10 Important Things To Know Before You Start IVF (Or Even If You're Further Along) That I've Learned The Hard Way
Here's my biggest learnings from my first failed own eggs IVF cycle
If only I’d known these things from the start.
But you don’t know what you don’t know! It’s a cliche but it’s so true with IVF.
I’ve been on a crash course since July 2024 and my failed cycle, to understand more about IVF, in countries around the world. (My first clinic was in Spain. I’m now moving to Greece.)
My first big mistake was not doing my homework ahead of my first cycle.
Essentially, I had absolute faith in my doctor - a faith I now realise was extremely naieve.
I am a Holistic Practitioner of Eastern holistic medicine, yet became so consumed by the highly medicalised IVF process, that I forgot about my own trainings and the need to support body and soul.
Western medicine may disregard other modalities due to the lack of “scientific” evidence. But it’s important to identify what is meaningful to you.
And incorporate those rituals and practices into your path to baby.
Now equipped with more knowledge, I am slowly recovering from my first IVF cycle, and preparing for the next, at the end of October 2024.
Knowledge is power.
It feels good to know more.
Both reflecting on the outcome of my first cycle - 5 eggs taken, 4 fertilised and 3 good day 6 blasts - all PGTA tested abnormal.
Plus the additional research I’m now undertaking.
So I’m feeling a little more in control - a weird dynamic in a process in which you often feel so powerless. I’ve got a new clinic, doctor and protocol. If only I had known more at the outset.
Better late than never.
Here’s 10 important things to know about IVF, specific to solo women above 40.
The fertility world is a multi-billion dollar industry.
This is not your local General Practitioner type affair, with a medical specialist operating in your best interests.
The fertility industry is big money high stakes stuff!
In 2023, the industry was valued at US$34·7 billion and is projected to grow to $62·8 billion in just 10 years. Every clinic wants your cash and is only too happy to take it.
Clinics are mini goldmines. Some people are getting very rich, on your hard earned cash.
You can guess that with such vast amounts of money changing hands, opportunity is ripe for shady practices and dodgy dealings.
Everything from sales tactics like ‘open days’ that give you discounts if you submit to the pressure and book a consultation with the doctor there and then; to Greek pharmacists trying to scam you when purchasing meds for your IVF cycle (recently happened to me); and issues that arise during the medical process (where decisions are made based on your clinic’s policy) that you are not informed about upfront.
So much smoke and mirrors.
The sooner you treat the IVF process as a service, the better, because you’ll more readily advocate for yourself. This means pushing your doctor to answer questions thoroughly.
I will more readily invest in a doctor who:
provides tailored advice rather than a cookie cutter approach;
is willing to ‘partner’ with me, share insights and answer my questions throughout the process. No question should be off limits;
Listens to my aims - one child using my on eggs, and repeat cycles as required. I do not wish to use donor eggs at this stage.
You’re an individual and should be treated like one.
And your hard earned cash should to go to a doctor who is willing to do the legwork - not tell you to move to donor eggs after one failed cycle without clear and specific reasons.
You don’t have to do PGTA (genetic testing).
To PGTA or not to PGTA - that is the eternal question.
There are convincing arguments for and against - both of which have their place depending on the scenario, such as your age, total number of eggs, and likelihood of obtaining more.
Without any clear concensus, it has become hotly debated. I like Emma the Embryologist’s video about it.
In my first cycle, I tested all three embryos because I didn’t realise I could choose not to. My clinic chose the package including PGTA because of my age, and I paid up without questioning it.
If you opt for PGTA - ask your doctor this key question:
If PGTA determins an embryo is "abnormal” will a genetic counsellor explain what that means, what my options are, and can I still choose to transfer an abnormal embryo if I wish?
My clinic in Spain would not let me transfer any of my embryos because PGTA said the biopsies taken from them showed abnormalities; so the clinic “discarded” them.
I had no choice.
Since PGTA is not a conclusive test - it’s possible that one of them could have been viable.
Review medical add-ons with caution.
PGTA is an add-on.
There are plenty more add-ons you can select - and they’ll cost you!
Women over 40 are more likely to be offered a wide range of expensive tests before undertaking IVF.
On the one hand, the thoroughness can seem appealing. Why not do a hysterscopy first, to check the uterine cavity is clear?
Makes sense, it would seem.
But on the other - if you have no prior indication of any issues, it could be unnecessary. As much as one clinic asserts a thorough approach, another will advise some tests are not required. Save your money.
So whose advice to trust?
You’ll need to find a doctor who you feel is aligned with you, and/or do your own research.
The benefits of East Asian medicine.
Some clinics are supportive of add-ons, and East Asian modalities such as Acupuncture.
Western medical ob-gyn doctors seem to be willing to accept that Acupuncture can be a relaxing experience; but won’t acknowledge that it could hold any further benefits.
Yet this is most likely because it is not their area of expertise, or training. Therefore they don’t have the detail on the efficacy of holistic medicine.
Or should you trust that they’ve done the research and have thoroughly ruled out the potential benefits for women trying to get pregnant, and stay pregnant?
Similarly, I wouldn’t expect my Shiatsu Practitioner to explain how my eggs are collected!
If you want to hire an Acupunctutrist, it’s good to shop around. I’ll explore this elsewhere. I have plenty to say given my work as a Shiatsu Practitioner and QiGong instructor.
(The British Acupuncture Council is a good place to start for insights on the benefits of Acupuncture for fertility.)
Which leads me to….
Do your own research!
I went into my first cycle totally naieve and trusting of my doctor, and the IVF process.
In our first consultation (120 euros) I asked about diet or lifestyle changes, but was advised to carry on as normal.
When I read It Starts With The Egg (the book that everyone talks about in the fertility world) I learned about DHEA and COQ10. I suggested both to my clinic and was advised to take 75mg of DHEA, and without first checking my testosterone levels.
Big mistake. (I had developed acne (which two months later is still bad) and my voice was changing, so I stopped it.)
In my first IVF cycle, I also had no Plan B, despite asking for one, because the doctor said he wanted me to be “fully optimistic”.
Doing your own research feels especially important to women in your 40s where the stakes are so much higher given the age of your body and the need for more care. Medical expertise becomes even more essential eg to overcome Diminished Ovarian Reserve.
But I have struggled to find any group specific to solo women in their 40s. There are groups for women over 40, or solo mums by choice, but not both!
This means doing the legwork to find relevant groups, podcasts, forums and people you intuitively feel are worth listening to, and are relevant to your situation.
The research you do becomes a product of your a) curiosity, b) time available to search online and interact in groups/forums c) knowledge about what questions you need to find answers to.
Select a doctor who is willing to “partner” with you.
This one is really important for women over 40.
Is your doctor clear on the outcome you want, and willing to work with you to achieve it? For example, how many cycles are possible for you (financially and otherwise) and are you open to using donor eggs if that seems to be the best path to parenthood for you?
We all hope and wish our first IVF cycle is successful. It certainly happens for some women in this age group, and I truly hope it’s the case for you.
However, we need to be real that at this age, it can take more than one IVF cycle to get to a live birth.
Should your first cycle fail, is your doctor clear on the fact you may wish to try again with your own eggs (you might see this written as OE in forums)?
Unfortunately, there are some lazy doctors who will try to automatically push you to donor eggs (you will see this written as DE) regardless of whether this has been discussed.
Opting for double donation (DD) becomes a whole other conversation, and needs to be sensitively managed.
Throwing out the idea of opting for donor eggs, at the same time as delivering the news about my abnormal embryos, is how my doctor handled my sad news. (He was also over an hour late to our scheduled call. Yet again, it felt like I didn’t matter.)
There was no warning in our initial conversations that I would have a high proportion of abnormal embryos.
Create your ‘Zona’.
Tbe zona is the protective layer around the egg.
I have created a protective shell around me, too, as I head into my second cycle.
Very little can prepare you for how emotionally, psychologically and physically draining IVF can be - regardless of doing this solo or with a partner.
On top of all the hormones, and injections, is the financial burden.
At least spending £5-10k on a car or a kitchen actually brings you something. IVF can leave you battered in mind, body and bank balance. (Let’s not sugar coat things!)
It gets even harder when some of your close friends vanish at the start. (Yet it’s better to know early on if they’re not going to hang around, than have them disppear once you’ve given birth.)
Learning to protect yourself as you go through this process becomes incredibly important.
Whether it’s limiting your news to a select few, or finding a few virtual (online) fertility friends who understand what you’re going through, to having early nights and baths, and slow peaceful downtime sessions - protect yourself like you never have before!
(See my Instagram for what’s In My Zona.)
Dose up on free natural practices.
Meditation, yoga videos, running around your local park, walks in nature….
They’re all free, available almost any time, and easy to access.
When your costs are sky high, and you’re taking the financal burden alone, enjoying some free practices feels a relief.
This is one of my favourite at home yoga videos.
Hire experts to support you.
First of all, I hired a fertility counsellor to help me through the trauma of my first cycle, and explore concerns around solo parenting.
Wanting to prepare better for my second cycle, than the almost nothing I did for my first, I then hired a fertility nutritionist. Having Milena’s support has saved me time and money. No more researching every supplement and wasting money on unnecessary pills.
There is a TON of online chat (noise) about which supplements to take and what diets to follow. I wish I hadn’t DIYed it and hired a nutritionist from the outset.
Milena looked at my recent blood tests, ordered some more from my doctor, reviewed everything I was already taking, and based on my test results, identified others to add in.
The package also includes vaginal microbiome testing by ScreenMe, the most thorough on the market. This was relevant as I have persistent HPV.
It feels good to have committed to improving my health during the three months before my next IVF cycle.
A nutritionist can help you maximise the benefits during this period. (I missed out on preparation because my Spanish clinic rushed me into the first cycle due to my low AMH (2.2).)
Starting on NMN has felt like rocketfuel. In less than a week, I could feel the difference. I felt noticeably brighter with more enthusiasm for life; and the feeling continues. I’ve even bought some for my 76 year old dad!
Perhaps you don’t need NMN, but the point is - a nutritionist can recommend supplements and dietary changes (and meal plans) based on your tests. This could make a huge difference to both how you feel now, and your reproductive health.
Manage your mindset.
I’ve been on a rollercoaster since July and my failed cycle.
Rebalancing has taken time, holistic practices from Shiatsu and Reiki, a fertility counsellor, lots of time alone, and far more sleep.
I’ve also felt very lucky to have found amazingly supportive women via fertility channels, some of whom are not In My Zona.
I’ve started paying attention to my thoughts throughout the day. If there is anxiety and cynicism and helplessness, I get outside and move.
Movement and nature are my favourite natural medicines. Moving stuckness
NEW: Resources page on Solo Fertility 40s with my favourite webinars, articles, forums and podcasts.
NEW: BUY ME A SMOOTHIE Each story takes 4-6 hours to write. I do this alongside my day job. I’m powered by daily berry smoothies! If you find my stories useful, you are welcome to show your appreciation by gifting a smoothie.
Sarah x
fertility40s@gmail.com