It is extremely rare that a woman who undergoes IVF thinks about the word “abortion” the day that she finds out she’s finally pregnant. But that was my inescapable reality the day I received the official call from my doctor who gleefully exclaimed, “Congratulations, we did it!”. Even she, despite knowing what we were up against, couldn’t help from losing herself in this traditionally happy moment – a moment that was almost two years in the making, plus countless blood, sweat, and tears. I tried to mimic her energy, but my mind kept scurrying away from the joy of those words – you’re pregnant – and back to the unavoidable question: “But are we keeping it?”
For thirteen painstaking weeks my husband and I lived in lurid limbo of hope and fear, as we experienced the raw realities of a pregnancy whose fate we didn’t know. Here is how the early pregnancy test of Chorionic Villus Sampling (CVS) helped to determine that fate and the importance of this incredible procedure.
Facing the CVS Test: The Irony of all Ironies
The subject of pregnancy termination was thrust into our lives two years ago when my husband and I found out that we are both genetic carriers of a terminal disease that could be inherited by our future child. We were advised that terminating any pregnancy affected with that disease would be the best option. Natural conception gives us a 1 in 4 chance that a pregnancy could be affected with the disease. Given those odds, my husband and I decided to undergo IVF in order to screen for the disease via preimplantation genetic diagnosis (PGD) to avoid it altogether.
But after two tedious years of no success when transferring PGD tested embryos, we were left with little hope that it would ever work. After a groundbreaking article about the risks of PGD and PGS testing hit the IVF community last fall, we decided to stop testing the embryos on a hunch that the PGD test itself was impeding success. That hunch proved correct, and we became pregnant after our latest transfer of a non-PGD tested embryo (plus the use of Lovenox injections).
Despite the joy of achieving pregnancy, we couldn’t ignore the irony of our situation: After two years of enduring the grueling racket of IVF, we ended up facing the exact problem we were trying to avoid, as we did not know if this pregnancy was affected by the disease or not. The sting of our predicament created a dark, bitter feeling that could have easily grown darker. But I simply wouldn’t let it. Instead, I decided to focus on our next best option: the Chorionic Villus Sampling (CVS) procedure.
What is a Chorionic Villus Sampling?
The Chorionic Villus Sampling (CVS) is an early prenatal diagnostic test for women whose pregnancies are at risk for either a chromosomal abnormality or a genetic disorder. Given our current situation, the CVS test was the most accurate way to screen for the disease. It was also the earliest way in which to obtain results, since a CVS can be done as early as 10-weeks of pregnancy. (For comparison, an amniocentesis isn’t done until 15-weeks of pregnancy).
The Chorionic villus sampling procedure is done by removing a sample of the developing embryo’s cells, called the “chorionic villi cells,” from the placenta to diagnostically test for a disorder. The Chorionic villus sampling results are obtained between two and four weeks after the procedure and have a 99-percent level of accuracy.
The Chorionic Villus Sampling Procedure – Does It Hurt?
I probably Googled the above query dozens of times during the weeks leading up to my procedure. Having now experienced the CVS procedure, I’ll save you the time and tell you that: Yes. Yes it hurts.
Unfortunately, the CVS feels exactly how you think a procedure that involves putting a large needle through an internal organ is going to feel like. Fortunately, it lasts less than 60-seconds and, from what I’ve learned after two years of doing IVF, I can tolerate anything for 60-seconds . And so can you.
I tempered my fear of this procedure by spending some time researching what the CVS actually does – and the science behind it is incredible! Essentially, the growing fetus has its own cells and the mother has her own cells and there is only one place in the body where these cells intermingle – the placenta. These placenta cells are called the chorionic villi, hence the name of the test, and the CVS procedure uses ultrasound guidance and the steady hands of a skilled professional to safely extract those cells from where the placenta attaches to the uterine wall. In this way, neither the amniotic sac nor the baby are compromised.
The CVS procedure is done in one of two ways, transcervical or transabdominal.
My CVS was conducted transabdominally and I’ve outlined my personal experience below. Please note that this is a personal, unedited account, so feel free to skip to the next section if you’d like to stick to the facts:
As I sat in the waiting room waiting for my CVS test, I felt pretty calm, all things considered. It’s amazing how two years of medical procedures via IVF make you completely unfazed by daunting things like this. I actually even laughed a bit when I looked around the room and saw that many of the women waiting were quietly nibbling on snacks that they had brought from home. Who snacks in a waiting room before a medical procedure that involves a needle to your gut? Women who are 10-weeks pregnant and battling nausea, that’s who! 🙂
I was called in pretty soon after we arrived and it was so nice that I didn’t have to say goodbye to my husband like I always had to during IVF. A nurse introduced herself to us and said she’d be helping with the procedure. We walked into a dark, cold room with a big ultrasound monitor in the far corner and an exam table in the center. I was instructed to lay on the table and was told I didn’t need to take anything off or change into scrubs. This felt weird to me and I actually took off my shoes because it felt too formal otherwise.
The nurse did an ultrasound (our first transabdominal ultrasound since becoming pregnant) and there was the baby, looking markedly bigger than last week. The first thing I noticed were its little legs and feet! They were kicking back and forth and looked so much like a real baby’s! My heart felt full and tears came to my eyes, but I didn’t let my gaze linger long. Given the current circumstances, I felt the overwhelming need to distance myself emotionally.
The doctor came in and introduced himself and we made small talk. He could tell by the big bruises on my stomach that I’m currently taking Lovenox and he asked why. After our chit-chat, he explained a quick overview of the CVS procedure. I was happy to hear that he’d be using novocain on my stomach to numb it, but when I expressed my happiness he said: “Well, please keep in mind it will numb your stomach, but it won’t numb your uterus or placenta.” Awesome. 🙁
I had needed a full bladder for the procedure and I was thrilled when the doctor said I could go relieve myself before the procedure began. I was really uncomfortable to the point that it was making me nervous that I wouldn’t be able to do the procedure. This was never the case when I needed a full bladder for my embryo transfers, but I think it’s because I’m pregnant now and there’s way less room. When I came back, he took a look at the screen again and said it was an even better ultrasound picture without my bladder full – so win / win for everyone!
The lights went back off, he put an antiseptic on my stomach and then he said: “Alright, big pinch.” And in a second, the novocain shot was done and it didn’t hurt at all. Then he said: “Okay, I’m placing the CVS needle in now.” And, again within seconds, the big hollow needle was injected into my lower abdomen and that didn’t hurt too bad either on account of the novocain, although it was a bit shocking. I grabbed my husband’s hand for support and the nurse gave me her hand too.
Then he said: “Okay, I’m now going to pierce the uterus and placenta with the CVS needle.” And suddenly – BAM! – he did it and holy freaking hell, it hurt so badly. It felt exactly what a needle to your uterus would feel like. My reflexes kicked in and I jumped and curled my legs up and he immediately said: “You’ll need to put those flat, please.” And the nurse leaned her weight against my body to keep me still. That’s when I started to really cry and squirm in pain. I squeezed onto my husband’s hand for dear life and tried to focus on my breathing, but I was sweating and kept thinking over and over “what if this doesn’t end?”
The doctor studied the ultrasound monitor carefully and said: “Okay your amniotic sac has not been pierced and all looks good. I’m now attaching the syringe onto the CVS needle to extract the cell sample.” And in a few seconds the syringe was on the CVS needle. Then he said: “Now I’m going to move around the needle to loosen the cell sample.” And then he did what I can only describe as a “jackhammering” motion of the needle into my stomach. It hurt so bad that I thought I was going to be sick. It was just so intense; that is the best way to describe it. Just so fucking intense. I kept wincing and crying and then apologizing saying “I’m sorry, I’m okay,” and he said “No you’re not okay – and that’s okay! This is a nasty procedure and I could never do this. You’re much braver than I am.”
His words made me feel both better and worse.
And then it was over, the whole ordeal taking less than 5-minutes, and there was instant relief from the pain. Keep in mind that this entire time everything the doctor was doing was visible on the big TV monitor, including the injection of the needle inches from our kicking baby. During the procedure, my husband watched the monitor intently, but I kept my eyes squeezed shut the entire time.
The nurse turned on the lights and I realized I was shaking and felt a bit dizzy. The doctor then showed us the cell sample he had just retrieved. The syringe was filled with a pink solution and floating inside were tiny, thin white tissue that resembled nail cuticles. “That’s the chorionic villi,” he explained. He then chatted through some basic next steps (you can shower, but take it easy the rest of the day) and then he shook our hands and left. I continued to the lay on the bed for a bit longer, even though the nurse said I could leave for my blood work. Blood work?! I didn’t trust my legs to stand and carry me down the hall let alone give blood!
I rested a few minutes more and continued to cry quietly as my husband held my hands and whispered encouragement. I was no longer in pain, but I couldn’t quiet recover from the shock of it all. It felt so violent and extreme – the absolute last thing you’d ever want to do during pregnancy – and I kept wincing just thinking about it.
When we finally got up to leave the nurse smiled and said “Bye guys, have a nice weekend!” Her words caught me by surprise and I thought how very odd this whole thing was. A mere 20-minutes ago, I met this woman as my confident and smiling self. Then I very quickly transformed into a writhing, sobbing, completely unhinged mess directly in front of her. And now here I was quietly sniffling and trying to recover my dignity as she breezily wished me a nice weekend. There was nothing wrong with her gesture; I just couldn’t help but note how weird it all was.
We rode in a cab back to Brooklyn in silence, both of us so exhausted from the ordeal and not quite knowing the right words to say. “You’re so brave,” my husband said finally as we pulled into our apartment complex. “No matter what happens with these results, please know that you did such a great thing and we’re going to be alright.” I smiled and teared-up again: “Now all that’s left to do is hope.”
Chorionic Villus Sampling – Timing of Results
The Chorionic villus sampling results are obtained between two and four weeks after the procedure and have a 99-percent level of accuracy. Although considered an “early pregnancy test,” the CVS results won’t realistically be determined until 12 to 14 weeks of pregnancy. This definitely does not feel “early” for those whose pregnancy is hanging in the balance. And if you’re doing the math, you’ll quickly realize that this time frame encapsulates an entire first trimester of pregnancy where you’re either waiting for the CVS procedure to happen or waiting to know the CVS procedure results.
Pro Tip: Often the cell sample collected during the CVS procedure is not large enough to test on its own. Therefore, the lab must “culture” the cells, i.e. give them time to multiply on their own. This adds another two weeks onto an already long wait time and should be taken into consideration when planning your procedure.
The day that I found out I was pregnant, I quickly scheduled my CVS test for the first day of my 10th week of pregnancy – which is the very first day it can safely be conducted. I highly recommend anyone that has to do this test to do the same. The sooner the appointment is booked, the sooner you’ll have those results in hand.
Waiting for the CVS Results
I’ll be brutally honest in saying that waiting for the CVS results was one of the hardest things I’ve ever endured. At the beginning of pregnancy, the thought of having my CVS done at 10-weeks and the results at approximately 14-weeks of pregnancy seemed less than ideal but certainly “doable” to me. But as my pregnancy started to progress and I got to experience first-hand the development of the embryo into a moving, breathing baby, it seemed insane and almost barbaric that we had to wait so long. As each week brought new changes of the baby and my growing belly, the fear of the unknown became harder and harder to endure.
No one has a great first trimester of pregnancy due to the usual woes of nausea and nerves. But for 13-weeks I endured all of that while still maintaining my normal IVF medical protocol – nightly shots of Progesterone in the buttocks, daily Lovenox shot in my abdomen, weekly Estrogen patches, and regular blood work and monitoring at the clinic – all while not knowing the fate of this pregnancy. It was the most physically and mentally exhausting time in my life.
But strangely, it was also a time that was still filled with some joy. Despite all of the worry and fear, nothing can ever snuff out the butterflies of excitement and wonder that come with carrying a baby for the first time, and I still felt its magic.
Chorionic Villus Sampling Risks vs Amniocentesis – Which is Safer?
Historically, an amniocentesis was considered slightly less risky than a CVS procedure. But with the changing of technology and the growing expertise of skilled CVS specialists, the risk of a CVS is now the same as an amniocentesis. Both early pregnancy tests have a an approximate 0.5 to 1–percent risk for early miscarriage. Common side effects from the CVS procedure include mild to light cramping and light spotting.
Pro Tip: Respect the fact that the developing baby’s entire world was just disrupted by this invasive procedure. Even if you feel okay, take 48-hours of rest for your body – and baby – to recover.
I did not experience any significant side effects from my CVS procedure other than sheer exhaustion from the emotional and mental anxiety that came with it. It was so significant that my entire body felt sore. Although some doctors will say it’s okay to resume normal activity 24-hours post procedure, my doctor advised me to stay off my feet for an entire 48-hours post procedure. As she explained to me, the growing baby’s entire environment was just disrupted by this invasive procedure – everything needs time to heal. I spent the two days post procedure on the couch watching old movies and trying to find some relief in the fact that this test was behind us.
Lucky Number 13: Our Chorionic Villus Sampling Results
We got our CVS results exactly two weeks and three days after our CVS exam.
On Tuesday the 13th during the 13th week of our pregnancy my phone rang as I was making myself breakfast. I immediately knew that it was the number from the genetic counselor and I quickly picked up the phone while my heart leapt into my throat.
The counselor wasted no time in telling me the results: “Your baby is not affected by the genetic disorder that both you and your husband carry, nor is it a carrier of this disease. It is also not affected by any other chromosomal abnormalities. All is completely “normal.” Congratulations.”
I immediately crumpled into a sobbing heap on the floor and the phone dropped from my hands.
“Hello? Are you still there?” the genetic counselor asked, slightly concerned.
“Yes…but…not really.” I sobbed.
She laughed and congratulated me again and said that when we were ready, my husband and I should call back to find out the results of the baby’s gender. Since the CVS test examines the baby’s chromosomes, its gender is also revealed. However my husband and I had decided not to find out this information until we knew that the pregnancy was viable.
With shaking hands I called my husband, who was on currently on a business trip in L.A. It was only 5:30 a.m. on the west coast, but he picked up on the first ring.
“The baby is healthy,” I managed to whisper before fully breaking into sobs once again.
That phone call and that entire day marks one of the happiest moments of my life and I’ll never forget it. After two years of trying to get pregnant and 13-weeks of being pregnant, we could finally celebrate this miracle of life — and I never felt so ready.
After two years of trying to get pregnant and 13-weeks of being pregnant, we could finally celebrate this miracle of life — and I never felt so ready.
The main advantage of chorionic villus sampling is that it is the only diagnostic test that gives conclusive results much earlier in the pregnancy than those of amniocentesis, or other pregnancy screenings. Although the actual procedure is uncomfortable and the waiting for results is difficult, this test is extremely valuable and we wouldn’t be able to fully embrace this pregnancy today if it weren’t for this amazing feat of medical technology.