Some queries and their replies regarding IVF

Query: Will the IVF technique damage my ovaries?

REPLY:  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.

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

REPLY:  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 sonographic (ultrasound) or surgical methods.

QUERY: What if I ovulate before oocyte (also called egg or ovum) retrieval?

REPLY:  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.

QUERY: If an egg is not retrieved or if the technique does not produce a pregnancy on the first attempt, how soon can the procedure are repeated?

REPLY:  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.

QUERY: How many times will IVF be repeated per couple?

REPLY:  There is no specific number. This is determined by the couple together with the physician.

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

REPLY:  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.

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

REPLY:  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.

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

REPLY:  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.

QUERY: How soon will I know if I'm pregnant?

REPLY:  Pregnancy can be confirmed using blood tests about 13 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.

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

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

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

REPLY:  Four to five medications normally are given:

1. Leuprolide acetate (Lupron), 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

QUERY: What side effects, if any, can these drugs cause?

REPLY: No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.

QUERY: Will I have an egg in every follicle?

REPLY:  It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.

QUERY: Is there a possibility of multiple births with IVF?

REPLY: Yes, when multiple pre-embryos are transferred. 25%. of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.

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

REPLY:  There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.

QUERY: How much time does the entire procedure require?

REPLY:  Approximately three weeks (all as an outpatient). 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.

QUERY: What happens to any extra pre-embryos?

REPLY: A maximum of four pre-embryos 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.