Friday, December 11, 2015

Moments of truth in an IVF cycle

An IVF cycle is like a series of hurdles, all of which you need to cross in order to get a baby. How well you manage to negotiate these depends partly on the skill of the doctor - and some of it is in nature's hands. Thus, the ovarian reserve for the patient will determine how many eggs she grows; the doctor's skill at super ovulating and using the right treatment protocol will decide how many mature eggs we can retrieve; and the embryologist’s skill will influence how many embryos we have available for transfer, and what their quality is. Finally, once the embryos are inside the uterus, implantation is a biological variable which no one can control. Each of these hurdles is a moment of truth, and it's important that all these be cleared, before you reach the finish line.

Each moment of truth creates a lot of suspense and anxiety, both for the patient, as well as the doctor and the embryologist. There are multiple moving parts, and everyone needs to be involved, in order to make sure that the journey has a happy ending. Thus, how well does the sonographer do scans, so that he tracks follicular growth accurately ? How skillful is the doctor retrieving the eggs from the follicles at the time of egg collection ? These are multiple complex variables, all of which need to be done to perfection, in order to reach a happy ending.

    The first moment of truth is the follicular response. Has the patient grown any follicles or not, when five days of super ovulation are over? Has  the E2 level risen, and are the follicles growing?  Is it a synchronous cohort? The next moment of truth is the egg collection. Did we get any eggs? How good are they? How many are mature? The next is the fertilization check. How many fertilized? Then there's cleavage  - how  many are continuing to cleave? And how many go on to form blastocysts on day 5.  From a medical perspective, the embryo transfer is the big moment of truth.

Then there is the  horrible two-week wait, and the pregnancy test is the final moment of truth. Did the cycle work, or not? It's best to prepare yourself for these, and learn to live one day at a time, because time is the one this we cannot fast forward  !

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