Because the IVF process bypasses the fallopian tubes (it was originally developed for women with blocked or missing fallopian tubes), it is the procedure of choice for those with fallopian tube issues, as well as for such conditions as endometriosis, male factor infertility and unexplained infertility. A physician can review a patient's history and help to guide them to the treatment and diagnostic procedures that are most appropriate for them.
While some research suggests a slightly higher incidence of birth defects in IVF-conceived children compared with the general population (4 - 5% vs. 3%), it is possible that this increase is due to factors other than IVF treatment itself.
It is important to recognize that the rate of birth defects in the general population is about 3% of all births for major malformations and 6% if minor defects are included. Recent studies have suggested that the rate of major birth defects in IVF-conceived children may be on the order of 4 to 5%. This slightly increased rate of defects has also been reported for children born after IUI and for naturally-conceived siblings of IVF children, thus it is possible that the risk factor is inherent in this particular patient population rather than in the technique used to achieve conception.
Research indicates that IVF-conceived children are on par with the general population in academic achievement as well as with regards to behavioral and psychological health. More studies are under way to further investigate this important issue.
Compared with the general population, women who have never conceived appear to have a slightly increased risk of ovarian cancer (about 1.6 times the rate). Because it is thought that many of these women have also used fertility medications, it has been hypothesized that a link might exist between fertility medications and this particular cancer. A number of studies have been conducted since 1992 when this concern was first raised. None have found an association between fertility medications and higher risk of ovarian or between IVF treatment itself and higher risk of ovarian cancer. Preliminary results from an ongoing National Institutes of Health study likewise suggest no association between fertility medications and ovarian, uterine or breast cancer.
It is possible that this association is due not to the use of fertility medication, but to the fact that this population of women has never undergone childbirth. Findings from the National Institutes of Health and others suggest that pregnancy or some component of the childbearing process may in fact protect directly against ovarian cancer.
The prospect of daily injections can be overwhelming. While injections are a necessary part of IVF treatment, we have designed our medication schedules and injection type to minimize discomfort and stress; and our nurses carefully instruct and support every patient throughout this process. Medications that once had to be injected into the muscle have been replaced by medications given as a small injection under the skin (subcutaneous). Such injections are most commonly taken over a 10-12 day period, followed by one intramuscular injection of hCG, a hormone that triggers ovulation at the conclusion of the stimulation cycle. The hCG injection, previously only available in an intramuscular form, is now available in a subcutaneous form (Ovidrel) for patients that wish to avoid intramuscular injection. Although the recombinant subcutaneous form of hCG in Ovidrel has not been around as long as intramuscular hCG, all indications are that it is just as effective.
After egg retrieval, patients are given a progesterone hormone supplement in order to prepare the lining of the uterus for the embryo transfer. For most patients, progesterone may be taken in a vaginal tablet or vaginal suppository form rather than an injection. In this way, injections may be avoided entirely during the second half of the IVF cycle. Progesterone vaginal tablets and suppositories have been proven to be as effective as progesterone injections.
Because anesthesia is used for egg retrieval, patients feel nothing during the procedure. Egg retrieval is a minor surgery, in which a vaginal ultrasound probe fitted with a long, thin needle is passed through the wall of the vagina and into each ovary. The needle punctures each egg follicle and gently removes the egg through a gentle suction. Anesthesia wears off quickly once egg retrieval is concluded. Patients may feel some minor cramping in the ovaries that can be treated with appropriate medications.
In general, the success of frozen-thawed embryo transfer procedures depends on three factors:
The quality and survival of the frozen-thawed embryos. In general, we only freeze good quality embryos so the current rate of survival is greater than 90%.
The age of the woman who produced the eggs. In patients under the age of 37, the chances of pregnancy with frozen-thawed embryos are similar to a pregnancy with fresh embryos.
In patients 37 years or older, pregnancy chances with frozen-thawed embryos decline in conjunction with declining fertility in general, but still can be quite good. As always it is best to discuss a woman's individual situation with their physician.
The status of the uterus in the woman receiving the embryos. A healthy endometrial lining free of any interfering fibroids or polyps provides a sound environment for embryo implantation.
Various medical conditions may make it impossible for a woman to carry a pregnancy. Reproductive medicine provides the option of enabling another woman, known as a gestational carrier (formerly called a surrogate) to carry the child of a woman who cannot sustain a pregnancy.
There are two types of gestational carriers:
Yes. Your doctor will recommend that you adhere to the basic guidelines below during the IVF process and into your pregnancy.
Once a pregnancy is confirmed, you’ll see your fertility doctor for continued blood testing, and eventually an ultrasound to confirm that the pregnancy is progressing smoothly. Once the fetus’ heartbeat has been verified, you’ll be referred to an obstetrician for the rest of your pregnancy.
Normally, patients are asked to wait for one or two full menstrual cycles before resuming another IVF cycle. Certain additional tests may be needed that could delay subsequent IVF cycles.
This is a very common question asked by couples considering IVF treatment, and the answer depends on several factors. You and your doctor will decide the number of embryos to be implanted into your uterus. If a single embryo is transferred, then it would be impossible to have a multiple pregnancy. However, given the uncertainty of the embryo successfully implanting into the lining of the uterus, many women choose to transfer multiple embryos into the womb; especially those women who may be unable to afford additional IVF cycles.
Interestingly, one’s chances of giving birth from multiple embryo transfers are only slightly higher than with transferring a single embryo, although the odds of having twins or triplets will increase significantly.
Fertility medications can cause mood swings, headaches, hot flashes, abdominal pain, and bloating. In very rare cases, fertility medication may induce ovarian hyper-stimulation syndrome (OHSS), which can produce more severe symptoms such as:
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