Navigating Your IVF Cycle
Navigating Your IVF Cycle – From the beginning
My RFP doctor has recommended an IVF cycle? What do I do now?
If your doctor has recommended an IVF cycle and you are interested in this treatment option, please proceed with the following steps:
1. Register for the IVF evening information session. Call 403-284-5444 and speak with the receptionist. You and your partner must attend this session in order to learn about IVF and decide if IVF is right for you. You need this information in order to give informed consent for IVF treatment. Attending the evening session DOES NOT mean you are obligated to proceed with IVF. However if you do register for the session, please attend. As there is a waiting list for attendance, you will be charged for missing the session if you do not cancel 48 hours ahead of time.
2. Register on the IVF wait-list. Call or come in person to the clinic and speak to the receptionist. There is a non-refundable fee of $310 for this wait-list. Once you have paid you are automatically placed on the wait-list. The most important thing to do on the wait-list is for the female partner to call in to the period hotline every month with the first day of her period. This is the first day of full flow – not spotting. If the full flow period begins after 3 pm the following day will be counted as day one.
3. Complete your prescreening tests. Prescreening tests are meant to give you the best chance of achieving a pregnancy through IVF. They need to be current, therefore all tests must be less than a year old at the time of your IVF cycle. You will receive this list of tests either from your RFP doctor at an appointment, or you will receive a letter in the mail with the requisitions after you register on the wait-list. If you live outside of the Calgary area you will receive a letter you can take to your local doctor to arrange the testing. There are basic prescreening tests for both female and male partners.
Do I have to do the steps in order?
No, you can choose to do your prescreening before you attend the evening session for example. Once you are sure you want to proceed with IVF you should register on the wait-list and for the evening session as soon as you can, so you can move forward with your treatment
Do I need to check if my results have been received by the clinic?
Not usually. If you know that you have completed the tests within the last year then there is no need to check if they are on your chart. The RFP clinic can now access most test results in Alberta electronically on-line through Alberta Health. If you are from out of province it would be wise to check if all results are on your chart 2-3 weeks after you and your partner have completed them all.
How long is the wait-list for IVF?
Once pre-IVF testing is complete, treatment can commence immediately. There is no wait-list for IVF.
If I get offered treatment and can’t accept – do I go to the bottom of the wait-list?
No, you do not. You will likely be offered treatment the next month again. Please be aware that if your treatment is delayed for a significant time your prescreening may need to be repeated.
What can I do while waiting for IVF treatment?
- While on the wait-list you need to ensure that your prescreening tests are completed done and that you have attended the evening session. The female partner or egg donor needs to call in her periods.
- IVF treatment is expensive. Refer to our schedule of costs and fees. You can expect to spend between $6000 and $8050 on treatment alone. The clinic requires full payment prior to cycle initiation as this is a non-insured procedure. All expenses related to this treatment are the responsibility of the patients undergoing this therapy. This does not include drug costs. That can range from $3000 to $7500. Use the time on the wait-list to check with any benefit plan you have about drug coverage. You can contact your drug insurance company and determine coverage based upon the DIN (Drug Identification Number) list.
- Start taking folic acid. At least 0.4 milligram (mg) per day is recommended for women attempting to get pregnant. It is important to start this supplement at least 6 weeks prior to attempting pregnancy
- Consider a multivitamin. Now is a good time to assess your daily diet. Increasing the number of healthy fruits and vegetables and whole grains in your diet and decreasing processed foods will help set you up to feel well and be well through your IVF treatment and hopefully your pregnancy. This is not the time for radical or fad diets. Extreme diet changes and sudden weight loss can create by-products that are toxic to growing embryos. If you have concerns about your diet consult a certified nutritionist and let them know you are attempting pregnancy
- Talk with your family and friends about what you are going through. This often will help decrease anxiety. You don’t have to tell everyone – choose people who will support you throughout this stressful time.
Navigating Your IVF Cycle – When a cycle is offered
The IVF set up nurse will call to offer you a cycle of IVF. You will likely hear from the nurse the beginning of the week following your period. The nurse will give you the following information:
A) An outline of the planned treatment schedule. Some dates will be known at this time, some will be estimated.
B) When you need to be in Calgary if you live out of town.
C) When you need to pay for the IVF cycle – this will be the week following this phone call.
D) There are cancellation charges if you accept treatment and then change your mind or have to cancel for some reason. These are required to cover the clinic’s costs. If you cancel before your start medications the cost is $825. If you cancel after starting medication the cost is $1290. The set up nurse will review these with you. Please be sure you are prepared to go ahead with IVF before you say yes.
E) The IVF set up nurse will discuss where you wish to purchase your medications.
F) A timetable and other papers will be mailed to you or sent with your medications if you purchase them from the RFP Pharmacy.
Once you have agreed to treatment your file leaves the IVF set up desk and transfers to the IVF Program nurse. You will be provided with the IVF Program nurse telephone extension to call regarding questions with your treatment. Please call and leave a message in the IVF Program nurses voice mailbox. The IVF Program nurse will return your call.
Starting my Standard IVF Cycle
A) You will be given a date to start your Suprefact© nasal spray. You will use one spray in each nostril 5 time a day (every four hours while awake), for example: 7 am, 11 am, 3 pm, 7 pm, and 11 pm. You will also start taking 1 baby aspirin (81 mg) a day at this time. You will receive a timetable either in the mail or with your medications with this information on it.
B) You will be using this spray for approximately two weeks before having a pelvic ultrasound. The IVF set up nurse will have told you what date to have your pelvic ultrasound. Please note: You will very likely have a period while on Suprefact©. If you are still having bleeding at the time of ultrasound, do not be concerned. This is normal. If you have not had a period, please proceed with the ultrasound regardless.
C) If you are in Calgary this appointment has been arranged at the clinic. Please arrive at 7:30 am for both a blood test and an ultrasound. You may be at the clinic for up to 2 hours. Blood tests and ultrasounds are done on a first come, first served basis using a number system. Wait times vary. Every effort is made to facilitate individual patient needs. If you live outside of Calgary you may have this pelvic ultrasound in your home town on the date given to you by the set up nurse. You will not need a blood test. You need to arrange this ultrasound with your family doctor or gynecologist. We need to get the results of the ultrasound the same day. Please have them faxed to 403-284-9633.
D) Once the results are reviewed and are normal you will start your injections (FSH) within 1-3 days. The nurse will review this timetable with you. She will tell when to start the injections, what to do with the Suprefact and when to start the antibiotics. You must speak to a nurse at this point. She will also tell you when to come for your next appointment.
Starting my Flare IVF Cycle
A) To start a FLARE cycle we need to wait for your next period. During this time you will receive a timetable in the mail. When your period comes, phone it in to the period hotline as usual. Keep your timetable handy. A nurse will call you within 1-2 days with instructions. You will start your birth control pill on the fifth day of your period. As well you will start taking a baby aspirin (81 mg). The nurse will give you a date for your pelvic ultrasound.
B) If you are in Calgary this appointment has been arranged at the clinic. Please arrive at 7:30 am for both a blood test and an ultrasound. You may be at the clinic for up to 2 hours. Blood tests and ultrasounds are done on a first come, first served basis using a number system. Wait times vary. Every effort is made to facilitate individual patient needs. If you live outside of Calgary you may have this pelvic ultrasound in your home town on the date given to you by the set up nurse. You will not need a blood test. You will need to arrange this ultrasound with your family doctor or gynecologist. We need to get the results of the ultrasound the same day. Please have them faxed to 403-284-9633.
C) Once the results are reviewed and are normal you will finish your pack of birth control pills. The nurse will review the timetable with you. She will tell you when to start the Suprefact© injections. You must speak to a nurse at this point. She will also tell you to call in by a certain date to report whether you have had a period.
Starting my Antagonist IVF Cycle
A) To start an Antagonist cycle we need to wait for your next period. During this time you will receive a timetable in the mail. When your period comes, phone it in to the period hotline as usual. Please keep your timetable handy. A nurse will call you the same day with instructions. You will need an ultrasound the next day.
B) If you are in Calgary this appointment will be arranged at the clinic. Please arrive at the clinic at 7:30 am for both a blood test and an ultrasound. You may be at the clinic for up to 2 hours. Blood tests and ultrasounds are done on a first come, first served basis using a number system. Wait times vary. Every effort is made to facilitate individual patient needs. If you live outside of Calgary you may have this pelvic ultrasound in your home town on the date given to you by the nurse (Day 2 of your period). You will not need a blood test. You need to arrange this ultrasound with your family doctor or gynecologist. We will need to get the results of the ultrasound the same day. Please have them faxed to 403-284-9633. Sometimes this may be difficult to arrange on such short notice. You can always come to Calgary for this ultrasound.
C) Once the results are reviewed and are normal the nurse will review your timetable with you. She will tell when to start the injections (FSH) and when to start taking baby aspirin (81 mg). You must speak to a nurse at this point. She will also tell you when to come for your next appointment.
Monitoring during my IVF Cycle
Most women will need between 3 and 7 visits to the clinic to monitor the growing follicles on her ovaries while taking the injections. Each woman responds differently to the medicine so it is very difficult to predict how many visits will be required. The doctors and nurses will give you as much information as they can at each visit so you can plan your life. If you need a blood test or ultrasound you need to be at the clinic at 7:30 am. You may be at the clinic for up to 2 hours.
In order to facilitate timing of the IVF morning blood tests and ultrasounds, a lock box with numbers will be available in the main floor lobby of the Cambrian Centre from 6 AM daily. The numbers will be available on a first-come first-served basis; please take the next available number to prioritize your arrival and wait in the lobby area until the clinic opens. Washroom facilities are available on the third floor.
Proceed to the RFP clinic on the fourth floor when the clinic doors open at 7:30 AM. You do not have to inform reception that you have arrived. Out of consideration for other patients you must be present when your number is called by the receptionist otherwise the next patient will be called in your place. If you need to be away, please inform reception staff.
Please be patient, wait times vary. Every effort is made to facilitate individual patient needs. If you need an ultrasound as well, that ultrasound will happen after the blood test. All our ultrasounds are done vaginally. It is best to have an empty bladder. A nurse and doctor will be present throughout the ultrasound procedure.
Navigating Your IVF Cycle – When your eggs are ready for retrieval
Preparing for my Egg Retrieval
Congratulations! You have worked hard to get this far. The day your ovaries are ready, a nurse will sit down with you and review your instructions for the last injections you will need. This medicine is called HCG. These last 2 injections are very important and must be done at a specific time. Make sure you understand the instructions. Once you have taken the last 2 injections as instructed you need to wait 35 hours for the medicine to work. You will have a day off between the injections and the retrieval. The nurses will give you a sleeping pill in case you need it for the night before the egg retrieval. You cannot eat after midnight on the night before the egg retrieval. You can drink clear fluids like water, tea, apple juice and ginger ale in the morning before the retrieval.
No one can wear perfumed or scented products of any kind in the recovery room and egg retrieval room. If you or your partner are wearing a scented product you will not be admitted to these areas until you have washed it off. Scent particles can harm eggs and embryos.
My Egg Retrieval: What to Expect
Egg retrieval is often the part of IVF that women worry about the most. After the procedure most women will tell us it wasn’t nearly as bad as they had feared. During the retrieval our very experienced and skilled staff will care for you and every effort will be made to keep you as comfortable as possible.
When you arrive you will change into a hospital gown. The nurse will check your weight, blood pressure and pulse. She will review instructions with you and answer any questions that you have. Either the nurse or the doctor will start your IV (intravenous). Both are available to answer any questions that you may have.
You will walk into the procedure room. Once comfortable, the doctor will give you medicine through the IV to help you relax and minimize any discomfert. You will be awake during the procedure and able to see your eggs on a TV monitor as they are found.
Following the procedure you will rest in the recovery area for a short interval until you are ready to go home. While you are resting the IVF lab staff will come to tell you how many eggs were harvested and their maturity and quality. If required, your partner will then go to the lab to provide his semen sample. He will need picture ID. You will need to have an adult (your partner most likely) drive you home and stay with you for the remainder of the day.
Waiting for my Transfer
You will begin medications to support the lining in your uterus the morning after the egg retrieval. You will be taking estrogen pills twice a day and Prometrium© vaginal suppositories three times a day. These medications need to be taken each day until your pregnancy test. Please note that if your pregnancy test is positive, you will continue to take them until you are 10 weeks pregnant. Do not stop the medication unless you have had a lab test showing that you are not pregnant.
You may be taking an additional medication called Medrol© if you are having assisted embryo hatching. Please follow the instructions you are given.
The IVF lab staff will call you each day while your embryos are in lab to tell you how they look. They will discuss with you the best day to transfer your embryos (either 3 or 5 days after egg retrieval) and the number of embryos to transfer. They will answer any questions you have and let the nursing staff know if you feel unwell.
My Embryo Transfer
The day of embryo transfer is an exciting one. Your partner or a support person is welcome to join you in the procedure room. Keep in mind: No one can wear scented products of any kind in the recovery and procedure room. If you or your partner are wearing a scented product you will not be admitted to these areas until you have washed it off. Scent particles can harm embryos.
You will be given an appointment time by the IVF lab staff. You will need a comfortably full bladder for the procedure. Generally speaking, empty your bladder 1.5 hours prior to the transfer and then drink 1-2 glasses of water. Each woman is different however so you need to judge what is right for you. The full bladder helps us to see the uterus on ultrasound during the transfer.
When you arrive you will change into a patient gown. Your partner will put on a hospital gown, hat and shoe covers over their clothes. A nurse will review instructions with you, including when to do a pregnancy test. The transfer itself feels similar to a PAP test. You will not need any medicine for pain. You will rest quietly afterwards for one half hour and then go home. You may travel up to 3 hours on this day. You should wait until the following day to travel further.