Trying to conceive is confusing initially because everyone told you that if you have sex you will get pregnant; so you swallowed pills and fumbled with condoms and pulled out and prayed more often than you care to admit, until you were more than ready to start trying and then all of a sudden…no baby. Then, when you first go online to ask your very own “what the hell is going on” question, you’re thrown into a world of acronyms where you get the impression that we’re all speaking a foreign language. “TTC for 2.5 years with OPKS, got positive on CD12 with EWCM and BD with DH but now it’s 14DPO with no sign of AF and got a BFN on a HPT (it was FRER too) but I didn’t use FMU and my CM is watery so maybe it’ll turn into a BFP if I POAS on 15DPO? This TWW is driving me crazy! FX for me ladies!” …WTF?!
The confusion doesn’t stop there though. Acronyms are commonly used in the medical field, and for good reason too: who wants to say that they had a hysteroscopy polypectomy after their saline infusion sonohysterography showed a polyp and their intrauterine insemination was canceled? (which is, of course, exactly what happened to me in March.) When you visit with your RE to discuss the big IVF (you know, In Vitro Fertilization: the thing where you walk into your doctor’s office and request that they make a baby for you), they’re going to bring up some brand new acronyms now that you finally just got comfortable with the online lingo. Nothing to worry about though – because I’m here to make sure you can walk into your appointment and wave off your RE like the infertile queen you are when they start to explain what ICSI is.
What it is – Preimplantation Genetic Screening (or Diagnosis). The screening is more like a check mark to say “yes, this embryo looks generally healthy” chromosomally speaking, whereas the diagnosis is testing for genetic conditions like cystic fibrosis (which is the only real example my RE felt like giving me).
Why you might need it – If you know that you and your partner are carriers of genetic abnormalities that you do not want to pass on to future babes, then this might be the test for you! For instance, if you do genetic testing and you find out that you both carry a certain abnormality (and don’t be surprised when you test positive – we all have something, which is the only thing that gets me through the day sometimes), then there’s a 25% chance that a child you conceive could have that abnormality as well. This testing (PGD) can check your embryo for that specific gene prior to implantation (hence the ‘preimplantation’ part) and you can avoid invasive testing later in your pregnancy. PGS may be a good choice if you have RPL (Recurrent Pregnancy Loss), as it will be able to determine if the embryo has the usual amount of chromosomes and therefore should have a higher chance of resulting in a successful pregnancy. Depending on where you’re having your IVF procedure done, your RE might strongly encourage this screening if you’re (*gulp*, don’t hate me!) “older”.
Why you might want it – PGS can also determine the male/female embies, so when they hand you your Baby’s First Embryo Photo you can turn to your husband and exclaim, “She has your eyes!” (Side note: my RE’s office doesn’t take pictures of embryos before implantation and I feel like I’m seriously missing out.)
Things to consider – per my RE, the results could take 6-8 weeks to get back. Also, most insurance companies don’t cover this genetic testing, and even if you’re paying out of pocket already – it could be a hefty additional cost (like, a per embryo cost). The time and financial commitment may be enough to deter you, but there’s also the fact that you could end up wasting perfectly good embryos due to the biopsy damaging little embies, or being performed at the wrong time and therefore giving an incorrect result.
ICSI (pronounced ick-see)
What it is – Intracytoplasmic Sperm Injection. AKA making your IVF experience as scientific as possible. This is where the lab workers (honestly no clue who actually does this) perfectly pair up your embryo with a handsome looking sperm – like an aggressive form of arranged marriage. Basically, they’re doing the fertilization for you as opposed to the alternative way of putting an egg in a petri dish with a handful of sperm as they all fight to the death to see who wins (you know, like nature intended).
Why you might need it – if you have any form of male factor infertility (yes, poor morphology included) you may want to have the opportunity for them to select the best swimmer so that there are increased chances of fertilization. My RE’s office recommends ICSI for most patients, unless your husband has Super Sperm and they instead want to spend their time watching almost-literal cock fights under the microscope as they see which sperm beats them all and gets to fertilize the egg.
Things to consider – notice I said increased chances of fertilization. That means even ICSI doesn’t guarantee that your Grade A egg is going to fertilize and grow. There have also been studies that say that birth defects can be SLIGHTLY increased when you use ICSI, but that could also be due to the fact that if you’re using ICSI, the sample might not be so great to begin with (sorry, guys). On the plus side, they’re still washed like they would be during IUI, so in theory you should be getting rid of the slow pokes and the sad deflated-balloon looking ones. Like everything else, this also costs money, so you will need to decide if you want to risk the chance of fewer fertilizations (or poor fertilizations) occuring in exchange for saving about $1,000 (yay for flat-fees!). You should also have the option (if you want to ‘pretend’ there’s something natural going on here) to use ICSI on some eggs and try ‘the usual way’ with the rest.
OHSS (pronounced OH-SSHIT)
What it is – painful. This stands for Ovarian Hyperstimulation Syndrome and it’s the number one thing to look out for while doing IVF. In short: your ovaries can get swollen and leak fluid into the belly and chest area – just another beautiful side effect of infertility!
Why it might happen – your ovaries were a little too amped up and got overstimulated during the process. It’s more likely to occur if you have PCOS or are a youngin (under 35) going through the process.
Symptoms to look out for – You’re going to be overly monitored during IVF (finally!) so your RE should be on the lookout for extremely high estrogen levels throughout your treatment, but you should also pay attention to: nausea, vomiting, bloating, and difficulty breathing (or what we’ve all pretended are pregnancy symptoms for at least a year now).
Things to consider – there’s a very, very small chance (2%) that this’ll happen to you (seriously, we’re all more likely to have ectopic pregnancies than we are to get OHSS…if that makes you feel better). If you do get OHSS, you may end up spending some time in the hospital, and you most definitely will be missing out on a fresh transfer due to your body needing to heal. Adding more wait time is the last thing us Infertiles usually want to do, but it’ll give your a body a chance regroup and prepare for the FET (see below) that will hopefully occur the following cycle.
What it is – Frozen Embryo Transfer. This one is pretty self explanatory, but for those of you who are juiced up on Clomid and having a difficult time gathering your thoughts: it’s when you’ve already undergone the IVF process and you have some beautiful 5 day old embryos on ice that are in need of a nice thaw and a cozy uterus!
Why you might need it – maybe you’re suffering from a slight case of OHSS or maybe you just can’t stand the idea of someone poking you one more time during your initial IVF cycle. There’s also the unfortunate possibility that your fresh transfer wasn’t successful, so you’ll need to move on to the frozen embs this next round (which is okay because that means you get to skip the stims and retrieval this time)!
Things to consider – there are some stats that say a FET is more successful than fresh (which seems like it should also be called FET but in reality it’s just bundled in with the whole IVF jazz) because you’re giving your body the chance to heal after weeks of injections and an invasive retrieval. FETs only require progesterone and estrogen – so your hormones are going to be a lot more mild than they were during your stim days. Not to mention an added plus that if your FET sticks, you’ll be able to get one of those cute onesies that say things like, “I survived the ice age”.
Keep in mind that you don’t have to do anything on this list, but it’s in your best interest to ask your RE if they recommend you use ICSI or PGS/PGD (they probably won’t recommend getting OHSS, but that’s just my opinion) and why they think you’ll need them. I’ve never accepted an answer of “this is just our process” and you shouldn’t either. If you’re stuck on the price tag of PGD but know that you should probably have it done (for whatever reason), then ask yourself what you’re willing to pay for peace of mind (that same question works for bar nights too). In the end, do what feels right to you and what you believe will make this process as successful as possible. FX (fingers crossed) for all you IVFers out there!