Fasten your seatbelts

We're about to take off! My period started last night, which means that the next phase of IVF will be starting on Monday. Many of you have emailed me asking for more details on how the whole process works. I'll try to give a bit of an overview, and if you still want more, there is a video you can watch that explains it all in great detail.

(OK, i admit, i copy/pasted this from my clinic's website)
Step One - Ovulation Induction
Hormone injections are given to stimulate multiple egg production rather than the single egg normally produced by the body each month. This stimulation process usually requires the initial use of Lupron to suppress the ovary to prevent ovulation until the desired time. Daily gonadotropin injections are then added to stimulate the development of the eggs. These are usually given subcutaneously (under the skin) and are much less uncomfortable than the previous generations of medication. We then monitor the progress of ovulation induction with ultrasounds and blood estrogen levels over several days.
In English? I've been taking these Lupron shots for a week now. Those are basically shutting everything down in order to be able to stimulate the ovaries to produces multiple follicles (which eventually mature into eggs). Starting on Monday, i will go in for monitoring appointments every other day. At this appointment they take blood so they can measure hormone levels and do a transvaginal ultrasound (lovingly referred to by a friend of mine as the Dildo Cam) to see how many follies and what size. On Monday i will also find out about when to start the next round of injections, the gonadotropins, which do the actual stimulation. So my injections may go up to 3 a day, fun fun! I will keep going for monitoring every other day, and then eventually every day, as they continue to check on the growth of the follies getting closer to ovulation. When everything is looking right, I will do one massive injection that triggers the ovulation and 36 hours will be in for step 2.

Step Two - Egg Retrieval
An egg retrieval is performed by placing a special needle into the ovarian follicle and removing the fluid that contains the egg. This is a relatively minor procedure and is performed by visualizing the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall, and into the ovary. To avoid any discomfort, strong, short acting intravenous sedation is provided.
Basically, i get to take the day off and go in to have all the follicles sucked out of me. This is also the day that M gets involved with his "sample". I get to be poked, prodded and drugged...he gets to calmly and pleasurefully (is that a word? doubt it) deliver it into a cup.
This will probably be in about 2 weeks (around 11/13) but it will all depend on how i respond to the stimulation drugs.

Step Three - Fertilization and Embryo Culture
Once the follicular fluid is removed from the follicle, the eggs are identified by the embryologist and placed into an incubator. The eggs are fertilized with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI).
During conventional insemination approximately 50,000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilization process. The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle.
The eggs will be checked the following day to document fertilization and again the next day to evaluate for early cell division. They are now called embryos and are placed in a solution called media to promote growth. Until recently, embryos were cultured for three days and then transferred to the uterus and/or cryopreserved (frozen). We now have the ability to grow the embryos for five or six days until they reach the blastocyst stage. For some couples these blastocysts may have a greater chance of implantation, allowing us to transfer fewer embryos, in some cases only one, and lower the risk of multiple birth while increasing the chance of pregnancy.
On day two or three after fertilization, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days.
Believe it or not, there are people with greater infertility problems than me! We do not have to do the ICSI procedure. M's swimmies get to meet up with my eggies in a dish and have their own fun without being chaperoned by an embryologist. I'll get a phone call to find out how many eggs were retrieved, and then a daily phone call with an update on how many are growing and to what size.

Step Four - Embryo Transfer
Embryos may be transferred on day 3, 5, or 6 after egg retrieval. Transfers on day 5 or 6 are called Blastocyst Transfers. They are placed through the cervix into the uterine cavity using a small, soft catheter.
This is when the doctor and embryologists decide which of the embryos look the strongest and have the greatest chance of survival. There is a ton of science and statistics behind the decision of when to transfer and how many to transfer. I'll get more into this at another time as i begin to understand it better.

Step 5 - Testing for Pregnancy
Two weeks after the embryo transfer you will return to our office for a pregnancy test. If you are pregnant, we will follow your progress with blood work and ultrasounds for four weeks before referring you back your to obstetrician for continued care. You should expect a normal pregnancy, unless advised otherwise.
Do you love that last sentence or what? I expect nothing at this point. The two weeks between the transfer and the pregnancy test are going to be brutal. Fortunately Thanksgiving will fall in that time, and scarily enough, we will be testing for pregnancy right around M's and my bdays.

If you are still reading, you must really care about me. :)
If you want to learn all this with audio and visual support, go to this link http://www.shadygrovefertility.com/webcast and choose the IVF Overview.