Frequently Asked Questions about IVF

1. Are there any restrictions on physical or personal activities during an IVF cycle?

1. Smoking: Stop smoking before ovulation induction begins. It is best to discontinue tobacco at least 2 months prior to an IVF cycle. If you cannot stop “cold turkey,” make an effort to stop at least two weeks prior to the egg aspiration. Byproducts of tobacco have been shown to be toxic to the egg. Numerous studies also have shown that smoking during pregnancy results in reduced birth weight and fetal compromise. There is some data that smoking can also lower pregnancy rates. We strongly recommend that all women, especially those undergoing fertility treatment, cease smoking.
2. Drinking: Alcohol is a drug, and should be avoided during infertility treatment and pregnancy. Please do not drink alcohol from the time fertility medications are initiated until the pregnancy test.
3. Medications: If you are taking any herbs, or prescription or over-the-counter medications, please inform your physician. Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation. A prenatal or multivitamin will be prescribed; if you are not taking a vitamin with folic acid, please inform the IVF nurses.
4. An IVF cycle can be an emotional and stressful time for you and your spouse. It may be helpful to have someone to speak with, such as friends and family, a clergy member, or a psychologist/therapist. We are proud to offer a Patient-Mentor Program, which matches patients new to the world of infertility with someone who already has experienced its ups and downs.
5. Heavy exercise such as aerobics, jogging, weight lifting, etc.. are prohibited during ovarian stimulation and until the pregnancy test results are known.

2. How does the IVF laboratory operate and what safety measures are taken? What will happen to the eggs and sperm after retrieval?

On the day before egg retrieval, egg culture dishes are labeled with the patient’s name and an identification number. The number and size of the ovarian follicles determines the number of dishes prepared. Each dish contains several drops of culture medium that are covered with mineral oil.

The dishes are then placed in the embryology incubator for warming to body temperature. The incubator also adjusts the pH of the culture media to the human body. A large amount of rinsing media is equilibrated in the incubator. The fluid is used by the physician to wash the egg from the ovarian follicle if it is not found in the initial aspirations. Media also is equilibrated in the andrology laboratory for processing of the sperm.

Upon arrival in the operating room the patient’s identity is verified by the embryologist, physician, and nurse. They also verify that the culture dishes are correctly labeled.

The physician aspirates the fluid from the ovarian follicles into a test tube. The embryologist then dispenses the fluid into a large dish and rapidly scans it under the microscope. The egg complex is usually visible to the naked eye, but microscopic verification is always done. The egg is removed from the large dish by pipette, rinsed in the warm equilibrated culture medium and placed in the culture drop. The presence of an egg in the follicular fluid is immediately reported to the physician. The physician will then discontinue washing that particular follicle.

After all of the eggs have been aspirated, the maturity and health of eggs is assessed. Eggs are incubated 1 to 4 hours before insemination. For standard insemination, 150,000 morphologically normal motile sperm are added to the egg. Dishes containing egg and sperm are then returned to the main embryology incubators for culture.

The male will be asked to collect a semen sample after the egg aspiration. He will be escorted to the collection room. Approximately 30 minutes after collection, the semen liquefies and semen analysis is performed. The sperm is prepared for insemination by density-gradient centrifugation to remove the seminal fluid, cellular debris and non-motile sperm.

Twenty to 24 hours after retrieval, the eggs are microscopically examined for sign of fertilization (presence of two pronuclei). Polyspermic eggs, those possessing more than two sperm pronuclei, are discarded.

Fertilized eggs (embryos) in excess of those needed may be cryopreserved (frozen) at this time or in the next two days of culture. Fertilized eggs for uterine transfer are returned to the incubator for 2-4 days. Embryo growth and quality is assessed every 24 hours. Based on the number if embryos available and their grade, embryo transfer is scheduled.

3. When is the pregnancy test performed?

The blood pregnancy test is performed 14 days after the embryo transfer.

4. What happens if I become pregnant?

If pregnant, the patient will return to the office for repeat blood work and ultrasounds to ensure an ongoing successful pregnancy. After a fetal heartbeat has been confirmed, patients are referred to an obstetrician for the remainder of the pregnancy.

5. If I am not pregnant, when can we try again?

Usually we ask that patients wait one or two complete menstrual cycles before beginning another IVF cycle. Sometimes tests are required that may delay subsequent cycles.

6. Will I need a high-risk obstetrician because I conceived with IVF?

A high-risk obstetrician is only needed when there are complications that put the mother or baby at increased risk, or in the case of multiple births. Other than a higher incidence of multiple births, IVF does not increase the risk to the fetus.

7. Is there a higher miscarriage rate for IVF patients?

The miscarriage rate is about the same for IVF as the general population. Many times older females undergo IVF and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.

8. What can be done to improve sperm quality?

Sperm quality on the day of egg retrieval often is related to what happened in the male’s body 2½-3 months ago because sperm development takes 74 days. Here are some guidelines to help ensure the semen specimen is of the best possible quality.

• A fever of 101 degrees Fahrenheit or higher within 3 months prior to IVF treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. If you become sick during the IVF cycle, please notify an IVF nurse, and take Tylenol to keep your temperature below 101 degrees Fahrenheit.
• Keep the use of alcohol and cigarettes to a minimum before and during IVF treatment. Do not use any “recreational” drugs.
• If any herbs or prescription medications have been taken during the last 3 months, notify the IVF nurse.
• Do not sit in hot tubs, spas, Jacuzzis, or saunas during or 3 months prior to the IVF cycle.
• Do not begin any new form of endurance exercise during or 3 months prior to the IVF cycle. Physical activity at a moderate level is acceptable and encouraged.
• Avoid all testosterone, DHEA, and Androstenedione/Androstanediol hormone containing supplements.
• Tell your physician if you have ever had genital herpes, or suspect you may have been exposed to genital herpes in the past. Also tell your physician if you have pre lesion symptoms, develop a lesion, or have healing lesions before or during the IVF cycle.
• Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the IVF cycle. The IVF nurse will have specific instructions for you.

9. How do we decide how many embryos to transfer?

Your physician will discuss this with you at the time of consent signing, but we usually follow the recommendations of The Society for Reproductive Medicine guidelines:

• Under 30 years old = 1-2 embryos
• 30-35 years of age = 2-3 embryos
• 35-40 years of age = 3 embryos

These numbers may vary depending on individual diagnosis and clinical circumstance.

10. Am I depleting my store of eggs by undergoing an IVF cycle?

A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and IVF procedures have no measurable lowering effects.