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Navigating Your IVF Cycle

Lunchtime Live with The Center – Navigating Your IVF Cycle – Transcript


Ami: [00:00:00] Understanding your IVF treatment cycle can seem like a new language, but here at The Center, we guide you through it and hold your hands, so you feel well taken care of. 


But it’s always important to understand what’s happening for you when you are doing IVF. So, that’s what we’re talking about today on Lunchtime Live with The Center. 


Erin Hastings, an IVF Nurse, will be sharing about how to navigate your IVF cycle to help you better understand it, what it entails, the process, and answer some frequently asked questions as well. 


Hi, Erin. Welcome. 


Erin: [00:00:32] Hi, thank you. 


Ami: [00:00:34] So Erin, as an IVF nurse, what does a typical day look like for you?


Erin: [00:00:40] You start pretty early in the morning because all of these cycles need morning monitoring so that we can make adjustments to each and every individual IVF plan. 

There are several doctors here, and they’re not all in one location at any given moment.  

Each doctor has their own set of patients, so they are the ones that are monitoring and changing and making adjustments to their own patients’ protocols. 


Ami: [00:01:10] And when a patient and their doctor decide that they’re going to do IVF, what types of things do they need to do? So pre IVF, what types of things, what do they need to know? What do they need to be doing before going in for IVF or before starting their cycle? 


Erin: [00:01:28] So there are some direct indications it might need IVF – if there is a patient that is not in a serious, committed relationship and want to freeze their eggs or if there’s severe male factor component. 

If the patient has even tried multiple IUI cycles and has not been successful, then they would come to IVF.

So. Sometimes patients are walking in, having already started their treatment with us. So they might already have some of these prerequisites done.


But let’s just take it as if you’re a brand new patient starting IVF because that’s your route. 

We require preconceptual blood work, day three labs. We require a uterine cavity assessment. So whether that’s an ultrasound or a water ultrasound, maybe even an HSG, which is a dye test to see if the tubes are open and patent. 


So every IVF cycle and the start of one is tailored to you, but we need some standard things. So a physical exam is always required and that we need a yearly.


Ami: [00:02:37] Okay. And then we have something called A1, a, and 1B as well. What are those, and how does that relate to this? 


Erin: [00:02:45] Sure. So in order to have a consult set up with your doctor, we do ask that you review these videos. So the  1A is broken up into part one and part two. Part one is more clinical information, so it kind of reviews the IVF process and then the. 1A part two is more of a psychological standpoint. So we do have an onsite psychologist, and she reviews it. This was with our former psychologist, but now we have Dr. Kim Crone here, who’s wonderful. 

And Casey Jacobs goes through a lot of the psych components that are involved because fertility is it can be very overwhelming. But we’re here to guide you every step of the way. 


Ami: [00:03:34] And what about the 1B? 


Erin: [00:03:37] So the one B that those videos go into greater detail on certain components of the, of IVF. So, you can be about a day three transfer versus a day five. , they’re, they’re just more broken down so that you can learn more about IVF.


Ami: [00:03:56] Okay. Do they have to do consent? And how does that work when 


Erin: [00:04:03] So once you review those videos and you have your consult with your doctor, they’ll review all the salts, and that is how they come up with their plan for you. Once the doctor. Up with a plan, they discuss it with their IVF nurse. We have six providers, six doctors, three APRNs, and we have fellows that are also here. And so the doctors have their assigned IVF nurses. Or, your assigned nurse would then reach out to you to kind of walk you through the next steps. So with that plan, we what kind of conversations we need to have with those patients in order to get them started. 


And that’s where consents come into play as, depending on the way that the provider and the patient have agreed to fertilize their eggs with this sperm versus if they’ve decided to use something called intracytoplasmic sperm injection, so that’s ICSI. We have to guide patients as far as how to properly complete those consents. 


So those come through EngagedMD, and this is a portal where we have access to the patients to be able to assign them medication, videos, and educational modules. And this is also where the consents come into role. We assign them the proper consents, which gives us permission to carry out their IVF procedure. 


Ami: [00:05:39] So can you also talk about the basic process of IVF and what they can expect from that?


Erin: [00:05:46] Yep. So once we have the plan in place and you’re ready, all of IVF is not a one-stop-shop. There’s not one, one plan that is the only plan that we use. So, it’s completely tailored to each individual patient based on multiple things. 


For a typical cycle, patients would call their nurse with their cycle day one, which is their full menses before midnight, and they would call to set up their baseline appointment. And in this baseline appointment, we are assessing their follicles with an ultrasound and starting them with blood work. So having their baseline blood work and will indicate to the doctor whether or not the patient is able to start. 


And with the okay to start, that’s we’re starting the patient with their stimulation. So the beginning is the stimulation component. They go to trigger once we see that they’re ready to their trigger shot to prepare for retrieval two days later. We will guide them. They’ll have their retrieval of their oocytes. And then they can either, do one of two things. They can freeze, so cryopreservation, or they can go on to fertilize, and either transfer or freeze all of them.  If they are in a relationship, they may choose to freeze embryos, or if they’re single, they may choose to just freeze their eggs. 


Ami: [00:07:14] Now, do they choose to continue or freeze prior to retrieval?


Erin: [00:07:22] Yeah. So that’s part of the whole plan. Patients can either do a fresh cycle or they can do a freeze all cycle. And, what that means is if they’re doing a fresh cycle, they are going right from stimulation to retrieval to transfer. And typically anything that is extra, if there are more embryos that have made it to a blastocyst stage  and the patient wants to freeze those. They can still transfer one of them and freeze other embryos for later use. Some choose to do a cycle and not transfer anything and freeze all of them. And that can be for multiple reasons, and they would discuss that with their doctors. But, one of the most known reasons why to freeze all the embryos is to do something called PGT testing, and that would be to test your embryos. 


Ami: [00:08:17] So after they say they have a transfer , what happens in those two weeks, and when would they have their pregnancy test, or what would happen there?


Erin: [00:08:32] So if they’re doing a fresh cycle, we instruct them exactly what they need to do from trigger night on and what medications they need to take.  If they are going into a fresh transfer, they will need to start some prep medications. They’ll need to start their progesterone and potentially even some estrogen for preparing themselves for their transfer. So once they have their transfer, nine days is when we would schedule their pregnancy test, and that’s basically two weeks from when they had their retrieval. 


Ami: [00:09:09] They have their pregnancy test nine days later if they don’t get their period, right?


Erin: [00:09:22] So we always schedule those. It’s a little bit different than IUI. We always schedule those pregnancy tests. And that will give us a little bit more guidance as far as what we need to do for their protocol. Do they return to us in two days for repeat blood work? And that gauge is what we need to do as far as follow-up and just going into the to the phase where they’re pre retrieval, how often do they come in and what is it what’s involved in monitoring them? So that’s a good question. They have to come in for their baseline ultrasound and their blood work, and that’s for every one of our protocols.


Ami: [00:10:01] Is that day two or three? 


Erin: [00:10:05] Usually day two. And then from there, every protocol is a little bit different, but you will be coming in for some other blood work a couple of days later. And then that’s to see if we need to make any adjustments to the stimulation medications that you’ve started. And then from there, you come in for another ultrasound a few days later with some more blood work, just seeing what you need to return us,  how your body is responding, and if we need to make any adjustments. And then basically from about day six, I would say or so on the ultrasounds become more frequent until we trigger you. They’re every other day or they may even be started daily. 


Ami: [00:10:46] When you say trigger, what does that mean? 


Erin: [00:10:52] So trigger to have the final maturation of your eggs, and so they can go in for the retrieval two days later. 


Ami: [00:11:03] And throughout this process, what does their doctor do versus what you do?


Erin: [00:11:09] So each one of the IVF nurses is every patient’s go-to person. We are talking to the patients and usually daily. First line of communication is always the telephone, but sometimes we do communicate through email. And we are there for the patient for, , every step of the way for any sort of question they have and to give them their next steps and to navigate them through their plan. The doctors are looking at patients through computer screens with cOVID, and they’re monitoring all of their blood work. And they’re reviewing all the images from the scans. The doctors may not see their patients physically, in-person, to do their scans. But, they are the ones that are eyeballing every single lab result and scan they’ve had to make the best call for each of their patients. 


Ami: [00:12:03] Someone else might be doing this scan depending on that morning or the schedule that day. 


Erin: [00:12:09] Absolutely. So it may be one of the other doctors here. It may be one  of the APNRs that we have, it could be an ultrasonographer. It could even be one of our fellows.


Ami: [00:12:18]  IVF is seven days a week. So, is there there’s someone always available in case it falls on a weekend or a holiday? Mostly we’re here. 


Erin: [00:12:29] Good question. We are here . We are here in Farmington 7 days a week. We have three other locations. We have a Branford office , a New London office, and we have a Hartford office, but they’re not open on the weekends.

 The nurses are accessible Mondays through Fridays, and emergencies are directed to an emergency line. 


Ami: [00:12:53] So on the weekends, if you’re not working that weekend, there are other nurses who are available to handle any questions, incoming questions that come up. 


Erin: [00:13:02] Absolutely. If it’s after hours or the office is closed, they can still access somebody if it’s an emergency. 


Ami: [00:13:10] Erin you’re here. You talk to hundreds of patients who are going through IVF. What would you like to share with them? Or, you’ve seen them go through a variety of things, but they’re probably a lot of commonalities. Any advice you would give to them? 


Erin: [00:13:28] This is a one day at a time, one step at a time, process. It is exciting. It is scary. It is overwhelming, but you have a team behind you the whole step of the way, and try not to get ahead of yourself. Give yourself,  take a deep breath and give yourself the chance to enjoy the process because it can be a long one. But we are here to help you succeed. 


Ami: [00:13:56] Oh, great.  Ashley is saying thank you for this information. After three failed IUIs, I’ve made my IVF appointments scheduled for March 5th. This has made me somewhat excited and not as scared.


Oh, good. Okay. So step-by-step day by day. That’s really great advice, Erin. Thank you so much for being here today. 


Erin: [00:14:17] Thank you 


Ami: [00:14:18] And be sure to check out our website for additional information, as well as the calendar of events to support you as well as help you feel connected.


And we’ll see you next time next week for another Lunchtime Live


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