Questions & Answers

Lose weight. Women with low body mass indices (BMI) have been shown to enjoy a higher probability of successfully conceiving a child.

Stop smoking. Smoking directly affects menstruation and reproductive function.

Eat well. Give your body the nutrition it needs — eat healthy foods, and supplement with vitamins and antioxidants.

Manage your stress. Emotional and mental well-being is as important as physical health. Try tension-reducing activities such as meditation, yoga or acupuncture.

Fibroids — benign uterine tumors made of fibrous and muscle tissue — may affect IVF treatment, depending on their size and location. For example, fibroids may need to be removed if they are located on the uterine wall where embryos implant, if they are larger than 5 centimeters, or if there are many fibroids that affect the size of the uterus.

Unlike men, who continuously produce sperm throughout their lives, women are born with all the eggs they will ever have. Normally, one egg is released during each menstrual cycle from puberty until menopause. The “biological clock” refers to these years, during which the number of viable eggs inside a woman’s ovaries — the “ovarian reserve” — steadily decreases. Further, as a woman ages, the ovaries produce fewer mature eggs. This ovarian resistance may begin very near to the onset of menopause, or earlier, in the 30’s or even 20’s. Ovarian reserve and resistance can be determined by measuring levels of follicle-stimulating hormone (FSH) and estradiol during the early part of the menstrual cycle.

Tests vary from patient to patient, and depend on a number of factors including age, medical history, previous treatment results and projected treatment plans. Some tests are for the intended mother, some for the male partner and some are for both. Common exams are blood tests, ultrasound, disease screening, and sperm analysis. Your doctor will be able to tell you and your partner which tests you will need after your consultation.

What medications will I take?
As with pre-treatment testing, medication plans are tailored to each patient. Some patients take birth control pills to regulate the menstrual cycle before medications are given. A combination of gonadotropins and follicle-stimulating drugs are given in the weeks leading up to egg retrieval, followed by a “trigger shot” of hCG shortly before the eggs are harvested. The natural hormones estrogen and progesterone are typically taken at the start of pregnancy. Additional medications may be recommended. Your doctor will be able to give you more specific information as treatment progresses.

Are treatments painful?
The medications given before egg harvesting are injected under the skin with a small hypodermic needle and should not cause much discomfort.

Egg retrieval is performed using unconscious sedation, so the patient is asleep and does not feel the ultrasound equipment or the fine needle. There will be a team of anesthesiologists closely monitoring the patient, but unconscious sedation is not the same as general anesthesia. The procedure lasts about 15 minutes and the patient wakes quickly.

After egg retrieval, there will be some medications and hormones that need to be injected into the muscle, sometimes in the buttocks. These can cause more discomfort than the earlier injections.

The sensations during embryo transfer are similar to those experienced during a routine pap smear. Occasionally, local anesthesia is recommended.

Could any of the IVF medications harm the fetus?
Most of the treatments are complete by the time the embryo is placed in the uterus. At that time, natural estrogen and progesterone are taken, usually within normal biological levels; studies indicate that these do not negatively affect a fetus. Some patients may need to take an anticoagulant called heparin, which also will not affect the fetus since it does not cross the placenta. Patients who take “baby aspirin” or gamma globulin also do not need to worry, since these have not been shown to harm the fetus. Please keep in mind, though, that a small percentage of children (3-4%) are born with abnormalities even to parents who conceived naturally and took no medications during pregnancy.

Will I experience any side effects from the IVF medications?
There are many medications taken during treatment which can cause varying side effects in patients. The most common complications include abdominal pain, bloating, weight gain and breast tenderness. Some patients are at risk of developing a serious condition called ovarian hyperstimulation syndrome (OHSS), although this can almost always be prevented. None of the medications have been shown to increase the likelihood of developing ovarian cancer unless there is a family history of the disease. Please share any questions you may have with your doctor, who can answer your questions in detail.

What is ovarian hyperstimulation syndrome (OHSS)?
OHSS is a rare but serious complication of fertility medication treatment. For about 1-2% of patients, an hCG injection causes estradiol levels to rise sharply and overstimulates egg production in the follicles in the ovaries. Symptoms include excessive fluid retention, thrombosis, abdominal swelling, enlarged ovaries and sometimes kidney failure. The exact cause of OHSS is not yet known, but age and a history of irregular or long (over 30 days) menstruation seem to be risk factors. OHSS can be a life-threatening condition and may require termination of IVF treatment or hospitalization. Talk to your doctor if you think you are at risk of developing OHSS.

An egg donor donates one or more of her eggs to the expectant couple. This is the extent of her role in conception, and both parties may remain anonymous. The egg is then fertilized by the biological father and placed in the expectant mother’s uterus.

A surrogate is a woman who carries the fertilized egg to term in her uterus on behalf of the intended mother. The surrogate may or may not be asked to use her own egg.

There are two kinds of surrogacy: classic and gestational. A classic surrogate is inseminated with sperm from the child’s father. Her own egg is fertilized, and she carries the baby to term on behalf of the intended mother.

In gestational surrogacy, the baby is conceived entirely by the intended parents: the biological mother’s egg is fertilized with the biological father’s sperm. The embryo is then placed in the surrogate’s uterus and carried to ter

What happens to embryos that aren’t transferred?
Viable embryos or blastocysts that are not selected for placement in the uterus may be frozen for possible future use, donated to one or more other couples, or given to researchers for study.

Absolutely. We refer all of our patients — both women and men — to counselors from the beginning stages of treatment to help them through this difficult and stressful time in their lives. Counselors can help patients minimize stress levels and deal with the range of emotions experienced during treatment, including anger, denial, depression and grief as well as euphoria.