Frequently Asked Questions
I am over 35 and have never been pregnant, but have never used any birth control. What is the best treatment to start my family?
At age 35 or older, unfortunately time is our worst enemy. If you have read about the “biological clock” ticking, the expression is absolutely true with respect to a woman’s fertility potential. This means that we will need to move quickly and start the evaluation process, which hopefully will allow rapid intervention to help get you arrive at pregnancy safely.
Most patients at CAG are older than age 35 when they book their initial appointment. That’s OK. The reason age matters so much is this: “The single most important factor impacting reproductive outcome is the age of the female”. The bright line cut-off of age 35 defining “advanced age” may be incorrect; some experts believe the difficulties may start earlier than was originally thought.
Unfortunately when it comes to reproductive biology, this means that women “of a certain age” must confront three important issues. First, their natural endowment of eggs is getting smaller over time and this makes attaining conception more difficult. Second, even if a pregnancy were to be achieved, the miscarriage rates will be higher among older moms compared to younger women. Third, the incidence of abnormal genetic conditions and/or birth defects will be higher for women who deliver at ages older than 35 (compared to younger moms).
But please don’t be discouraged. In the 21st Century, we have several very effective medical techniques which can be used to rise above and offset these three challenges. This is why CAG is here. Experts have improved reproductive treatments to a refined level, where we can now safely obtain embryos and quickly test them, with a view to identify those embryos best suited to implant and grow normally.
I already did IVF someplace else and it didn’t work. Can anything be done to improve my embryo quality for next time?
Maybe not, but we can most likely enlarge the overall number of embryos and then look to find the single best one for transfer. If this kind of embryo (genetic) testing wasn’t done in the previous IVF cycle, then maybe that’s why the treatment didn’t yield a pregnancy?
In other words, if we can get numerous embryos here, we can then perform newer, highly accurate genetic assessments on those embryos to identify the single best (i.e., genetically balanced) embryo for transfer. Even if a patent’s age is well above 35, using this approach will be highly successful in helping her safely reach her goal of pregnancy.
Another way to look at this puzzle is to clarify the actual goal. Do you want to improve embryo quality in general? Or, do you really need to screen for outstanding embryo quality from among several embryos and then just select one healthy, euploid (i.e., genetically normal) embryo for transfer? This is what CAG does…and our approach can be enormously beneficial even when we know that one or both parents has a genetic condition themselves.
What happens to any embryos that are not transferred?
You decide this. Most patients prefer that any viable embryos which remain after transfer are kept for possible use in the future. This is done by embryo freezing (vitrification). Embryos stored in this way are conserved at a very low temperature, -196° C. Using this freezing technique, embryos can remain available for use in another (thawed) embryo transfer many years later.
For IVF, how long will my egg retrieval take?
Egg retrieval can be completed in less than 15-20min for most patients. How long your procedure will take will depend on how many follicles you have. Fewer follicles will mean your retrieval will finish faster than if there are many follicles present (remember, eggs live inside the follicles).
Do I get pain medicine for the egg retrieval procedure?
Your egg retrieval will be performed under monitored sedation, meaning you will be asleep but not intubated. Most of our patients wake up after their retrieval to ask Dr. Sills, “So, are you going to give me anything before the retrieval?”—even though it has all already been done by then.
Does the egg retrieval surgery itself result in any damage to the ovaries?
Patient data from many years of IVF experience indicates that the answer is no. Looking at large populations of patients, the age for menopause is the same for women who do IVF compared to those who do not. Also, women who do multiple IVF cycles continue to show that their ovaries undergo no short-term change in their ability to respond to stimulatory medications.
Can an egg be retrieved from every follicle?
Usually yes, but there will sometimes be follicles that are empty. Because the egg is essentially a microscopic structure, and since the ultrasound equipment used for monitoring in IVF is not a microscope, there is no way to know for sure if each follicle contains an egg until the retrieval is done. Typically, one egg can be obtained for each follicle although even then an egg might not be sufficiently mature to be fertilized.
I’m nervous about the embryo transfer…does it hurt?
No. In most cases, an embryo transfer is brief and takes only about 5-10min. First, a speculum is used to see the cervix much like a Pap test. A very soft, small catheter is then placed inside the cervical canal and in the exact right place within the uterine cavity (this will be confirmed on ultrasound for precise guidance). The moment the embryo leaves the catheter cannot be felt by the patient, but it can be seen on ultrasound.
Many IVF experts have recognized the embryo transfer as perhaps the most critical part of the entire IVF treatment sequence. So, it is important for you to be especially relaxed on this day. It does not require anesthesia, but if you would like 5mg valium (oral) before the procedure just let Dr. Sills know in advance. Please note that if valium is taken before your embryo transfer, you will need someone else to drive you home afterwards.
Do I need to be on strict bed rest after my embryo transfer?
There is conflicting information on this; it probably does not matter as was once thought. In unassisted (natural) conceptions, the embryo floats around freely in the endometrial cavity for several days before it implants and it will behave the same way in an IVF cycle. Certainly the patient should avoid strenuous activity after transfer, so do take it easy. Routine work activities can be safely resumed the day after embryo transfer, as this has never been conclusively linked to IVF failures. If there is an increased risk for ovarian hyperstimulation syndrome (OHSS), bed rest will be suggested.
When will I know if I’m pregnant?
This is what it’s all about! CAG staff will schedule a highly sensitive (blood) pregnancy test for you about 12-14d after your transfer. Most patients arrive in the morning because they want the result the same day!
Of note, there will be the occasional patient who uses a home (urine) early pregnancy test before she arrives for her blood test at CAG. EPT (early pregnancy tests) are widely available without a doctor’s prescription and are quite accurate nowdays. Several types of EPTs are able to detect hCG in the urine at very low levels, at about 15-20mIU/ml. However, they can be wrong so please do not rely exclusively on a home urine pregnancy test for answers at this crucial time.
Can I stay with Dr. Sills at CAG after I’m pregnant?
For a little while, yes. Dr. Sills does not deliver babies, so you will need an obstetrician for your big day when baby arrives. We will carefully monitor your pregnancy for the first 10-12wks, then your care will be seamlessly transferred to the OB of your choosing. If you do not already have an OB, don’t worry…we will help you select one and make sure any records at CAG are sent to your OB for review. Don’t forget to visit us later…so we can see you & baby!