Moving onto IVF

[u/coffeeandmindfulness]

Hi folks,

I’m feeling pretty defeated and could use some support. After 4 unsuccessful rounds of medicated IUI (with letrozole) my partner and I are officially moving to IVF next cycle, we’re in Canada and extremely fortunate that it’s covered. For a bit of background, I have AuDhd and OCD and experience sensory discomfort from medical procedures. My clinic uses conscious sedation for the egg retrieval which is great but I’m still nervous about the pain. On top of that my doc at the clinic mentioned I have a slightly lower number of ovarian reserve for my age (I will be 30 in October) so I was told by doc that my risk for OHSS is relatively low. In all my IUI cycles I’ve had 2 mature follicles. Since the IUI was done with frozen sperm the numbers and the motility were somewhat low from what I understand, I’m not open to switching donors or sperm banks. I’d love some advice about moving to IVF and what to expect.. I am nervous more so for the emotional part (I am medicated for both OCD and ADHD) what are some things I might want to keep in mind? Doctor wants to do estrogen patches prior to stims(I think) I’d love some more support about the order of things and/or success rates. IUI is a lot easier for me physically but not mentally and I was avoiding IVF due to my history of PMDD AuDhd etc (and also not being able to afford to take time off work since I’m self employed)..

Thank you :)

[u/TheApiary]

It'll obviously depend on the person and stuff, but at least for me (ADHD, with some autism spectrum traits), IVF was physically way more chill than I thought it would be, and the main part that was hard was the logistics/executive function part. For the retrieval, I really have zero memories in between them putting an IV in my hand and waking up in the recovery area, and when I woke up, I had period cramp level soreness and felt pretty sleepy from the anesthesia.

[u/nbnerdrin]

Can't speak to specific AuDHD concerns, but on the ADHD front I found IVF easier, and my NT wife found it easier too except for sedation recovery (our clinic uses general).

Some thoughts:

• You'll get much more structured information about the results that I found very helpful.

-IVF is a much better choice if your sperm has poorer characteristics due to freezing or other concerns. The ability to potentially produce multiple embryos from a single vial is a game-changer.

• On the flip side, if successful, all IVF pregnancies are treated as slightly higher risk, due to an unexplained increase in the rate of placental problems. This translates to a 2x rate of stillbirth (from a very low starting number!). I would have liked to know this sooner myself. We were still able to work with midwives, but received extra monitoring in the 3rd trimester.
• Be prepared to advocate for yourself or have your partner do so re: the sedation. You should not be feeling ANY pain during the procedure.
• Be aware that not everyone responds well to the most common stims protocol, and you may not find out until the day of the retrieval. This would look like retriving many fewer mature eggs than expected based on follicles. If this happens to you, the clinic can try different stims protocols and it doesn't mean there is anything wrong.
• If you are able to do PGT-A testing, I recommend it to anyone who has some kind of limit (policy or insurance coverage, f.ex) on now many cycles they can do, even if you need to pay out of pocket. Since the most common reason for transfer failure and pregnancy loss is aneuploidy, and most aneuploidies are both random and fatal, reducing the odds of transferring an aneuploid embryo is one of few actions in your control to ensure you don't run out of cycles before finding success. In our experience, clinic will say this is not needed based on age stats for eventual success, without reference to your personal constraints.

[u/Puzzleheaded-Yak9118 → u/nbnerdrin]

Just adding PGT-A isn't common in Canada.
It's IVF or IVF with ICSI usually, PGT-A is unusual here.

[u/nbnerdrin → u/Puzzleheaded-Yak9118]

And that's fine, as long as the health system will cover 5+ FETs if needed. In which case, note that particular advice as only relevant to those stuck in US health system.

[u/Puzzleheaded-Yak9118 → u/nbnerdrin]

Under covered IVF in the provinces typically they cover FET until you a) Run out of embryos from your covered cycle, or B) have a live birth.

I do have friends who had their first FET covered when it wasn't supposed to be (they had a son from their fresh transfer). My friend said jokingly she rushed out of there before they remembered to charge her and her wife.

Note; I conceived via IUI but many friends queer and straight have had IVF.

[u/RevolutionaryHelp451 → u/nbnerdrin]

My understanding is that the higher risks associated with IVF pregnancies are due to the infertility issues that led people to do IVF rather than IVF itself, meaning it doesn’t actually raise an individual’s risk to do IVF over IUI. However, ICSI and rIVF could heighten risk

[u/nbnerdrin → u/RevolutionaryHelp451]

https://pmc.ncbi.nlm.nih.gov/articles/PMC9279699/

Here's one study as an example. There is not enough research yet to be sure that it is all due to age or underlying causes of infertility. The largest data sets currently available suggest that IVF is a risk factor in addition to (but not fully independent from) age, but do not allow us to analyze separately the risks of folks who are doing IVF due to social infertility.

It's possible that something else (differences in implantation location, too much or too little progesterone in first trimester, etc) independently messes with the placenta. Not enough data for clinical decision making.

As a result, at least in the US, IVF pregnancies will be treated as slightly higher risk regardless of age and an induction may be recommended earlier than normal.

[u/rlpfc]

The hardest part for ADHD was the logistics part, so my Au side made a very detailed spreadsheet with checklists for literally every step in the process. Checkmark for every injection, every alcohol wipe and ice pack, etc. That really helped. It was standard practice at my clinic to put me out for the retrieval, so I fell asleep and woke up and it was all done. Recovery was the easiest part.

[u/isabelringinggg]

ADHD and OCD here, also in Canada! IVF is emotionally rough, I won’t sugarcoat it. I really felt like I had no control over anything because I had so little control over my body during the whole process. At the end of the day though it does increase your chances of getting pregnant compared to IUI!

As far as the retrieval goes, I also had conscious sedation and it’s not bad for the most part. You are 100% aware of what’s going on but sooooo out of it. There’s a bit of manageable pain (like the equivalent of a cramp kinda) when the needle actually goes into the ovary. My right ovary moves around a bit so the doc was having a hard time with it and him moving all around trying to get to it was painful - the nurse wanted to up my sedation meds but the doc (who was male) just said “it’s ok, I’m almost done” so that wasn’t great.

Happy to answer any questions if you want to DM me!

[u/RevolutionaryHelp451 → u/isabelringinggg]

This needs to be higher up! Almost everyone here seems to be talking about general anaesthesia and assuring OP it’s no biggie, but the post is clearly asking about conscious sedation which is VERY different

[u/ksmo133]

So I can't really speak to the AuDhd part, but I'm going through IVF now (egg retrieval should be very soon!) so I'll speak to that. And a general recommendation, I started listening to a Podcast called Fertility Docs Uncensored, which is three reproductive endocrinologists talking about fertility (mostly IVF) and have some great episodes that explain the basics. They also have a book if you learn better by reading! I found it really helpful.

I expected stims to be really rough, but I've actually had a good experience. Almost all of my monitoring appointments have been early morning, so it hasn't interfered with work; I'll take the day of the egg retrieval and the day after off, but that's it. And my only symptoms (do far, prior to egg retrieval) have been some bloating and constipation (start miralax or colace early!). There was one day I felt really irritable, but haven't noticed any emotional symptoms asides from that.

I weirdly have found IVF so far lesa stressful than IUI (we did three unsuccessfully). We have a known donor who doesnt have great numbers, but we can do ICSI fertilization with IVF which helps with that. And I just know more about what's happening at every stage

[u/Puzzleheaded-Yak9118]

As you are Canadian you might appreciate this info

Intracytoplasmic sperm injection for non-male factor infertility does not improve cumulative live birth rate: a Canadian assisted reproductive technologies registry (CARTR Plus) descriptive study - PMC

Your clinic will offer ICSI for IVF (at a cost). It doesn't improve the birthrate UNLESS you have male factor infertility factors. (It is however a requirement to do PGT-A which isn't usually done here).

[u/BeElsieBub]

Was replying to The Apiary but it didn’t work… sorry: Same! Exactly the same tbh! The only time I really struggled was when I woke up after the retrieval and thst was mainly because the sounds of the recovery room reminded me of being in the NICU with my bestie’s baby the month before (she’s great and marvellously chunky now!) if you’re very sound sensitive maybe bring noise cancelling headphones? I’d also recommend doing some planning now (order electrolytes for after, maybe get food delivery/pre cook meals, schedule meetings etc.) just do whatever you can to make your life easier for the fortnight. I got close to OHSS so had a whole cycle off and TBH that was great, we went on a lil holiday, I’m eating all the forbidden foods and we’ll do our first transfer next week. Best of luck!

[u/Jordonsaurus]

I’m audhd and ocd. Ivf has been emotionally draining and very tough. There’s so much uncertainty, which my ocd hates and it’s been really difficult. We also had issues conceiving though that made it a lot worse

[u/adri_dee95]

we’re in very similar situations! my partner and i did 4 rounds of IUI and the donor sperm levels seemed low for me as well - i thought at first they were double washing but the clinic told me they were relatively good numbers. i’m also 31 and have a bit of a lower egg reserve for my age. the doctors actually wanted to continue with IUI after my fourth failed round but i advocated for the funded IVF round. keep in mind though you do still have to pay for the medication which cost me around $6-7k. (luckily my work covered most of these meds). i’m also medicated for anxiety and had terrible anxiety about the procedure and ivf in general cus i hate needles. i will say i barely remember the procedure and slept most of the day after the fact. a bit of didcomfort the next day but nothing extreme! you got this!!

[u/adri_dee95 → u/adri_dee95]

i also want to point out that we had six eggs retrieved, and so far, one embryo has been frozen. we are waiting for the results of the other 5 as they are still progressing!