My Short Protocol IVF Freeze-All Timeline

After I learned that my doctor was recommending a “short protocol” my for my IVF egg retrieval, I spent a couple of hours researching what exactly that meant on the internet. My previous doctor had prescribed a long protocol for my treatment, so I was familiar the administration of suppression and stimulation medications for that type of cycle. But a short protocol? I had no clue what to expect, or how much it would differ.

As the name suggests, it is shorter

It turns out, it wouldn’t have differed much when comparing the stimulation phases of the two. However, unlike a long protocol, the short protocol has no suppression phase. Therefore, short protocol treatment starts on Cycle Day (CD) 2 or 3 of the cycle during which you will have the retrieval.

My timeline

Here is my actual timeline for my short protocol stimulation phase. It is worth noting that I am doing a freeze-all cycle, so after my stimulation and trigger injections, all other hormonal treatment stopped. The timeline shows when I had my appointments and the other types of services I received from the clinic, and the type of medication I took on which days.

 

Obviously everyone’s cycle and treatment protocol is different. That said, I hope I can shed some light on what this process might look like for you!

 

Current Update – My IVF Consultation and Protocol in Valencia

ivi clinic valencia

I cannot believe how quickly time has flown since we have arrived in Valencia! We arrived on Tuesday, April 17th, and on Friday, April 20th we had our first consultation with Dr. C* at the IVI clinic.

Our initial consultation

Our hotel was a short walk to the clinic, and when we arrived at the modern and bright facility we were directed to go to the international patients’ check-in desk. Here we were greeted by an English speaking coordinator, who took our photographs, documented our passport information, and then explained that we would be assigned a “tutor.” Tutors at the clinic are medical professionals who guide international patients through the initial consultation and the IVF process.

We waited in the waiting room for only several minutes before our tutor introduced herself, and then she ushered us from one room to another to complete the intake process. During this process we submitted all of our recent bloodwork, semen analysis results, and other diagnostic test and health history information. We reviewed and signed the treatment paperwork, and then were directed back to the waiting room to wait for our appointment with Dr. C.

Meeting Dr. C

Just before our scheduled time to meet with Dr. C, our friend Phillip (who is a friend of Dr. C and arranged for us to be seen at the clinic) met us to say hello and to make sure we were having a pleasant experience so far. He then walked us into Dr. C’s office to personally introduce us.

During our meeting with the doctor MH and I reviewed our health histories, the doctor performed a transvaginal ultrasound and a trial transfer (note, this was quick and painless, and I did not take Advil prior to my appointment), and then we discussed next steps. I had several more tests to take, which I would need to do the following Monday since I needed to fast beforehand. MH would need to have another semen analysis and we would also do a freeze.  Thankfully, all tests are performed at and processed by the clinic, so waiting time for the results were just a matter of hours (as opposed to days or a week when compared with my experience in the USA).

Consultation surprises

There were a couple of surprises during this consultation. One, we learned that I would need to complete an ERA test. This is a test that evaluates the ideal time for implantation, and based on these results, will determine the optimal day for the FET. Unfortunately, this test means we have to do a “mock cycle” in between the retrieval cycle and the transfer cycle. Therefore, it will extend the amount of time before we could actually become pregnant. We were planning on taking a month off in between regardless, but since we have to a mock cycle with a biopsy for the test, I will need to be on medication and have to stay close to Valencia for several doctor’s visits during this time. We considered traveling back to the USA to perform the test there, but the cost of the test would be at least double than what we would pay here in Valencia.

The second surprise was according to testing I had completed in the USA, my AMH levels had dropped significantly from June 2017 to April 2018. Dr. C was not happy with the latest number, but his concerns dissipated when he conducted the ultrasound and counted about 17 follicles. He said that AMH was just one of the parameters he looked at when evaluating ovarian reserve, and the drop in levels could have been due to a faulty test. To be sure, he wanted me to get my levels retested prior to my next appointment.

We also learned that Dr. C was going to put me on a “short protocol“. At first I was disappointed to learn that we couldn’t start treatment in my current cycle. I had assumed that I would be on a protocol that was similar to what my previous doctor had recommended, which was referred to as a “long protocol.” A long protocol requires about two extra weeks of medication and it starts during the menstrual cycle preceding the ovarian stimulation phase. However, Dr. C explained that the clinic’s approach is to use the most gentle protocol as possible, so there was no need for me to be on medication prior to my next period. With a short protocol, I would start my stimulation medications on day 2 or 3 of my next cycle, and if all goes well, have the retrieval 10-12 days later. Since I was dreading the shots and how the medication would make me feel, that sounded good to me!

Follow up visit

The following Monday we went back to the clinic for blood work and our follow up visit to discuss next steps. Dr. C confirmed that my AMH levels looked great, and we would start treatment on either Day 2 or Day 3 of my next cycle.

Dr. C did have concerns about MH’s semen test results from Friday. Due to the low count, low motility, poor direction, and poor morphology, Dr. C recommended that we PGS test the embryos. He explained that there is a correlation between poor parameters and genetic issues (which we were aware of because we were recommended to have the DNA fragmentation test performed in the States). Since we are at a higher risk of having genetically abnormal embryos, he wanted to mitigate the risk of transferring an abnormal embryo as much as possible by screening them out.

A different kind of TWW

After our last appointment we excitedly awaited my period… for over two weeks! We visited the clinic several times to pay for services, pick up my prescriptions, receive my first tutorial for administering the medication, and have my questions answered about timing of the ERA test and the FET. On the first day of my cycle I walked to the clinic to inform them I was ready to start; luckily, I already had an appointment on the books for the following day, so I returned to meet with Dr. C and officially started my protocol.

Overall experience

We have been beyond pleased with the clinic and the service so far, with the exception of being able to easily contact an English speaking operator during peak hours. Luckily we are only a 25 minute walk or bike ride away, so we have been able to simply “show up” and speak with someone who can answer our questions.

Everyone at the clinic- including Dr. C- is so friendly, helpful, and efficient. Despite coming from thousands of miles away, we feel completely at ease. I learned that approximately 50% of the patients are international patients, many of whom come to Valencia specifically to be seen by Dr. C. Based on the “concierge” level of service we have received, the clinic is clearly set up to treat a global patient population .

*We have changed the names to protect the privacy of these individuals.

Current Update- Llegamos a Valencia!

My posts so far have been sharing my background, and all of the twists and turns that have led up to this point. But I want to share where we are now… right now.. because it is absolutely surreal.

Two years ago, if you had told me that we would have tried unsuccessfully for 18 months without a having a viable pregnancy, I would have been shocked.

If you had told me three months ago that we would be traveling to Valencia, Spain, to meet with a world renowned doctor and (fingers crossed) start IVF treatment, I would have been incredulous. At that time ago our doctors, MH, and I had a plan: to complete a non-medicated IUI every other month, and to try naturally in the months in between. The agreement we had all reached was to give it six months. We believed that time, along with the Clomid MH was taking to help correct the male factor infertility issues, was the winning recipe to getting pregnant.

However, our plan disintegrated at the first IUI appointment. Shortly after the doctor removed the catheter, while I was still naked on the table, she told me we “probably want to move on to IVF”.  I knew that statement was more of a directive than a suggestion.

So here we are in Valencia, with my IVF consult just hours away. By a serendipitous sequence of events this opportunity landed in our lap- or more literally in our home- by way of an Airbnb guest. And since I have been screaming to the universe that all I want is to be a mother, when the universe threw me a bone, I snatched that shit up.

Pursuing IVF in Spain was a simple decision for us. When we found out that it would cost almost $20K less than the US, that the clinic was best in class, and the doctor is world renowned. All of our boxes were checked and we ran to take that leap of faith.

The choice to pursue more invasive artificial reproductive technologies is an extremely personal decision, and the paths to finding peace for having to rely on a scientific process to do the work that our bodies have failed to naturally do are unique. For MH, he was happy with the path of least resistance despite the cost. For me, once I was able to forgive my failing and build up confidence to move forward with the potentially harmful procedure, the biggest chasm I had to cross was the cost of the treatment. To spend $30,000…THIRTY THOUSAND DOLLARS…it felt like a sin; it is money we do not have. And what if it didn’t work? It would take us years to recover. It would mean more years of waiting, more years devoid of bedtimes stories and play dates and lullabies. It was not only daunting when thinking about the “what if my body fails me after spending all of that money”, it literally made me feel sick to my stomach. I felt like I was being dragged down a path that I did not want to be on, but was I willing to risk years of resentment and self-loathing for the chance of success. I didn’t want to, but I was willing.

Packing to be away from home for several months felt surreal. It barely registered what I was actually pursuing, or where I was going. And that is the way I wanted it. Instead of focusing on the “what happens if this doesn’t result in a pregnancy”, I was worrying about which shoes will fit in best with Valencian fashion, how many bikinis to pack, and if there was going to be any surf. I was happily trading thoughts about sunning topless on Spanish beaches for worries about the stakes of this trip- and make no mistake- this distraction was intentional. MH and I were genuinely able to frame our upcoming travels as an adventure we were excited to embark, rather than a process we were beholden to.

On the overnight leg of the flight from Dallas to Madrid I was reminiscing about the only time I had been to Spain. Several Months after MH and I met, we traveled to Ibiza for his friends’ wedding celebration. It was during this trip I became enchanted with the island and the Mediterranean culture. We had the quintessential Ibiza experience: red wine buzzed never-ending dinners, dancing until dawn’s first light at Pacha to David Guetta and Dimitri from Paris, island hopping, and eating grapes and figs off the trees that lined our community’s streets. During one of our pre-dinner activities, we sat around a table and everyone answered the question of where they saw themselves in five years. When I was asked that question, I said that I hoped I would be married to MH, with children, and maybe even spending some time living in the Dominican Republic. That was almost six years ago, and after having navigated setbacks that I would have perceived as insurmountable then, we are returning to (almost) that same part of the world to make this dream come true. On this flight I looked at my sleeping husband in awe, and came to the realization that he must love me so fucking much to upend his life for the next four or five months to do this for me. We could have stayed at home, and yes, it would have cost a lot more money. But I knew he is taking this leap of faith for me.

And now that we are here, everything about our decision feels right. I am so grateful to have arrived in Valencia.