There are a number of factors involved in determining if a patient is suitable for IVF treatment. Appropriate candidates often include couples who may experience:
• Low sperm counts • Endometriosis • Problems with the uterus or fallopian tubes • Ovulation disorders • Sperm unable to penetrate or survive in the cervical mucus • Other health or unexplained reproductive issues
Because the IVF process bypasses the fallopian tubes (it was originally developed for women with blocked or missing fallopian tubes), it is the procedure of choice for those with fallopian tube issues, as well as for such conditions as endometriosis, male factor infertility, and unexplained infertility. A physician can review a patient’s history and help to guide them to the treatment and diagnostic procedures that are most appropriate for them
In general, patients will seek advice from a fertility doctor after one year of trying unsuccessfully to get pregnant. The chances of a fertile couple conceiving a child in any given month (called the natural pregnancy rate) are around 20%; resulting in roughly ninety percent of couples becoming pregnant after one year of trying to conceive. It’s recommended that the remaining 10 percent of couples consult a fertility specialist. In particular, women over thirty are encouraged to undergo a fertility treatment evaluation, after six months of attempting to conceive. And it may be beneficial for women over forty to meet with a fertility doctor shortly after deciding to try and have a child.
The possibilities of success with an IVF treatment vary from patient to patient. Your physician can best predict the outcome in your case after a complete evaluation. This includes reviewing your history and prior responses to fertility medications, a thorough physical examination and drawing up a plan to prepare for your treatment.
The in vitro fertilization process can last anywhere from four to six weeks prior to egg retrieval. The embryo(s) will then be implanted between two to five days afterward. Not all patients are successful on their first IVF attempt; in fact, it’s not uncommon for patients to go through multiple IVF cycles before finally becoming pregnant.
It would depend on the number of follicles and accessibility of the ovary by the ultrasound? It usually takes about 15- 30 mins.
No, as it is done under anesthesia. You may have a few or none of the typical side effects of anesthesia such as nausea and vomiting.
Day one of your cycle is considered your first day of full flow menstrual bleeding, not spotting. If this occurs after 12 p.m. (noon), the next day is considered day one. The length of time that you will be taking the injections will depend on the in-vitro fertilization (IVF) protocol chosen for you at Houston Fertility Institute. Typically, patients receive injections for 8 to 10 days, but some must take them for a little longer.
Yes. Your doctor will recommend that you adhere to the basic guidelines below during the IVF process and into your pregnancy.
- Smoking: It’s recommended that both partners stop smoking at least three months before beginning an IVF cycle, and before ovulation induction begins. The effects of tobacco have been shown to be toxic and harmful to a woman’s eggs.
- Drinking: Alcohol should be avoided at the outset of IVF treatment, until one’s pregnancy test, and if pregnant, until the birth of the child.
- Medications: It’s important to inform your doctor if you’re taking any prescription or over-the-counter medications. Some medicines can interfere with the prescribed fertility medication or embryo transference, and others may not be safe to take before surgery.
- Vigorous exercise: Intense physical activities like aerobics, weightlifting, and running is prohibited during ovarian stimulation and until the results of one’s pregnancy are known.
- Supplements: Herbal supplements are completely prohibited during the IVF process.
In general, the success of frozen-thawed embryo transfer procedures depends on three factors:
- The quality and survival of the frozen-thawed embryos. In general, we only freeze good quality embryos so the current rate of survival is greater than 90%.
- The age of the woman who produced the eggs. In patients under the age of 37, the chances of pregnancy with frozen-thawed embryos are similar to pregnancy with fresh embryos. In patients 37 years or older, pregnancy chances with frozen-thawed embryos decline in conjunction with declining fertility in general but still can be quite good. As always it is best to discuss a woman’s individual situation with their physician.
- The status of the uterus in the woman receiving the embryos. A healthy endometrial lining free of any interfering fibroids or polyps provides a sound environment for embryo implantation.
Previously frozen embryos may be transferred during a woman’s natural cycle or in a controlled (artificial) cycle. The embryo transfer will occur 5-7 days after ovulation/hCG injection, depending on whether the embryos are frozen at a Day 3 or Day 5 stage. For the transfer procedure itself, the embryo is thawed at room temperature, and then warmed to body temperature (37° C). As with a fresh embryo transfer, embryos are placed inside a special catheter (a very thin tube), which is guided through the cervix and into the uterus. Embryos are gently injected into the uterus and the catheter is removed. This procedure requires no anesthesia and is done in a position similar to a pelvic examination for a Pap smear. After transfer, the woman rests for 15 minutes and then is able to go home, where a day of rest or very gentle daily activity is recommended.
A pregnancy test is scheduled 14 days after the embryo transfer.
Normally, patients are asked to wait for one or two full menstrual cycles before resuming another IVF cycle. Certain additional tests may be needed that could delay subsequent IVF cycles.
In the past, physicians recommended transferring multiple embryos to improve the chances of fertility since knowing which embryo was viable was hard to determine. This sometimes led to multiple births. However, new advances like extended blastocyst culture and PGS/CCS have made this less necessary. In fact, due to the potential health risks related to multiple births, most fertility specialists advise against implanting more than one embryo at a time unless indicated. Instead, viable embryos can be frozen and stored for future use.
Fertility medications can cause mood swings, headaches, hot flashes, abdominal pain, and bloating. In very rare cases, fertility medication may induce ovarian hyperstimulation syndrome (OHSS), which can produce more severe symptoms such as:
- Nausea or vomiting
- Shortness of breath
- Decreased urinary frequency
- Feeling faint
- Significant weight gain within three to five days
- Severe stomach pain and bloating
- Passing a tiny small amount of clear or blood-colored fluid after the procedure
- Mild bloating
- Mild cramping
- Breast tenderness
After your embryo transfer, we ask that you refrain from intercourse until your pregnancy test, which is about two weeks later. If you are pregnant, as long as you are not experiencing bleeding or discomfort, intercourse is okay after we are able to detect the baby’s heartbeat. This will be approximately two weeks after your positive pregnancy test.
While some research suggests a slightly higher incidence of birth defects in IVF-conceived children compared with the general population (4 - 5% vs. 3%), it is possible that this increase is due to factors other than IVF treatment itself. It is important to recognize that the rate of birth defects in the general population is about 3% of all births for major malformations and 6% if minor defects are included. Recent studies have suggested that the rate of major birth defects in IVF-conceived children may be on the order of 4 to 5%. This slightly increased rate of defects has also been reported for children born after IUI and for naturally-conceived siblings of IVF children, thus it is possible that the risk factor is inherent in this particular patient population rather than in the technique used to achieve conception. Research indicates that IVF-conceived children are on par with the general population in academic achievement as well as with regards to behavioral and psychological health. More studies are underway to further investigate this important issue.
Some exercise is acceptable during in-vitro fertilization treatment, but as the IVF treatment cycle progresses, only low impact exercise (such as walking) is recommended. The ovaries may become enlarged from the fertility medications, and high impact exercise may put you at risk for ovarian torsion, a condition in which the ovary can twist on itself. This is a very rare but serious side effect.
During the first two weeks of each IVF cycle, hair colouring is allowed. However, from mid-cycle on, including waiting to find out if you are pregnant, it is best to wait until after 12 weeks to receive any chemical hair treatment.
No. It is imperative that during the monitoring phase of your treatment cycle you are available for multiple appointments to assess the growth of your follicles.