IVF initial consultation - what to expect
Note the obligatory disclaimer: The below is from my personal knowledge and experience of IVF. The exact advice and processes from your IVF clinic may differ.
What happens at the first consultation for IVF?
You meet with a fertility nurse and IVF consultant at the clinic. They explain the process and you ask (hopefully not idiotic) questions.
First you have your identity checked more thoroughly than at passport control and sign forms. Lots more forms. For everything.
Then comes your appointment with the consultant, who explains the IVF process in detail, how they think you’ll respond to the drugs and therefore which protocol (fancy way of saying drugs plan/schedule/regime) you’ll be on. They also cover when the IVF is likely to start and any other tests you may need beforehand. Do not anticipate a life-changing appointment (it isn’t) because you think IVF begins today (it doesn’t) and the wait is over (unfortunately, it’s not). The initial consultation is you boarding the IVF train, whilst the train waits at the station.
What are you expected to bring to your first IVF consultation?
Your IVF clinic will tell you what to bring and it is likely to differ between clinics, but we were asked to provide:
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
What questions to ask at the initial IVF consultation?
It is always a good plan to plan questions. Otherwise all thoughts will elude you during the meeting to re-emerge only in the car on the way home. Here is what we planned to ask in our initial consultation:
How long will it take to start our IVF?
What are our chances of success?
What can I do to help my chances of success?
Is the sperm quality sufficient for straightforward IVF or will we need ICSI?
What is your assessment of my fertility issues - do I have PCOS or unexplained infertility?
What drugs protocol will I be on? Short or long protocol?
Does the clinic have its own pharmacy, or does it provide a prescription for the IVF drugs to be obtained elsewhere?
Under what circumstances could my cycle be cancelled?
What is the impact on my NHS funding if my cycle is cancelled - does it count towards my NHS funded IVF rounds?
Would the plan be to transfer one embryo only?
Under what circumstances would more than one embryo be transferred?
What is discussed at the IVF initial consultation?
Due to varying personal circumstances and health issues, the discussion will vary considerable. For us, discussion covered:
The IVF process
Our medical condition(s)
The appropriate drugs protocol, given our test results and medical history
The key risks during IVF including potential poor egg quality, potential for overstimulation resulting in a cancelled cycle or requiring all the embryos to be frozen, the potential for no eggs or no embryos of sufficient quality to transfer
Our likely success rate of IVF, given our age and personal circumstances.
How long does IVF take from the initial consultation?
The initial IVF consultation may seem like the start of the IVF process, but your actual IVF round is likely to start a few months later. For me, my first IVF injection was 7 weeks after my initial consultation.
I attended my IVF drugs appointment with the fertility nurse 3 weeks after my initial appointment. I then had to wait for my period to begin, which marked the cycle in which my IVF began.
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 you will then start on stimulation drugs during that cycle. This is different to the long protocol, where usually you will take down regulation drugs during the cycle before your IVF begins.
What happens at the first IVF consultation? A peek into mine.
The most eagerly anticipated and long awaited appointment on our three year infertility calendar - the IVF initial consultation. Much like a radical haircut, I have unreasonable expectations for it to be life-changing, when it is nothing of the sort. In reality, the initial consultation is all talking, form filling and information leaflets. Unexpectedly, at no point am I asked for blood, asked 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 my car.
Initial impressions of the IVF clinic
The clinic is tired and shabby at the edges, as if it too has spent considerable time on IVF drugs. One can expect dated carpets, pine veneer, 90’s décor and a stash of drastically out of date magazines on niche topics. On entry, every emotionally charged client passes through the corridor of smiling baby photos, a test of stoicism. It is a wall of success hiding the true statistics that each round is more likely than not to fail. We sip scorching tea from a structurally unsound plastic cup in the Clinic’s waiting area and deliberate on whether The Wall is in poor taste. From an emotional standpoint, it is obviously poor taste, decoratively. We conclude ‘yes’, whilst simultaneously making a mental note to send in a photo, should our treatment be successful.
The warm smiles of caring staff make the clinic a happy place. If closer to home, I’d spend my spare time in the waiting room, soaking up the kindness. Confirmation that I am no longer in an NHS facility comes when a) the system has a record of me being a patient at the clinic, b) they are expecting me for an appointment and c) it is at the same time that I’m expecting the appointment. This, to me, is a revolutionary service.
Meeting with the fertility nurse and completing yet more forms
Our first session, running beautifully to time, is a meeting with the fertility 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. I ask the nurse what our IVF consultant is like and she describes him as 'very tall and smiley’ and ‘softly spoken’, a colourful description that covered none of the necessary bases. Once our lives are signed away, our identity checked more thoroughly than at passport control 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 are released back to the waiting pen.
Appointment with our IVF consultant
At this late stage of infertility surely we all know what IVF is and the basics of how it works, but this is where someone with credentials explains it to you. Our IVF consultant, Dr C, makes an educated stab at why we are struggling to conceive, putting underwear on the naked diagnosis of unexplained infertility (if 'unexplained' can ever be considered a diagnosis). Is it unexplained? Or is it PCOS? I am told that the newly discovered cysts on my ovaries, coupled with my abnormally high AMH (50.9) indicates PCOS. Finally, after over 3 years and countless tests, the diagnosis from my IVF consultant is a mind boggling 'unexplained infertility underpinned by a diagnosis of polycystic ovaries'. So both, then.
Dr C picks up a pen, pulls a sheet of paper from the back of his printer and sketches a diagram of why my body is unlikely to release eggs. It is a visual representation of the physiology underlying my last three years of suffering. A welcome moment of complete clarity. Five minutes after leaving Dr C’s office, Joe and I debate which way round the paper goes. And what do these lines mean again? The harder we hunt for its original meaning, the more it mutates into a scribble. We later consider, then dismiss, framing it on our wall as 'IVF interpretative art'. I foresee loved ones pausing, pondering and asking, ‘but what does it mean?’. And I’d respond with ‘well, what does it mean to you?’. No, seriously though, what does it mean to you? Can you make any sense of it?
Next up, as with any medical procedure, comes a long list of all the risks and possible negative consequences. Dr C provides us with the IVF equivalent of a house buyers' survey, in which we are made so aware of every possible failing that we question how the house is still standing. I try to calm the rising panic whilst listening to the following risks:
potential for 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 (‘freeze all’).
reassurance that "ovarian hyperstimulation syndrome (OHSS) is rarely fatal", which has the counter effect to reassuring me, given I wasn’t previously aware that it is ever fatal.
potential for no eggs to be collected (the opposite of the previous mention risked of overstimulation), and finally
potential for no embryos of sufficient quality to transfer.
Just as I am wondering what’s the damn point in us doing IVF, Dr C gives us a likely success rate of 40%. I later wished I had asked what the estimate is based on. Is it simply our age? Or is it a tailored calculation based on my specific test results and diagnosed conditions? It’s good to be clear. I often forget my age. Sometimes my house number. But the percentage of likely success torments me throughout my IVF, reappearing uninvited in my mind during every quiet moment of every day.
Dr C’s part is done. It seems that the next item on the undisclosed agenda is for us to lead and it takes the form of Q&A. It’s the first time I have spent any real time This is the first time in the company of a fertility expert. During the previous two years at our NHS hospital fertility clinic I saw my registrar for less than 10 minutes. In total. I will now ask the detailed questions I have always wanted to know. Ah, perhaps not. Like all fertility appointments, it is inexplicably overwhelming and the dozen of the urgent and insightful questions I simply must know the answer to evaporate. On passing through the threshold to Dr C’s office, I am stripped of any independent thought, to be reborn a simpleton, of the silent staring variety.
Thankfully, my husband Joe leaps into the void with a relevant query on the likely timeframes for treatment. Unfortunately this then leads him to a less relevant statement about his family all being born in August. This meanders on to badgers having breeding seasons and tumbles in to a brief opinion on culling, leading the consultant to ask 'and any questions on fertility?’. The only thing more perplexing than Badger-Gate, is my husband's absolute insistence on leaving that room that I must be losing my mind as the word ‘badger’ at no time escaped his lips.
For reference, these are the questions we meant to ask:
How long will it take to start our IVF?
What are our chances of success?
What can I do to help my chances of success?
Is the sperm quality sufficient for straightforward IVF or will we need ICSI?
What is your assessment of my fertility issues - do I have PCOS or unexplained infertility?
What drugs protocol will I be on? Short or long protocol?
Does the clinic have its own pharmacy, or does it provide a prescription for the IVF drugs to be obtained elsewhere?
Under what circumstances could my cycle be cancelled?
What is the impact on my NHS funding if my cycle is cancelled - does it count towards my NHS funded IVF rounds?
Would the plan be to transfer one embryo only?
Under what circumstances would more than one embryo be transferred?
One solid tip from me is to take notes. I didn’t and I regret it. Emotions run high and despite being convinced that you will definitely, definitely remember what was said at the appointment. Definitely. You will instantly forget every word on exiting the room and curse yourself for not taking notes. I feared that writing it all down would seem too keen, even desperate. Everyone walking into his office is desperate. It’s an IVF clinic. Things are not going well. Besides, later in the IVF process he will see your vagina. Up close and under a bright light. By that stage, you really won’t care what he thinks.
Further meeting with the fertility nurse
Following the meeting with our consultant, we have one further session with the nurse, who books us in for our perplexingly named Implications Appointment (and what, pray tell, is that?) combined with the drugs appointment. We are given a leaflet on what ‘short protocol’ means and sent on our way.
Overall it was an informative, efficient and supportive experience, but one that is strangely emotional. I spend the remainder of the day in inexplicable ugly tears.