The highly anticipated day is finally here and we are ready.

The last few days were a real emotional roller coaster. Fortunately, I did not have any physical symptoms after the oocyte (egg) retrieval. The most common side effects are cramping and spotting, and I was lucky I did not have to experience either one of them. The only thing that was a little bit uncomfortable were my very sore and painful breasts, but it was tolerable.

The embryos are transferred into the uterus through the vagina by using a very thin catheter. When the embryos reach their final destination, you can see little air bubbles on the monitor. Here they are! Now it is up to them and the universe. We just have to wait.

Nevertheless, I felt very anxious during the last few days while waiting for the embryo transfer. I’m not sure if it was because of the hormones playing with my emotions, or just my thoughts. Either way, handling the last few days was very difficult. After the oocyte retrieval I felt like a part of my soul was placed outside of my body - not knowing what was happening with our tiny embryos was truly nerve-wracking. I would have given anything to have a spy camera in the lab to check on them and make sure that everything was going well and according to plan.

But now the wait is finally over. Our embryo transfer is scheduled for today and if all goes well, at least one embryo is going to be placed back where it belongs and will give us the chance to become parents.

The last procedure of IVF does not require a lot of preparation. The clinic asked me not to wear any deodorant, perfume, nail polish, makeup, or apply lotions or powder, as the embryos are very sensitive to strong scents and chemicals. They also asked me to come to the clinic with a full bladder, which can make the transfer easier and may aid with placing the embryo perfectly. This part (the full bladder) is a little uncomfortable, especially if you are as excited as I am!

Embryos are transferred back to the uterus between day 2 and day 5 after fertilisation. There are many factors to consider when choosing the best transfer time, such as the number of fertilised oocytes, the number of previous treatments, the quality of your embryos, or the age of the patient. We were scheduled for a transfer on day 3.

After arriving at the clinic, we met with our doctor first. He confirmed that we have two well-developed embryos that are ready for transfer. He recommended transferring both of them back to the uterus in order to increase the chances of at least one of them implanting successfully. I found an article on www.webmd.com about embryo transfer statistics, which explained that “about half of IVF procedures in the U.S. involve the transfer of two embryos, 23% involve three, and around 10% involve four or five embryos. Close to 1 in 3 IVF births involves twins.”

Hence, two is an ideal number for us because:

• it increases our chances of conceiving;
• it has a low risk of complications;
• and we would be very happy with twins.

The transfer was a very quick and simple procedure - it is actually very similar to a pap smear test, so there really is nothing to worry about. The nicest thing about it is that your partner can share this special moment with you.

Be the rock your partner can lean on during your IVF treatment - just like she deserves.

Some men are raised to be some kind of soldier from childhood on. Hide your emotions! Be tough! They learn very early on that boys are not supposed to cry or complain. In fact, they grow a protective shield around them based on what everyone tells them, which makes it hard for them to express their emotions. Unfortunately, this can become a natural and permanent state of mind for them.

Other men grow up surrounded by the freedom to express their emotions. It is natural for them to talk about their feelings, which makes them considerably more empathetic and vulnerable at the same time. I belong to this group and, in my opinion, my kind of men need more support throughout their life, especially in relationships. That is why they often choose stronger women as their partners.

It does not matter which group you belong to. When undergoing fertility treatments, we all need to make some changes. If you have a stronger character you will need to become a bit more sensitive and learn how to respond to the challenges of your journey with sufficient subtlety. There is nothing wrong with determination or a healthy sense of reality. However, you will need to try to soften your character and become a little more compassionate. The sensitive souls, myself included, should put their hypersensitivity somewhat aside because your partner needs someone who can be strong and provide solid support during difficult days.

The reality of IVF is uncertain; either you succeed or you don’t. Your fertility treatment will be accompanied by constant doubts and question marks. The truth is that during your journey you will most probably experience some great victories, but many failures as well. All of these new experiences will greatly affect you both mentally and emotionally, and you will have to be her number one supporter during all of these ups and downs.

My strategy is to empathise with all of the emotions that she may feel at that moment. I accept the fact that her mood changes more frequently than it normally does. Every time I feel like she wants to talk about the fertility process or tell me how she is feeling, I put everything else aside because the most important thing for me is to be there for her. Sometimes I just listen, other times I tell her my point of view, even though I am definitely not trying to be a know-it-all. Typically, I don’t even initiate a conversation about IVF, unless I read or hear something interesting or beneficial that I would like to share with her.

Another useful trick I have learnt was to divert her attention, which was necessary more than just a few times. This came particularly handy when we were waiting for important news regarding test results or procedure outcomes, for example, after the oocyte (egg) retrieval, when we were waiting for information about how many of our oocytes had been fertilised.

I try to stay level headed at all times, even though my overly emotional self is trying to rebel against that from time to time. Believe me when I say that sometimes deep down inside there is more tension in me than in her. I experience the same uncertainties as she does, and I am scared and disappointed at times, too. But I really hope that she doesn’t know this.

And the conclusion? Make sure that your woman and her feelings are always the centre of attention. Don’t forget to be cooperative, supportive, and attentive.

The emotional numbers game of counting follicles, oocytes, hopes, and dreams.

Today is day 1 after my oocyte (egg) retrieval (known simply as OCR in the IVF community). The phone call with my fertility clinic is scheduled for 9am to receive some details about yesterday's events. At 9am I dial the number that I found on the document that I received after my oocyte collection. I turn on the speaker on my phone to make sure that my husband does not miss any information. A very kind voice answers the call and the woman introduces herself as our embryologist. After a short identification process, she informs us that she found two mature oocytes out of the five that were collected yesterday, and one of the two was successfully fertilised.

I am speechless. That is not the news I expected. She must feel my disappointment because she quickly continues. She will go back and check on the other three oocytes again later today to see if they also matured. If they have, they will be fertilised, too. She also let us know that our embryo transfer (ET) is scheduled for Monday, four days from now, at 7.30 in the morning. She kindly wishes us a great weekend and we hang up the phone.

I am sitting on the couch, trying to recall every single word of the conversation. My summary is this: yesterday we had five oocytes collected, two of them were definitely matured, but only one of the two was fertilised. However, there is still a possibility that we might have more fertilised oocytes by Monday. All of these facts play an equally important role.

I don’t allow myself too much time for an emotional breakdown. My analytical mind needs to inspect every fact that I have learnt today. It is time to turn to my best friend: Google. Here is what I learnt and why I call this the Numbers Game:

• There is a set number of follicles before the OCR. In our case this number was five follicles. BUT
• Some oocytes may be partially or completely damaged. I do not have any information on whether this has happened to our oocytes, so let’s just say that the number stays at five oocytes.
• There is a possibility that some of the follicles were empty, meaning, they did not contain any oocytes. In my case, each of my follicles had an oocyte inside of it, so our number is still five. BUT
• There is a chance that some of the collected oocytes were immature at the time of the OCR. Furthermore, some of them could be overly mature, as well. In our case the embryologist found two mature oocytes after the OCR but she will wait and see if the others will mature by the time of our embryo transfer. BUT…

Why we need a Trigger Injection for oocyte maturation, and why it is so important to use it properly.

Let's learn the basics about the Trigger shot stage of the IVF treatment. Ovarian follicles are small fluid-filled sacs in the ovaries. Inside of each follicle is an immature egg, which grows and undergoes a set of changes. After the follicle reaches its optimal size, ovulation occurs and the mature egg is released.

After the Trigger Shot, I spent the next 36 hours before the egg retrieval relaxing and preparing myself for the egg collection.

During my ovarian stimulation period, I had two ultrasound appointments to check how my ovaries reacted to the hormone injections. I was quite surprised that a simple ultrasound test was able to detect my follicles. At the first appointment, we found four follicles, two on each ovary, and later on, one more little miracle follicle showed up on the screen. By the end of the stimulation stage, my ovaries developed five good looking follicles.

Five follicles is not a big number if we compare it to the optimal figure. Usually, anywhere between 8 and 15 follicles is considered an acceptable amount for an IVF treatment. Even though I received a fairly high dosage of fertility drugs, my ovaries reacted poorly to the stimulation. However, it only takes one egg to succeed, so the game has not been over yet!

The great news was that all of my follicles were a good size. When a follicle reaches the measurements between 16mm and 22mm, it is more likely that it contains a fully mature egg, which is ideal for the IVF process. All of my follicles reached this size, so it was definitely a small victory. The doctor also checked the thickness of my uterine lining, which was 12mm, and found it to be optimal for implantation.

The doctor gave us the green light to move forward to stage 2: the Trigger Shot, also called the Trigger Injection. The Trigger shot sends the eggs into meiosis (a state of reproductive division), and helps them to mature for egg collection. The objective is to decrease the number of chromosomes in the eggs from 46 to 23 prior to egg retrieval. If exactly 23 chromosomes are not present in the egg that undergoes fertilisation, it will not be able to create an embryo. I see now why it is so important.

The Trigger Shot usually contains the HCG hormone, which is the famous “pregnancy hormone” that we are looking for while taking a pregnancy test. After receiving the injection, ovulation can start between 36-48 hours. I had to use this single shot exactly 36 hours prior to my scheduled egg collection appointment. The most important step of the Trigger Shot is the timing; the success of the fertility treatment greatly depends on it and its effect on the quality of eggs. To make sure I did not forget this important task, I scheduled the shot in the Leeaf calendar, and waited for the selected time.

Injecting the Trigger Shot is exactly the same process as administering the daily hormonal stimulation shots, so there is nothing to be concerned about.

Even though we were rationally and emotionally prepared for hormonal stimulation, we were both stunned by some of the side effects.

Most couples who go through IVF for the first time, like us, are quite inexperienced and not very informed. Obviously, we asked a lot of questions and read as much information as possible about what to expect, however, actually experiencing this process first hand is fairly different. There are things that you just cannot fully prepare for. One of them is the amount of hormones your partner is going to receive and how she will react to it.

The main problem with hormonal stimulation is that the side effects are unpredictable. It affects everyone differently. Unfortunately, this part of the process cannot be avoided but you can get through it with a great deal of care.

The main question that came to me was: why does she need this huge amount of hormones? Well, hormones are used for many different things during the IVF treatment. Initially, the ovaries must be stimulated to grow as many follicles as possible. Then, the hormones help with maturation of the eggs before the actual egg retrieval. Also, certain hormones are used to improve the chances of embryo implantation. IVF is a precise process that requires exact doses of different hormones for each step, and that is why the final amount of hormones seems so excessive.

As it turned out, the stimulation process can be a little scary. My wife had to administer the hormone injections by herself. Do you understand? She has to poke herself with a needle every day for weeks. I still shudder as I write. And that is not all. Hormones can have two very perceptible side effects. One of them is that they can make your partner experience certain physical changes, the other can cause emotional tsunamis. Which one is worse? It is usually a tie, but both are definitely difficult issues.

I don’t know if we were lucky or we handled the situation well, but we only experienced one emotional side effect: my Love was able to laugh through her tears at practically anything, even in a completely neutral situation. The seven-headed dragon that I’ve read so much about was, fortunately, asleep.

On the contrary, dealing with the physical side effects was very difficult for her. Even though I tried to comfort her and reassure her that she is beautiful (which she truly is), it was hard for her to handle that her waist suddenly vanished and her belly doubled from bloating. Unfortunately, neither diet nor exercise helped, but after a few weeks it disappeared as it came. This is something that both of you should keep in mind.

Looking back, we can laugh at our experience now, but sadly, many women can have serious hormonal imbalances affecting them both physically and emotionally. This is one of the main reasons why many couples give up on IVF altogether, and that is completely understandable. Emotional support helps you both to be there for each other, to relieve the heavy pressure, which normally affects your partner more, and to handle the physical changes with ease.

A few tips to win over your fear of needles, and be a superwoman.

These days are about growing as many healthy, and mature eggs as possible with the help of ovarian stimulation. More eggs mean a better chance of succeeding.

According to my stimulation protocol I uploaded my medication plan to Leeaf, and also scheduled my next ultrasound appointment. This little extra help ensures me that all are on track. Being organized always comforts me.

That’s how I won over my fears of needles. I felt like an unstoppable superwoman every day after my injections, but to be honest, my fear was much bigger than realistic.

The day following my clinic visit, I had to administer my first daily hormone injection by myself. Of course – because of my nervousness – I was not sure anymore how to use the injection pen properly, even though the nurse gave me a proper training just 24 hours ago. The instruction book seemed a bit complicated to me, so I decided to go for an official Youtube tutorial. It’s better to check it twice, than doing anything wrong, right?

After double-checking the theory, I still had to deal with the reality: my fear of needles. This little problem won’t stop me for sure, but it makes me feel anxious. The needle is very tinny, but still - I am not professional – I am scarred that it’s going to hurt. I can be sure that 1 out of 4 women undergoing IVF has the same feeling as I do, because it's estimated that fear of needles affects up to 25% of adults. So, I am definitely not alone with this one either.

I did some research, and actually there are a few tricks we can do to make the daily injections easier:

1. Ice the area before injecting so you can numb it.
2. Pinch the skin at the injection site. Injections go right under the skin before you reach the muscle.
3. Keep the muscle flaccid by standing on the leg opposite to the one in which you are injecting.
4. Make sure to relax. Practice some deep breaths and make sure the muscle you are going to inject is loose.
5. Pretend you’re braver than you feel. Count to three and shoot.

The system of fertility programs, based on my own experience, takes men as side characters. No problem at all, bad systems are there to break them

Did you know what ‘infertility’ means? The definition is very simple: if a couple has unprotected sex for 12 months and they are not able to conceive, they are labelled as infertile. I was sincerely surprised by this simple definition.

Unfortunately, most people still identify infertility as a ‘woman problem’. Although if we check on the main causes of infertility, we can find it easily that nothing can be further from the truth. For me, the turning point definitely was, when it turned out that - based on my spermiogram - I was an active participant in our lack of success. Before that I supported actively my wife, but then it became a completely different story. Even though if you have award-winning sperm quality, you still need to participate in the program with the same dedication as if it were all up to you.

"Don’t wait to be asked for staring in the movie. This is not Hollywood. It’s simply one, if not the most important movie of your life."

When I found myself in the world of IVF, I had to face the fact that everything is apparently all about the woman. In this story I felt like a “supporting family member”. There are a lot more tests and examination on her, some of them can be painful (fallopian test), and she even has to undergo a surgery (egg retrieval). These are the physical parts of the fertility program. I can’t take the hormones, or go under a surgery instead of her, even though I would do it happily. But there are many situations where I can make my partner’s job easier with my presence and support.

I don’t want to be a passive character in the story. I would like to have a child with her, such as much as she wants it. I can never leave her alone under any circumstances. I always want to be there for her, and make her feel, she can count on me. It’s also true if I play a more active role, I can own the process much more as well. It already makes an enormous difference when instead of saying ‘we have to undergo fertility treatment because my wife cannot have a child naturally’, I take it as ‘we, as a couple’ have fertility problems.

Your partner will need a constant emotional support. She is going to go through so many challenges over the process. Don’t be surprised if she laughs when she supposed to feel sad, and the other way around, and it won’t be the weirdest situation believe me. During these difficult weeks, you will be her rock, because you have to be.

The system of fertility programs, based on my own experience, takes men as side characters. No problem at all, bad systems are there to break them, it doesn’t have to be, work this way. Feel free to be more active in the process, first of all it will make your partner happy, and secondly you will be proud of yourself. Believe me, this will be very much needed too.

The first stage of our IVF cycle began with ovarian stimulation.

Per my doctor’s request, I went to the fertility clinic on the second day of my period for a final check up to make sure that it is safe to start our IVF treatment. The examination was quick and easy; it was only a simple ultrasound test and also the last pre-treatment evaluation, which is done to check the presence of any ovarian cysts. The absence of ovarian cysts is important because they can interfere with proper egg development during the treatment. Fortunately, there were no signs of any cysts, so nothing could hold us back from starting our fertility treatment this month. We were ready for stage 1: the ovarian stimulation.

I had to administer the hormone injections every day for five days. After that I came back to the clinic to find out how my ovaries reacted to the stimulation and how many follicles started to grow.

After the ultrasound examination, I received the stimulation protocol from my doctor. He explained that the medication plan is based on my previous test results. It is one of the reasons why we needed to do the previous blood tests. My AMH (anti-müllerian hormone) level was pretty low, so I needed a higher dosage of stimulation drugs.

But what actually is a controlled ovarian stimulation (COS)? During the ovarian stimulation phase of IVF, I used injectable fertility medication to stimulate my ovaries to produce multiple mature eggs. The injections that I used contained follicle stimulating hormone (FSH), which is necessary for ovaries to produce follicles, and luteinizing hormone (LH), which stimulates the growth of small follicles. The average length of the stimulation is 7-10 days, but in some cases it can take a couple of weeks before the medication starts working. The duration mainly depends on how the ovaries respond to the stimulation.

The right stimulation protocol highly affects the outcome of the treatment. I am sure that the process is more complicated than this, but generally speaking, if the stimulation dose is too small, none or only a small number of eggs are retrieved, and the IVF success rates decrease. On the other hand, if the dose of gonadotropins is too high, the woman is at a higher risk of hyperstimulation, also known as Ovarian Hyperstimulation Syndrome (OHSS). It is an exaggerated response to too many hormones and it can cause swelling to the ovaries, which can become painful. What is interesting about the whole stimulation process is that the same IVF protocol may work more successfully than others simply due to the different amount of available follicles. The instructions were clearly written down on the paper I received from the doctor, nevertheless, it was definitely comforting that a nurse explained everything about the injection pens and how to use them. I had to administer the first dosage of hormones to myself with the guidance of the nurse, and she said that I did it very well 🙂 Here are some tips from the nurse:

1. Keep the drugs and the injectable pens in the fridge but leave them out at a room temperature for 20 minutes before administering them. Injecting a cold fluid can be unpleasant.
2. Try to administer the injections in the same 4 hour window every day.
3. To avoid skin irritation and soreness, alternate injection sites every day. One day use the right side of the belly (or the right thigh), the next day use the left side of the belly (or the left thigh).

If we cannot conceive naturally, it’s good to know which options we have in the world of artificial reproduction treatments (ART).

When we are confronted with the fact that we are not able to have a child in the natural way, we are directed to a fertility center. At the clinic it’s easy to get overwhelmed with all the new information we have to take in. As beginners, we didn’t even know which are the ways to consider or what are the differences between the different forms of fertility treatments. The most commonly known fertility treatment is IVF, but it’s not the only one. But which are real options for us, and which direction should we take?

"We also have to talk about the classic in vivo fertilization. Simply put, have sex because anything can happen at any time."

The first two are relatively simple solutions to treat infertility, such as Planned Intercourse and Artificial Insemination.

The simplest fertility treatment is called Planned (or Timed) Intercourse. In this procedure a mild ovarian stimulation can be involved, promoting the growth of 2-3 follicles ideally. If the follicular growth is optimal (the doc checks it though ultrasound), ovulation can happen naturally or can be provoked by a trigger injection. By the end of the process the doctor will determine the days when it is most recommended to be together (have sex). This is a relatively natural fertility solution with some extra help. I think it’s an option for couples with good test results.

The second option is Artificial Insemination. The treatment starts with hormonal ovarian stimulation, and followed by a trigger injection. Even the most fertile days are determined by the doctor. However, the fertilization doesn’t take place by natural intercourse. By the end of the stimulation phase the male partner is asked for sperm collection. Sperms that have been washed and concentrated are placed directly in the woman’s uterus, cervix or fallopian tubes around the time the ovaries release one or more eggs to be fertilized. Insemination is usually recommended when everything is fine with the sperm and the woman’s fallopian tubes (or at least one of them) are permeable. The procedure is completely painless, it’s less expensive compared to IVF, but the success rate is lower: only 15-20%.

The next option is IVF (In Vitro Fertilization), which I think is the most known fertility treatment type. The main difference compared to the previous treatments is that the fertilization happens outside the body – ‘in vitro’ means ‘in a test tube’. The procedure is longer, more expensive, more complicated and involves a higher hormonal load than insemination.

What are the main stages you are going to undergo during an IVF treatment?

1. Ovarian Stimulation. The goal of ovarian stimulation is to achieve multifollicular development by administering daily hormone injections, hoping more follicles, more eggs will be available for fertilization. There are several different medication protocols in use to achieve this. In the case of short protocol, the stimulation starts on Day 2 or 3 of the menstrual cycle, and takes about 7-11 days. The long protocol can take up to 4 weeks. It starts on Day 20 of the menstrual cycle with a 10-day long medication which helps to shut down the ovaries first. In step two the same ovarian stimulation starts as in the short protocol.
2. Trigger Injection. If the follicles are sufficiently mature, the Trigger helps the growth and maturing of eggs.
3. Egg retrieval, and Sperm Collection. 36 hours after the Trigger Injection the Egg Retrieval is going to take place. Using ultrasound, the fluid containing the eggs is collected from the follicles through the vagina with a needle. At the same time sperm is collected from the male partner.
4. Fertilization. After collection, the eggs and sperm are cleaned in the embryologist’s laboratory, then a group of sperm is put together with the eggs to be fertilized. Practically the same thing happens in the incubator as in nature. There is no special intervention, they just organize a date between the eggs and sperm.
5. Embryo development. The fertilized eggs spend 3-5 days in a special incubator at the embryology lab. The embryo divides and multiplies its cells. The embryologist selects the most viable embryo(s) for transfer by the end of the process.
6. Embryo transfer. 3-5 days after fertilization, the most viable embryos are transferred back to the uterus with a simple, quick and painless procedure.
7. 2-week-wait. The time period from embryo transfer to pregnancy test. If all goes well, implantation takes place during this time, and the embryo attaches to the uterus lining and continues its development there.

It’s also good to know about ICSI (Intracytoplasmic Sperm Injection), as a special type of IVF treatment. It is practically one of the methods used in egg fertilization. It is usually recommended when sperm quality is not the best, or only a few eggs are available for fertilization. During ICSI procedure the embryologist selects the most beautiful and healthiest sperm and injects it directly into the egg. This can increase the chances of successful fertilization.

We also have to talk about the classic in vivo fertilization. Simply put, have sex because anything can happen at any time. We can meet a million wonderful stories; I also have several close friends who once had a baby arriving magically. Yet they had a paper about that impossibility. Never give up!

IVF is an emotional roller coaster that we have to be prepared for not only physically, but also emotionally. In my opinion, we do not speak about this particular side of IVF enough.

My partner and I are new to the world of IVF, but we are completely aware that this journey will be full of emotional ups and downs. The fact that we do not even know what is going to happen to us during the process or what the outcome will be… it just does not make it any easier.

Instead of listening to others, focus on listening to your own body and soul.

The whole process of preparing for our first IVF cycle looked quite fascinating, and, surprisingly, simple at the same time, especially the technical side of it. However, we do not know how we are going to react to the treatment itself and how we are going to face all of the upcoming challenges. But most importantly, what is the outcome going to be?

It feels impossible to prepare for everything. However, there are two things that are extremely important in order to get through all of the challenges together: a solid foundation in a relationship and, above all, communication. Talking about feelings, fears and even doubts in these new, unknown life situations with maximum understanding and open minds is key to tackling them together.

We visited a specialist who handles the emotional side of infertility and fertility treatments. We had sessions individually and together as a couple. It was very liberating for me to speak openly about my feelings, especially when discussing my fears. The therapist and I discussed all the emotional phases that me and my partner are most probably going to face during the treatment. It still feels like a very abstract way to describe what lies ahead of us, but at least we got another guideline that can help us get through all of it. By the end of our sessions, we built a list of some great suggestions and tips for our upcoming journey. These are not magic tricks but they can probably be useful for anyone who is on the same path as us.

1. Instead of listening to others, focus on listening to your own body and soul
2. Try to limit the use of Google. Chances are that googling will only add to your stress.
3. Plan your days ahead. This can help you to reduce anxiety and stress
4. Go for a walk or perform light exercise, such as yoga. Your body will produce dopamine and release endorphins. These are known as “happy” hormones and they have the ability to lift you up when you are feeling down.
5. Try to do something creative every day. Activities such as painting, drawing, colouring or even baking can increase positive emotions, reduce stress and decrease anxiety.
6. Keep a diary. Writing your feelings down on a page will help you express yourself better. Journaling can also help you reduce stress and prioritise your fears and concerns.
7. Learn how to relax. Meditation is a great way to harbour self confidence and improve stress and anxiety, which can be a part of the IVF process.