General IVF Hints The main IVF hint is to pamper yourself! An IVF cycle is a very stressful thing and anything that helps you through it without harming a potential baby is okay! Decide ahead of time where and how you want to get news each day for how much medication to take, etc. This is especially important on the big days of finding out about fertilization and pregnancy test. Those days can be tough if things don't go well! You might want your partner or a good friend around! Rest is very important, even before transfer. All those developing eggs are taking up a lot of space and energy. Try to get to know the people who are treating you so you aren't just another patient. It may help to make a friend or two who is at the clinic for IVF, too. Bring a book, magazine, or hand-held game with you to appointments. You might be there for awhile. Make sure they do a mock transfer prior to the actual embryo transfer. This is not fun, but it is necessary that they know the depth of your uterus so they know where to put the embryos. Do whatever it is you need to do to make this manageable for you. (Naps, backrubs, favorite foods, etc. Be very good to yourself during this time.) Small amounts of alcohol will probably not adversely affect you or your eggs, but caffeine has been shown to affect fertility, even in small amounts, so try to avoid it. Buy a good, up-to-date fertility book and try to find out as much as you can about the IVF process beforehand. There are always new advances, so try to keep up with the changes in techniques. Always ask your RE a lot of questions about your progress, what the numbers mean, etc. That is what they are there for! Also, you should be able to get copies of anything in your file (like your follicle growth and E2 test results and fertilization report). The more knowledgeable you are, the more likely they are to openly share information and take time to explain. It can be very comforting to find someone, either in cyberspace or in person, that is in a similar situation (factor, cycle) that you can share stories and progress with. Try to keep a very flexible schedule the week before the pregnancy test. Some people start their periods early and are stuck somewhere where they cannot just be alone and grieve. Start taking a prenatal vitamin prior to your cycle. At the minimum, you should take 400mcg of folic acid daily for three months before conception to reduce neural tube defects such as spina bifida. The FDA suggests 800 mcg during pregnancy, so it is best to look for a prenatal with that amount. Some clinics believe that a diet that is high in protein and low in salt and potassium can help you avoid hyperstimulation. Gatorade is a poor choice of fluid to drink to prevent/control hyperstimulation because it contains large quantities of salt. Water or Pedialyte is best, in quantities recommended by your RE. At a certain stage of OHSS, too much fluid can be detrimental. Remember that some people get very uncomfortable and even have a lot of pain as the ovaries are stimulated. This may get worse as the follicles ripen. Loose clothing may help. Don't worry about your weight unless you are tracking it for hyperstimulation purposes. Unless you hyperstimulate, most of the weight gained during an IVF cycle usually disappears once your period starts and if you are lucky enough to get pregnant your weight won't matter anyway! If you are not taking birth control pills the cycle previous to your IVF, be sure to use birth control (no matter how ridiculous it may seem). Usually, you will start Lupron before you would know if you conceived or not and Lupron is very dangerous to a developing baby. The extra fluid your developing follicles are taking up and being NPO before retrieval can sometimes cause constipation. Increasing your consumption of fiber and fluids as you approach egg retrieval may help alleviate this. Don't talk to your partner too much about his role. This may cause him extra anxiety during an already stressful time and the extra stress can aggravate the performance anxiety that men suffer on the day of retrieval. If this is your first IVF, be conservative about the number of blastocysts or embryos you transfer, especially if they are of very good quality. You may find that fertilization was your big hurdle and now that is complete you are on your way! If you have had more than one failed IVF, consider changing clinics, especially if your doctor doesn't have a change in protocol planned. Remember that all cycles are not alike. Using the exact same protocol on another attempt even at the same clinic can lead to different results. Some clinics use medications to prevent embryo rejection (low dose corticosteroids, etc.) which may help your chances of success. Check with your clinic to see if they think it would make a difference for you. Always repeat the directions for medication to the nurse and get your E2 level. If something seems wrong or unclear, ask for clarification. Prior to the stimulation part of your cycle, make sure you and your partner discuss how many embryos or blastocysts you plan to transfer. (While remembering that your plan may have to change because of circumstances of the IVF!) If you think you will have extra embryos beyond what you want to transfer to avoid high order multiple risk, decide whether you will freeze them or discard them. Decide whether you would consider selective reduction. These are not things to discuss under pressure right before transfer! Blood Draw Hints Apply gentle pressure to the spot after the needle is removed for at least 5 minutes, as this will help reduce bruising. Some people find that a butterfly needle is less painful for blood draws, others find it more painful. If you haven't tried it, ask for the clinic to use one and see whether it will work for you. Drinking lots of water or other fluid (without caffeine) an hour or two before blood is drawn usually makes it easier to find your veins. If you are taking baby aspirin or heparin, remember that you will need to keep pressure on your blood draw site for longer than you normally would. (This is also true for your IV site after it is removed.) If you know a place that is generally easier to get blood from, ask them to use that site rather than just trusting them to find the best site. (If you are careful to not let it bruise, they can use the same general area a few times.) Remove the bandage within half an hour of the blood draw (unless you are on blood thinners then you should wait an hour or so just to be sure). This will help keep you from developing a tape allergy. If you do develop a tape allergy, ask for Tegaderm or get the clear kind of 3M bandages called Nexcare and ask the clinic to use them. They often are less irritating than other forms of tape or bandaids. General Shot Hints (For these, you must experiment and find what works best for you.) Remember that not everyone finds the shots painful! Before any shot, the person giving the shot should wash their hands thoroughly and dry them on a clean paper towel. Wipe the rubber top of any medicine vial with an alcohol swab before drawing up the medicine. Use a clean alcohol swab to thoroughly wipe the area to be injected. Do not touch the area with anything else until after the shot. If you are using any pain relieving methods (ice, flicking, EMLA cream, etc.) be sure to use them before you wipe the area with alcohol. Some people find that icing the area beforehand helps lessen the pain. If your shots are particularly painful, you can ask your doctor for a prescription for EMLA cream. It will deaden the area so the needle won't hurt going in. (This will not prevent all pain, though, as often some of the pain from the shots is from the medication itself.) Some people use Anbesol to deaden the skin before a shot. Try flicking the spot where the shot is going to be injected a few times until it hurts. Then you can inject and it may be numb. Try strongly depressing and applying pressure to the area with your alcohol-cleansed thumb for 60 seconds prior to injecting. Remember if you are treating your injection site with ice or other pain control methods, be sure to cleanse the area with alcohol after treating and before injecting. Some people find that lying down helps, but only if your partner still feels comfortable giving the shot that way. Some people find that one side is less painful for the shots and if that is the case, you can keep doing the shots on the same side until soreness sets in. For sub-q shots, some people find the thigh less painful than the stomach, and some people find the stomach less painful than the thigh. Try both and see what works best for you. Sometimes the brand or type of needle may affect how much the shot hurts. They may be the same gauge but have different tips. If you are having a lot of pain with a shot and are using a small enough gauge needle (25-27 gauge or so), try seeing if a different brand will help. Try a warm bath after your shot. You may find yourself looking forward to the bath, which will give you something positive to focus on. Line up who will do your shots ahead of time and learn how to do them yourself in case you have to. It may help to make up a daily chart of what medication to take. Leave blanks for the amount for the medications that the clinic will call to tell you how much to take. Put a check each time you take the medication to make sure you don't forget anything. For IM shots, it's important to inject medication into the right spot -- otherwise you can hit nerves, which can be really painful. Have a nurse at your clinic draw a circle on each hip to show exactly where the shots should go (they made need redrawing after a few days). Sometimes, when giving an IM shot, the area a bit on the outside toward the hip can be less painful. For IM shots in the hip your needles need to be at least 1 1/2" long. If you are giving the shot in the thigh your needle should only be 1" long. The needle gauge is not important to the shot, but it may be important for pain. The larger number, the smaller the needle. (A 27-gauge needle is smaller than a 22 gauge.) If you use a different needle for drawing the medications and shooting, it may help, too. Some medications need to be kept at certain temperatures, and the pharmacy and clinic don't always point this out to you. Read the labels or ask your pharmacist. A good way to practice filling the syringe is to get an extra bottle of diluent and fill and empty the same syringe until you feel comfortable with this procedure. Breathe in through your nose slow and deep while you the needle goes in and out slowly through your mouth the medicine is going in -- it can help keep you relaxed and while will help the shot not hurt so much! Some people find that bending over a counter or a bed with your weight on the leg opposite the injection side is a very comfortable position for an IM hip injection. When using the glass ampules, put them out on a clean paper towel and use another clean paper towel to break them. Then, once they are used, you can dispose of the glass tops by folding them into the paper towels. This avoids having little shards of glass all over your table. For Lupron injections, insulin syringes seem to work especially well, because they come with very small needles. Progesterone Hints (For these, you must experiment and find what works best for you.) There are many different options for progesterone, so you may be able to avoid the shots. Do not refrigerate progesterone in oil. It will only make the shots more painful because the oil is thicker. Do refrigerate progesterone suppositories. Some clinics let you take progesterone suppositories rectally. It is much less messy, and they say it gets into your bloodstream just as effectively as doing it vaginally. Oral progesterone is an option if your clinic will let you. Usually the dose is higher because it may not be absorbed as well. The injection is much easier if you warm the progesterone beforehand. The oil thins out when heated and needs less effort to inject and bruises less. You can do this by holding the bottle of progesterone, or a syringe with the proper amount of progesterone in it, in your hand for a few minutes prior to the shot. Progesterone is made in peanut and sesame oil (in the US anyway, not sure about overseas). If one form is particularly bothering you (lumps, rash, etc.) try switching to the other kind of oil. You may have a slight allergy to the original oil. Progesterone in sesame oil is a tiny bit less viscous than progesterone in peanut oil, so it goes through small needles a little better. Try not icing the area beforehand, if you can stand it. Chilling the muscle first may make it harder for the progesterone to dissipate. Moist heat on the area may help dissipate the progesterone and make the area less painful. (Microwaveable heating pads are perfect for this!) Massaging the area after the shot helps the progesterone dissipate. If you have lumps forming, try to make sure the shot doesn't go right into one. If it does, it makes the shot extra painful. Most clinics recommend that you do progesterone shots in larger needles because the oil is so much thicker than the other medications. You can use smaller needles (25 to 27 needles gauge work fine). The injection will take longer, but it may help reduce the pain and soreness from the shot. (It will not affect whether the progesterone itself is painful or forms lumps.) Remember that progesterone often brings on pregnancy-like symptoms, and also makes your cycle longer. So, if you're on progesterone and have breast tenderness, etc., you aren't necessarily pregnant and you will need to have a test to know for sure. Remember that you can still be pregnant even if you seem to have started your period, so be sure to go for your blood pregnancy test before stopping progesterone support. Travel Hints Keep a watch on your normal time zone and take your medication according to that watch, rather than doing the math and trying to keep it straight. Finding a hotel with a refrigerator in the room is helpful for keeping the medication at the right temp. Another option is a small, portable camping refrigerator. Traveling to do IVF may make it less stressful for you. Getting prepared for the cycle is more stressful (things to do to get ready for the trip, etc.), but the cycle itself may be less stressful. You can do a lot of sightseeing and you may obsess less about the cycle that way than you would have if you were home and working. Also, you have fewer responsibilities to worry about and can concentrate on your cycle. Bring loose clothes with you. You may be bloated and need looser clothes to be comfortable. You may want to purchase a Diabetic Care case. It comes with space for your medications, needles, alcohol swabs, and even an ice pack to keep them chilled while you are traveling. They can easily be found at most medical supply companies or pharmacies. Positive Thinking and De-Stressing Hints Try self-hypnosis tapes to keep your mind on warm and fuzzy thoughts. Keep social contacts to a minimum. Use the cycle as an opportunity to focus on yourself and on each other. Try to relax and think positive. For sanity sake, review the odds of success ahead of time. Some people try to stay as neutral as possible to avoid major ups and downs, others try to stay hopeful to help make all the procedures easier. Try doing things to take your mind off the process. Visualization may just make the obsessing worse. Try to manage stress in whatever way works best for you. Some suggestions are relaxation or deep breathing exercises, yoga, or meditation. Egg Rerieval And Embryo Transfer Hints You will probably need at least the day after your retrieval off of work. You may be in pain or you may just be tired and need the rest. Levels of pain post-retrieval vary from person to person. Some people may have little or no pain and others may have a lot of pain. Be prepared for both extremes. Prior to retrieval, remind your partner (or the nurse if your partner isn't there) to keep pressure on your IV site for you once it is removed (especially if you are taking baby aspirin or heparin). You will still be a bit woozy and may not remember. Often the medication used for sedation for retrieval is one that causes amnesia, so don't be worried if you cannot remember everything that happened. It is disconcerting, but not a problem. Remind your partner about this so that he doesn't expect you to remember everything! Some people have reported that the sedation used for retrieval can cause nightmares. A heating pad on your belly may help with pain after egg retrieval. If you are concerned about nausea during the retrieval, ask for something to stem nausea. A drug called Phenergan is a mild sedative and also will help keep you from vomiting or having nausea from other medications. Have someone there to drive you back from retrieval and transfer. Make sure that you tell them about any allergies. You may be given a narcotic pain killer afterwards. If you have problems with narcotic pain relievers, you can ask for a non-narcotic pain killer which may work just as well for you. Eat a low fat diet for a few days before retrieval. Sometimes the embryos are stored in a vial of the mother's blood, and they don't react well to fat (or is it lipids, or whatever), which can temporarily rise as a result of high dietary fat intake. (You can check with your clinic ahead of time to find out whether they use your blood or not.) Some clinics suggest you avoid soaps, shampoos, and perfume on retrieval and transfer day as embryos can react poorly to odors. Don't wear fingernail polish to retrieval. Some clinics use a clip on your finger to read oxygen saturation levels during retrieval and fingernail polish will interfere with that. Remember that not every follicle contains an egg, so don't be surprised if the number of eggs harvested is less or more than the number of follicles you've been watching develop. If you have any significant pain within the first couple of days after retrieval, something may be wrong. LET YOUR CLINIC KNOW IMMEDIATELY! Some people have had a blood vessel nicked which led to internal bleeding so they had to go to the hospital for monitoring. You may find it very hard to lay still for the required time after transfer (this varies some from clinic to clinic). You may want to bring extra pillows to make you comfortable, or some music to distract you. Many clinics aren't requiring *any* post-transfer rest, as recent studies indicate it has no impact in success rate. If it helps you feel like you are doing everything you can, rest as much as you feel necessary. Most clinics recommend you avoid the following after transfer: swimming, saunas, baths, intercourse, orgasms, lifting over 10 pounds, exercise that breaks out into a sweat. So, look forward to taking it easy! Good luck!!!!!
