Recap
Kate and Toby had a miscarriage and then experience secondary infertility. They decide to do IVF. For my full analysis, watch my complete review of Season 3 Episode 1
Episode 2
So Kate and Toby have started the medical treatment phase of IVF. Kate is taking fertility medication injections. In the Uber on the way to Kevin’s movie premier, Kate gets hot flashes. Is this accurate? Well possibly… There are a few type of IVF medication protocols. In the older protocol, called a Down Regulation protocol, women take a medication called Lupron to suppress the pituitary gland. The reduces the chance of premature ovulation or ovulation before the eggs can be retrieved. Most women will need to take this medication for a couple of weeks before starting the actual fertility drugs which stimulate the ovaries. During this time, the estrogen levels from the ovaries get very low and this will commonly result in hot flashes.
These days, many IVF experts will use a shorter protocol in which the medications to prevent ovulation are given at the same time as the fertility drugs instead of beforehand. As a result, there is no decrease in estrogen levels so this protocol does not result in hot flashes
The big drama in this episode is when Kate’s mom, Rebecca discovers that Kate and Toby are doing IVF. This occurs, when Miguel goes into the refrigerator and accidentally discovers Kate’s medications. For this, the show gets good marks. Many of these medications have to be kept in the refrigerator. I know many stories of patients trying to hide the medications when guests are over.
The show also hits the right mark when dealing with Kate’s concern about her family finding out. Many of my IVF patients, do not reveal to their families what they are going through until after the fact.
Skip ahead to Kevin’s movie premier. Toby, who usually gives Kate her injections, is nowhere to be found. Kate is freaking out because she has been told that the medications have to be given at an exact time. A newly convinced Rebecca ends up giving the injection to Kate. The reality is that is overly dramatic. With one exception, these medications do NOT have to be timed to the minute. Generally speaking, we talk about these medications being given in the morning or the evening. There is a few hour leeway.
The one exception to that is that injection that is given before the eggs are retrieved. This is known as the trigger injection. This injection has to be given at a precise time according to the doctors injections. We know that this wasn’t Kate’s trigger injection however, because if it was, then Kate would have had the egg retrieval two mornings after Kevin’s premier - which she did not.
So Rebecca ends up giving Kate her injection in the bathroom of the movie theater. Love this scene! Many patients have told me stories about the odd places that they have had to given injections. Movie theaters, restaurants, weddings they were standing up at and even in airports and airplanes during flights. Where was the oddest place you gave or received fertility injections? Let us know in the comments or on Twitter #InfertilityTV and #milehighclub
I do have a bone to pick about the location of the injection on Kate’s body. Rebecca gives the injection in Kate’s thigh muscle. Almost all fertility medications these days are given with a tiny needle under the skin - typically in the abdomen. Plus, most women do these injections themselves. But I’’ let them slide on this one because I loved Rebecca’s turn around on this.
One thing I didn’t like. Kate was drinking alcohol at the movie premier. A number of studies have found that alcohol use is associated with decreased success rates with IVF. At IVF1, we recommend to our patients that both partners stop alcohol use a month before starting the IVF medications.
Finally, this episode brings up the issue of risks. Specifically, Rebecca asks “Have you guys really considered all of the risks?”. I think she is not just talking about IVF here but about the risks of pregnancy in general. The biggest risk that Kate face with IVF is simply that it won’t work. The other risks associated with IVF egg retrieval like all procedures include infection, bleeding, damage to nearby organs and most importantly for Kate, anesthesia risk.
However, there are many more risks to pregnancy. These risks are magnified in women who have a history of infertility and women who have a high BMI. If Kate gets pregnant it will be interesting to see whether she has problems with gestational diabetes or the high blood pressure problem known as pre-eclampsia.
Episode 3
In this episode, Kate finally gets to the point of having her IVF egg retrieval but not before getting into an argument with Randall in which he suggests that maybe she and Toby should be adopting instead of doing IVF. Kate hits him with my favorite line in Season 2. She states “How dare you throw adoption in my face right now, and how dare you make me defend wanting this.”
I love this because it is something that infertility patients hear commonly. It's an absurd comment to make because it implies that women who have infertility have a greater responsibility to adopt children than anyone else does simply because they have a disease process which requires them to have medical treatment to be able conceive on their own
Now on to the egg retrieval. I should point out here that 90% of the time, the anesthesia that is given for an egg retrieval is administered through an IV in the arm and that’s all. In Kate’s case, however, she gets Intubated. This means that the anesthesiologist buts a tube down her windpipe. This allows a deeper level of anesthesia to be given and at the same time allows the anesthesiologist to help her breathe if any problems come up during the procedure.
This is an excellent idea for women who are very obese, like Kate and at higher risk from anesthesia.
Next we learn that Kate’s IVF specialist, Dr Jasper, was able to retrieve 8 eggs and tells Kate that’s a good number. But is it? At IVF1, the average number of eggs retrieved for a 36 years is 14 but obese women do not respond as well to fertility medications and commonly get less eggs so 8 is probably doing pretty good
Incidentally, it seems Kate was lucky to get her own doctor to do the egg retrieval. It’s Dr Jasper who comes into the recovery room after Kate wakes up from anesthesia to tell her the number of eggs. We know from episode 1 that Dr Jasper is part of a larger group. With large groups, the doctors will commonly take turns each day. So one doctor would do all of the egg retrievals for a given day whether its for her patients or another doctor in the group. However, when we see the picture of Kate and Toby’s embryo later it says the Doctor was Dr. Arroyo. Production error ir was Dr Jasper trying to take credit for Dr Arroyo’s work?
Episode 4 is all about Jack in Vietnam so lets skip to Episode 5
This is the embryology episode. We learn that out of the 8 eggs, there were only 3 that fertilized. This seems a little low. An average fertilization rate is 70 percent. However, we are never told how many of the eggs were actually mature, healthy eggs that had Toby’s sperm injected. If we assume 5 mature eggs, then having three out of five fertilize seems closer to an expected number.
One confusing thing happens here. Dr Jasper calls Kate and Toby, the day after the egg retrieval to tell them they have three fertilized eggs but the picture they post on their refrigerator of the “Three Amigos” is of embryos at the 4 cell cell stage which is 2 days after the egg retrieval which is possible but most IVF labs don’t check or photograph embryos at that stage.
From the three fertilized eggs, only one embryo develops and is available for transfer. Is this typical? Actually, yes. Most of the the embryos that a woman produces either on her own or with IVF are not viable embryos that do not have the ability to produce a live born baby. In many cases, embryos will stop dividing or even degenerate.
The one embryo remaining, to which Toby sings, “One Singular Sensation” is an 8 cell embryo which means that Kate’s embryo transfer occurred on the 3rd day after the egg retrieval. The picture says its Day 9 which is impossible so this is likely just another tiny production error.
Finally, we learn that Kate had a positive pregnancy test. Before getting the official news from Dr. Jasper, Toby wisely tells Kate to avoid doing a home pregnancy test which is a great idea because as Kate says, these home tests are not accurate enough when done this early in pregnancy and could quite possibly cause “emotional chaos.
Yay! Kate is pregnant. Will she miscarry again? Will she experience pregnancy complications? Did the embryo split and produce twins? Or Triplets? And most importantly, will the medical information presented on the show be accurate? Tune in to This is Us and Click that notification bell so you dont miss any future episodes of Infertility TV.
