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Frequently Asked Questions

What screening would we (husband and wife) require before the IVF procedure?

You would be advised the following before the IVF cycle:

  • Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of anti-mullerian hormone (AMH) in your blood. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication. The trio of age, serum AMH and Antral follicle count (AFC) on ultrasound is the best predictor of ovarian (egg) reserve and time on hand

  • Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle. This is the most important test as it gives maximum information about male fertility in terms of sperm counts, motility, morphology, etc.

  • Sperm DNA fragmentation index (DFI or SDF) for determining the proportion of sperms with normal DNA. DFI of more than 25% would indicate the need for antioxidants for the male partner, As much as 50% of unexplained infertility in the man is owing to oxidative stress on the sperms. This could be due to environmental factors (pollution, pesticides, fertilizers in food, leaded and unleaded fuel fumes), lifestyle factors (smoking, alcohol, use of narcotics and other banned substances such as gutkha, obesity, diabetes, lack of exercise) or often unexplained. Doctor would prescribe you antioxidants like coenzyme Q, Resveratrol, L-arginine, L-Carnitine and other similar supplements prior to your IVF cycle.

  • Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV, Hepatitis B & C, VDRL for syphilis.

  • Uterine cavity: Your doctor will examine your uterine cavity before you start IVF. This might involve a transvaginal ultrasound to create images of your uterine cavity including a color Doppler and sometimes 3D. Or it might include a hysteroscopy — in which a thin, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

  • Genetic testing or Gene sequencing: If your family has some inheritable disease or if you have had recurrent IVF failures or miscarriages. Modern methods are extremely accurate for identifying faulty genes and then eliminating the affected embryos by preimplantation genetic testing.

How many embryos will be implanted?

The number of embryos implanted is typically based on the age and number of eggs retrieved. For young patients on their first cycle, 1-2 embryos are introduced. Since the rate of implantation is lower for older women, more embryos (even as many as 3) are usually implanted — except for women using donor eggs. However, most doctors follow specific guidelines to prevent a higher order multiple pregnancies — and in some countries, legislation limits the number of embryos that can be implanted at once. Make sure you and your doctor agree on the number of embryos that will be implanted before they're transferred. There are no indications for transferring more than 3 embryos. Our clinic is making serious efforts to shift to single embryo transfers for young and good prognosis patients to eliminate the complications associated with multiple pregnancies.

What will you do with any extra embryos?

Extra embryos would be frozen and stored for future use for several years. You can have several rounds of embryo transfer if you have surplus embryos frozen. Success rates with frozen embryos are excellent and often better than with fresh embryos (owing to more physiological preparation of the endometrium in frozen cycles thereby giving higher receptivity of the uterus). Cryopreservation can make future cycles of IVF less expensive and less invasive. With current techniques of vitrification the pregnancy rates with fresh and frozen embryos are the same. Or you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.

How will you handle a multiple pregnancies?

If more than one embryo is implanted in your uterus, IVF can result in multiple pregnancies — which poses health risks for you and your babies. In some cases (triplets or more), fetal reduction can be used to help a woman deliver just a single or twin babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences. The technique requires a skilled ultrasound expert but is generally safe. Also, the reduction would not affect the normal babies that are left intact.

How would I know the potential complications associated with using donor eggs, sperm or embryos or a surrogate mother?

We have trained counsellors with expertise in third party reproduction who can help you understand the legal, ethical, emotional and procedural aspects of these techniques. It is useful to read about epigenetics of donor pregnancies to help you get a better perspective and understanding. In general, the complication rates are lower with donor eggs or embryos as the donors are all very young and have normal healthy babies of their own. For instance, if a 40 year old woman were to get pregnant with her own eggs and IVF the chance of a Down’s syndrome baby would be about 2-3%. However, if the same woman were to get pregnant with young donor eggs that risk would reduce to less than 1:500. The same would hold true for the risk of early miscarriages owing to other genetic defects in the embryo (this risk increases with increasing age of the eggs).

What medications will I take during the IVF cycle?

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 5-20. 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 such as a GnRH agonist (Decapeptyl) 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. These are either the GnRH agonist (Lupron, leuprolide, busarlin, decapeptyl) or the antagonist (cetrorelix, ganirelix).

  • 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. For frozen embryo transfers we might recommend a GnRH agonist depot preparation on day 21 of the preceding cycle (to help control the day of embryo transfer). Also, you would take tablets of estradiol to prepare the endometrium. Other supplements such as aspirin, folic acid and low molecular weight heparin injections might also be suggested. A few days before embryo transfer we would ask you to begin progesterone (vaginal gel or intramuscular injections or oral tablets) which would continue along with the estradiol tablets until the date of the pregnancy test. If the test is positive, these medicines have to be continued for a further 45 days.

How will the doctor monitor my egg development?

Typically, you'll need 8-12 days 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). Ultrasound is usually sufficient to monitor the follicles adequately and hormone estimations are no longer required in modern day IVF. This has considerably eased out the procedure (minimal visits and no repeated blood collections). For the short antagonist protocol you would need scans on days 2,7,10 and sometimes one more (if the follicular development is slow). For the long agonist protocol you would need scans on day 21 of preceding cycle (optional), then days 4, 11 and 14 of your periods in the actual stimulation month. The last injection (trigger) is usually administered when 3 follicles cross 18 mm in mean diameter. We are functional 24 x 7 and do not manipulate egg retrieval days (to avoid weekend work) as this could impair egg quality and final outcome.

Is there any possibility of the IVF treatment being cancelled mid-way?

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

  • Inadequate number of follicles developing. We normally do not cancel if there are 2 or more follicles in expected poor responders with a low ovarian reserve.

  • Premature ovulation (rupture of the follicles before egg retrieval) which is extremely rare when agonist or antagonist have been administered.

  • Wife testing positive for COVID a day before egg retrieval

  • If your cycle is cancelled for an inadequate response (expected in patients with very low AMH levels), 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.

How will they do the Egg retrieval?

Egg retrieval is usually done in the IVF Operating room about 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 covered with a pre-lubricated probe cover is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound biopsy 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.

What symptoms will I have after the egg retrieval?

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 side effects are because of the sedation and are usually mild and resolve on their own.

How are the eggs fertilized?

Mature eggs are placed in a nutritive liquid (culture medium) and incubated. In conventional IVF, eggs that appear healthy and mature will be fertilized with normal and fast moving sperm to attempt to create embryos. About a million spermare added to each egg and nature will select which one of those will fertilize the egg. This works well for normal sperm samples. 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. We like to avoid unnecessary intervention with nature and therefore do not perform ICSI for all. Research has shown that with normal sperm, IVF often yields better outcomes. However, the final decision of IVF vs ICSI depends upon the sperm sample on the day of the procedure.

How will sperm be collected?

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.

Is Embryo transfer a painful procedure?

Embryo transfer usually takes place two to six days after egg retrieval if it’s a fresh embryo transfer. Frozen embryo transfer is usually done in a subsequent month (after egg retrieval). The procedure is 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. The entire procedure takes less than a minute.

What precautions do I have to take after the procedure?

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.

What fertility factors affect my pregnancy rate with IVF?

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.


What are my chances of pregnancy?

It is important to remember that the maximum you can expect per cycle of treatment would be 15 – 20% with IUI, 40 - 50% with IVF and ICSI, 50 – 60% with oocyte donation, embryo donation and surrogacy. However, the good statistic is that the cumulative pregnancy rate with 3 cycles of the selected treatment would be in the range of 60 – 70%

Is it normal to feel heaviness in the abdomen during treatment and what can I do?

Most of the injectables used in all treatments are for multiple egg production. Owing to this, there is an enlargement of the ovaries which commonly causes heaviness and a sense of bloating in the abdomen. This is normal and not a cause for concern. In the event of ovarian hyperstimulation (too many eggs), doctor will inform you that might have excessive pain or abdominal swelling and could require admission for a few days.

Can we have sexual relations after embryo transfer ?

It is better to avoid sexual intercourse after embryo transfer for a period of 15 days until the pregnancy test and for 20 more days if the result is positive. In IUI cycles, sexual intercourse is permitted after the procedure until the pregnancy test.

What food restrictions should I follow?

All vegetarian food is allowed during these treatments. Non-vegetarians can avoid excess consumption of red meat and eggs. Fruits and salads can be taken in plenty. Avoid fasting until the pregnancy test. Chicken and fish can be consumed in moderated portions. Some people believe that mango and papaya in excess can cause abortion so you may avoid these fruits after embryo transfer.

When can I resume work at office?

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.

What about travel restrictions ?

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.

How many times can I climb a staircase?

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

Do I have to sleep in a straight position?

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.

What about hair color, Hennna and tattoos ?

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.

What about exercise and yoga during treatments?

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.

Can I also take ayurvedic / homeopathic co-treatment to boost my fertility?

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.

Why am I being asked to repeat the pregnancy test?

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 could be 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. Often, the matter is not resolved until numerous repeat checks have been done. There is usually a waiting period of 15-20 days to reach a correct diagnosis (normal pregnancy or miscarriage or tubal / ectopic pregnancy).

Why did my cycle fail?

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 counselled earlier you have to remember that you have to often do multiple cycles before attaining success. You can request a meeting with the doctor, preferably 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.

Common prescriptions for problems after embryo transfer

  • 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.

  • 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.

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