Making the decision to begin fertility treatment is a big step for any hopeful parent. Now that you've decided to move forward with in vitro fertilization (IVF), what happens next? Let's walk through what to expect as you prepare for your IVF cycle, including which fertility tests and procedures you may undergo and why proper preparation for IVF is so essential.
In this article:
As a nurse at Illume Fertility who also went through IVF to grow my own family, I know how overwhelming it can be to try and understand all the different pieces of the puzzle!
While your doctor and Care Team will always be on hand to answer your questions and guide you through the process, it can be helpful to have a full guide to refer to as you prepare for your IVF cycle. Let's explore what fertility tests or surgical procedures you may undergo before you begin fertility treatment.
Before you begin any type of fertility treatment, your reproductive endocrinologist will complete a full assessment of your current fertility, uncover potential underlying causes of your fertility issues, and perform any necessary therapeutic procedures to give you the best chance at successfully conceiving.
Here's what you can expect:
One of the most important parts of your fertility assessment is evaluating your hormone levels via blood work. This is typically performed on two different days of your cycle.
This blood work (referred to as "Day 3" blood work) is typically performed between days 2-4 of your cycle. We will check your estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH). Here's why:
What does a high FSH level mean? High levels of FSH are an indication of poor ovarian reserve. In other words, the quality and quantity of eggs is likely low. This does not necessarily mean that pregnancy is impossible, but it may be more difficult to achieve.
We will perform a second set of blood work on "Day 21" of your cycle. These tests will include checking your estradiol and progesterone levels, which will help determine if you ovulated this cycle. In addition, your team will check your Anti-Mullerian hormone (AMH) to determine your ovarian reserve, as well as your thyroid levels.
The goal here is to make sure these hormones are within normal limits before starting any treatment, as well as help determine the best course of treatment for your specific diagnoses.
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Your partner finally gets to join in on the fun for blood work!
You will both have the option to be screened for up to 500+ genetic conditions that you may pass on to your future children. Genetic carrier testing is especially important for patients with a known family history of serious inheritable medical conditions (i.e. cystic fibrosis, sickle cell anemia, and others).
As soon as we receive your genetic screening results, we will inform you and help you set up a meeting with one of our knowledgable genetic counselors to discuss your results.
If you have a male partner, they will also undergo some testing. A semen analysis (often referred to as an SA) is a simple test that analyzes sperm count, motility, and shape. This will help determine the best treatment plan and uncover any possible male factor fertility issues.
Once all the poking and prodding of your veins is done, you get to move on to your baseline ultrasound. This is an internal (transvaginal) ultrasound that measures both the lining of your uterus, as well as the number of follicles you have on each ovary during that particular cycle (known as a basal antral follicle count).
This number can vary depending on individual diagnoses, but we typically see between 10-15 follicles on average.
One of the procedures you will have done is a saline sonohysterogram (often referred to an SHG or SIS). This is done to evaluate the shape and condition of your uterus.
A small amount of saline (water) is gently pushed into the uterus for visualization. This procedure can determine if there are an abnormalities in the uterus (i.e. polyps, fibroids, septum) that we would want to take care of before moving into a treatment cycle.
The second procedure you will have done is called hysterosalpingography (we know that’s a mouthful - so we just call it an HSG). It involves an X-ray that will determine the patency of your fallopian tubes, which is fancy talk for making sure your fallopian tubes are open!
This procedure can sometimes be accompanied by cramps and discomfort, so it’s recommended to take 600mg of ibuprofen about a half hour prior to keep you comfortable.
Note: You will receive a full instruction sheet from your Care Team prior to any procedures!
The SHG/SIS test discussed above will determine if you need a hysteroscopy or any other surgical procedures by identifying any uterine abnormalities that may hinder an IVF embryo transfer from being successful. We want to make sure the uterine cavity is nice and ready for your little embryo!
Note: Not every fertility patient will need a hysteroscopy in order to be successful growing their family! Your reproductive endocrinologist will discuss the findings of your SIS/SHG test with you and determine whether a hysteroscopy is necessary.
A hysteroscopy is performed to find the cause of abnormal bleeding, remove uterine growths like polyps and small fibroids, and/or examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing recurrent pregnancy loss. A hysteroscopy is both a diagnostic and therapeutic procedure.
Here's what you can expect on the day of your hysteroscopy procedure:
You will arrive at Illume's Norwalk office an hour before the surgery start time given to you by your team. You will then be walked back to our surgical suite where you will sign a host of paperwork, have an IV inserted, and get your vital signs taken.
You will also meet with your surgeon to discuss exactly what he/she is looking for (polyp, fibroid, etc.) and then talk with your anesthesiologist to discuss the medications he will be giving you for your surgery.
Finally, you will walk with us into the operating room (OR) where your surgery will take place.
You will feel no pain or discomfort during your hysteroscopy procedure, thanks to the wonderful thing that is anesthesia! You will be asleep the entire time.
After anesthesia has been administered and you are comfortably resting, our surgeon (AKA the doctor performing procedures that day) will begin the hysteroscopy. As they visualize your uterus, they will locate and remove any fibroids or polyps that could impede the implantation of an embryo.
If you have a septate uterus (i.e. have a membrane separating your uterus into two different sections), your doctor may also be able to modify the septum during your hysteroscopy.
Some patients wake up after their procedure with menstrual-like cramping, but this is normal and usually can be treated with Tylenol post-operatively. The most important thing to do after your procedure is rest! Delegate all important chores and tasks to your support person, whether that be a partner, parent, sibling, or friend.
You will be instructed to call your Care Team when you get "day one" of your next menstrual cycle so you can begin treatment. If you forget to call us, don't worry - your supportive team will be in touch with you!
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Nope! You will be comfortably asleep the entire time under anesthesia. No pain or discomfort.
Because you will be under anesthesia, you will need someone to accompany you to and from the procedure. You are not allowed to drive for 24 hours.
How long your surgery takes depends on your diagnosis and how complex your case is, but on average, patients are in the OR for 30 minutes and in the recovery area for 30 minutes. Since you are asked to arrive an hour before your procedure, you can expect to be at Illume for a total of about two hours.
Most patients bounce back from their hysteroscopy the next day. It should be a fairly easy recovery, depending on your individual diagnosis. We recommend going back to your normal activities the next day. Of course, reach out to your nurse if you have any concerns or lingering discomfort!
I find that a lot of patients arrive feeling anxious about their procedures. While it is totally normal to be nervous, remember that you will be well taken care of throughout the entire experience.
All of us are rooting for you in every single way imaginable, and we will all work together to ensure that you have the best possible experience, as well as the best possible outcome.
And though no one loves having to be poked and prodded in order to get to the next step of their family-building journey, try to focus on the fact that all these tests and procedures are ultimately getting you closer to your end goal: a healthy pregnancy and baby!
Want to know what comes next? Read my guide to egg retrieval and embryo transfer!