IVF FAQ

How much time does the entire procedure require?

Pre-evaluation phase takes about 2 weeks, then approximately three weeks fro the actual cycle. Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.
 

What should I expect during IVF treatment?

In general, the entire IVF process takes approximately two months once a decision is made to proceed. The first month (preparation cycle) involves diagnostic tests and evaluations of the couple, consultations, and preparation of the ovaries.  The second month (stimulation cycle) involves the actual hormone stimulation of the ovaries, monitoring with frequent blood tests and ultrasound (US) exams, retrieval of the eggs, followed 3 - 5 days later by the transfer of embryos into the uterus.

The couple starts with a thorough IVF consultation with me in order to discuss the entire IVF process (diagnostic evaluations, ovarian hormone stimulation, egg retrieval technique, anesthesia, embryo transfer, risks, benefits and costs). Optional techniques such as cryopreservation of extra embryos and preimplantation genetic diagnosis (PGD) are also outlined. Questions are then answered and reading materials are provided to help the couple understand the process.

The preparation cycle then starts with the next menstrual period. On cycle day 2, 3 or 4 several endocrine and infectious disease labs are drawn. Some of these endocrine lab tests (Estrogen and Follicle Stimulating Hormone) indicate the womans ovarian reserve of eggs and determine the medication dosage and IVF protocol to be used for stimulation of the ovaries the next month. The labs for the man can be drawn at any time. The woman is often then placed on oral contraceptive pills (OCPs) or progesterone for the next several weeks in order torest the ovaries (by suppressing her pituitary hormones), making her more responsive to the fertility injections the following month. The uterine cavity is assessed for any abnormalities such as polyps, fibroids or adhesions (saline sonogram, hysterosalpingogram or office hysteroscopy) if it has not been checked within the previous 12 - 18 months. Next, an IVF nurse coordinator consultation takes place in order to help the couple understand the IVF process, schedule the actual IVF stimulation cycle, sign consent forms and schedule an injection teaching session. Depending on the IVF protocol selected, many women begin Lupron injections later in the month (approximately cycle day 21) in order to prevent spontaneous ovulation during the subsequent stimulation cycle.

Upon finishing the OCPs, a period begins, signaling the start of the stimulation cycle. The fertility drug injections are usually started on cycle day 2, 3 or 4 and are given for an average of 10 - 12 days. During stimulation there may be 6 - 8 office visits needed for labs and ultrasounds in order to monitor the size and number of egg follicles developing and Estrogen levels. The fertility medication dosages are adjusted accordingly. When the largest follicles reach a certain size, another hormone injection is given to mature the eggs (within the follicles) and the retrieval is scheduled 36 hours later. The egg retrieval is done transvaginally with ultrasound guidance under anesthesia (conscious sedation) and takes approximately 20 minutes. The eggs are fertilized with the sperm in the IVF embryology lab. The development of the fertilized eggs (embryos) is carefully monitored by the embryologists for several days. Depending on the number and quality of the embryos, some are transferred into the uterus 3 or 5 days later. Extra normal appearing embryos may be cryo-preserved. The woman is instructed to rest at home (couch potato) for 1 - 2 days. Two weeks after the embryo transfer a pregnancy test is done and a consultation is scheduled.
 

Will the IVF technique safe to my pelvic organs?

There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.

What if I ovulated before egg retrieval?

Once ovulation has occurred it is impossible to retrieve the eggs. The entire team of physician, nurse and embryologist will monitor your cycle very carefully to avoid premature ovulation.

Will scar tissue around my ovaries make it impossible to retrieve the eggs?

Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by ultrasound or surgical methods.
 

If I failed on the first attempt, how soon can the procedure be repeated?

This depends on the individual. The primary reason for delay is to allow the patient’s normal menstrual cycle to resume, which may take 2 to 3 cycles.

How many times will IVF be repeated per couple?

There is no specific number. This is determined by the couple together with the physician. Usually the number is between 3 to 6.

Can we have intercourse during the two-week period before an IVF procedure is performed?

Most definitely. We recommend that the husband refrain from ejaculation for at least 48 hours, but for no more than 5 to 6 days preceding egg retrieval. This precaution assures that the semen sample obtained for IVF will contain a maximum number of healthy, motile sperm.

After the IVF procedure, how long must we wait to have intercourse?

Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before pre-embryo transfer is acceptable. Some physicians will advise intercourse before transfer as they feel that this will improve the chances of a pregnancy.

What about other activities? How soon can I resume my normal routine?

The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.

How soon will I know if I’m pregnant?

Pregnancy can be confirmed using blood tests about 2 weeks after egg retrieval. Pregnancy can be confirmed by ultrasound 4 weeks after aspiration.

I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?

Perhaps, in certain situations, IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes.

What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the pre-embryo?

Four to five medications normally are given:

        1. Leuprolide acetate (Lupron), or Ganirelix an injectable drug that blocks secretions of the pituitary gland, thereby optimizing the number of oocytes retrieved;
        2. Human menopausal gonadotropin (Pergonal or hMG) or Follicle Stimulating Hormone (Metrodin or FSH), hormones that stimulate ovarian activity, are injected daily for about 6-10 days prior to the procedure;
        3. Human chorionic gonadotropin (hCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production;
        4. Progesterone, a natural hormone that enables the uterus to support pregnancy, may be used as a daily injection after egg retrieval; and
        5. Clomid, or Femara, a pill used to promote egg development.

Will I have an egg in every follicle?

It varies from patient to patient . On average the expected recovery rate is 70%, however, occasionally less than half of the follicles may not contain an egg in some patients.

Is the chance of multiple births with IVF?

Yes, when multiple pre-embryos are transferred. 25%. of pregnancies with IVF are twins. (In normal population, the rate is 1 to 2%.) Triplets are seen in approximately 2-3% of pregnancies.

Is there an increased chance of birth defects if I become pregnant through IVF?

There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. Mother nature usually discard the abnormal embryos which leads to failure to conceive either naturally or with IVF. Studies comparing birth defects among IVF babies versus naturally conceived babies so far are still statiscally insignificant. However, any long-term effects of IVF remain to be determined.
 

What happens to any extra pre-embryos?

A maximum of four pre-embryos or two blastocysts will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for your later use. Other options are to donate or simply dispose of them. Excess pre-embryos, if any, belong to you, and you will determine what is to be done.