Frequently Asked Questions

A trained counselor with expertise in donor issues can help you understand the legal, ethical, emotional and procedural aspects of these techniques.

You may need several different medications, such as:

• Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time. The ideal number of eggs for IVF success is 5-15. This would ensure enough number of embryos for fresh and frozen transfer.

• Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally 10th or 11th day of stimulation — you will take 10000 IU human chorionic gonadotropin (HCG) or other medications to help the eggs mature.

• Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon. It is important that the eggs do not release before we can retrieve them from the ovaries

• Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation. Other supplements such as aspirin, folic acid, low molecular weight heparin injections and estradiol valerate might also be suggested.

Typically, you'll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform Trans Vaginal ultrasound, a procedure that uses sound waves to create an image of your ovaries to monitor the development of fluid-filled ovarian sacs where eggs mature (follicles). Blood tests to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation. Progesterone will also be checked on the day of the hCG night trigger.

Sometimes the cycle has to be cancelled in your own interest. Common reasons are:

• Inadequate number of follicles developing.

• Premature ovulation.

• Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome

Other medical issues.

If your cycle is cancelled, your doctor might recommend changing medications or their dose to promote a better response during future IVF cycles. Or you may be advised that you need an egg donor.

Egg retrieval can be done in the IVF Operating room 34 to 36 hours after the final injection (usually a night trigger of hCG) and before ovulation.During egg retrieval, you'll be sedated and given pain medication. Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs. The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 10 minutes.

After egg retrieval, you may experience cramping and feelings of fullness or pressure in the lower abdomen. You might also experience some dizziness for a couple of hours. Make sure that you are accompanied home by your husband or a relative. Sometimes, you may feel nausea and even vomit. These are usually mild and resolve on their own.

Mature eggs are placed in a nutritive liquid (culture medium) and incubated. In conventional IVF, eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized. For patients with sperm problems or unexplained infertility we prefer ICSI where a single sperm is picked up in a microneedle and injected into the egg to ensure that fertilization occurs.

If you're using your partner's sperm, he'll provide a semen sample at your doctor's office or a clinic through masturbation the morning of egg retrieval. If he feels anxious, you should inform the clinic so that they can have him deposit a semen sample for cryofreezing any time before the actual procedure date. The results with fresh and frozen sperm are the same. Other methods, such as testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — are sometimes required. Donor sperm also can be used. Sperm are separated from the semen fluid in the lab.

Embryo transfer is done at your doctor's office or a clinic and usually takes place two to six days after egg retrieval. The procedure is usually painless, although you might experience mild cramping. You can request a sedative if you feel nervous. The doctor or nurse will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus. A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter and then delivered through the tube into your uterus.

After the embryo transfer, you can resume your normal daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.

Typical side effects include

• Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer.

• Breast tenderness due to high estrogen levels.

• Mild bloating.

• Mild cramping.

• Constipation.

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for factors such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

After the embryo transfer, you can resume your normal daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.

• Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counselled to consider using donor eggs during IVF to increase the chances of success.

• Embryo status. The number and quality of embryos will affect the pregnancy rates. Grade 1 is usually associated with a 50% chance which drops to 30% with grade 2, 10 % with grade 3 and < 2% with grade 4.

• Reproductive history: Women who've previously given birth or had previous miscarriages or ectopic (tubal) pregnancies are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant.

• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have endometriosis and low serum AMH levels are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.

• Lifestyle factors. Women who smoke have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.

We normally advice 3 – 4 days of restricted activity after embryo transfer (not complete bed rest). However, you can resume work the next day if there is not too much of travel and physical stress involved in your work pattern. Most available research suggests that resting does not help the pregnancy outcome so there is no advantage of staying at home and discontinuing office and work after the procedure.

All modes of transport are fine as long as you avoid bumpy drives, potholes and autorickshaws. Train and car are equally safe for all Mumbai patients and also for patients returning to their hometowns in Gujarat or maharashtra. It is also safe to catch a flight on the same day as the embryo transfer but if you wish you could rest for a night and fly the next day. Yes, you can also sit on the back seat of a two-wheeler without any problems or cause for concern. International patients can return within a couple of days of the transfer.

As many times as you wish. Of course it would be preferable if you did so slowly and without exerting yourself too much.

No, you can sleep in any position that you are comfortable with, even on your stomach if you wish. External pressure is not transmitted to the uterus as it is well protected in the pelvic bone. So also, a small child sitting on your stomach cannot cause any harm to a potential pregnancy.

Non-ammonical hair color is supposed to be safe but can be avoided if not very urgent. Henna is safe. Tattooing can be done before embryo transfer, better to avoid thereafter. Bleaching creams are to be avoided as are ointments for pimples and acne. Waxing is fine and permitted.

You can do moderate exercise during the treatment cycle until the day of the egg retrieval. Therafter it is better to avoid any vigorous exercise, gym, cardio and brisk walks. Also, strenuous yogasanas are to be avoided after embryo transfer. A 20 – 30 minute casual stroll is permitted 4 days after the embryo transfer. Also, avoid pranayama which is associated with rapid changes in abdominal pressure after embryo transfer.

We would advice you not to mix other therapies with our injections as the adverse effects of such combinations have not been studied. However, there are some reports showing beneficial effects of acupuncture and reflexology during an IVF cycle. You need to consult the proper person for the same.

Sometimes, the first reading of serum beta hCG (pregnancy test) may be < 100 mIU/ml which indicates implantation. In that case the clinic will ask you to repeat the test after 48 hours. If the level doubles in 48 hours, we probably have a good pregnancy. However, if the reading remains low or does not double, it is know as a biochemical pregnancy which usually ends in a miscarriage. We understand your anxiety but there is no way to resolve the issue until the second test is performed. Please continue all medication until the second test is done. Biochemical pregnancies are often due to some genetic defects in the embryo or some hormone deficiencies which cannot be diagnosed or corrected.

We understand your feelings in case of failure. It is important to remember and understand the success rates which have been told to you at the beginning of the cycle. Please do not blame failure on anything that you feel you did wrong (such as eating out, traveling long distances, bumps or jerks with a autorickshaw, cold, cough, fever, or any other such events). As counseled earlier you have to remember that you have to often do multiple cycles before attaining success. You can request a meeting with the doctor in the evening hours, preferable more than a week after the negative test (to allow for emotional recovery) and then discuss things out. Doctor will review the file and the cycle events and counsel you about the possible reasons (for example – egg or sperm quality, some problem in the womb which could not hold on to the embryos although they were of best quality and other such reasons.

• Cold: Tab Cetzine / Alerid twice a day for excess sneezing. Excessive sneezing will not affect the result or pregnancy outcome

• Cough: Syr Chericof 2 tspf three times is safe even in early pregnancy. For excessive coughing, can take a spoonful of Syr Benadryl or Corex at bedtime for a good nights sleep. Again this will not affect the results

• Fever: Tab Crocin or any paracetamol tablet twice or thrice as required is safe in pregnancy. If it persists, you will need to consult your GP for further tests and medication. Antibiotics are ok and all you need to do is inform him that you might be pregnant so that he can select appropriate medication for you.

• Pain in abdomen: Mild cramping and pain are normal during treatment. Can take a tablet of Drotin or Cyclopam for relief. If pain persists please contact the clinic for further action.

• Rash / allergy: Inj Gestone or any progesterone can cause skin rashes and allergies in 10% of patients. Cetzine / Cetgel tablets can be taken twice daily for relief. In case of excessive rash, you could contact your GP. He might have to administer a shot of dexamethasone (4 – 8 mg) for instant relief. Also, you need to discontinue the gestone injections and switch to vaginal tablets of microgest / naturogest / susten / gestofit 200 mg to inserted in the vagina three times daily. Results will not be affected by this change./p>

• Constipation: This is common with progesterone – can take Syr Duphalac 15 ml twice daily for the whole 15 days. This will also help relieve gas. In case this does not help, can take Naturecare – 1 large tablespoon in a glass of water at bedtime. Also, Syr Cremaffin 2 taspf at bedtime is a good remedy for constipation.

• Gas: For excessive gas, you can take tab Pankreoflat – 1 after lunch daily

• Injection pain: Most of the initial shots are water soluble, quickly absorbed and relatively painless. However, injections of gestone / progesterone are oil based and will form lumps (often painful) at the site of injection. It helps to massage the site of injection for 5 minutes with the ice-pack provided to you immediately after injection for 5 minutes. Also, application of thrombophob gel is useful in some patients. In case of severe discomfort, stop the injections and change to Capsules of microgest / naturogest / susten (200 mg) to be inserted vaginally three times daily or Susten 8% vaginal gel to be inserted vaginally twice daily.

• Excessive vaginal discharge: This is common in the first half of treatment when you are receiving injections for multiple egg production. If there is itching or foul smell, you can insert Tab Clingen -3- vaginal tablets for three consecutive nights.

• Pre-menstrual cramps, backache and leg pain: If this happens do not assume that treatment has failed as the same symptoms are caused by progesterone injections and vaginal capsules. You have to wait for the pregnancy test before assuming failure of treatment.

• Bleeding before the pregnancy test: This could be either due to implantation of the embryos (especially multiple pregnancies) which is a good sign, mild breakthrough bleeding (which is common when you are taking vaginal progesterone) or failure of treatment (pre-menstrual bleeding). In either case, we can't do anything until the pregnancy test, so please be patient and wait for the results before assuming failure or success.