Are the procedures involved in IVF painful and am I awake during these procedures? The preparation for an IVF cycle includes the drawing of blood for various precycle laboratory tests and also an evaluation of the cavity of the uterus called the saline sonogram which can be done in your gynecologist’s office and with minimal discomfort. Once you are ready to start the IVF process you will start on 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 and discomfort should be tolerable. After the embryo transfer there are intramuscular injections especially of progesterone which may be more uncomfortable and are required to be given in the upper outer quadrant of the buttocks. The main procedure involved in IVF is the egg retrieval and this is performed through the vagina with ultrasound and a fine needle. Patients at Zouves Fertility Center are asleep during this procedure and are cared for by a team of anesthesiologists who are available to us seven days a week. The procedure is known as unconscious sedation which is not a general anesthetic. Patients are not awake, they have no pain with this procedure and they wake up very quickly with the egg retrieval lasting 10-15 minutes. The embryo transfer procedure is a little different from a pap smear or a gentle IUI and very occasionally when there are specific problems with the cervix, a light anesthetic may be required for the embryo transfer.
How do I manage stress, grief and loss during a cycle? There is no question that the whole process of infertility represents a tremendous loss of control over what should be a basic function and this causes initially denial then anger and depression and adds to the stress of therapies like in vitro fertilization. At ZFC we have available to us Shelley Tarnoff, LMFT, JD, our Clinical Counselor. You will have the opportunity to speak with Shelley during the early stages of your IVF cycle so that you may best use certain practices and procedures to cope with the stress of assisted reproduction. In addition, Shelley is available to help during phases of grief and loss especially with a negative pregnancy test and also after pregnancy loss be it early on or unfortunately even later on in the pregnancy. It is impossible to eliminate stress completely and each one of us needs a certain amount of stress in our lives to keep us vital. The important factor is our response to this stress and we need to learn coping strategies which prevent us from reacting in a way that is detrimental to the whole aim of therapy which is to establish and nurture a pregnancy.
What is the attitude of ZFC to alternative treatments like acupuncture and Chinese herbs? These alternative therapies have been available for many thousands of years and we support patients seeking these alternative therapies during in vitro fertilization. Acupuncture administered by an experienced practitioner who is aware of your participation in assisted reproduction can facilitate relaxation as well as optimize ovarian response and implantation. Under the guidance of an experienced practitioner, herbs geared towards assisting implantation and known to be safe in pregnancy are permitted bearing in mind that certain herbs are used to shrink endometriosis and fibroids and may not be appropriate when trying to establish an implantation. In addition, certain herbs may thin the blood and when added to aspirin and heparin may be potentially dangerous.
What is the policy of ZFC on storing embryos for patients? Patients who produce good quality embryos in excess of those used for the fresh embryo transfer can elect to have these additional embryos 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 at which time we will ask the patient to make a decision about these embryos. If you plan to use these embryos for a frozen transfer, then this one year storage may be extended for an additional year while final 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 either here in California or in the Midwest where they will be held awaiting your decision.
What can be done with our frozen embryos if we choose not to do another cycle? Patients or couples with frozen embryos at ZFC may choose to use them, transfer them out to a permanent storage facility, or these embryos may be donated to science in which case they will never be used to make a baby.
I have done five cycles of IVF and on three occasions my pregnancy test was negative while two cycles showed a low positive that never progressed to a pregnancy. What is wrong? When sperm meets egg, creating an embryo, an individual, genetically different from the mother, is nurtured within the uterus until delivery. Fortunately, the maternal immune system responds in a protective way in the majority of pregnancies. In some pregnancies, the implanting embryo elicits an aggressive response and this abnormal response can result in failure to implant, very early loss as in a chemical pregnancy, first trimester miscarriage or even placental insufficiency and decreased fetal growth in the second and third trimester.
Patients who conceive without any assistance, but have recurrent pregnancy loss, were the first studied by Dr. Alan Beer and other reproductive immunologists. In these patients, autoantibodies like phospholipid or thyroid antibodies and specialized lymphocytes like natural killer cells may damage the delicate vessels and blood supply of the early placenta, causing clotting in the vessels and pregnancy loss.
Certain patients, who have recurrent loss or repeated failure with IVF treatment, may have abnormalities within this system of autoantibodies and natural killer cells that can be identified and treated prior to initiating another IVF cycle. This testing and treatment is controversial and is considered experimental because there are as yet, no large prospective randomized studies to prove efficacy. For additional information, check http://www.repro-med.net/.
Can fibroids interfere with IVF? Fibroids are benign tumors consisting of fibrous tissue and muscle that grow in the uterus. The significance of fibroids relates to not only their size but also their location. Even small fibroids located inside the cavity of the uterus where embryos need to implant, may interfere with success and need to be removed. Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 5 cm in diameter and also if there are many fibroids causing significant uterine enlargement.
I am 34 years of age and have been told that I have premature ovarian failure. My periods stopped completely about two years ago and my FSH level is 55. Can you help? For reasons that we do not completely understand, your ovaries have stopped producing eggs prematurely. This may be because you started out with less than the average number of eggs or something in your system has caused your body to use up your allotted store of eggs sooner than is average.
If your FSH has remained elevated on a number of repeat tests, then the diagnosis of premature ovarian failure is probably correct and your options include living child-free, adoption or in vitro fertilization using the egg from another woman preferably under 30 years of age.
You can use the eggs of a friend, a family member, or you can recruit a donor through one of the agencies that we work closely with. Once you have chosen a donor, you will both be screened for infectious diseases as well as psychologically and we will then synchronize both of your cycles using the birth control pill. The egg donor will be given fertility medications and your uterus will be prepared with natural estrogen and progesterone and we will then harvest the eggs, fertilize them with your husband’s sperm and then transfer embryos to your uterus during a short procedure no different from a pap smear or intrauterine insemination.
If your egg provider is under 30 years of age, the chances of a successful birth can be as high as 60% per fresh transfer procedure.
What is ovarian hyperstimulation syndrome (OHSS)? The single most serious complication that an IVF patient faces, apart from multiple pregnancy, is the risk of becoming seriously ill after being stimulated with injectable fertility medications. This condition is known as Ovarian Hyperstimulation Syndrome (OHSS) and reports suggest that 1 to 2% of patients who receive these medications may develop signs of hemoconcentration, weight gain, severe abdominal distension, ovarian enlargement and in severe cases even renal failure. The exact cause of this syndrome is still incompletely understood, although it is well known that the administration of Human Chorionic Gonadotropin (HCG) is the precipitating event which sets in motion the symptoms mentioned above and that OHSS is made worse by pregnancy! When there are more than 20 follicles developing and the estradiol level rises above 4000 pg/ml then there is a risk of moderate OHSS and with more than 30 follicles and estradiol greater than 6000 pg/ml there is an 80% chance of developing severe OHSS. In the past, the only way of avoiding severe OHSS was to withhold the administration of the HCG and cancel the IVF cycle.
