Infertile Women of the Bible

I recently found this interesting article about infertile women in the Bible and women who were infertile for a period of time. I found this article at http://www.infertilitysurvivalguide.com/issues/chapter13.htm it is an excerpt from a book called Infertility, Survival Guide for Couples and Those Who Love Them by Cindy Lewis Drake

She writes:

If infertility is hard to endure in the 21^st century, think how helpless an infertile woman felt when the nearest fertility clinic was 2,000-6,000 years down the road. The chief value of a woman in biblical times was first her chastity and, after marriage, her reproductivity.

When I began looking for any woman in God’s Word who preceded us in the sisterhood of infertility, names like Rachel, Sarah, and Hannah came to mind quickly, but there were others. What can we learn from each woman? How did she cope with her plight? How did her story end?

Women’s names began filling my scribbled pages as I researched the 300-plus women mentioned in Scripture. The most easily identifiable women were barren temporarily, then later blessed with children. In most cases, their barrenness and how God resolved it appeared to be one of the main reasons she was present in Scripture. The point? God used infertility to show His miraculous power and to carry out His plan for human history. These women are described in Women who were temporarily infertile.The biggest surprise was I could find only one woman who was mentioned as never having children—Michal, first wife of King David. That certainly doesn’t mean there weren’t more, because surely there were. But the details are missing, so we’ll never know who they were. Read Michal’s lone story in A woman who remained childless. Hannah is the most notable infertile woman in the Bible. We see the depth of her pain physically, emotionally, and spiritually. Hannah’s story is told in more detail in this chapter because so many aspects of her plight call to us from the depths of our own pain. When I started my research, I intended to title this chapter “All the Infertile Women of the Bible,” thinking I could compile every woman who struggled with infertility. But digging in, I realized the lack of details on most biblical women prevented me from discerning if they were mothers or not. A large number of women are mentioned only once in Scripture, such as Job’s beautiful daughters, Jemima, Kezia, Kerenhappuch. They are listed only by name, not whether or not they became mothers eventually. Thus, an absolutely complete list of the infertile women of the Bible will have to remain open-ended. Their stories will remain untold, but the women whose stories we know have spoken to barren women through the ages.

Women who were temporarily infertile

Elizabeth Elizabeth and Zechariah “were upright in the sight of God, observing all the Lord’s commandments and regulations blamelessly. But they had no children, because Elizabeth was barren; and they were both well along in years” (Luke 1:6-7). A godly couple, barren, and old—the perfect setting for a miracle! And that’s just what happened. While performing his priestly duties, Zechariah is visited by an angel announcing that “your prayer has been heard. Your wife Elizabeth will bear you a son, and you are to give him the name John. He will be a joy and delight to you, and many will rejoice because of his birth, for he will be great in the sight of the Lord” (vv. 13-15). Elizabeth becomes the mother of John the Baptist, the long-prophesied one who would prepare the people for the coming of Christ. Had Elizabeth become a mother in her youth, the news of this post-menopausal baby probably would have been amazing, but not really in the miraculous category. God’s plan was to keep her womb closed until both Elizabeth and Zechariah (and everyone who knew them) had given up on their chance of children, and it was precisely the absence of previous children that made the coming of this one so remarkable. After John’s birth and naming (complete with a tongue-loosing miracle for the new dad), “the neighbors were all filled with awe, and throughout the hill country of Judea people were talking about all these things. Everyone who heard this wondered about it, asking, ‘What then is this child going to be?’ For the Lord’s hand was with him” (vv. 65-66). (See Luke 1.)

Manoah’s wife, Samson’s mother It’s surprising that we’re never given this barren woman’s name, because her faith is certainly worth admiring. Twice an angel appeared to her to provide details of her upcoming pregnancy, and twice the angel explains that she will carry the burden of raising the child in strict accordance to the Nazirite vow, a consecration to God that would begin in the womb for this baby….

(Nine biblical women are highlighted in this section of this chapter.)

A woman who remained childless: Michal She was a princess and the wife of a king, but her life was no Cinderella story. The daughter of King Saul, she fell in love with handsome young David, the warrior destined to be king. As a prize for his military success, she was given in marriage to David. Her loyalty was wrapped up in their mutual love, and to protect him, she helped him escape Saul’s crazed vengeance in one memorable incident (1 Sam. 19). But once David was in hiding, Saul repossessed her to strike back at David.

An example to us all: Hannah’s story What a gift God has given us in the story of Hannah! Her 11^th century B.C. journey closely resembles the struggles of 21^st century infertile women. She was often consumed by her thoughts of infertility—she went alone to the temple and cried her heart out to God. She made drastic promises to the Lord in hopes she would be given a child. She was stabbed with the pain of watching other women bear children with no problem. In Hannah, we see a complete picture of the pain of infertility. 

Further research available online only! This list of women got their fair share of press in Scripture, but we’re never told if they were mothers. Because motherhood was central to a woman’s purpose in society, the absence of such defining information leads me to think perhaps these women were childless. Their presence in the Bible was based on who they were and what they did, not simply on whether or not they produced offspring.

Women who may have been childless This list doesn’t include every woman in Scripture whose motherhood was undetermined. Instead, these are the most significant women, the ones we can piece together something about their lives and contributions to the events of their time. The interesting thing is that their infertility is not the central point in their lives. Most of these women were faithful to their God and are prime examples of remarkable service. We can learn much from their commitment to give their lives purpose and meaning by searching out and fulfilling God’s plan for them, even though it appears children were not part of that plan.

Anna A prophetess who lived at the Temple in Jerusalem, our only insights about Anna are three verses, enough to let us know she was almost assuredly childless. Married for seven years, she was then widowed for the rest of her life. Some commentaries interpret the text’s wording of “a widow until she was eighty-four” to mean she was 84 when she encountered Jesus and His earthly parents in the Temple; others interpret the original Greek to mean she had been widowed 84 years. Either way, the lady was old, well past child-bearing years, and content to serve her Lord constantly and completely. She literally lived at the Temple, worshipping and praising God every day. She walked up to Mary, Joseph, and baby Jesus at the Temple and immediately proclaimed that this was the long-awaited Christ. We can admire the depth of spirit she possessed after many decades of dedication to the study of God’s Word. She moved beyond her loss, filling her life with love and service. (See Luke 2:36-38.)

Dorcas (or Tabitha) This benevolent woman was known for her ministry in Joppa, a port town on the coast of the Mediterranean Sea which had its share of widows and fatherless children, probably due to the deaths of men who made their living on the sea. We don’t know her age, but we can wonder if she, too, was a childless widow, since neither husband nor children are mentioned. Her gift is her ability to sew clothing for the needy. When she dies suddenly, the disciples send for Peter, who had just arrived in nearby Lydda (10 miles east). He came to Joppa and restored Dorcas to life and ministry. (See Acts 9:36-42.)

Esther As a Jewish girl adopted by her cousin Mordecai, Esther probably had dreams of marrying a Jewish young man and having a half dozen kids. Yet her path took a radical, irreversible diversion when her beauty brought her to the Persian palace to be considered as the new queen for King Xerxes. The purpose of the book of Esther is to tell the story of how she rose to the throne for the divine purpose of rescuing the entire Jewish population from a ruthless plot to murder them. But since the book covers the events of several years, it seems logical that if she had birthed royal children, it would have been noted. A half-Jewish prince or princess in a Persian palace would be something to talk about! The book ends abruptly, leaving us wanting to know the rest of the story. (See Esther.)

Huldah Huldah was a woman in the right place at the right time to say the right thing for the Lord. She lived in Jerusalem, was married, and known as a Hebrew prophetess, like Miriam and Deborah were. No children are mentioned. She was a contemporary of prophets Zephaniah and Jeremiah, and Jewish tradition says she was a woman of academia who taught school. One day, a priest, a scribe, and some royal servants came knocking on her door. These men were sent by King Josiah to find someone who could interpret the Scriptures found hidden in the crumbling walls of the Temple. (Josiah had instigated massive refurbishing of the temple built by Solomon, which had fallen into neglect.) One commentary said that other prophets were too far away, so a prophet close at hand was needed immediately. She had distinguished herself as a woman of God, and when the visitors came, she spoke the truth from her Lord: Destruction and ruin would come upon the land, and Jerusalem will be destroyed. But because of Josiah’s heart for God, he would not see the devastation in his lifetime. Josiah immediately swept away the pagan temples, monuments, and altars built by his forefathers, some by King Solomon 300 years before. Passover was celebrated more purely, completely, and exuberantly than it had been in about 500 years (since the days of Samuel the prophet). Huldah must have rejoiced to know she had been a part of bringing revival to her people. But she knew it would be short-lived. As predicted, the reprieve from desolation was a mere window in time. Just 13 years later, Josiah was killed in battle. He rested in peace, but the country fell into ruins. (See 2 Kings 22-24 and parallel passage in 2 Chronicles 34.)

Jehosheba Every child should have a doting aunt like Aunt Jehosheba was to little Joash. Both of them were of royal blood, and little Joash was even one of the possible heirs to the throne. But they lived in savage times. The reigning queen had sat on the throne with her husband/king before he died, then ruled through her son/king before he died. Now, Athaliah claimed the throne as her own and set out to kill everyone who had any claim to it. This meant she tried to kill her own grandchildren (Joash was one) and other blood relatives. Godly Jehosheba managed to kidnap Joash, who was only about a year old, before Athaliah got to him. Joash was hidden in the Lord’s temple for six years since Jehosheba’s husband was the priest in charge of the entire temple. At age 7, Jehosheba’s husband, Jehoiada, brought forth the little king, gathered the armies, and overthrew wicked Athaliah in one day. Jehosheba and Jehoiada have no children listed, but what she did to protect her nephew brought godliness back to the kingdom of Judah, at least for a few decades while Joash reigned. (See 2 Kings 11:1-21; 2 Chronicles 22:10-24:1.)

Joanna As a follower of Christ, she joined with the disciples and women who went from town to town as Jesus preached. She was the wife of Cuza, who managed King Herod’s household, so she was likely a woman of considerable wealth. She and other women were helping to support Jesus’ ministry from their own pocketbooks. It’s unlikely she would have felt free to follow Jesus’ traveling ministry if she’d had children at home. She surely must have been one of the women who stood at the foot of the cross as Jesus died, because she is one of three named women who went to embalm Jesus at the tomb, only to find He had risen. (See Luke 8:1-3, 23:55-24:12.)

Miriam As the older sister of Moses, Miriam saw a lifetime of remarkable works of God, from the rescue of her infant brother from the Nile River by Pharoah’s daughter, to the Exodus of the Israelites from Egypt, to the opening of the Red Sea, to the encounters Moses had with God. Miriam saw it all. She was quite human, though, and her privileged role as sister of God’s chosen leader didn’t ensure she was always a bastion of unshakeable faith. Undoubtedly, though, Miriam was the most vocal female leader of the Israelite nation in her day. Though the Bible doesn’t mention her husband, “tradition has it that she became the wife of Hur, who with Aaron held up the hands of Moses.” (Edith Deen, All of the Women of the Bible, HarperSanFrancisco, 1983, page 353) Tradition doesn’t suggest any children, though, so we’re fairly safe in assuming Miriam was never a mother. Her life was far from empty because every day was full of matters related to helping Moses govern the people. Centuries later in the years of Micah the prophet, God sent this word to Israel, “I brought you up out of Egypt and redeemed you from the land of slavery. I sent Moses to lead you, also Aaron and Miriam” (Micah 6:4). Miriam’s role as one of the top three leaders for the millions of wandering Israelites elevates her to a status untouched by any other woman in Scripture. (See Exodus 2, 15 and Numbers 12, 20, 26.)

Moses’ Egyptian mother We know her only as Pharoah’s daughter in Scripture, the woman who adopted Moses. And though she was surely a worshipper of Egyptian idols, God chose her to participate unknowingly in a divine plan to protect the Hebrew child who would be the liberator of His enslaved people. We have no record of her barrenness, but we also have no record that she bore or adopted additional children. When you consider her reaction to finding a three-month-old slave-child in a basket on the Nile, we can only wonder if her deep mercy was a result of her deep pain of infertility. Maybe she saw this baby as a benevolence handed down from her gods in answer to her prayers for a child. But why risk her life by sparing a slave’s baby? As a princess, she could have adopted an Egyptian baby any day of the week. And it wasn’t like she could hide the truth from Pharoah—Moses scampered around the palace like the other royal children and grandchildren. If she already had other children, her need to mother Moses would surely not have been so strong. We can only guess that Moses must have been one adorable baby for her to risk Pharoah’s wrath. Exodus 2:2 seems to support that, because Jochebed, Moses’ Hebrew mother, “saw that he was a fine child” so she hid him in the basket. In this case, royal infertility had a divine purpose. (See Exodus 2:1-10.)

Priscilla This woman from Italy and her husband, Aquila, became great friends with Paul and exceptional leaders in the new church. Though she is never labeled as barren, neither are her offspring ever mentioned. Five of seven times she is listed before Aquila, which may indicate she carried the greater responsibility in the church. In Romans, Paul sent his greetings to this couple and the church that met in their home, then he highly praises Priscilla and Aquila for risking their lives for his sake. “Not only I but all the churches of the Gentiles are grateful to them.” Their lives may have been childless, but they were not empty or purposeless. Instead, this couple made eternal contributions to the first century Christian church. (See Romans 16:3-5, Acts 18, 1 Corinthians 16:19, 2 Timothy 4:19.)

Samaritan woman at the well Jesus had one of His longest recorded dialogues with a woman as He spoke to the infamous woman in this passage. When He struck up a conversation with her, He knew He was going to change her life, but she didn’t. She only found it curious that a Jewish man would bother talking with the likes of her, the one probably known in her village as “that woman.” Jesus pegged her life and lifestyle when He said she’d had five husbands and was living with still another man. Was her barrenness one of the reasons for her marital dissatisfaction? Was she pushed aside for more fertile women once or twice until she became known as used goods, no longer appealing to men who would respect her? If she had children, Jesus never mentioned them, and neither did she. If she’d had children from other marriages, especially young children, it seems they would have looked forward to going to the well with Mama every day to draw water. But she was alone. Jesus offered her spiritual healing and “living water,” and she was so impressed, she ran to town with news of Jesus. She earned back her respect as a woman who could be trusted, because her neighbors later said, “‘We no longer believe just because of what you said; now we have heard for ourselves, and we know that this man really is the Savior of the world’” (v. 42). (See John 4:7-42.)

Sapphira Ananias and Sapphira were participants in the early Jerusalem church. In the eleven verses that tell their story (a significant amount for minor characters), nothing is mentioned of their offspring. The couple sold some property, and Ananias delivered the money to the church himself, claiming he was giving the total sum to God. Peter was given divine insight to know Ananias had in fact kept back part of the profit. The sin was not in keeping some back, but in lying that he was giving it all. Confronted with the truth, Ananias fell dead on the spot and was immediately buried by young men in the church (not by any of his own sons). A few hours later, Sapphira came to the church, unaware of her husband’s death. When asked the price of the land, she lied, too, which proves they made a prior agreement with each other to hide the truth. Peter revealed to her that her husband had been caught in the same lie and was now dead and buried. She died immediately and was buried beside him. (See Acts 5:1-11.)

Sheerah This daughter of Beriah lived in about 1450 B.C. and made herself notable because she directed the building of several towns, which was certainly not the average job for a woman who lived 3,500 years ago. We aren’t told if she was married or if she was a mother. (See 1 Chronicles 7:24.)

Vashti Formerly the queen of Persia, King Xerxes divorced her because she wouldn’t appear before him and his noblemen to parade her beauty at his feast, which was more like an orgy. Jewish sources indicate she was requested to appear naked before this crowd of drunken men, clothed with only the royal crown on her head. Persian wives were kept in seclusion in each other’s company during such festivities, so the king’s inebriated request was far from proper, even if she were to appear clothed. The king’s advisers offered poor advice, doling out much harsher consequences than the offense deserved. An irrevocable law was passed so that Vashti could never enter the king’s presence again. No reference is made to any children she may have born for the king, and we know nothing else of Vashti after this early reference in a book about Esther’s rise to the throne. Producing royal heirs would have made her a more valuable player on the royal scene, and the advisers might have had a harder time convincing the king to depose her. (See Esther 1-2.)

Widow with two mites
Jesus observed this unnamed widow as He and the disciples watched people in the Jerusalem temple. We know she was poor, because she gave all she had, only two small copper coins worth a fraction of a penny. We know she was a widow, though we don’t have a clue about her age. Finally, we know she was faithful, because Jesus praised her giving more than all the others. What we don’t know is if she was a mother. Adult children would have had some responsibility to provide financially for their widowed mother. If she were a young widow with children at home, Jesus might have said, “she put in all she and her children had to live on.” Giving what she would have spent on food for her children would be an important aspect of faith for Jesus to note. Her belief in God’s constancy to provide for her needs is unparalleled, so that “today the world knows more about the poor widow than about the richest man in Jerusalem in her day.” (All of the Women of the Bible, page 58) (See Mark 12:41-44, Luke 21:1-4.)

How do you like your eggs?...

...over easy, over medium, hard boiled, scrambled, poached, deviled...

I like my eggs to measure at 20mm and up! They are working on it. All 11 or 12 of them are measuring at about 14mm. A few more days of meds and then we are ready to crack them open and scramble them up with the secret ingredient. And if you don't know what the secret ingredient is, then you should consult your high school biology book! 

Measurements of my egg follicle growth

Here are 3 of my egg follicles in all their glory! And me looking pretty stupid. :)

Egg Growth

I am less than a week away from my egg retrieval. I am really excited about this procedure which is unusual considering I hate hospitals and medical procedures. As a child, I experienced enough surgeries and I almost decided not to undergo any fertility treatment because of this. I had 2 eye surgeries at age 1 and 2 yrs. old to correct strabismus and then kidney valve reconstruction surgery at 10 years old. The kidney valve surgery may be the culprit for the damaged fallopian tubes. My mom remembers the doctors saying that I may have trouble getting pregnant. Which turned out to be true except God has provided the miracle of science to help us and for that I am grateful and very very excited. Today was exciting too because I had another ultrasound to determine my egg growth and progress. Earlier this week was discouraging because my estrogen was low, which is not a problem except for my bank account. I had to up my Bravelle to 5 units a day instead of 3. For 3 days worth of meds it cost me $962. I am hoping that will do it and I don't need anymore. Pray for that!

Normally vaginal ultrasounds are not exciting, but it was fun to see my little potential babies!! Who gets to see that before they find out they are pregnant. I will be able to tell my future children that I saw them at their egg stage, cell division stage, blastocyst stage and embryo stage. The cool part is they will be able to see that too as long as I get copies of the pictures! :) Now even though there are 8 follicles, I am not sure all of them contain an egg or will make it to the fertilization stage. Egg growth is measured by mm and the doc likes them to be between 18 mm and 22 mm before retrieval. A few of mine are 11, a few at 14 one at 16 and one or two are 8. I am hoping that they all do what they are suppose to do and grow! The weird thing is I can feel them growing. It is like period cramps and then lots of pressure!  Retrieval day is tentative for Wednesday, Oct. 5th!

First Ultrasound

Today I had my first ultrasound, blood draw and trial transfer for our first IVF cycle. It was a good appointment overall. I do have one ovarian cyst on my right ovary. It is no big deal, women actual get them all the time with each period, but some women get more than others and they can become painful and bothersome. I think that mine is no biggie and the doctor didn't appear to be concerned. The trial transfer went well too; much better than when we did an IUI transfer.

I was suppose to get another prescription for John for Azithromycin because he had a sinus infection last week and the pharmacy got confused and didn't send his for the retrieval because they thought he already had it. For some reason, John has to be on an antibiotic before he gives his specimen. Well, he lucked out and doesn't have to take the antibiotic because he already took it this month. The nurse was joking around about the guy being so lucky... he lucked out on his antibiotic and he lucks out on not having to do several injections everyday of the month. I told the nurse that John said he would stick himself in the stomach with an empty syringe and needle just so he had to go through it too! :) Which was very sweet of him and the nurse thought so too, so she willing gave me several extra needle/syringes for John! I won't actually make him do that, but it was nice of him to offer. Honestly, unless you are deathly afraid of needles, that part really is not a big deal at all. The bigger deal is getting a hot flash while trying to find your seat at a Red's game, or just randomly while I am watching T.V. Not to mention the headaches, exhaustion, lack of motivation (to pretty much anything but shop), weight gain and pain in my legs... all nice side effects of Lupron. I am almost positive that John also experiences these side effects from his job, except the shopping part. :) The nice thing though is the side effects really are pretty mild and so far I am doing great. I am getting more and more excited as I count the days to October 20th!

Baby Showers!

This past Sunday was a very busy day, but a very good day. I went to a friend's baby shower after church and it was awesome to be able to celebrate with her. I think of her as a very dear friend. We went to high school together, but then to different colleges and through the years have lost touch with one another. However, I will always think of her as one of my very best friends. It would be awesome if our children will be friends one day.

I am sympathetic to those who are like me and can't get pregnant or (worse in my opinion) suffer from miscarriages not wanting to go to their friend's baby showers. Though, I am different in that I love going to their baby showers and celebrating with them. Not only are they important to me, but their children are important to me. I want to share and spend as much time with them as possible. I want to have a close relationship with my nieces, nephews and friend's children and that starts when they are in the womb.

I had a foster mom friend of mine who has twin girls who are about 2 yrs. old. We would get the kids together when I also had foster children, twin boys. When my kids left and she still had hers, I told her that we were going to use a fertility specialist to help us get pregnant. She understood as she also has not been able to get pregnant. I mentioned to her that I would love to see the girls and she told me that she was hesitant to let me see them as she did not want it to be too hard on me to see them. WHAT? I can't believe she would say that to me. My response to her was I LOVE CHILDREN. That only makes me want to be around children more, not less. I enjoy the presence of children so much more now because I can't get pregnant. I do not cry over my infertility, it is what is... we will pray that God chooses to change it. In the meantime, to my friends, do not keep your pregnancies from me now that you know my situation. It will not make me sad. I will be extremely happy for you and rejoice with you in your gift from GOD. I will support you and buy you presents! :) When my turn comes, I want my friends and family to be there for me so why in the world would I not be there for you!

One of my weaknesses right now in my journey through infertility is I love to buy baby clothes, shoes and other cute baby things. I try to resist the temptation until I know for sure I will actually need those items. The beauty of my weakness is that those of you (my friends and family members) who either have children or are pregnant will only get more gifts from me because I can't help myself. The other temptation on the shopping front is an occasional "I can't get pregnant" Coach purse or pair of Ugg boots! :) See I take my sadness out on the shopping world, not my friends... haha!

I think this is the cutest picture ever! John and his nieces, Brooke & Addy!

Explanation of IVF

from http://cnyfertility.com/fertility-treatments/in-vitro-fertilization/detailed-explanation-of-ivf/


Detailed Explanation of IVF
Ovarian Stimulation  - This is the stage where I am at right now...
An IVF treatment cycle begins with the onset of a menstrual period. A week before the beginning of the next period a medication called Lupron is administered. Lupron prevents premature release of eggs from the ovaries. Lupron is a very small daily subcutaneous injection given just under the skin. Any part of the body can be used for these shots and the woman or her partner can administer them. Lupron is given daily for about three to four weeks. Because estrogen levels are low, side effects may include fluid retention, headaches or hot flashes.

About a week after taking Lupron your period will start. From this point on, Lupron will keep you hormonally “frozen” in that normal egg production is put on hold. A few days to a week from the start of your period, hMG injections will be taken along with the Lupron injections. Follistim, Gonal-F, Fertinex, Perganol, Repronex and Humegon are all collectively known as hMG, but you will only be injecting one of these medications. Lupron puts your ovaries on “hold,” – that is, prevents them from releasing the eggs before we are ready to collect them. At the same time, HMG stimulates development and maturation of multiple eggs in the ovaries. The objective of this medication protocol is to produce as many eggs as possible in a given cycle, and “tell” the ovaries to hold them until we are ready to collect them. On average, about 6 to 12 eggs develop.

Before starting HMG injections, an ultrasound will be made of your ovaries to check that no cysts or large follicles exist. Injections in the form of Follistim, Gonal-F or Fertinex are shallow injections whereas Pergonal, Repronex and Humegon are deeper injections. Some side effects may occur with hMG injections, such as abdominal bloating, weight gain due to fluid retention and pelvic or abdominal discomfort or both. These are signs of ovarian hyperstimulation and usually do not require any treatment. It is rare for a woman to be hospitalized for severe symptoms.
You will be taking Lupron and hMG injections every day for about ten days. During these ten days your progress will be monitored with ultrasound and possibly estradiol blood tests. Since the eggs are microscopic, they cannot be seen on ultrasound. However, we can see when the eggs are mature from the size of the ovarian follicles, or the fluid filled sacs within the ovaries that contain the eggs. These monitoring visits are brief and usually done in the morning

Once the eggs are almost mature you will stop taking the Lupron and hMG. You will then take a single injection of hCG hormone. This medication triggers the final stages of egg maturation. The eggs are nonsurgically removed from the ovaries 36 hours after the hCG injection. You should not have intercourse during the time between the hCG injection and egg retrieval.

Egg Retrieval
Egg retrieval is an office procedure during which partners are invited to be present. Using ultrasound as a guide, a thin needle is passed through the top of the vagina and into the ovarian follicles. This nonsurgical procedure is possible because the ovaries are located directly next to the vagina. The needle enters the follicles and removes the follicular fluid which contains the eggs. The fluid is then examined under a microscope to identify the eggs.
Egg retrieval can take anywhere from 15 to 45 minutes. Medications are used to relieve the pain of the needle, but many women cannot feel the eggs and follicular fluid being drawn. Most likely, you will feel a short menstrual-like cramp when the needle is passed through the top of the vagina – once for each ovary. Because of the pain medications you will receive that day, you should not drive. Egg retrieval is a very safe procedure and serious complications are rare.


Fertilization

The number of eggs retrieved will depend upon your age and response to hMG. But on average, 6 to 12 eggs are developed. As soon as the eggs are identified under the microscope, they are placed in petri dishes which contain a culture medium. The prepared culture medium is a composition that so closely resembles your own body’s fallopian tube secretion that the eggs, and subsequently the embryos, will develop in the petri dish just as they would in your body. The dishes are kept in an incubator at a constant temperature of 37ºC, 100% humidity and 5% CO2 concentration.

At the time of egg retrieval, the male partner will collect his sperm into a clean cup. The semen is then washed and processed to remove the seminal fluid to get the highest quality sperm possible. It takes about four to six hours after retrieval for the eggs to finally mature to the point that they are ready for insemination. Traditionally, sperm has been added to each dish containing the eggs and letting nature take its course by fertilizating overnight. However, we are using ICSI even in normal cases to ensure that the best eggs are indeed fertilized. The fertilized eggs, now called embryos, continue to grow in the IVF laboratory. In three to five days, you will return for embryo transfer.

ICSI
Intracytoplasmic sperm injection (ICSI) is a micromanipulation procedure developed to help couples with male factor infertility or previous low or failed fertilization. ICSI involves using a powerful microscope and an extremely small glass needle to physically inject a single sperm into the center of the woman’s egg. After egg retrieval, the eggs which are most likely to be successful ICSI candidates are chosen. While holding the egg in place, the glass needle containing the single sperm is inserted into the egg and the sperm is injected directly into the cytoplasm, thereby fertilizing the egg.


Embryo Transfer
Dr. Kiltz along with the embryologist will examine the embryos before transfer to determine the likelihood that any given embryo will implant. The quality of the embryos is very important. Several other factors may determine how many embryos will be transferred, such as your age, how many years you have been infertile and previous IVF cycles. Most couples with an average embryo quality usually select between two or three embryos to transfer. Generally, the pregnancy rate increases as more embryos are transferred, but so does the chance for multiple pregnancies. These issues will be discussed prior to your embryo transfer.

The actual transfer is a brief procedure. The embryos are “loaded” into the tip of a catheter along with a very small amount of transfer medium. The catheter is then gently passed through the cervical canal and into the uterus. Usually, you never feel this. The embryos are slowly expelled near the top of the uterus. This transfer only takes a few seconds. No rest period is required after transfer and you can go back to your normal routine right away.


Establishing Pregnancy
To help your body prepare itself for the embryos, you will be given daily progesterone to supplement your own. This additional progesterone starts the day after egg retrieval and continues for at least two weeks. Progesterone is a hormone which transforms the lining of the uterus to be an ideal receptor for the embryos.
After the embryo transfer, it’s now up to nature. The front and back walls of the uterus gently squeeze the embryos and keeps them in the uterine cavity. Your embryos cannot fall out, so there is no need to restrict physical or sexual activity. Even so, it might be wise to wait a few days before beginning any strenuous activity.

About two weeks after transfer, a blood test will be performed to determine if you are pregnant. This can be done at any lab of your choice. Your results should be available the same day. If the pregnancy test is positive, an ultrasound will be scheduled two weeks later to determine the implantation site and often detects a heartbeat. The heartbeat should be seen by four weeks after a positive pregnancy test. At this time, you will be given instructions regarding progesterone or other medication use.
Once a heartbeat is detected, there is a 90-95% probability that the pregnancy will continue to a live birth. There is only a 5-10% chance of miscarriage. IVF pregnancies are no higher a risk than natural pregnancies. At about 12 weeks into your pregnancy, you can return to your obstetrician for routine prenatal care.
If the pregnancy test comes back negative, you can stop the progesterone. Your period should start in a few days. You can begin another IVF cycle after one spontaneous menstrual cycle. Waiting will give your ovaries time to rest from the previous IVF treatment. There are several factors to consider before deciding on how many IVF cycles you may try before moving on to other treatments. These factors include your response, age, previous IVF cycles and the number of years you have been infertile. Just because you may not become pregnant after one, two or even three tries, does not automatically mean your chances of becoming pregnant are slim.

A Typical IVF Calendar (based on 28-day menstrual cycle)

First Injection

I did it! I successfully stuck myself with a needle in my stomach. Last time we did an IUI, John did it for me and it was only once for the entire month. I have to do this everyday. Oh boy... thankfully I am not that squeemish. I am meticulous and I had to read the instructions about three times before actually giving it to myself. Then I had to call my nurse to make sure I did proper storage of all medications. Whew... that is over. I am going to go take a bath!