My Second IVF at 38: A Tale of Two Protocols

I used to write a lot about infertility, medical procedures, and other obstacles on the path to motherhood. But life had other plans, and I found myself starting my second IVF protocol at 38. Why? Well, I had an unused quota and no medical contraindications, but I wasn't exactly bursting with confidence about the outcome. Still, I'd established a comfortable routine, and I figured it was worth a shot.

I'll remind you briefly about my first IVF and my then dislike for the procedure. Back in 2018, I was 32, my husband was 35, and we were young and in love. We tried one attempt at IVF in a stimulated cycle without ICSI, but it didn't work out. We retrieved one egg, but it didn't fertilize. That was it, no more. I was left with a complex of guilt, inadequacy, and suspicion of genetic X-chromosome defects and premature ovarian exhaustion syndrome, neither of which was confirmed.

Between protocols, I had a quota, but I couldn't decide on a new IVF and kept returning it, re-registering it for the next year. That was until my follicle count in the ovarian biopsy dropped to a single follicle. My reproductive endocrinologist ordered an AMH test, and the result came back at 1.27. At that time, my doctor told me, 'You know this is the last train?' I understood, so I decided to try to enter the program. I reassured myself that at least I wouldn't be heartbroken about not doing everything I could. But I didn't believe in the success of the venture. It was my intuition, a pessimistic mindset - call it what you will.

As an aside, I've always been told that a positive attitude is crucial during IVF, but professional 'psychoanalysts' advise you to learn to accept any outcome and be prepared for anything during IVF. So, by the time X, I had all the required analyses updated, which the clinic needed. I just had to wait for my period.

On the second day, my husband and I arrived at the clinic. The doctor did another ultrasound, which showed a total of 6 tiny things. We signed the contract, and I received the first injections and medication at home.

The longest and most challenging stage of IVF began - the stimulation of superovulation. I had 2 main medications: Primapur and Humog. Both were unknown to me, and we started with high doses, 150 of each daily, administered subcutaneously in the anterior abdominal wall.

I was stoked with the stimulation! I was worried about the dreaded hormonal nausea after the last protocol, but I didn't experience any side effects. I was busy as usual - cleaning the house, going for walks, and shopping. I mean, I was just living my life.

However, the first ultrasound after three days of stimulation showed that nothing was happening - my ovaries were still small and contained only tiny follicles. So, my doctor increased the dosage of Primapure, and things started to get interesting!

The next check-up showed that my ovaries were finally responding, and the existing follicles were growing. My doctor added Orgalutran to prevent premature ovulation.

The Orgalutran shot was the worst one in the entire protocol! It was painful, and my arm swelled up and turned red after the injection. But I have to give credit to my husband - he's a pro at giving shots, and I didn't even get any bruises.Then, I was scheduled for egg retrieval.

The trigger shot has to be done exactly 36 hours before the procedure - in my case, it was Ovitrel.

After the shot, I had to inform my doctor that I had done everything as instructed. I sent her a message at midnight, just to be on the safe side.

The day before the procedure was a quiet day - no shots, no stress. I could finally rest and prepare myself for the operation.

I already knew what to expect from the follicle retrieval procedure - fasting, no eating or drinking, and a short anesthesia. Of course, I followed all the instructions, and this time, I was much more relaxed. I even found it easier to watch the medical staff scrambling around the operating room. The only new thing was the 'questioning' before the anesthesia - they asked me to state my name and the exact time of the trigger shot. Then, the anesthesiologist finally found a vein in my second arm and started injecting propofol. I remember seeing colorful dots dancing in front of my eyes and...nothing.

I didn't have any dreams or glitches. I woke up easily, opened my eyes in the operating room, and saw that the catheter was gone. I felt ready to get up and go home, but they transferred me to the recovery room instead.

Two hours of waiting! I had eaten everything I brought with me, and I let everyone know that I was awake. They were still monitoring me, though.

My doctor came to visit me in the ward: seven eggs! That's a huge success for me! She said she retrieved 10 follicles (we started with just one). I had some mild lower abdominal cramps, but they were much easier to handle than the first day of my period. There was no spotting at all.

As a precaution, I was prescribed utrozhestan three times a day, and I was sent home to wait for the transfer.

The next morning, I was waiting for the embryologist's call. I knew that the situation could repeat itself, just like it did seven years ago when the natural conception in the test tube didn't happen and the program ended. That's why I asked them to do ICSI in advance.

ICSI, in simple terms, is a procedure where they force-fertilize an egg with a sperm. After centrifugation, they select the best representatives of the male team, and the embryologist decides who's going to be the potential dad. The sperm's tail is cut off (so it doesn't escape), and it's injected into the egg with a needle. This significantly increases the effectiveness of fertilization in the IVF program.

ICSI, although it's covered by OMS, isn't done for everyone who wants it, but only on a case-by-case basis. We had a male factor infertility indication, so they did ICSI for all the cells during fertilization.

The next morning, I found out that we had three tiny embryos, and they'd be observing them for five days. Now I could finally breathe and wait for the transfer date. At this point, it was out of my hands.

The only instruction from my doctor that I didn't follow was the 'water torture.' In the IVF protocol, they recommend drinking at least 2.5 liters of water per day. During the first program, I struggled, cried, but drank. This time, I didn't. My body just didn't take kindly to that kind of abuse.

If I had an idea of what the puncture was like, the transfer was a whole new experience for me. And it turned out to be the most painful part of IVF.

The transfer takes place in the operating room, just like the puncture, but it's much faster.

But I was in a lot of pain because the gynecologist couldn't dilate my cervix: she said I was gripping it with my teeth. They had to use pessaries, and those who have experienced it will understand.

Next, the embryologist came out of her white-coated kingdom. Again, they asked for my name and said that only one embryo, 2aa, small but of excellent quality, had made it to day five.

Honestly, I would have liked to do the cryopreservation and PGD for the embryo, since it's the only one. I wanted to come to my senses after the stimulation, with a fresh head and new energy, to enter the cryo. But the doctor decided we'd do the transfer right now, since the endometrium is so good, and embryos can't handle the thawing. Who am I to argue with a specialist?

The embryologist held up a stick, like a straw from a juice box, and almost instantly, a tiny point appeared on the ultrasound screen, symbolizing new life.

They sent us off to rest in the ward while the doctor prepared the discharge papers.

And here's a part of the discharge summary:

With the detailed further treatment plan and other recommendations, they sent me home to take the HCG test in 11 days.

I've gotta say, trying to get a pregnancy test result on the due date is for the birds. I mean, who wants to stress themselves out with multiple home pregnancy tests?

I'm not one of those smart people who starts testing at 7 days past ovulation. I dove in at 3 days and didn't see my first faint line until day 7.

The line got progressively darker each day, and by the time I got my first HCG test, I was pretty sure I was pregnant.

I wrote a whole post about my first positive tests and first HCG results here. It's a long story, but I'll give you the short version: the pregnancy was confirmed, and even the ultrasound showed a healthy embryo. But then came the 12-day waiting game, and I ended up having a miscarriage...

If I compare my two protocols, they're like night and day, but the second one, at an older age, was definitely easier and more successful:

My AMH levels dropped significantly over 7 years, and antral follicles were almost non-existent, but we got 7 eggs

Thanks to ICSI, 3 of those eggs fertilized

I felt way better at 38 than I did at 32! Maybe it's the meds, maybe it's just luck, or maybe the protocols have improved

I went into this with zero expectations, no signs or symptoms, and no silly superstitions like I used to have

I changed doctors and clinics

And I got pregnant with just one embryo at 38 years old in a brand new protocol!

I've been to see my doctors after the miscarriage, and they're saying my IVF attempt was a failure since successful ones usually end in a birth. But I'm not convinced! If you haven't been through years of infertility, you can't understand what a miracle it is - even if it's just temporary - to see two lines on a pregnancy test, a growing embryo on an ultrasound, and a fertile egg on an ultrasound. My reproductive specialist thinks we should try again, since our bodies can get pregnant. I'm not ready to do it again anytime soon, or in the near future. As for what's next... who knows?

I'm incredibly grateful to all the specialists who gave me this chance!

If IVF is the only way to parenthood, and a couple is ready for the challenges and isn't thinking of their life without a child, and there are no contraindications or risks, then yes, you should consider it! There are many happy stories, and my experience shows that even in not-so-great circumstances, pregnancy is possible. IVF doesn't guarantee a birth, though - it just helps create an embryo and figure out the best time for implantation. And let's be real, nobody's immune to miscarriages, whether it's IVF or a natural pregnancy.

To all the people planning to start a family, I wish you two lines on your pregnancy test ASAP, and I hope everything works out for you!