The most eagerly anticipated, long awaited, important appointment on our three year infertility calendar - the IVF initial consultation. But what the hell happens at it? What do I ask? How long do I have to wait following it to actually start pumping my body full of hormones and get the IVF train out of the station? Once again, I had as much knowledge of what occurs at the first IVF consultation as I do about quantum physics (and I studied humanities). This article sets out all that happened to me at the initial IVF consultation so that you know roughly what to expect.
First IVF appointment, what to expect: The IVF clinic - Victoria Wing, Nuffield Woking
From the name ‘Woking Hospital’ I expected a larger building than the small brick affair that confronted me, tucked away on the outskirts of Woking. It is easy to miss in the car and creeps upon you as you bomb along the back roads circling Woking centre. Just to clarify, I’m hyperbolising as I don’t ‘bomb’ anywhere in my car. I struggle to find third gear, so once I’m in it I’m reluctant to come out in case it once again eludes me on the way back down. My speed limit is therefore mechanically set to around 40 miles per hour before the car begins to groan that it is once again being driven by the muppet.
My first indication that the Victoria Wing, Woking was likely to be an all-round better service than our previous NHS Hospital was arriving in the car park to a) find a space immediately and b) not have to re-mortgage our house, asking for the equity in pound coins to pay for the parking. At Nuffield it is free (FREE!). The Nuffield Woking building looks a little tired, like it has itself spent a good proportion of its life on IVF drugs. Inside one can expect dated carpets, 90’s décor, a wall of baby photos from successful patients and warm welcoming smiles from all the staff. It is a happy place full of caring employees. If it wasn't so far from home I'd be tempted to come and spend spare time in the waiting room, soaking up the kindness. The final confirmation that I was no longer in an NHS facility was booking in at reception to find the clinic both had some recollection that I was a patient and were expecting me for an appointment.
What happens when you go for IVF?
It is all talking, form filling and information leaflets and both partners are expected to attend. Unexpectedly, at no point was I asked for blood, expected to remove my trousers (so please don’t pull them down), attacked with a twat wand or given a box of drugs worth more than the cost of our car. That all comes later. It was simply a consultation, with nothing directly happening as a result other than further appointments being scheduled and me spending the remainder of the day in an overwhelmed fit of ugly tears. You wait for so long, counting down the days and it is THE event that you anticipate marking the start of IVF. But on leaving the clinic I realised that it was just another appointment (an important one, admittedly) and that there was more waiting still to come.
We were asked to bring:
Photographic ID (passport or driving license)
Passport photos (that were then attached to our notes to remind them who we were)
Both partners NHS numbers
Copies of all tests results that may have been done at a GP or local hospital
Appointment with a nurse
The first session, running beautifully to time, was a meeting with the nurse. No matter how many forms we complete for IVF, there are always more. It is a never ending succession of ticking boxes and signatures. The one thing that I was taught at law school (that I actually remember) was NOT to sign anything without reading it. Well I'm guessing my tutor never went through IVF because after the tenth form I would happily sign anything, requiring a signature or not (it took a perplexed few moments of searching for the signature box on the counselling sheet before the nurse clarified that it was an information leaflet). Once the forms were complete, my life signed away and a photocopy taken of our passports to check that we are who we say we are and not someone who we are not, we were taken to see the consultant.
Meeting our consultant
Do you know what IVF is and how it works? By this stage you probably do, but this is where someone very well qualified and experienced explained it to us. They will undoubtedly draw you a diagram or graph which makes it all crystal clear during the appointment, then 5 minutes after leaving the room you will debate with your partner which way round the paper goes as it no longer look familiar or makes an ounce of sense. For me, this was the first time that I had spent 30 minutes in the company of a fertility expert. For the previous nearly two years in the care of the hospital fertility clinic I had seen my consultant for less than 10 minutes in total. So if this is also your experience, savour the moment and ask the questions you have always wanted to know. Like all fertility appointments, it is unintentionally overwhelming. Dozens or important and intelligent questions race through your mind prior to the consultation, but when you are in the room your blank mind results in you staring, smiling and nodding like a simpleton. So this time I came with a list of questions.
IVF first consultation questions
The His and Hers Survival Guide to IVF, a fantastic book that I thoroughly recommend, provides a list of questions to ask at your first consultation, which I found to be very helpful and which I drew upon, along with my own questions, many of which were specific to my circumstances. The questions I had were:
How long would it take to start IVF?
What are our chances of success?
Do I have PCOS or unexplained infertility?
Is the sperm quality sufficient for straightforward IVF or would we need ICSI?
What drugs protocol would I be on?
What can I do to help my chances of success?
Under what circumstances could my cycle be cancelled?
Would just one embryo be transferred back and under what circumstances would more than one be transferred?
What is discussed at the IVF initial consultation?
Due to varying personal circumstances and health issues I can imagine that the discussion during an initial consultation can vary considerable. For us, the following was covered:
Our medical condition. Did we have unexplained infertility (the diagnosis following us from the hospital like a lingering fart) or PCOS, the newly diagnosed issue revealed at the pelvic scan and confirmed by the AMH results? The answer was a mind boggling ‘unexplained infertility underpinned by a diagnosis of polycystic ovaries’. Right, so both then? This was followed by an informative diagram drawn by the consultant of why my body is unlikely to release eggs in the same way as a fertile Myrtle and some excellent advice on diet and lifestyle, along with the revelation that I am likely to struggle with insulin resistance, despite being a skinny cow. Just to confirm. my consultant did not call me a skinny cow (to my face anyhow).
Appropriate drugs protocol for us, given our test results and medical history, was to be short protocol and low doses of stimulation hormones.
The key risks for our circumstances, including potential poor egg quality due to PCOS, potential for overstimulation resulting in a cancelled cycle or requiring all the embryos to be frozen whilst my body recovers (“but don’t worry, ovarian hyperstimulation syndrome (OHSS) is rarely fatal…” Fatal?! It can be fatal? Is that reassuring? Why would you bring up the F word?) , potential for no eggs (the opposite of overstimulation) or no embryos of sufficient quality to transfer. Their job is to run through all conceivable risks and I spent a ‘mindful moment’ straight after the consultation trying to calm the rising panic. It is the IVF equivalent of a house buyers’ survey, it makes you so aware of every possible thing that could go wrong that you question how the house is still standing. But that is their job, to make the risks clear to you from the start. It does not mean that all or any of these risks will occur to you.
Likely success rates, placed at 40% for us. What I wished I asked at the time but didn’t was whether this was simply based on my age (which it was) or whether it was a tailored estimate based on my specific test results and diagnosed conditions, combined with my age. It’s good to be really clear what the success rate means and how personal it is to you, as this number is something that go round in your mind, over and over like a car on a scalextric track tormenting you over the coming months.
Further meeting with the nurse
Following the meeting with our consultant we had a further meeting with the nurse who booked us in for our perplexingly named Implications Appointment (and what, pray tell, is that?) combined with the drugs appointment. We were given a leaflet on what short protocol means and sent on our way. It was an informative, efficient and supportive experience. But emotional, very emotional. The remainder of the day I spent crying ugly tears. On a repeated loop in my head, round and round it went: I have PCOS for sure, it is my fault that we cannot have a baby, I thought the process to start would be quicker, there is a 60% chance it will fail, what if we never get our baby, it’s all my fault. A walk by the river, a total uncontrollable breakdown, a self-hosted pity party of epic proportions, a mini pep talk in my head and a strongly worded instruction to myself to get my sh*t together and I was back to normal. IVF had begun.
How long does IVF take from first appointment? What happens next?
Implications Appointment/Counselling and Drugs Appointment
Three weeks after our initial consultation we returned to the clinic for further appointments with the nurse. It is not clear from the name what to expect from the Implications Appointment. To me, the obvious implications of IVF were things such as:
My boss getting crabby because I spent more time at the clinic than in the office
Me becoming a miserable bitch on the hormones (or should that read more of a miserable bitch, given three years of infertility had already zapped my joy)
My heart breaking at a negative result
Owing our families a vast amount of money if we have to fund a private cycle, meaning that they have literally bought our first born
But the implications appointment (quite sensibly) does not broach these topics. Instead it is really an information session covering all aspects of the IVF treatment. It must be attended by both partners and if combined with a drugs appointment, will cover a detailed breakdown of the drugs protocol and likely timings of the IVF. Based on our consultant's review of our test results, a wonderfully kind nurse outlined the plan that our consultant has for our IVF. Short or long protocol, which drugs I'll be taking and at what dosage, when the drugs will start, when the scans are likely to be etc. I came away clutching a sheet of paper setting out the proposed timeframes and estimated dates. This is exactly what I had been seeking, something concrete to pin my hope onto.
The Victoria Wing only wave the twat wand around (i.e. do scans) on a Monday, Wednesday or Friday. I take note of all these things in my little notebook, like an over eager student that is just asking to be bullied. And then it comes. It wouldn't be a fertility appointment without a needle winging it our way. In fact, on this instance I was treated to two needles, what a lucky sausage. First was a self administered mock injection, a recce of what I would have to do at home. The nurse demonstrates on herself how to grab some stomach fat. I mirrored this on my own tummy whilst also making a comment to boost my self esteem that there wasn't much obvious fat to grab, to which my husband pointed out a section with 'plenty of fat' (thanks love), and I inserted the world's slimmest needle into my belly fat. It was painless, a non-event. I felt confident at what was to come. That was until the nurse mentioned that it was not the needle but the stingy vial of liquid within the syringe that hurts. Oh dear. Back to mild trepidation.
The second needle was a blood test to check again for HIV and Hep B, basically sexually transmitted diseases. My husband and I both undertook these exact tests when referred to the IVF clinic 5 months before. But they need to be within 3 months of starting IVF to satisfy the Human Fertilisation and Embryology Authority (HFEA) rules, so despite neither of us having any STDs 5 months before and only having sex with each other (I hope) they required repeating. We are both brave in front of each other and pretended like it was the easiest blood test ever (it smarted a bit, if I'm honest) and we were released back into the wild to wait for the big event: THE START OF IVF.
When does IVF start? Waiting for my period
And then we waited. On the short protocol, the IVF cycle begins on day one of a menstrual cycle, meaning that you wait for your period to arrive and then call the clinic to book in for your baseline scan and collect your drugs. This is different on the long protocol, where usually you will put on down regulation drugs at some point during the cycle before, often starting on day 21. For the first time in a very long time I eagerly awaited the arrival of Aunt Flo. And just to prove that Aunt Flo had a unshakeable sense of humour, she delayed her appearance by a week just to keep me on my toes. What a cow. A foolproof way to predict when your period will start is to find out when the IVF clinic closes on a Friday and add ten minutes. I was spared that frustration by only a couple of hours as Aunt Flo graced me with her presence early on a Friday afternoon. The call to the clinic to book in and start the IVF process (7 weeks after the initial consultation) was the best call of the year.
Beware of Christmas delays
If you are one of the unfortunate souls whose IVF bumps up against the Christmas holidays, beware that this can delay when your IVF cycle may start. The Victoria Wing closes between Christmas and New Year in order to undertake its annual deep clean of the embryology lab. The result is that IVF cycles must have started by certain dates (different cut off dates for short and long protocols) in November, otherwise you wait until January. We were lucky and snuck in just 10 days before the deadline. It is worth double checking with your clinic whether Christmas closures will have an impact and what the cut-off dates are for beginning a cycle prior to the festive period. It only occurred to me later that our little embryos would have experienced the lab at its absolute dirtiest that year, a few days before the deep clean. Oh well, a bit of dirt never hurt anyone....
The initial IVF consultation seems like the start of the IVF process and it was the appointment that I was eagerly counting down the days until. But this isn't actually when it all begins and the IVF cycle itself can be a month of few after this appointment. Just prepare yourself for this and take the initial consultation for what it is, the important first step towards IVF but ultimately, it's just a meeting with a consultant and nurse. No more, no less. But IVF is on its way soon. Oh yes, Sir!