specific area on the upper hips where the shot must be administered, and if you ask, the nurses will use a special skin marker to draw “happy-face” circles on your hips in the area where the IM shots should be given. Ask about this on your last visit (Ultrasound/Estradiol blood draw) before your trigger shot. This is very helpful, and you may want to re-mark the faces at home before they wash off.
  • TRIGGER SHOT: All of your shots are important, but the trigger shot is THE most important shot that you will take. It triggers the final maturation of your eggs 35 hours before the retrieval procedure. It will probably be your first intramuscular (IM) shot, so be prepared to give it at the EXACT time the nurses prescribe.
  • PROGESTERONE STORAGE/INJECTIONS: HEAT is a big key to making progesterone shots as comfortable as possible. Since you may be taking progesterone shots through the end of your 12th week of pregnancy, you’ll want to make these shots as comfortable as possible. We have several specific tips:
    • DO NOT store your progesterone oil in the refrigerator.
    • Before administering the progesterone shots, put the vial in a glass of very warm water. This helps thin the oil and allows for smoother injections. Or, if hot water is not available, just roll the vial between your hands for a few minutes to warm the oil.
    • DO NOT apply ice to your hips before giving progesterone shots. This can make your muscles tighten and may cause more pain instead of less.
    • Apply moist heat AFTER giving after progesterone shots. Microwavable heating pads are great, but other types of heating pads are fine, too.
    • If your hips begin to form small knots, try to avoid the knots or tight spots in your hips for your future injections.
  • EVERY PERSON RESPONDS DIFFERENTLY to medications. Some patients experience no side effects, while others may experience mild, moderate, or more significant side effects to IVF injections. A few common side affects are as follows:
    • Bloating
    • Sore Breasts
    • Hot Flashes
    • Mood Swings
    • Short-Fused Temper (Husbands, be patient!)
  • HYPERSTIMULATION: As discussed in the IVF training course, a small percentage of IVF patients develop Ovarian Hyperstimulation Syndrome from their course of treatments. There are varying degrees of hyperstimulation, but if you recognize symptoms that are common to hyperstimulation, call a nurse at Bennett Clinic to make sure you don’t need further attention. Common symptoms of hyperstimulation include:
    • MILD: Abdominal bloating, nausea, diarrhea, slight weight gain
    • MODERATE: Mild symptoms, plus greater weight gain (2+ lbs. per day), abdominal swelling that makes clothing fit tightly, vomiting; darker urine and urinating less; dry skin & hair, feeling of dehydration
    • SEVERE: Bloating above the belly button, shortness of breath, calf or chest pains, lower abdominal pain.
  • DOCTOR’S INSTRUCTIONS: Be sure to read the list of instructions the day before the procedure. Specific instructions such as using unscented soap and deodorant, wearing no makeup, etc. should be followed as directed.
  • YOUR HUSBAND’S ROLE: While you may be going through the majority of the discomfort and inconvenience of the IVF process, your husband’s role on the retrieval day is very important and may cause him some anxiety. You will need a driver to take you home after the retrieval procedure.
  • PAIN/SIDE EFFECTS: While the egg retrieval procedure is more invasive than the embryo transfer, it is not extremely painful. With anesthesia, you will feel nothing during the procedure, and may experience some mild side effects afterwards. Some patients have no problems, and others experience some cramping following the procedure. You may be given a prescription pain medication following this procedure, but many patients handle slight discomfort with Tylenol, or no pain medication.
  • NAUSEA: Due to the anesthesia, you may experience slight nausea immediately following the procedure. If you have a long drive home, be prepared by bringing some 7 Up and crackers for a light snack on the return home.
  • FORGETFULNESS: One side effect that many patients experience is forgetfulness after the procedure. You will probably ask, “How many eggs did they get” several times before finally remembering the number. One patient recommends that the husband just WRITE the number on his wife’s hand, and that she will remember to look at her hand!
  • NUMBER OF EGGS RETRIEVED: Always remember that each patient is different. Some retrieval procedures result in a harvest of 16 or more eggs, while others may result in just two or three. With egg retrieval, MORE IS NOT ALWAYS BETTER. Higher retrieval rates are more likely to be associated with hyperstimulation, and the nurses and lab technicians will testify to the fact that QUALITY rather than QUANTITY is the key. Don’t lose hope over retrieval numbers!
  • CALLS FROM THE LAB: Each morning following your retrieval procedure, someone from the Bennett lab will call you to give you a status report on your embryos. They’ll tell you how many embryos you have and how many cells each embryo consists of. A couple of tips regarding these calls:
    • Be ready with a paper and pen. They will give you the stats very quickly, and you’ll want to record everything so that you can share all the information with your husband.
    • Be prepared for your number of viable embryos to decline as the days pass, and know that this is normal.
    • If you are scheduled for a Day-5 (blastocyst) Transfer, here’s what you are looking for:
      • Day 1 after retrieval – A report on the number of embryos
      • Day 2 after retrieval – Looking for cell division – between 2-4 cells
      • Day 3 after retrieval – Should be between 4-8 cells
      • Day 4 after retrieval – No report. They leave the embryos alone.
      • Day 5 after retrieval – This is the day of the transfer, and they will not call you the morning of the transfer. You will discuss the status of the embryos with a lab tech when you arrive 1 hour early for your transfer. This is also the time to request pictures of the embryos that the lab will be transferring.
  • The embryo transfer is a fairly easy procedure. It is similar to a pap smear, and is much simpler than the retrieval. You will probably not have too much discomfort or many side effects from this procedure.
  • On the day of your embryo transfer, the lab technicians will grade your embryos and select the most viable one/s for transfer. The embryo grading system is similar to a school grading system, with A being the highest quality and F being the lowest quality. DON’T BE OVERLY CONCERNED WITH THE GRADE OF YOUR EMBRYOS. Embryos with a grade of C are the most common, while embryos with an A grade are much more rare.
  • Take it easy after your transfer. There are differing opinions about how long you should be flat on your back following the transfer procedure. Your doctor should give you directions on this, but also remember that when it doubt, it will not hurt to be overly cautious. Don’t push yourself!!
  • Because you will be flat on your back for a long period of time, your back will likely become very sore. Ask your doctor whether it is okay to take Tylenol or another medication to help alleviate this pain.
  • DON’T JUMP TO CONCLUSIONS on your pregnancy status based on your side effects. Many of the shots you’ve taken and procedures you’ve undergone, in addition to the progesterone shots you’ll continue to take, may cause symptoms similar to those of pregnancy.
  • TRY TO STAY DISTRACTED to make the wait pass more quickly. Again, frequent movie/date nights, dinners out, or reading are good options to keep your mind off of the upcoming pregnancy test. Just BE SURE TO TAKE IT EASY. Don’t push yourself physically; enjoy taking a break from moderate-to heavy physical activity!
  • DON’T TAKE A HOME PREGNANCY TEST before your scheduled blood test. The trigger shot contains the same hCG hormone that is detected with pregnancy tests, and taking a home test before the blood test can result in both false positives and false negatives. Avoid this stress by avoiding an early test.


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