what happens after IVF works?

[bri276]

DH & I will need IVF w/ PGD to conceive our next child because I am a carrier of a chromosome disorder. Right now we are simply in the talking/planning stages because we need to buy a house and get settled first (within the next year). Right now I'm doing all the research I can to get comfortable with this decision (DH is very happy about it already ).

My question has to do with what happens once pregnancy is achieved. With DD I had a pretty mainstream pregnancy/birth. I really want to avoid unnecessary interventions this time. Meaning, I don't want frequent or early ultrasounds (besides for transfer, obviously), I don't want millions of tests, I want to use a midwife for routine checkups and I plan to UC. Am I going to encounter a lot of negativity if I'm declining ultrasounds (including doppler) and AFPs? How early are you "allowed" to switch from the RE to the midwife?

sorry, I know I will be lucky just to be successful with IVF in the first place, but I'd want to give any baby, no matter how they were conceived, the same type of gestation and birth that I wish DD had.

[crazyrunningmama]

HI! First, I am in Canada, so that might make things different. In our case, the clinic did internal ultrasounds (many!) throughout to see what was going on with the follicles, how many are maturing etc. I think after ET, I just had the 2ww, then an ultrasound to check on things maybe once or twice? (still internals, you can't see much with external ultrasound at that stage). I think the idea is that they can tell by 6 or 7 weeks if things are progressing normally. If I recall correctly, we said goodbye to them at 6weeks pg. And then I was on my own, just as if I hadn't had IVF, find a doc or a midwife, get the prenatal tests done or not. In fact, it was a bit weird for me to be just pregnant like a normal person, because how I got there did NOT feel normal to me at all. good luck to you.

[gemasita]

I'm just planning on refusing early u/s's.

After that, I most likely will not be high-risk so my pregnancy shouldn't be any different than any other.

I still plan to use a midwife and homebirth...

[Perdita_in_Ontario]

Same as crazyrunningmama, once we had the u/s to confirm heartbeat, we were more or less on our own. The clinic had no more interest in us - we had achieved their goal LOL. Our RE did refer us to an OB (he talked us (well, DH) out of a midwife - that won't happen if there's a next time).

I would assume where your care goes depends on how high risk you are. In our case, our Dx is male factor, so once I'm pregnant I'm like any other woman - and boy was that a welcome anti-climax after weekly and daily visits during the cycle!

[YummyYarnAddict]

With my very first pregnancy achieved by IVF, I was 32yo and not in any high risk category. I had my first u/s to confirm a heartbeat around 8wks and was then released to my OB. Because I didn't have any risk factors to cause me to be considered otherwise, other than my first trimester screen (which was just bloodwork back in the olden days, not w/the NT scan like it was by the time I conceived my ds), and my next u/s was the level II at 20w. There wasn't anything "atypical" or "high(er) risk" about my prenatal care just because I did IVF.

With my second successful pregnancy things were different because I had several pregnancy losses in between, so it wasn't because of the method of conception, but because of my pregnancy history.

I should mention that my OB group is a "go to" group for high risk pregnancies, so they could have easily labeled me high risk but didn't. Even my being 35+ at the time I conceived ds wasn't enough because they consider advanced maternal age (for their practice) to be 40+.

[bri276]

thanks for the info, I am still learning so anything from the pros is helpful

what if I refuse an early u/s to check for the h/b? are they going to go all mainstream medical on me and have a fit? I'd sort of like to be on good terms with them in case I have to use them repeatedly. but I really don't want any u/s after transfer. I'd prefer having a missed miscarriage to that, even (and I've had a missed m/c before). I just...don't want any u/s unless there is a strong suspicion of multiples, and if that's the case, I'd still want to wait til the beginning of the 2nd tri.

[AdinaL]

I actually moved states about five days after finding out I was pregnant. I found an OB here so that I could get an u/s to see how many were there, since we transferred two embryos. That was at 7wks or so. I was trying to figure out if I wanted to see an OB or a midwife and saw the OB until my 20wk u/s, which I did do. And then I switched to my midwives and had a homebirth.

You can decline anything you want. If I hadn't sought out an OB, no one would have ever "made" me have an u/s. I mean once transfer happens, and you get a positive beta - it's pretty much all yours. So, I recommend telling them what you want in advance. Let them know that you won't be doing the u/s to confirm a heartbeat, etc. It is always easier if they know in advance. They may try and talk you around to what they want you to do, but, if you are aware of that, then you can be prepared for it.

[gemasita]

Absolutely you can decline anything you want. I have sure learned that. I always tell my doula clients that but I have really had to put it into practice for myself and let me tell you, it is not always easy but you have to do what you feel comfortable with. In the grand scheme of things, I don't think the clinic will care that much. U/s's is just what they are used to and most people beg for them. Of course it is exciting to see our babies but if you have reasons for not wanting u/s's, that is your business.

I probably won't try to explain to them why I don't want u/s's. Maybe I can just claim religion as a reason so that they won't want to keep hounding me.

I have already refused some things that my clinic suggested and it didn't really cause a stir...they were just surprised by some things and didn't understand why. But now, I feel even more strongly that I am not doing anything I don't feel comfortable with. As I said, it's not always easy but it's YOUR body and your baby.

[bri276]

thanks. it's taking a lot to come to terms with the fact that this is basically our only option for adding to our family (very long, complicated history). and I guess it just makes it even harder when I feel like it's so incredibly medical and interventive, and I want to minimize that as best I can, so that if and when pregnancy is acheived, we can proceed as usual. there's a lot that scares me though, especially the possibility of multiples. I guess most people go through some type of emotional rollercoaster when preparing for IVF, though, the subject matter just varies a little.

I've joined an IVF forum and of course, like everywhere, most of the members are just extremely mainstream and I'm glad I at least have a few people here that know what I'm about to go through. If anyone has any recommendations about websites, not just forums but anything informative, I'd appreciate it.

[gemasita]

it's taking a lot to come to terms with the fact that this is basically our only option for adding to our family (very long, complicated history). and I guess it just makes it even harder when I feel like it's so incredibly medical and interventive, and I want to minimize that as best I can, so that if and when pregnancy is acheived, we can proceed as usual. there's a lot that scares me though, especially the possibility of multiples.

I could have written this exactly! I am a doula so I have been dreaming of my non-medical birth for a long time and this whole IVF thing has already put such a wrench in things. But I still want a natural experience and that is so important to me.

I will PM you some information about another forum I talk on....

[crazyrunningmama]

Originally Posted by Perdita_in_Ontario

I would assume where your care goes depends on how high risk you are. In our case, our Dx is male factor, so once I'm pregnant I'm like any other woman - and boy was that a welcome anti-climax after weekly and daily visits during the cycle!

:
Yes, that is exactly what I meant!!! Ours is male factor too. I felt so odd having the clinic just say, bye, we're done after I felt like I had practically moved in there.

[christophersmom]

My infertility practice is associated with an OB office that offers midwives. Had everything gone good at my ultrasound I would have been transferred over to them as a normal patient. We have unexplained infertility.

[nummies]

Decline anything you want mama! We did an early u/s to ensure the number of embies that implanted and to check heartbeat. Then we were off to the midwife. Best of luck to you!

[Leslie in Chicago]

all great advice above...if you're pregnancy with a singleton. If you do conceive multiples, well, welcome to the big bad world of mainstream obstetrics. It's not as bad as it sounds, actually, and we managed to find high-risk perinatologists that are very respectful and not u/s happy.

Which is not to say that all IVF multiples pregnancies are high-risk. Mine was because I'm 39, it's my first pregnancy, I bled and passed clots the entire first trimester and needed an emergency cerclage at 22 weeks. But here I am, ready and waiting to birth two babies within a few weeks. It's ALL worth it!

(Then again, maybe I have crossed over...if we need a c/s, I'm open to it. At this point it's about having healthy babies, not carrying through on my ideal birth plan.)

HTH

[bri276]

at this point, if we did IVF, it would be a single embryo transfer. Mass General Hospital has a clinic with a 25% SET rate and they're very happy about it. So, while there's still a higher risk of identical twinning, I still wouldn't see a need for an u/s until the beginning of the 2nd tri if I was measuring ahead. And even if it was twins, I would still strive for a low technology pregnancy and a homebirth as long as no problems were evident, like ttts. I had a pretty mainstream obstetrics team until I switched to a CNM group at 36 wks with DD and I hated it. it's not about my ideal birth plan either- I've had a baby born with problems and I know the most important thing is the baby(s), but that's exactly why I want to avoid unnecessary interventions. key word being unnecessary.

I don't know. We are still so stressed about this and we're going to have a lot to discuss. talk about mixed emotions!

[devilish_fetish]

Originally Posted by Leslie in Chicago

all great advice above...if you're pregnancy with a singleton. If you do conceive multiples, well, welcome to the big bad world of mainstream obstetrics. It's not as bad as it sounds, actually, and we managed to find high-risk perinatologists that are very respectful and not u/s happy.

Which is not to say that all IVF multiples pregnancies are high-risk. Mine was because I'm 39, it's my first pregnancy, I bled and passed clots the entire first trimester and needed an emergency cerclage at 22 weeks. But here I am, ready and waiting to birth two babies within a few weeks. It's ALL worth it!

(Then again, maybe I have crossed over...if we need a c/s, I'm open to it. At this point it's about having healthy babies, not carrying through on my ideal birth plan.)

HTH

That's not necessarily true. Even if you got pregnant with twins, it would still be up to you whether or not you wanted to go the mainstream ob route (barring any complications, of course). This is my first pregnancy and i'm having twins and a homebirth.

Dh and i did IVF in October. After the embryo transfer, they did a beta to confirm pregnancy. Then they did 2 ultrasounds (they confirmed twins during the first ultrasound) and we "graduated". They asked what ob i was seeing and i told them i was seeing a midwife and they never even batted an eye. After i "graduated" from the RE, i started seeing a homebirth midwife and a CNM for dual care. Our homebirth midwife doesn't require dual care, but we wanted to have it at first because we had "new pregnancy jitters" and i had hyperesis gravidarum and needed zofran (our homebirth midwife can't write scripts). The CNM knew from the beginning that we were planning a homebirth. While i was seeing the CNM (who works with an ob and only delivers in a hospital), i declined all testing except for ultrasounds/doppler. We didn't do the triple screen, the amnio, the gestational diabetes test, or ANY of the blood tests. We have seen a high-risk specialist one time, and that was simply for the big ultrasound (our CNM didn't have an ultrasound machine there). We're not doing dual care anymore, and we're simply seeing our homebirth midwife. Our twins have two sacs and two placentas and they're growing right on target for a singleton, so we're not really any higher risk than a singleton pregnancy.

For us the choice to have a homebirth with our twins was pretty easy. We were planning a hospital waterbirth until we found out we were having twins. The hospital we were going to have a waterbirth at doesn't allow it with twins or vbacs. I actually called every hospital in our network, and they ALL told me they would give me a "trial of labor" (read labor on a short time clock), and that i would have to labor AND deliver in the OR, regardless of it they "ended up" being born vaginally. And i would have to do all of this with IV access and epidural access in place (no meds, just the catheter in "in case" i needed a c-section). I wasn't too keen on laboring/delivering on a hard metal table under bright lights (and after learning about how just stepping foot in a hospital raises your risk of a c-section, not to mention all the interventions also raise your risk of a c-section), i wasn't too keen on being in the hospital at all. So for us it was easy. It all depends on your comfort level though. Lots of people don't feel comfortable having a homebirth with a singleton, much less twins, and that's perfectly fine. Just pointing out that you DO still have a choice of how/where/with whom you give birth, even if you get pregnant with twins. It's all up to you and your comfort level and what you feel like doing.

[wannabe]

Originally Posted by AdinaL

You can decline anything you want. If I hadn't sought out an OB, no one would have ever "made" me have an u/s. I mean once transfer happens, and you get a positive beta - it's pretty much all yours.

Just wanted to agree with this. They'll probably be surprised, but it's your body.