IVF: A Process Based on Science and Hope.

Disclaimer: I include this section for some posts that can be intense/ personal for many people and would like to clarify that the post is written completely from my own personal experience. If I intended to let you know of something, it's because I wanted to share it with you. If I didn't share something (eg: specific medical conditions/ medicines) it means I didn't want you to know. Not here. I am always up for a more personal conversation, so send me an email :) The most important disclaimer: My IVF attempts were unsuccessful followed by a normal pregnancy. So if you feel you can't relate to it, you can stop reading now. But it is precisely this difference that made me understand even more the vast world of IVF that simply people outside it cannot comprehend, especially if you tried to get pregnant and, you know, it just worked...

Coming back to putting my thoughts into words after a long hiatus. A lot happened in the past two years on the personal front. From getting married to being a mom. These milestones in life certainly came with its fair share of surprise, decision-making and trusting the universe (universe? read here to know what it means) that everything will be fine. I crossed by 30s by the time I got married. So I have seen the vast majority of family-related life updates from my peers on social media before going through one. There was the first phase of wedding photos and how blissful married life is- accompanied by lots of travel photos to destinations that spanned the entire world. These were then followed by a slow release of child birth pictures that became videos of toddlers and how fulfilling life was becoming. It was a natural evolution in one's life and there was nothing weird about it. Until...

As close friends and family started to go through that trajectory, I became aware of the nuances that comes with this so-called "natural evolution". Not all wedding were marriages- certainly not as ideal as they seemed on Instagram and I realized that child-birth announcements were made quite suddenly, followed by release of pregnancy pictures that makes one go "ah, so they were pregnant before!". Pregnancy was almost always kept a secret to the "public audience". The essential reason, I am guessing, is probably the unpredictability of the process and maybe for some people have a little to do with not wanting to get 'jinxed'! Seems understandable. After a few more years when you're in the crust of figuring similar things out for yourself, you start to wonder one level more- "I saw baby pictures, and then I saw pregnancy stories. And it seems like these routine yet extremely complicated process happened just fine for everyone". By everyone, I mean everyone.

"I do not know a single 'Instagram friend' who underwent a complicated pregnancy process. I know about 80% of personal friends/ family who underwent at least one complication or the other" What an enigma!

This really did seal the idea about how social media portrayal of one's life is the least truthful of all. Not because everyone is lying on their profile. It is just that not everyone is comfortable sharing the entire truth and often does not point that out either. Nothing wrong in that. But it is important to be aware.

Six months before entering the process of IVF (in vitro fertilization):

We women know that the 27-day cycle is a myth. It can be stretched front and back by several days. Now if you add in teenage years of stress and a lifestyle of unconscious nutrient choices, this can get even worse. I have always had irregular cycles- not even ashamed to say it because I never had a regular one. Through phases the gynecologists always complained it on different things. In teenage years it was stress about studying or maybe even a lot of sports... in my early 20s it was about maybe you should make healthier eating choices, and in my late 20s it was about managing the irregularity but not worrying too much because this is just nature... All of these conclusions were made after routine blood panel checks that revealed absolutely nothing wrong. Coming from the Indian sub-continent and being a part of a family with generational T2DM (Type II Diabetis Mellitus) history, it wasn't hard to guess I probably had insulin resistance (a condition where my blood sugar is elevated because insulin cannot do its job of pushing the sugar into my cells), a common consequence of PCOS (polycystic ovary syndrome- development of cysts around the ovaries- a condition that completely causes your reproductive hormones to go haywire and prevents timely maturation and release of eggs aka ovulation). It was when I turned 30 that my blood panel showed proof of this. It wasn't a big deal, I was not surprised and thankful for me, there were ways to treat it. I knew there was a treatment, which is probably why I never worried so much about my irregular periods but there have been times where I have wondered... can I have/ bear a child? There are so many other variables in the process, my condition was just one and more so, a common one. I started treatment.

"One tablet in the morning and one in the evening. How bad can that be?" That's what I thought when I received my prescription (that is not covered by health insurance by the way, although I had blood tests proving my condition... a women's problem is never everyone's problem.. but that's a debate for another day!). There are two common side effects to it: immediate trigger of diarrhea post food intake and nausea that includes changing your perception/ taste to food (which was the worst and long lasting in my case). I spent six months on the tablet and during that time I have ran across the streets of Marseille, France looking for a cafe with a bathroom while sight-seeing and dropped everything at work spontaneously to get the next train to come home because my stomach was really upset. As for the food, now, over a year and half later I still can't eat at most restaurants I went to during that time because all I remember is the nausea while eating the food and how much I hated it! Of course I worked through these days, I travelled to places I wanted to see and tried to keep it as normal as possible. Some days were very tough and some were okay. But I knew I had a bigger goal in mind... to have a kid some day!

IVF? How do I start?

The treatment for PCOS sort of regularized my cycles but it was not a given that I could get normally pregnant now. Being a scientist and for some more vague reasons, my husband and I decided to visit an IVF clinic. Had no clue where and how to start and therefore I decided to search online. Luckily there was a clinic very close to where we lived and they had a fancy website explaining everything. Emphasis on the word 'fancy' here because although I live in a country like Germany where we have health insurance, processes like IVF are not entirely covered by health insurance. So we have to pitch in. And let me tell you, your guess is right.. It is DAMN expensive, which is partially justified by the complicated processes that come with it and the rest feeds on the desire of couples to have kids. While IVF itself involves the process of retrieving eggs from the female and fusing it with the sperm from the male externally in a dish, an IVF clinic performs many more processes than just that. For example, artificial insemination, where they can time your egg release and inject sperm manually and basically your body does everything else... No 'external dishes' involved :P It's the more simpler process and is often opted before going for IVF treatments. To decide which treatment, the clinic runs an extensive panel of tests measuring every single hormone that is directly or indirectly related to altering your reproductive biology. As a scientist, I found it pretty amazing to see the developments in medical science. Unlucky for us, some values were very very low suggesting that we need to start with the end game method- the most complicated and expensive form of IVF. Thanks Universe!!!

I remember the day we got the news. My mind was more disturbed than sad. But because I trust science and technology, I did have hope that science is going to help me out on this. That day I came across Ludovico Einaudi's Concert ad which was going to happen in Paris over half a year later, in the summer of 2025. My husband and I bonded over his music during our initial dating days. It took me a second to book those expensive tickets. I was doing it for us. "We are two people who are going to take this new journey together and enjoy life in parallel no matter the consequences"- I told myself. Or rather convinced myself that everything will be fine.

Let's start. Trial 1.

The tests and conclusions took a couple of months already and holiday time around New Year 2025 didn't help. What was the point trying to speed it up anyway? We knew it was going to be a long journey. We redid our tests in the new year, only to end up with the same results, so we scheduled the first trial. When I say scheduled it doesn't mean we have the one date in our calendar. It is a series of dates- it spans your entire month. So you will have to fit it into your other schedules that involve work, hobbies and other travel plans, if any. We prioritized the process and everything else was somehow managed around it. The day we received THE PLAN was also the same day we received prescriptions to buy medicines that I had to start from day one. The process, of course to no one's surprise, is extremely one-sided. Your husband being around is the best thing he can do but nothing more. We went to the pharmacy with the prescriptions and received a bill for 50% of the costs (that's how it works here in Germany where the health insurance covers the other 50%). The money we paid that day was higher than anything we had paid for health-related reasons till date. We knew it was just the beginning. I went back to the clinic with three different injections and they showed me how I can self-administer them.

In the beginning it was not a big deal. There was a schedule. I had to inject myself once in the morning, and then with two or three different injections in the evening. Sometimes it was painful, mostly it was okay. The 14 days went well and my ovaries managed to develop a good amount of mature eggs (age does matter for this process). During temporary anesthesia, they retrieved the eggs by literally 'puncturing' my ovaries. I started to feel it as the numbness wore off. And there it was. The first real physical pain in all of this process (excluding the minor pain from the hundred injections you already have taken). I could point to you from the outside exactly where my two ovaries were because I felt the sting every time I walked, sat or moved. Luckily, I had the day off from work so I ended up in bed the rest of the day.

The extremely timed process of early human embryonic development

Freshly retrieved eggs are fertilized the same day. They wait 24 hours to see if the eggs are nucleated - where the nucleus containing the DNA from the dad is inside the egg where it precisely mixes with the mom's DNA. Eggs that do not show this are trashed because they are unfertilized. It is normal to lose 30% in this process. The rest of the eggs are kept in an incubator to grow up to either 3 days or 5 days and this depends on how much you are willing to pay. Keeping your eggs from a 3-day stage to 5-day stage can cause you several hundreds of Euro , but scientifically it can also increase the chances of pregnancy. During early embryo development there can be several faults in DNA that automatically aborts this process. Its a good thing. Without such a mechanism the world will be filled with a majority of disabled/ morphologically different humans who may not necessarily be viable long term. But this also means that the prediction of successful pregnancy from a day 3 fertilized egg is less than the eggs that were able to develop successfully until day 5. If you were trying to get pregnant normally, you would not know that any of this is happening. If any of this process didn't happen successfully, you would have your period in the normal schedule which would let you conclude "Okay, not this cycle. Let's try again". But when you walk through each and every 24 hours of the process and pay a lot for it, you know what should ideally happen every single day and you pray with all your might that it happens well. Rooting for better odds, we shelled out the extra hundreds. BAM!! we were now left with only 25% of the eggs that we initially started the process with which successfully went to day 5. It was not a lot. After checking for successful development of the eggs and my uterus being ready to receive one of them, we went to the next stage: Transfer. Through a capillary they carefully transferred one fertilized day-5 egg into my uterus and froze the rest (for a few hundred Euro more).

Early stages of embryo development. Each step approximately takes 24 hours. After 5 days it is called a 'Blastocyst'.

The wait.

The morning of the transfer, which was relatively early for a Saturday, my husband and I were sitting in the reception talking about how we could walk back home with a potential offspring. One that will be ours in the future and would give us company in this life. Fun fact: this day was also our first wedding anniversary. What a gift we returned with!! We were excited but we knew the odds: approx. 40% chance that this will end up in a successful pregnancy (not successful child birth, by the way. Statistics are based on a positive pregnancy test and not if your pregnancy follows through. You probably know that 30% of pregnancies end in a miscarriage within the first 3-4 months. This was not included and frankly, not a problem for the IVF clinic to deal with). While I was lying down in bed, still throbbing from the puncture pain from 5 days ago, I couldn't help gently rub that belly wondering what is happening inside. After the transfer, the clinic asks you to wait for 14 days before coming back to them for a blood test. Indication of HCG, the pregnancy hormone, would mean "successful" pregnancy. When HCG is high enough, over-the-counter pregnancy tests can detect them in your urine. I bought a few tests from the pharmacy and tried to wait the 14 days before testing, but my curiosity got the better of me. I woke up in the middle of the night 5 days after the transfer and tested. Negative. Should I be surprised? No. Frantic googling gave a whole new range of answers but most people said day 5 is too early. But my sister (a well-informed doctor herself, not a gynecologist though) thought that there should be indications at least in the next few days. What started off as a excited walk from the clinic a week ago was turning into full blown anxiety now. The next day morning I woke up with a headache and throat pain. First signs of a cold. I was worried but hoped that it would pass. What followed the next few days was a severe flu with very high temperatures at night, throat lesions and endless body pain. I was worried that this tiny ball of cells would likely not survive this, but I was too sick to think about it. About 9 days after the transfer, my period started and I knew the ball of cells did not survive. It wasn't even a surprise but it felt very disappointing. As I recovered from the flu, it had been 14 days. I managed to go to the clinic for a blood test knowing the obvious result. It was painful emotionally. Blaming it on the flu for an unsuccessful first try made me feel a bit better, and hopeful about the next. We immediately scheduled an appointment with the doctor to discuss options for the next try.

Second time a charm?

Every new trial is always timed from day 1 of the period. Duration of a pregnancy is also calculated like that. For example, 40 weeks from the first day of your last period is the normal duration of a pregnancy. 37 weeks from the first day of period means you are full term and the baby can be out any time. Modern medical technology can help a 24-week old fetus survive in the outside world. However, the probability of survival increases the longer they stay inside the mother's womb for development. Since my period started in the middle of my first try, I was already ready for timing the next. Getting your period means something like your uterus has started to cleanse itself of the "old" cells that were waiting for a baby the previous month. Once its all shed, new ones will form for a potential baby. We timed that carefully and this time, because we had some frozen fertilized cells in the freezer, could skip all the injections and puncturing of the first 14 days. THAT was a relief. Just like the previous time, I started my progesterone tablets a few days before doing the transfer. 'Progesterone'- the hormone that surprised me the most in this process... It is sort of a muscle relaxant, so it affects a lot of major processes. You feel bloated (like you have stuffed air in your belly) all the time. In my case, the tablets also caused dizziness and tiredness . It was hard to explain to colleagues why I felt tired all the time. Natural pregnancy slowly boosts progesterone production- an essential to keep the pregnancy. You also have an increase in progesterone every month during the second half of a cycle. So many women experience bloating pretty much every month. My irregular cycles never helped me realize any of it. Since IVF is a carefully curated process and does everything to maximize the chances of a pregnancy, they jack up your progesterone with tablets. I had an additional injection as a supplement (yaay, let's multiply the side effects). Finally, I was ready for the transfer. This time I carried home two fertilized ball of cells with the hope that at least one would be successful (my husband carried the confidence that maybe both will which I immediately rejected, but secretly hoped... yes, it could be true!). I was more prepared emotionally to carry the next 14 days forward than the previous one. As a treatment plan they recommended no hot showers/ sauna, not to carry weight more than 3 kg, be relaxed etc etc to help with successful implantation and pregnancy. I tried to do all of that. I bought less pregnancy tests than last time. I managed to wait for 7 days instead of just 5 last time to do my first pregnancy test. Negative. Disappointed? Of course. Kept some hope after frantic googling. At Day 10 I was negative again. That removed the rest of the hope. The day 14 blood test was a clear negative too, suggesting that it was an unsuccessful second attempt. My body officially failed to house three fertilized embryos. Sigh!

Let's change everything in life

The two failed attempts brought us to April, when signs of Spring were in full swing and longer daytimes were becoming a bliss. I felt like the darkness has passed. After summarizing the process with our doctor, who assured us that there is nothing to be disappointed about and it will all be fine if we tried another time, my husband and I came back to our 'empty' home. I don't know why that 'empty' feeling lingered. It's not like we had a baby walking around the apartment and then left us. Hell, the baby wasn't even formed.

I have heard of so many miscarriage stories from people with normal pregnancy and the toughness and grief that lingers with it. I didn't know how to express the grief of not being pregnant. As I sat on the couch, I realized my body was tired, my mind- even more.

April also meant that a whirlwind of plans and trips were upon us the next couple of months. I had language exams and trips to Austria, US, France and Italy planned within the next two months. My period started in the beginning of April, a few days after the negative day-14 blood test, cementing again the failed try but indicating that it is ready for the next round. But we had already discussed with our doctor that we will take a break to finish all our Spring trips the next few months and will be back emotionally, physically and financially ready in summer to try again. Winters in our apartment was tough because of bad heating. So we decided to move- away from the rooms where I lied down terribly sick, bathroom where I pee-ed in the middle of the night on tests that were only negative. Almost like changing the scenario hoping something different will happen the next time but with no indication that it will. So the first few weeks of April was filled with running to an exam and then running back to pack an entire apartment, moving boxes to a new apartment and having no time to unpack them, and most important of all the changes- getting a new haircut.

Is that real?

Not being in the process of IVF also meant that I did not have to take the different types of tablets anymore (at some point during this process I was taking 6 different tablets, two times a day!!!). I could climb a fleet of stairs without catching my breath. After months I felt like I had my body back. Unpacking in the new house was a tough task- carrying heavy boxes and rearranging everything. Luckily I could do it all because the requirements of "do not lift anything more than 3 kg" did not apply anymore. At least not for a while. I wrote my German exam in the meantime- wanted to check that off my list for a long time. My husband and I enjoyed a nice trip to Innsbruck, a small beautiful village at the foothills of the Austrian Alps. I didn't have to watch what I eat- so I ate ice cream and cake and everything I wanted. The next week I had plans to go on a girls trip to Strasbourg in France. We have all been there already but we wanted to go somewhere close to Germany and still enjoy nice food and this was a great compromise. I took the train on a Wednesday evening and thanks to delays in German trains (which happens 80% of the time) I was going to miss my last connection to Strasbourg. As I got out, I saw a whole bunch of people running violently towards another platform where the train to Strasbourg was waiting for us. The first person who reached the door held it open for everyone that followed. I was lagging behind the crowd due to my luggage, lack of fitness due to my experiences in the past months and a feeling of what if. What if I am pregnant? Don't be surprised. While IVF was not on the cards for the next months, one can always naturally try, right?! Of course chances that it works normally the first time after months of IVF are close to none but anything can happen, right? My mind blatantly rejected the idea as I made the last sprint to the door successfully with my heavy suitcase. I didn't care. No 3 kg rule, no medicines, no restrictions. I was going to enjoy and have a good trip. As a matter of fact, I had a great trip. One where, in an attic room of a rustic hotel in France, where I saw for the very first time, a positive line in a pregnancy test. Is that real?

The beautiful town of Strasbourg, France. April 2025

I write this post as my 37 weeks baby is wriggling inside my uterus. I can feel the bones now from the outside. What a miracle, yet alien feeling all of this is. We went to that Einaudi concert when I was at the end of my first trimester. The process of pregnancy taught me valuable lessons for life. IVF can be a very isolating process if you do not have the right people around you to share it with. Reading several blogs on the internet, even with my scientific mind, did not help declutter opinions about this process. There are reddit threads for every day after transfer- is it positive? can it be negative? People give a range of opinions. Not all of them are true or false. The more I knew about this process, the more it became clear to me that IVF is a scientifically driven process that has large black holes in knowledge and understanding. That's why the process has only a 40% success rate. But it still works because if you repeat several times, you increase the chances of pregnancy. At least that's the hope. It was always weird for me to have undergone the process of transfer, which is a simple yet highly technical process medically, and then they send you home saying 'Daumen drücken". It literally means thumbs crossed in German or could translate to fingers crossed in English- meaning now let's hope that pregnancy happens in the next 14 days. Hope? Yes, because IVF cannot not do more. You can swallow all the tablets and take supplementary injections, but after a certain point the doctors also hope it just works. What can we do? Also just hope.

Life is a whirlwind we all experience in our own timeline,

Swetha, now also a mom.

Image courtesy: https://www.alphaspecialists.com.sg/1873/embryo-development-stages-of-embryo-growth-with-ivf/