We regularly gets questions about IVF. So, to make it easy for our current and perspective patients we have put together a list of commonly asked IVF questions and associated answers.
Egg retrieval is a fairly rapid procedure. Obviously the length of the procedure depends on how many follicles are present. Also the accessibility of the ovaries will determine how long the procedure will take. Accessibility means how easy is it to reach the ovaries with the ultrasound probe, whether they have a tendency to move away from the probe and so on. The typical egg retrieval will take from 20-30 minutes.
We do our egg retrievals under anesthesia so the patient is asleep for the procedure. Our anesthesiologists use medications which heavily sedate the patient so she is “asleep” however, she is not anesthetized so that breathing tubes are not necessary.
There has been not much information regarding long term outcomes because IVF and egg retrievals have only been done since 1978, however in our center the egg retrieval is a safe procedure where the benefits outweigh the risks.
Vaginal bleeding is not uncommon after egg retrieval. Usually this bleeding is from the needle puncture sites in the vaginal wall. It is usually minor (spotting).
Not necessarily. Although we will usually get an egg from most mature sized follicles, most women will have a mixed group of follicles after ovulation induction. Some of those follicles will have immature eggs or post mature eggs which may not be identifiable so they will seem to have been “empty” follicles.
The embryo transfer does not require any anesthesia. It is performed using a speculum that allows the doctor to see the cervix, (like a Pap smear) and is very similar in technique to an intrauterine insemination (IUI). Usually the woman feels only the speculum and nothing else.
It is really not necessary from the conception point of view. In nature, the embryo floats freely in the endometrial cavity for a number of days before implantation and it will do the same in an IVF cycle. We do recommend that our patients take it easy following transfer, but routine work activities are certainly reasonable. If there is an increased risk of Ovarian Hyperstimulation, we will recommend prophylactic bed rest.
When the above criteria are followed, approximately 25-30% of pregnancies are multiple. The vast majority of these are twin pregnancies. The rate of triplets is approximately 5% and that of quadruplets is much less than 1% when the above criteria are followed. These odds are related to the number of transferred embryos.
Ultimately the answer is no. If an embryo is of poor quality because it is genetically abnormal, there is nothing that can be done to salvage it.
Embryos which progress to the blastocyst stage and are good quality can then be cryopreserved, if that is the couple’s wishes. If couples do not elect to freeze the extra embryos for later use, they can donate their embryos for research, for stem cells research, to another couple, or simply discard them.
Since hCG is used to finalize egg maturation and to schedule egg retrieval, a pregnancy test (which is a measurement of hCG hormone in the urine or blood) will be positive for a number of days following egg retrieval. Some women will metabolize the hormone quickly and it will be out of the blood stream in a couple of days, while others may take up to 9 days to do so. Simultaneously, a pregnancy starts secreting hCG in measurable amounts in the blood approximately 1-2 days before the expected period. Keeping these two issues in mind, then, we recommend that a pregnancy test be performed 10-12 days after the embryo transfer.
This issue has been looked at extensively. The simple answer is that there is no increased risk of birth defects after IVF. Human beings have an overall rate of birth defects of approximately 2% at birth. The rate has been shown to be the same for IVF pregnancies. There is some recent data showing that there may be a minimal increase in this rate among those pregnancies established by means of IVF with ICSI. The increase was found to be in the 1% range.
We find that most couples will get pregnant within 2 tries. Occasionally, there may be a reason to do a third attempt but that is not common. More than this would really require extenuating circumstances such as a miscarriage due to a non-recurring reason.