I was surprised by how many of you found helpful my last fertility post about all the specific details of our fertility journey. I write so much about the emotional and spiritual side of infertility, but I know sometimes the tangible details are helpful as well. Before walking down this path, I wanted all the information I could get on what the different steps and stages would look like. So here’s my attempt to give a condensed (but detailed) account of our experience with mini-IVF.
This post will include our mini-ivf experience, as well as our next steps. I’ll also share details of the retrieval process, including medications, side effects, and cost details. At the very bottom I’ll share what we would have done differently given what we know now.
As a reminder, our main concern going into the conversation about IVF centered around excess embryos. You can read more about our convictions surrounding this under “Year 4” of this post.
(NOTE: If you have questions about numbers and specifics from our experience, please do reach out to me. I’d love to share more details in a personal message to you—it feels a little safer than posting ALL the juicy details on the internet).
Without giving too many personal details, I’ll share that we were a little disappointed with the outcome of our mini-IVF cycle. Our main concern was having too many embryos. We knew that we wanted to use every embryo we were given, so we wanted to be very careful about that number. We knew going into mini-IVF that since we were doing less medications, we would run the risk of getting too few embryos, which would mean we would have to do another IVF cycle. But, of course, we wanted to avoid a second IVF cycle if at all possible.
Immediately after our first IVF retrieval, our doctor shared how many eggs were retrieved. The number was slightly lower than expected (but depending on attrition rates, at this point we still could have ended up with the number of embryos we wanted). However, upon further inspection in the lab, the embryologist found an issue with egg quality. As a result, very few of the eggs that were retrieved were able to be successfully fertilized, and even fewer made it through the 5-6 days of growth to become a full blastocyst embryo.
* This news about poor egg quality was obviously so discouraging to hear, but it was also the first answer we’ve gotten to perhaps why we haven’t been able to get pregnant in 3.5 years *
All of this left us with a very low embryo number. Given this low embryo number, we knew that if we wanted more than one child (which we do), we would have to do IVF again.
After consulting with our doctor, she suggested that we move forward immediately with another retrieval round. Thankfully, they had an opening the next month, but if they hadn’t we might have had to wait several months to start the process again. For this next retrieval cycle, we have decided to do full IVF medications (in order to get a larger number of eggs) with limited fertilization (not all eggs will be fertilized—to prevent too many embryos). Given the issues with egg quality, this will allow a larger sample size of eggs, meaning more will be able to be fertilized, meaning—Lord willing—a good number of healthy embryos.
Below I’ll share the details of our IVF process (for both mini and regular IVF), as well as what we would have done differently.
Trial Transfer: Before egg retrieval, part of our clinics “pre-IVF checklist” is doing a trial transfer. This is just a simple appointment to make sure that the probes and catheters are able to be inserted correctly for a successful transfer into the uterus. This is a very simple procedure, only took about 5 minutes, and resulted in minimal side effects (very light spotting for the remainder of the day).
Baseline Ultrasound: This appointment was scheduled the day after I took my last birth control pill. At this appointment and each of the following monitoring appointments, I would come in for an ultrasound and blood work. At my baseline ultrasounds for both mini-IVF and regular-IVF, I was told that I had about 30 tiny follicles. In any given monthly cycle, each follicle has the potential to release an egg, but this does not mean that each follicle will release an egg. Regardless, this baseline appointment is helpful to know some sort of ballpark for what to expect (with mini-IVF, you could expect maybe half or less of your follicles to mature and release an egg).
Monitoring Ultrasounds: Over the next two weeks I came in for multiple monitoring ultrasounds (every few days as we got closer to egg retrieval). At each appointment I had an ultrasound and blood work done. Each ultrasound was intended to measure the growth of my follicles (follicles of size 16-20mm are typically considered “mature”, meaning they will likely release an egg).
Medications and Side-Effects:
- Birth Control (the suppressor): Before starting an IVF cycle, most doctors will prescribe birth control to the patient. This helps to suppress any hormones and essentially to give them a clean slate to start with the stimulation hormones. It also helps them to time the cycle (our clinic does monthly cycles, with everyone in that month on the same schedule). For both cycles, I was on birth control for about two weeks, taking my last pill the day before my baseline ultrasound (day one of the cycle). After coming off of the pill, I did have a very short, light period about three days later.
Side Effects: Of all the medications during IVF, I actually had the worst side effects from the birth control. I was severely nauseous for almost the entire two weeks I was on it (I’ve heard this is a common symptom when starting out on the pill); it was slightly less severe for the second cycle. It also caused a series of breakouts on my face, so I was grateful it was just for a short period of time.
- Clomid 100mg (the stimulator – pill): For mini-IVF, I took this for 5 days, starting on day 3 of my cycle. I’d taken this medication before for our four previous IUIs, and the symptoms I experienced were consistent with my previous experiences. I did not take this medication for regular-IVF.
Side Effects: Flashes in my vision (especially at night), hot flashes, and abdominal bloating
- Menopur 75IU (the stimulator – injection): I started nightly Menopur injections on day 6 of my mini-IVF cycle; I started on day 4 for my regular-IVF cycle. I started out with a dose of 75IU, (which, for mini-IVF, the doctors then doubled after a few days based on how my follicles were looking in monitoring ultrasounds).
Side Effects: This was the most painful injection at this point in the process because of the burning at site of injections while injecting the medicine. Also experienced abdominal bloating (because of all the little growing eggs!)
- Gonal F 225IU (the stimulator – injection): For my regular-IVF cycle, I was prescribed 225IU of Gonal F, starting on day 4 of my cycle.
Side Effects: when you’re on multiple medications it becomes hard to distinguish side effects for each one, but an added symptom during regular-IVF that I didn’t have during mini-IVF was nausea, especially as we got closer to retrieval. Since this was the only new medication, I think the nausea could be attributed to the Gonal F.
- Cetrotide (the antagonist – injection; some also prescribe Ganirelix): Once you reach a certain point of follicle growth, your doctor will start you on antagonist injections. Essentially, this prevents you from ovulating early and allows them to time the egg retrieval for the point when your follicles are at their most mature. For mini-IVF, I was on these morning injections for 6 days. I did my last antagonist injection two days before egg retrieval.
Side Effects: Redness and itchiness at the injection site after injection. I was told this isn’t a common side effect, but that I might just have some sort of reaction to the medicine. No other noted side effects.
- HCG 10,000IU (the trigger – injection; some also prescribe Lupron 20 units): Once the follicles are looking like they’re reaching maturity, your doctor will instruct you take your ovulation trigger shot. This is done precisely 36 hours before your scheduled egg retrieval so that the follicles and eggs are ready to go for retrieval!
Side Effects: No major noted side effects (although at this point in the process it becomes hard to tell what medication is causing what side effect!)
- Embryo Transfer Medications (I haven’t yet taken any of these, as we aren’t yet at transfer stage. I’ll do another post with those details in the months to come)
- Estrace (2mg twice daily, then increased to 3x daily after one week) and Baby Aspirin: Our clinic starts patients on these two medications 3 weeks before transfer.
- PiO (Progesterone in Oil – injection): Our clinic starts patients on progesterone shots 6 days before transfer, and (if the transfer is successful) theses injections are continued until 10-12 weeks of pregnancy.
For mini-IVF, my egg retrieval was scheduled 18 days after my baseline ultrasound (for my regular-IVF round, our doctors wanted to have a shorter timeframe to hopefully slightly improve egg quality—my egg retrieval was scheduled 14 days after my baseline). This date was decided after several monitoring ultrasounds in the week and a half prior. The egg retrieval was scheduled 36 hours after my trigger shot. I was reminded to not eat or drink anything after midnight the night prior to retrieval.
- The Process: During the egg retrieval, you are under partial anesthesia. The doctors insert an ultrasound probe to guide the procedure, followed by a needle that is inserted through the vaginal wall up into the ovaries. Using the ultrasound for guidance, the doctor then sucks out the liquid (and the egg) from each follicle.
- The Recovery: Recovery wasn’t terrible, but it took a bit longer than I expected. For the first few days after surgery, I had a lot of cramping and pain (likely from the probe and the needle). I used a hot water bottle, ibuprofen, and the prescription pain killers that the doctors prescribed.
- The Results: The eggs are immediately fertilized and taken to the lab to grow for the next 5 days. Our doctor called us the day after the retrieval to let us know how many eggs fertilized. She then updated us every other day with how many embryos we had / if they continued growing from day 1 to day 6.
Frozen Embryo Transfer:
- Will add this information in the next few months
Mini-IVF Expected Costs Vs. Actual Costs:
The costs were very similar to what we expected and were quoted. In fact, the mini-IVF medications came in lower than we expected (we had expected $5,000-7,000 for meds, but it was only around $2,500). You can see the full breakdown of each of these costs in my previous post, but below is the approximation of our costs for one mini-IVF retrieval cycle (does not include any embryo transfers) as well as the projected costs for a full round of IVF with limited fertilization.
Baseline IVF Charges: ~$12,000
Mini-IVF Meds: $2,500
Full-IVF Meds: $4,200
Embryo Transfer: $2,390
TOTALS (including meds; not including transfers):
Round 1 (Mini-IVF)
ESTIMATED COST: ~$14,000-$16,000
ACTUAL COST: ~$14,500
Round 2 (Full-IVF meds with Limited Fertilization)
ESTIMATED COST: ~$16,000-$17,000
What We Would Do Differently
If we were starting over knowing what we know now—or if we were sharing our suggestions to anyone in our shoes 5 months ago with our same concerns—we likely would encourage starting with a full IVF medication round with limited fertilization of the retrieved eggs.
Our reasoning for this is that even though the costs would be a little higher on the front end (because you’re paying for almost double the amount of medications), getting a larger sample size of eggs could prevent you from having to do the entire process over again.
*note: obviously everyone’s situation is different, so please listen to your doctor and not me 😉
With mini-IVF we paid about $14,500. This second round of full-IVF will be about $16,500, bringing the total for two IVF rounds (one mini, one regular) to $31,000. Of course, it’s not all about the money (although such a large number makes me a little sick to my stomach), and we did the best that we could given our convictions and the information we had (we didn’t yet know about the poor egg quality). But for those considering this same process, I think it would have been much less emotionally and financially taxing to only do one round of full-IVF/limited fertilization versus starting with mini-IVF and then needing to follow with a second round.
There are so many things that go into the process of IVF. The physical and mental side of things is incredibly taxing (sticking yourself with needles and having your hormones all over the place). But there’s also a huge emotional and spiritual factor that plays into all of it as well. For anyone going through this process, I’d encourage you to share your journey with a few safe people—family, friends, or a trusted counselor. You’re even welcome to reach out to me if you want to talk about your journey. This is a heavy road to walk, but know that even though it may feel like it sometimes, you’re not alone 🤍