GENERAL QUESTIONSWill I see the doctor in every visit?
When should I seek treatment for infertility?
Yes, we believe that close patient-physician interaction is essential for optimal result and will make every effort to ensure that our patients have access to the physician in every visit. Drs. Le and Haas themselves perform sonogram and insemination most of the time, with the nurses assisting only occasionally.
How does the natural fertility rate change with time?
If you are less than 35 years old and have tried unsuccessfully for one year to conceive despite having regular cycles you should see your OBGYN for evaluation. If you are a woman of 35 years or older, however, you should seek help after 6 months of trying and request to see a reproductive endocrinologist in order to save time. Regardless of age, you should see a physician right away if your periods are irregular (cycles shorter than 25 days or longer than 35 days), if you know that your tubes are abnormal, or if your male partner has a sperm problem.
What success rates can be expected of treatments?
The woman is most fertile between age 20 and 30, when she has at best a 25% chance to conceive every cycle. At age 35, her chance to conceive becomes 15-20% per cycle, and drops quickly afterward so that by age 40, her rate of conceiving is only 10% or less. The reason behind these low rates is the tendency of human eggs to be abnormal, even when the woman is young. Studies have shown that up to 50% of human eggs are abnormal during the twenties, and about to 80% of the eggs are abnormal when the woman reaches age 38. Abnormal eggs do not fertilize or lead to abnormal embryos that do not implant, thus the low rates of natural pregnancy.
What's the effect of smoking, alcohol, and caffeine on my fertility?
Ovulation induction with clomiphene or letrozole can give up to 15-20% pregnancy rate per cycle in the best age group, while the injectable fertility drugs give about 20-25% pregnancy rate per cycle. IVF treatment can give up to 60% pregnancy rate in women younger than 35.
Are hot baths bad for reproduction?
Cigarette smoking has been strongly shown to adversely affect the quality of the egg, the fertilization process, and the implantation rate. Tobacco is a potent reproductive toxin and must be avoided. The effect of alcohol and caffeine on female fertility is less clear. It is advisable to avoid hard liquor, to limit wine consumption to one glass a day, and to avoid alcohol completely once pregnancy occurs. The evidences regarding caffeine are conflicting.
Yes, sperm production is adversely affected by high temperature. It is a good idea to avoid hot tubs, sauna, and to wear loose pants and underwear. Pregnant women should also avoid taking hot bath during the first 5 months. High body temperature has been linked to spinal abnormality in the fetus.
IVF RELATED QUESTIONSWhat protocols do we use for poor responders?
Is there a weight limit in order for me to undergo IVF?
We are willing to try any protocol that has been shown to be effective in treating patients with low ovarian reserve. We often use the estrogen primed antagonist protocol or the microdose Lupron flare protocol. In our experience, however, even these protocols will be of little benefit if the total number of antral follicles is less than 5.
Do fertility drugs increase the risk of ovarian cancer?
Because our program is office based, we insist that our patients meet certain weight criteria before they can proceed with IVF at our center. Generally, the BMI (Body Mass Index) of less than 40 is desirable for safety reasons.
Does IVF treatment lead to a higher rate of birth defects?
The scientific data currently do not support a direct causal relationship between fertility drugs and ovarian cancer.
Why do I have to take birth control pills?
Past research has not found an increased risk of birth defects with IVF treatment. However, in 2001 a large study concluded that the rate of major birth defects in babies conceived via IVF was twice that of babies conceived naturally (8.4% vs. 4%, respectively). Another way to look at this, however, is that a couple has more than a 90% chance of having a healthy baby via IVF. Also for many people, IVF is the only option available to have a child.
Why am I spotting during the pill?
Taking birth control pills prior to start of the treatment cycle helps to suppress the pituitary to prevent premature ovulation later on. The pill also eliminates any ovarian cyst left over from previous cycles. Moreover, the pills can also lead to better follicular development due to its suppression of testosterone production in the ovaries. Finally, the pill gives us some flexibility in scheduling patients into groups for better efficiency.
When do I stop the pill?
The pill has two hormones, an synthetic version estrogen and a progestin (synthetic version of progesterone). the progestin can make the uterine lining to be thin and fragile, making it easy to slough off. However, the bleeding does not mean that anything is wrong, and you should continue taking the pill as instructed.
Why do I have to take Medrol and Doxycycline?
You should not stop taking the active pills until instructed. All patients in a group will stop the pill on a predetermined day. If you run out of the active pill before this date, you should call us to get more pills.
Does the egg retrieval procedure hurt?
Medrol is a light steroid that is used to prevent ‘inflammation’ of the uterine lining that can cause it to reject the embryo. Doxycycline is an antibiotics to prevent infection from the retrieval and to ensure that the uterus is free of bacteria before embryo transfer.
How much work will I miss during my IVF cycle?
Our board certified anesthesiologists will make sure that the procedure is comfortable for you. We had many patients who were surprised at how easy the process was. You may feel mild cramps afterward, but you should be able to walk out of the clinic after 30 minutes of rest.
Should I worry if I spot after my transfer day or in the days before the pregnancy test?
We try to make the IVF monitoring process as convenient for our patients as possible. During the 7-10 days stimulation period, you will likely come to the clinic 4-5 times for sonogram and blood work. You need to be off from work for only 2 days, on the day of egg retrieval and on the day of embryo transfer. Most patients will take another day off following the day of embryo transfer.
How do I inject my medications?
No, spotting after transfer may be the result of implantation. You should have a pregnancy test even if you have heavy bleeding to confirm.
What form of progesterone supplement can I use?
All injectable medications for the IVF cycles can be given subcutaneously at our center. We do not use intramuscular progesterone. For specific instructions on method of injection you can visit the pharmacy links listed elsewhere in this web site.
Why do I need to use estrogen after embryo transfer?
We prefer that you use the vaginal progesterone supplement rather than the intramuscular injection (the oral route is ineffective). Our decision to use vaginal progesterone is based on numerous scientific researches that showed the superiority of the vaginal route over the intramuscular or oral route in endometrial maturation. Once placed inside the vagina, progesterone is absorbed quickly by the local vessels and brought to the uterus where it prepares the endometrium for the implantation process. The level of progesterone within the endometrium is highest with vaginal progesterone. Progesterone vaginal supplements can be used as Prometrium (200-mg three times a day) or as Crinone 8% (once a day), and can be started the day following egg retrieval.
I am newly pregnant but am bleeding, what happened?
Estrogen is added back to help maintain the hormonal balance within the endometrium. During egg retrieval, estrogen producing cells are aspirated along with the eggs, so there is a tendency for estrogen level to drop. If the estrogen level within the endometrium is too low in relative to the progesterone level, destabilization of the lining can occur to cause bleeding.
It is quite common for IVF patients to bleed after they become pregnant. It is possible that the endometrium in IVF cycles is made less stable from exposure to high levels of hormones and drugs. In the majority of cases, however, the bleeding will eventually stop and the pregnancy will continue uneventfully. There is really not much we can do but to wait and hope for the best at this early stage of pregnancy.