I get asked questions about IVF daily. From my patients and from those seeking treatment elsewhere in the United States and beyond. While the steps involved in IVF are generally the same, the factors to consider and the patient’s needs are all unique.
While I can’t cover all scenarios in a single show (or blog post), I do want to recap some of the most common questions I get and answer some specific inquiries that were emailed to me. There’s a chance you have the same question as someone else. I hope this is helpful, and if you still have a lingering question you’ll find my email at the end of this article. Please send me a note! I’d love to hear from you.
For now, here is the recap of my IVF Q+A show:
Question: What is IVF?
Answer: It stands for, “Is Very Fun”…okay, so I’m kidding. It stands for In Vitro Fertilization. In simplistic terms, it’s the process of taking an egg and a sperm and putting them together thereby creating an embryo inside a lab.
Things to expect while preparing for IVF:
As estrogen rises, you can expect your body to react the same as it would during a normal cycle (egg white cervical mucus). This does not mean you’re ovulating like in a natural cycle. This means your body is doing what it should in response to an estrogen rise. We give women medication to prevent ovulation from happening during the IVF process.
How soon can I begin treatment? I tell patients, “your timeline is mine”. I like to diagnose people’s fertility issues before treatment and gear their protocol towards their body’s needs.
I always want to give patients the opportunity to establish a strong foundation before any treatment. In other words, I want people to be the healthiest version of themselves to increase the likelihood of conception. Things like eating well, exercising, and avoiding lifestyle toxins where possible. Or I may recommend more involved measures like seeing a urologist if necessary and additional DNA tests (Read about my Egg Whisperer D.I.E.T.).
Once your body is ready and as healthy as it can be then I’m ready to do IVF — any day of the week. Again, your timeline is mine.
Question: What is a person’s success rate for IVF?
Great question! I use an online tool which estimates the percent likelihood of conception based on factors like age, body mass, how many times you’ve been pregnant, etc. This will generate a percentage, and that’s what I give to my patients so they start IVF with accurate and personal health information to set the right expectations. We absolutely cannot create a super baby through IVF. We can’t reverse things like menopause (sadly). But I can help patients never look back with regret or feel like they could have done more or a better job during their fertility treatments with me.
Ultimately, I want patients to clearly understand two things:
- How many cycles is it going to take to get the family size they want at the age of starting IVF.
2. Their personal fertility diagnosis (health).
Question: Will I need to be on Birth Control Pills before IVF?
There are some situations where taking birth control pills will help.
Here are some of them:
Women with lots of eggs, egg donors, and women who have very tight schedules who need to have the egg retrieval fall on a very specific day.
We use BC pills as “IVF readiness pills”. It seems counter-intuitive. Some centers don’t run IVF 7 days a week so they have to put patients on birth control pills. For some patients, it’s not the best option as it may lead to less egg production.
Typically my patients in the San Francisco Bay Area are of a certain age where I like to use a natural cycle approach. In other words, on day one of the cycle, your period starts, on day two you begin medication for IVF.
Question: Do You Foresee Any Problems that Could Arise while going through IVF?
Yes, there are things that you can learn throughout the cycle.
For Example: Say you show up for your baseline ultrasound and find out there’s a cyst or that your estrogen is high. This would be a reason to pause and “not take off from that landing pad”. That’s okay! When your body gives you signs that it may not be the best cycle for IVF it’s best to listen! This is helpful information that we’re collecting and learning from to adjust your treatment as needed.
Another example is that at the time of the egg retrieval, you may not get as many eggs as you had wanted. You may also learn that the fertilization rate may not be as high, the embryo progression rate what you expected, or that the number of blastocysts was either not what you expected or absent. Finally, you may learn that you do not have any genetically normal embryos. Talking through these scenarios is so important. At the same time, sometimes the cycles that look the worst are the best because it just takes one egg and embryo that goes into a successful conception.
Ultimately, it’s important to have a provider care about you and your cycle and understand what’s going on. Do not be afraid to ask questions. Understand what you’re going into ahead of time. I hear it all the time from patients that they wished they’d known more about what they were doing and how knowing would have made the process less frustrating.
Question: Do you prefer day 3 or day 5 transfer?
Most of my patients do genetic testing. This means that most embryos are day 5 embryos (blastocysts). In order to test embryos, you have to go through a process of IVF with PGS which is now called PGT-A (pre-implantation genetic testing for aneuploidies) and a frozen embryo transfer. This is not something that’s required. It won’t tell you everything, but it may help increase your chances of a healthy pregnancy and decrease your risk of miscarriage.
A key point to remember again is that you can’t make a super baby doing IVF!
Question: Do you do a mock transfer?
If you don’t know what a mock transfer is it’s like a practice run where you’d insert a catheter into the cervix and then enter the uterus. This allows you to make sure you can get to the uterus without a problem. The last thing you’d want to happen is having an embryo in a catheter that can’t make it into the uterus on the day of the transfer. I want to troubleshoot potential problems like this in advance.
I also like to do a mock cycle for implantation testing. This is because embryos are so important to me. I treat my patients like I’d want to be treated and this involves turning over every stone BEFORE doing the transfer. I want to give everyone the best chance at a successful IVF cycle.
The mock cycle process involves taking medication just as if you were going to do an embryo transfer, but instead of doing a transfer I place a catheter into the uterus and instead of pushing in an embryo, I withdraw cells to test at two labs. One lab tells me about inflammation, endometriosis. The Bcl6 histologic score tells me if I have the right medication protocol. The ERA test will tell me the number of hours of progesterone that your body needs in order for implantation to occur. I literally call it your evite for your embryo party (https://www.draimee.org/era-your-embryo-party-evite).
Question: Do you test the uterine wall to make sure it’s receptive? Can you also do a uterine scratch test?
Yes — many of these screens can be done at the same time. A saline sonogram and an endometrial biopsy can even happen together.
Question: Intralipid therapy
Intralipid infusions are like getting a smoothie but rather than drinking it, you’re having it go into your vein. There’s been a study that indicated it may not be effective among fertility patients so to put it bluntly, it’s still considered controversial. That said, sometimes you have to think outside the box and it’s not hurtful to get intralipid infusions. It’s not something I prescribe upfront or as the standard treatment, but it is something I consider on a case-by-case basis.
Question: What sort of medication for IVF would you prescribe?
This is based on age, AMH level, the number of follicles, and what the patient wants. One of the myths is that you have to take lots of drugs to get lots of eggs. The answer to that question is that it’s really individualized. I have some patients that want me to get lots of eggs, and that’s okay. The one thing to talk to your doctor about is understanding what you’re going to do with all of those eggs when you get them. If you’re 29-years-old and you have 20 follicles, do you really want to make 20 embryos? If you’re 38 years old and you’re lucky enough to have 20 follicles you may actually want to make embryos out of all of them because we know that probably two out of the 20 eggs will be genetically normal.
Question: Which pharmacies specifically do you work with?
We work with several reputable pharmacies across the country. I’d encourage you to work with your doctor to understand where you have coverage and where you might get the best rates for medication.
Question: Which protocols do you prefer?
In patients that are typically high responders, I prefer a protocol that includes an antagonist. This is a hormone that prevents you from ovulating. You can then use a Lupron trigger shot (potentially combined with a low dose HCG trigger shot) to maximize the number of eggs retrieved with minimal risks. I also use bromocriptine after the retrieval to prevent ovarian hyperstimulation syndrome in high responders.
For patients with a lower egg count, I prefer protocols that are similar to what are referred to as “mini-IVF” protocols — I call those hybrid protocols. This is where you combine fertility pills with fertility shots. I also recommend supplements to improve egg quality (I call this my egg beauty regimen) and HGH hormone.
Question: Do I need to lose weight before my transfer?
I calculate a patient’s BMI and tell them what I think will be a BMI that gives us the best chance of success. That can mean asking patients to consider losing or gaining weight. That said, I celebrate every body type and do not body shame, but recommend that all patients eat healthy with fresh fruits and vegetables and follow a Mediterranean diet.
Question: Do you ever transfer more than one embryo at a time?
I’ve had so many awesome twin stories, but at the same time, I haven’t. I’ve had patients who have lost their twins at 25 weeks or had prematurely born twins resulting in lifelong birth defects. There are risks, that’s just the truth that I hope any doctor will tell you. For those reasons, I always encourage one embryo transfer at a time. If a patient does want twins, I try and educate them about the risk and almost all of my patients in 2018 agreed that transferring one makes the most sense.
Question: Do you recommend acupuncture during the cycle?
Yes, and I actually did a past show on this which I’d recommend you check out. I think acupuncture is great for a few reasons. I think it’s great to help you manage the symptoms of going through an IVF cycle. You may feel emotional, bloated, stressed, fatigued, or start to experience what I call “the estrogen fog” and I think especially with symptoms like nausea and bloating. I’ve also found that it’s also helpful for my patients after a retrieval. There are so many benefits.
Question: How long will the IVF cycle take from day 1 to transfer?
I understand that by the time you’ve decided to pursue the route of IVF to conceive, that you’ve wanted to be pregnant yesterday. However, I try and take my time with patients so that everyone gets the results they want without rushing a single thing. Typically it can take anywhere from 1 to 3 months to achieve the cycle results that you really want.
Question: Does age matter in how soon you can repeat IVF after delivering?
I encourage patients to wait 18 months in between pregnancies. We call that the interpregnancy interval. This has been shown to provide babies and moms with the best outcome.
Question: How soon after delivering can you do another round of IVF (if you have no embryos left)?
I tell patients to get their AMH checked, see what’s going on and maybe do another cycle as soon as 3 months after delivery. It’s a very good question as sometimes patients wait too late and as the biological clock ticks, the quality and quantity of eggs may decrease.
Question: Are there any supplements you’d suggest I take during this time leading up to the transfer, after as well as into the pregnancy?
I highly recommend a prenatal vitamin, fish oil, and making sure your vitamin D levels are normal. You may also want to take probiotics before and during pregnancy.
Question: Can you offer some insight into what empty follicle syndrome is?
Empty follicle syndrome is an extremely rare genetic issue. But the most common reason behind not having eggs retrieved isn’t because the follicles were “empty” but rather from one of the four scenarios below:
- The woman has ovulated
- The trigger shot failed
- The eggs were super immature
- It was a cyst and not a follicle
Talking to your doctors about these possibilities is very important.
Question: What are your thoughts on genetic testing of embryos? I’m not convinced the chances or results are any different than naturally conceived pregnancies.
Great question. The choice to do genetic testing is a personal decision. It’s based on your age and your diagnosis. For example, if you had multiple miscarriages and you know they were genetically abnormal then genetic testing probably makes sense to do.
However, if you’re 29 years old and your egg quality looks good then you may not need or want to do genetic testing. The good news is that if you work with me you can test embryos that have been previously frozen whenever you determine the need to. Not all labs have the ability to do that so be sure to talk to your doctor ahead of time.
Question: What do women with thyroid disorders need to know when considering IVF? Do you treat them?
The answer is yes — I do treat women who have existing thyroid disorders. Checking someone’s TSH level is part of routine fertility care. We look at hormones and thyroid is one of them. That’s what the “H” of tusHy method stands for.
Question: I’m starting IVF due to severe male factor infertility. What questions should I be asking at this appointment since this is new territory for us?
Question #1: What can I do to make the sperm even better?
Question #2: Why is the sperm quality the way it is?
- Is it lifestyle induced? Is it heat exposure? What is causing the sperm abnormalities? Make sure you’ve seen a male fertility specialist or a urologist who can diagnose the abnormalities. Are there drugs or supplements to consider that can improve the sperm quality?
Question #3: Is the sperm DNA fragmentation very high?
These are questions you want to ask in advance of your cycle.
Question: If I had a reaction to estrogen that caused anxiety bad enough to send me to the ER, should I wait to try to conceive?
Yes. Listen to your body. Some patients have a reaction to estrogen and above all else, it’s important to give your body time. Going through IVF is an emotional process so talk to your doctor if any hormones are bothering you. There are other options.
Question: Have you ever had a patient with a psychiatric disorder and how do you handle this?
Yes. Part of the process is emotional and moods can fluctuate. Make sure you have your team established to help you as you go through the process. It does not prohibit you from going through IVF or becoming a mother.
Question: What can I do to help my partner through the IVF process?
A simple question to your partner can go a long way, “How can I help?” “What do you need?” Just make sure your partner knows that you’re there for them.
Having a supportive partner that you are aligned with and that’s part of your fertility team is essential.
Question: Is there anything I can do from a dietary perspective to improve my sperm morphology?
Yes — go see a specialist and get testing to know what type of treatment and lifestyle changes you can make.
Fertility diagnosis before treatment is so important. It’s how I like to work as a doctor. It’s why you’ll see me wear a TUSHY t-shirt and talk about it. (Tubes, Uterus, Sperm, Hormones, Your Genetic Profile).
Have a question that wasn’t covered? Send me a note: firstname.lastname@example.org
You can also catch more of me and topics like this through the Egg Whisperer Show. The episodes are live-streamed on YouTube, Facebook, and Twitter and on Wednesdays at 7 PM PST. Subscribe to the podcast too!