When is IVF Needed?
IVF was originally developed for women with blocked tubes or missing fallopian tubes and it is still the procedure of choice for these situations. It is also used when other conditions are present, including endometriosis, male factor infertility and unexplained infertility in which no medical cause for infertility can be found. Our physicians will review your history and help to guide you to the treatment and diagnostic procedures that are most appropriate for you.What is the percentage of success with each treatment cycle?
The possibilities of success with IVF vary from patient to patient. Your physician can best predict the outcome in your case after a complete evaluation, which includes reviewing your history and any prior response to fertility medications.Will the hormones cause long-term health risks?
The only suggested long-term health risk of IVF is medications, and a possible association between these drugs and the risk of cancer, specifically ovarian cancer.An important fact to keep in mind is that women who suffer from infertility and never conceive appear to have a slightly increased risk of ovarian cancer as compared to the general population (about 1.6 times the rate). As these are the women who use fertility medications, the medications themselves have been implicated in the cancer risk but have never been proven to be a cause of cancer. Since the initial concern was raised in a 1992 study by Whittemore and colleagues, several studies have addressed the issue more directly. These studies from Australia, England and Denmark all failed to find an association between fertility medications or IVF treatment and any higher risk of ovarian cancer.
An ongoing National Institutes of Health-funded study is specifically designed to address the question of whether fertility medications themselves may play a causal role in ovarian, breast or uterine cancer. While the study is still under way and needs another 5-10 years of follow-up to be conclusive, preliminary results suggest no association between fertility medications and risks for invasive cancers. At this time, we can say that there is no direct evidence that fertility drugs play a causal role in increasing a woman's risk of invasive ovarian, breast or uterine cancer.
Are the injections painful?
With the advent of newer fertility medications, many injections that were given intramuscularly can now be replaced by medications given as a little injection under the skin (subcutaneous). This method is similar to insulin injections of diabetic patients. Additionally one medication, which has been given as a subcutaneous injection (Lupron), can be replaced by a medication administered as a nasal spray (Synarel). Both medications are equally effective, and we leave this choice to you. There is only a one-time injection that is currently given intramuscularly (HCG), but this will soon be replaced by a subcutaneous preparation (available in early 2001).Once the egg retrieval is performed, progesterone supplementation is used to prepare the lining of the uterus for the transfer of embryos. For most of our treatment cycles, we recommend using progesterone gel or suppositories. This protocol makes it possible to avoid injections during the second half of your IVF cycle.
Using our protocols at Akansha a woman may have to take only 10-12 days of subcutaneous injections and one intramuscular injection of HCG (soon to be replaced by a subcutaneous injection). That's it!
How long do I have to take the fertility injections?
The length of time that you will be taking the injections will depend on the in-vitro fertilization (IVF) protocol chosen for you at our Clinic. Typically, patients receive injections for 7 to 10 days, but some must take them for a little longer.Who will give me the injections?
You, or a family member of your choosing, will be taught by our staff how to give the subcutaneous injections.Is the egg retrieval process painful?
No, not generally. It lasts approximately 20 to 30 minutes, and IV sedation is administered by a certified MD anesthesiologist so that you will not be awake. Some patients have mild cramping after the procedure and are discharged with safe pain medication.How long do I have to stay in Anand, India?
At Akansha, we care for many patients who come for treatment from other parts of the world. All consultations can be done by telephone (medical, nurse coordinator, financial), and communication with our staff throughout your treatment can be via telephone or E-mail. Many of the required screening blood testing and procedures can be coordinated with your local gynecologist or reproductive endocrinologist. On average, most patients need to be in Anand, India for about 10-20 days.Our staff can provide recommendations for local accommodations, restaurants, and sights to visit!
Can I travel?
Many of our patients have to travel various distances to return home after treatment.Air travel in commercial aircraft is fine (pressurized aircraft). Drink lots of fluids while flying, since the circulated air can be quite dry, and dehydration should be avoided.
Car travel is also fine. Sitting for an extended period of time will not affect chances of pregnancy.
If you live out of town, most patients return home the day after the transfer. There is no medical reason to stay in Anand any longer.
Am I using up all my eggs if I do IVF?
In a natural ovulation cycle, the ovary selects one egg from a pool of approximately 100-1000 eggs. Those eggs which are not selected for that month undergo a natural cell death process called atresia. Fertility medications override the body's selection process, and cause many of these "rescued" eggs to grow (hopefully between 10-20 eggs). These eggs would otherwise undergo atresia. Therefore, you are not "using up eggs faster" by undergoing ovulation induction, but are "rescuing" eggs to use in that cycle, which otherwise would have expired.Can I freeze eggs for future use?
Unfortunately, current technology does not allow us to freeze eggs, then thaw, fertilize and develop embryos efficiently. Therefore, egg freezing is not currently a viable option for fertility preservation. The best option for preserving future fertility is to freeze embryos (fertilized eggs). Hopefully, the egg freezing technology will improve over the next 5-10 years, so that this option could then be a viable method to preserve future childbearing.What are my chances of pregnancy with frozen embryos?
In general, the success of frozen-thawed embryo transfer procedures depends on 3 things: the quality and survival of the frozen-thawed embryos, the age of the patient who produced the eggs, and the uterus of the woman receiving the embryos. For patients < 37 years, the chances of pregnancy with frozen-thawed embryos is similar to fresh embryos. For patients > 37 years, the pregnancy chances with frozen-thawed embryos decline.Can I do a natural cycle frozen embryo transfer (FET)?
For most patients, frozen-thawed embryos can be transferred in either a controlled cycle (hormone injections required to prepare the uterus), or in a natural cycle (minimal medications). Patients with normal/regular menstrual cycles have the options of using a natural cycle for transfer of frozen-thawed embryos. We have extensive experience coordinating these types of cycles, and have a very successful FET program. Natural FETcycles save patients money (less medications and monitoring needed), time, and still provide a good pregnancy rate.
When do I need an egg donor?
Women who are unable to produce healthy eggs, but have a healthy uterus are candidates for egg donation with IVF. This procedure is the same as for IVF except the intended parents select a donor and use the donor's egg to create the embryo. Patients may seek egg donation services at Pacific Fertility Center's Egg Donor Agency or at an outside agency.Why do I need to get a treatment date from the clinic for my IVF with donor eggs?
When undergoing IVF using your own eggs, we tell you to choose the best 14 days that will best work for your schedule, and the clinic will work around your schedule.As IVF with donor eggs is a more difficult procedure, and more people are involved (the donor and the recipient’s schedules need to be synchronized) the clinic will review your medical questionnaire and your questionnaire for OD recipient and provide you with a treatment date when they can offer you the best donor matching your requirements. We try to accommodate your treatment dates at least for a particularly requested treatment month, but that cannot always be guaranteed.
Your medical needs are of the upmost importance, and the clinic excels in its ability to provide exceptional medical care, giving every patient the time and attention they deserve.
How can I select 2 weeks in advance if I don’t know where I will be in my cycle?
It is very easy. We ask all our patients undergoing IVF treatment to start any brand of Monophasic birth control pills (BCP) after all of their tests are done. Thanks to this BCP, you are in charge of your cycle. BCP will not only help your body prepare for your treatment but it also give us the option to shorten or lengthen your cycle as needed to fit your travel dates without any problems. Monophasic BCP is the only kind of BCP that can do that. That is why you don’t have to worry and calculate when you should go so that you ovulate on time. You just pick the best two weeks that work for you and the Monophasic BCP will help your cycle and your body to cooperate.Why are we given estimated dates of my/donor’s egg retrieval?
Because we are working with human bodies, and because we want to provide you with the best treatment in regards to having mature quality eggs instead of sticking to a time schedule, we give you estimated dates and discuss with you in person what you can expect. Your stay in Anand, India is calculated with this variable in mind and our patients have appreciated this approach.What if my husband or I get sick during an IVF cycle?
Please call our office for instructions. Most colds or upper respiratory infections will not be a problem. Most over the counter medications and antibiotics are safe to use with the fertility drugs, but check with us first.What is the average number of embryos transferred?
The doctor will make the decision after discussing this with you. Generally, two or three embryos will be transferred, but the number may vary slightly depending on the quality of the embryos and the age of the female partner.Why must I get a blood pregnancy test after an IVF cycle?
We must show documentation that a blood test was performed to verify pregnancy status. Many patients will often have implantation bleeding and assume they are not pregnant when in fact they are.How do I interpret Sperm analysis?
If you’ve wondered what those numbers and percentages mean on your partner’s sperm analysis, here’s a guide you can use for interpreting the results. Please remember that your doctor can best tell you what the sperm analysis mean for your IVF treatment.Normally, seminal fluid is clear to milky white in color, thick and sticky (viscous) in consistency, has a pH (acidity) level between 7.8 and 8.0, and contains few or no white blood cells (leukocytes).
The World Health Organization (WHO) has developed the following values for normal semen analysis:
- Total volume – greater than 2 mL
- Concentration – at least 20 million sperm per mL
- Morphology – at least 15% normal sperm
- Motility – greater than 50% sperm with forward movement, or 25 % with rapid movement within 1 hour of ejaculation
- White blood cells – fewer than 1 million per mL
- Further analysis (sperm mixed antiglobulin reaction [MAR] test) shows adherent particles in less than 10 % of sperm
Are medications included in the cost of a cycle?
No. Medications are not included in the cost of an IVF cycle, but you will be given a prescription that can be filled at a local pharmacy of your choice.What constitutes day one of my cycle?
Day one of your cycle is considered your first day of heavy full flow bleeding, not spotting. If this occurs after 12 p.m. (noon), the next day is considered day one.How many monitoring visits will I have while I am in treatment?
This will depend on your individual response to the medications. During an IVF cycle at our clinic, you will have between six to nine appointments, including one for egg retrieval.Can I exercise while going through treatment? What can I do?
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 you will be taking, 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.Can I take herbal supplements?
Herbal supplements are not recommended and may cause unknown effects. If you are currently on such supplements, please inform one of our nurses.Can I color my hair if I am going through treatment or think I am pregnant?
During the first two weeks of each IVF cycle, hair coloring 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 a hair color treatment.
Can I get my nails done if I am going through treatment or think I am pregnant?
Having a manicure or wearing artificial nails will not cause any harm during IVF treatment or pregnancy, but make sure your nails are treated in a well-ventilated area.When can we have intercourse after embryo transfer and if I am pregnant?
After embryo transfer, we ask that you refrain from intercourse until your pregnancy test, which is approximately 14 days 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.Is there a higher risk of birth defects with a child born from IVF?
The simple answer is no. Children born from IVF are no more inclined to any particular birth defect than those conceived naturally.When will I be able to tell if I am pregnant?
A pregnancy test is scheduled 14 days after the embryo transfer.How long will I stay with the practice once I am pregnant?
Typically, you will not be discharged to your Ob-Gyn until 8 to10 weeks into your pregnancy. You will have several blood tests and ultrasounds to determine the development of the pregnancy before we can release you.Under what circumstances is a Gestational Carrier (surrogate) appropriate?
A woman who accepts to bear (or be pregnant with) the child of another woman who is incapable of becoming pregnant using her own uterus is called a gestational carrier. Women who need gestational carriers with IVF include those who do not have a uterus, have an abnormal uterine cavity, have had several recurrent miscarriages or have had recurrent, failed IVF cycles. "Surrogate" is an older term for what we now refer to as a "gestational carrier".Is surrogacy legal in India?
Yes surrogacy is legal in India and hence infertility clinics offer this treatment option to their patients. Our doctors are here to help patients get the baby they have been longing for and not to judge who will give birth. In other words you can get your IVF treatment using a surrogate.It is important however, that you have complete legal papers documented with your surrogate. We recommend legal paperwork be managed by a certified attorney.
