To make sure Dr. Zouves understands your exact medical history – fertility-related and otherwise – it is important to collect all medical records. Dr. Zouves will review them in advance of the consultation to maximize appointment time.
Acces this form to request the transfer of medical records to Zouves Fertility Center.
All female and male partners undergoing IVF at ZFC require pre-cycle testing. Tests vary depending on treatment path. ZFC will supply a comprehensive list after the initial telephone consultation with Dr. Zouves.
Before an IVF cycle: In preparation for an IVF cycle, several blood tests will be taken as well as an evaluation of the cavity of the uterus called a saline sonogram. This can be done in the patient’s gynecologist’s office with minimal discomfort.
Starting your Cycle: The process will start by taking birth control pills followed by two to three weeks of injectable medications. Almost all of these injections are now administered subcutaneously with a short needle with mild discomfort.
Retrieval: Egg retrieval is performed through the vagina with an ultrasound and a fine needle. Patients at Zouves Fertility Center are asleep during the retrieval, have no pain and wake up very quickly after the 10-15 minute procedure.
The Transfer: The embryo transfer procedure is a little different from a pap smear or a gentle IUI. Occasionally, when there are specific problems with the cervix, a light anesthetic may be required for the embryo transfer.
Post Transfer: After the embryo transfer, there are intramuscular injections that may be more uncomfortable and are required to be given in the upper outer quadrant of the buttocks.
None of the medications that ZFC uses before and during treatment cycles are known to cause fetal abnormalities.
The most common side effect of IVF medications are abdominal discomfort and bloating as the follicles increase in size, especially if there is a large number of follicles. Ovarian Hyperstimulation Syndrome (OHSS) is the most common serious side effect.
At ZFC we use a combination of a pure FSH product (Follistim, Gonal F or Bravelle) and a product containing LH (Menopur) in approximately 4 to 1 proportions.
Dr. Zouves or any of the staff nurses will provide a detailed list and glossary of fertility medications that will be prescribed throughout treatment.
Patients who produce good quality embryos in excess of those used in transfer can elect to have the additional ones stored either as day-three cleaved embryos or as blastocysts on day five or six. These embryos will be stored for a period of one year. If the embryos are planned to be used for a frozen transfer, the one-year storage period may be extended for an additional year while preparations are made for the frozen embryo transfer. Patients who are uncertain about proceeding with the frozen/thawed transfer may elect to transfer their embryos at the end of one year to a permanent storage facility. Otherwise, these embryos may be donated to science.
Cycle monitoring and treatment is the same for local, out-of-state and international clients. All pre-cycle testing is performed through patients’ local doctor. Arrival is necessary approximately 1 week after injectable fertility medications begin with a required stay of 8 – 14 days. Timing may be shorter or longer depending on how fast or slow the ovaries respond to medication and whether the transfer is done on day 3 or day 5 post egg retrieval. Information for Out of Towners.
While the quality of a woman’s own eggs sharply declines after 40, Zouves Fertility Center will never turn away a prospective patient because of their age. While a 40-year-old egg provider can have as high as a 25% chance of a birth with one single fresh cycle of IVF, as she approaches 45, even the most aggressive IVF treatment using her own egg will yield no greater than 1% chance of a birth. If using one’s own eggs is not an option, ZFC will help determine the next best course of action, such as egg donation, specific medication treatments and specialized testing such as Comprehensive Chromosomal Screening (CCS).
Both pre and post-treatment, a Clinical Counselor is available to assist with stress management.
For some patients, a reaction of the immunological system may impair the embryo’s ability to attach to the uterine lining and flourish, causing recurrent failed IVF cycles or pregnancy loss. For those with immunological issues, the implanting embryo can elicit an aggressive response, resulting in failure to implant, very early miscarriage (first trimester) or decreased fetal growth in the second and third trimester. Appropriate testing may suggest therapy as simple as baby aspirin or as complex as immunization, with patient’s white blood cells (PLI), Intralipid infusion (IL)or a new class of anti-inflammatory medication called Enbrel. Learn more about Immunology at ZFC.
Fibroids are benign tumors consisting of fibrous tissue and muscle that grow in the uterus. The significance of fibroids and whether they will interfere with IVF, relates to not only their size but also their location. During initial consultations with Dr. Zouves, if applicable, this topic will be discussed in further detail.
Egg quality is usually driven by the age of the egg provider. Although it is possible for a young woman to have poor quality eggs, this would be uncommon. It sounds as though the patient above has a very good egg reserve and was overstimulated developing ovarian hyperstimulation syndrome (OHHS). Depending on the choice of protocol for stimulation, there can appear to be an egg problem when it is more likely that the problem was created by the stimulation and the attempt to avoid overstimulation. The ideal stimulation method for patients with high egg reserve would be the antagonist protocol with a Lupron trigger instead of the traditional human chorionic gonadotropin (hCG).
Read about Ovarian Syndrome (OHSS).
Endometriosis is a condition where cells that usually remain confined to the cavity of the uterus grow outside of the uterus – most likely on or in the ovaries and on the surface of the pelvic cavity between the uterus and the rectum. Endometriosis can cause pelvic pain and may also decrease the chances of natural conception by about 33%. Patients with endometriosis who require IVF still have the same chances of a successful outcome as healthy patients of the same age, as long as immunological factors that accompany endometriosis are identified and treated appropriately.