What are the side effects of gonadotropins?
- Multiple Births: While most multiple pregnancies are twins, some are composed of triplets or more. High-order multiple gestation pregnancies are associated with increased risk of pregnancy loss, premature delivery, infant abnormalities, handicaps due to the consequences of a very premature delivery, pregnancy-induced hypertension, hemorrhage and other significant maternal complications.
- Ovarian Hyperstimulation Syndrome (OHSS): OHSS is uncommon, occurring in only 1-5% of cycles and is more frequently seen in women who have been diagnosed with Polycystic Ovarian Syndrome (PCOS). It is characterized by rather sudden ovarian enlargement and abdominal fluid retention.
- If your monitoring indicates that you may develop hyperstimulation, we will bring this to your attention as soon as possible. Treatments most likely will consist of bed rest and careful monitoring of fluid levels. Hyperstimulation may be aggravated if pregnancy does occur. In such cases, we may either cancel the cycle or proceed with the egg retrieval but then cryopreserve (freeze) all embryos and transfer a month or 2 later.
- In severe cases, OHSS can result in kidney damage, blood clots, ovarian twisting and chest and abdominal fluid collections. During these times hospitalization may be required, usually for monitoring purposes, although a surgical procedure may be called for in some instances.
What are possible reasons for cycle cancellation?
- The follicles are not developing properly.
- An inadequate blood estrogen level.
- Excessive estradiol level, indicating an increased risk for ovarian hyperstimulation.
- Less than 3 maturing follicles seen on ultrasound.
- If a cycle is canceled, medication may be modified in subsequent cycles in an attempt to improve your response.
I had my tubes tied (tubal ligation) a few years ago. Should I have a tubal reversal or IVF?
Depending on the method of tubal ligation, you may or may not be able to have a tubal reversal. Factors such as the age of the woman or in couples with male factor infertility become important considerations in determining whether tubal reversal is reasonable. If tubal ligation reversal has been attempted and was unsuccessful, then IVF-ET represents the best option.
Is there a possibility of multiple births from ART?
Yes, any time more than one embryo is transferred, there is a chance for multiple pregnancies. It appears that the rate of twin births is greater than in the normal population (1 in 80). We follow the guidelines established by the American Society of Reproductive Medicine (ASRM) regarding the number of embryo’s to transfer.
Is there an increased risk of birth defects if I become pregnant through ART?
Recent studies suggest there is an increased risk of birth defects among patients who conceive through IVF compared to patients without fertility issues. What is unclear is whether or not patients who have infertility have an inherent increased risk of conceiving babies with birth defects or if the increased risk is due to the ART procedures themselves. Research is ongoing to clarify these issues. When comparing groups of infertile patients who conceive with ART to infertile patients who conceive spontaneously, there appears to only be an increased risk of birth defects for those patients using intracytoplasmic sperm injection (ICSI), and those defects are still quite rare.
Can we have intercourse while taking the hormone medications?
Yes. However, it is recommended that the male abstains from ejaculating for 3-5 days preceding the egg retrieval. This precaution assures that the semen sample on the day of egg retrieval contains the maximum number of motile sperm. You may find that near the time of egg retrieval your ovaries will be markedly enlarged and tender, possibly making intercourse very uncomfortable.
Are activity restrictions recommended during my stimulation?
As your ovaries begin to stimulate, they will become enlarged and tender. Limited activity reduces the risk of ovarian torsion and/or rupturing the follicles on the ovaries. As a general rule, it is advised that you stop any activity that involves bouncing, or jarring the pelvis by the time you are returning for your first ultrasound to monitor your stimulation.
What if I ovulate before the retrieval?
On the day of the egg retrieval, a vaginal ultrasound will confirm that the follicles are still intact. If they are, it can be assumed that ovulation has not occurred, and oocyte retrieval will be attempted. The medications Lupron, Antagon, or Cetrotide also help to assure that ovulation does not occur before egg retrieval has been performed.
How much activity is recommended after Embryo Transfer (ET)?
Strenuous exercises, like running or heavy lifting, etc. should be avoided until a pregnancy test has been performed.
If an embryo transfer takes place, how long should we wait until we have intercourse without risk to the embryo?
Nobody really knows for sure if intercourse aids or impedes implantation. Theoretically, uterine contractions result from intercourse, so to be safe, we advise abstaining from intercourse until after the pregnancy test.
Can I have a glass of wine or alcohol during the cycle up until the pregnancy test?
No alcohol should be consumed after the procedure.
Can I travel more than 4-6 hours in a car after my transfer or fly in a plane?
Yes, but extended travel is not recommended until the day after the transfer.
The following list of immunizations or injections are OK during a cycle:
- Flu shot
- Hepatitis vaccine
- Chicken Pox immunoglobulin
- TB test
- Tetanus shot
- Allergy shots
- Novocaine (dental procedures)
The following list of medications are OK to take before or after embryo transfer:
- Cold medications (Robitussin for cough/alcohol-free; Claritin, Bendryl)
- Neosporin-type ointments over a cut
- Benedryl cream, caladryl, 1% hydrocortisone for rash
- MOM, Colace, Surfak, Kaopectate, TUMS or Rolaids
- Amoxicillin, Ampicillin, Erythromycin
- Bactrim – OK before pregnancy test
- Flagyl – OK before pregnancy test
Do NOT take the following medications:
- St. John’s Wort
- Gingko Biloba