FAQ
Bay IVF - Advanced Reproductive Care                                Palo Alto  650-322-0500

 

Frequently Asked Questions

You are welcome to call or email us with any questions. We try to respond as soon as possible but never later than the next business day. Please contact us by phone at 650-322-0500 or via email at care@BayIVF.com.

You can also check the Glossary of Reproductive Treatments Terminology for definitions of terms used in reproductive medicine.

 

How long should I wait before seeking treatment?

It is important that you do not wait too long before seeing an infertility specialist. Please note that there is no distinction between having unprotected intercourse and "trying" to conceive. They both represent "exposure" to conception.

The following table illustrates the recommended length of "exposure", as it relates to the female partner’s age, before consulting a Reproductive Endocrinology and Infertility (REI) specialist.

Length of "Exposure" Before Consulting REI Specialist
Female Age No
Exposure
1 to 3 months 4 to 6 months 7 to 9 months 10 to 12 months 13 or more months
35 or Less Begin sexual activity Continue sexual activity Continue sexual activity Continue sexual activity Continue sexual activity Consult
REI
36 to 37 Begin sexual activity Continue sexual activity Continue sexual activity Continue sexual activity Consult
REI
 
38 to 39 Begin sexual activity Continue sexual activity Continue sexual activity Consult
REI
   
40 to 41 Begin sexual activity Continue sexual activity Consult
REI
     
42 to 44 Consult
REI
         
How can I increase my chance of pregnancy?

Your state of reproductive health can play an important role when trying to conceive. Please use the "Optimize Your Fertility" link in the menu and try to follow the recommendations as closely as possible.

Should I go straight to IVF or consider other treatments first?

The decision which treatment is the most appropriate for you is based on your past reproductive history, results of your fertility testing, and the outcome of any previous reproductive treatments you may have had. You may need In Vitro Fertilization treatment if any of the following apply to you:

  • History of tubal blockage and pelvic adhesions
  • Male Factor Infertility
  • Infertility associated with endometriosis
  • Infertility associated with Polycystic Ovary Syndrome (PCO)
  • Unexplained infertility
  • Long-standing infertility: no contraception for more than a year and a half
  • Decreasing "ovarian reserve": IVF may be the most appropriate treatment for women over the age of 37.
  • You did not become pregnant with intrauterine insemination (IUI) cycles.
  • You did not become pregnant with ovarian stimulation cycles with oral or injectable medications.
How long does it take to complete a cycle of IVF?

It takes approximately 6 to 8 weeks from the beginning of your treatment to the egg retrieval and embryo transfer.

Do I need to take breaks between treatment cycles?

Treatments that require ovarian stimulation (IVF) require a resting cycle before another cycle of treatment can begin. It does not make a difference whether you rest your ovaries just for one cycle or several menstrual cycles.

Other treatments (Donor Egg IVF, Frozen Embryo Transfer) do not require a resting cycle, and your new treatment cycle can start right away.

How many cycles of treatment should I plan for?

We typically do not recommend more than three cycles of IVF and Donor Egg IVF treatment. The number of treatment cycles you should plan for is ultimately a personal choice, but we will help you with your decision. The lower the probability of a successful outcome per cycle of treatment, the more cycles of treatment you should be planning for.

Most patients can increase their cumulative pregnancy probability by having more than one cycle of treatment. The following graph illustrates the increase in successful outcome probability if you are considering more than one cycle of treatment.

Two or Three Cycles (Embryo Transfers)
Increase Likelihood of Successful Outcome

Cumulative Probability of IVF

 

In this example, we used an arbitrary 35% successful outcome probability per IVF treatment cycle. Your actual likelihood of pregnancy could be higher or lower.

Once you have completed your treatment prerequisites, we will be able to estimate your probability of success and help you with your decision.

What kind of testing is required for Advanced Reproductive Treatments?

Your reproductive history, together with the result of your testing, will determine which treatment will most likely and inexpensively result in a pregnancy.

We plan your fertility testing around the three categories of infertility factors:

  • Male factor infertility
  • Ovulation and egg quality disorders
  • Uterine and Fallopian tubes factors

 

As much as possible, we try to make use of reproductive test results done prior to your becoming a patient at Bay IVF to minimize your cost without compromising your treatment outcome. The following reproductive tests are an example of the most commonly performed tests at Bay IVF.

  • Semen evaluation

    A significant portion of all infertility is due to male factor infertility, and the presence of male infertility has a major impact on the direction of fertility testing and treatment.

    Unless semen evaluation results are highly abnormal (i.e., a concentration of less than 3 million, total motility less than 3%, and normal morphology less than 3%), the test results cannot be reliably used to assess the male fertility potential.

    We use your semen assessment to guide us in selecting the optimal method for semen preparation in your upcoming treatment.

  • Ovarian reserve testing (egg quality tests)

    We utilize a combination of transvaginal ultrasound examination of the ovaries and an assessment of reproductive hormones levels: Ovarian Reserve Assay (ORA) to estimate your "biological age." The results of these tests will determine the most appropriate treatment for you.

    During your initial visit at Bay IVF, you will have an ultrasound examination of your ovaries to determine the number of antral follicles (seen as small dark circles) within each ovary. The number of antral follicles is related to the quality of the eggs. Ideally, there should be approximately a total of 20 antral follicles in both ovaries. Too few or too many antral follicles mean that normal quality eggs may be infrequent or even absent within the ovaries.

    There must be a total of four or more antral follicles in both ovaries combined for the reproductive treatments to have a chance of success. The majority of women will have 12 to 24 antral follicles.

    ORA assesses the likelihood that normal quality eggs can be produced. It consists of the measurement of Follicle Stimulating Hormone (FSH), estradiol (estrogen, E2), and Anti-Mullerian Hormone (AMH) blood levels.

    FSH stimulates the ovaries to produce eggs. If the ovaries cannot produce normal quality eggs, the FSH level is increased. Estradiol production by the ovaries influences FSH secretion and is also related to the egg quality. FSH should ideally be less than 7.0 and estradiol less than 30.

    AMH level also reflects the quality of eggs, and the result should ideally be 2 to 3. Lower or substantially higher levels signify less than optimal egg quality. AMH result is used to optimize your ovarian stimulation.

    Most women will have normal Ovarian Reserve Assay results. An abnormal result does not necessarily mean that you cannot get pregnant with your own eggs. If the test results are abnormal, we typically recommend repeating the test up to three times.

  • Evaluation of the Uterus

    Your endometrial cavity must be free of polyps, scarring, and myomas (fibroids) before any treatment can be initiated. The presence of any of these structures inside the uterus could significantly compromise the likelihood of embryo implantation.

    We use a Sonohysterogram (saline ultrasound) to assess the endometrial cavity of your uterus. A thin, soft catheter is passed through the cervix into the uterus, and a small amount of sterile saline solution is gently instilled. A transvaginal ultrasound is used to confirm the absence of polyps, scarring, or fibroids inside the uterus.

    This ultrasound image shows a normal endometrial cavity. Polyps and fibroids (myomas) would show as lighter shade "filling defects" within the dark saline-filled endometrial cavity.

Sonohysterogram

 

  • Testing Required by the State of California and FDA

    Hepatitis B-Surface Antigen, Hepatitis C-Antibody, HIV I&II, HTLV I&II, and RPR screening are required as prerequisites for advanced reproductive treatments. In addition, Chlamydia and Gonorrhea tests are required for sperm and egg donors.

Typically, all necessary testing can be performed within two to four weeks, and then the most appropriate treatment can be initiated.

Do medications used in the IVF treatment have any side-effects?

Most patients should expect minimal, if any, side-effects from the In Vitro Fertilization medications. You should be able to continue with your everyday activities during your treatment.

What is Ovarian Hyperstimulation Syndrome (OHSS)?

Any patient undergoing ovulation induction is at risk of developing OHSS, although some more than others. Ovarian hyperstimulation syndrome may be classified as mild, moderate, or severe by symptoms and signs.

The symptoms usually begin four to five days after the egg retrieval. A majority of women have a mild or moderate form of the syndrome which invariably resolves within a few days. Patients may complain of abdominal discomfort and mild abdominal swelling. In a small proportion of women, the degree of discomfort can be quite pronounced. If a pregnancy occurs, it may delay recovery.

What happens if I have extra embryos that I do not transfer?

There may be more embryos than the future parents wish to have transferred. It is possible to cryopreserve (freeze, vitrify) these embryos and store them in liquid nitrogen. The majority of the embryos will survive the cryopreservation and thawing process. The implantation rate of the surviving embryos is similar to the "fresh" embryos.

How long can you store frozen embryos?

There is no time limit on storing cryopreserved embryos. They are stored in liquid nitrogen at close to absolute zero degrees temperature and do not age. Your uterus also does not "grow old." Theoretically, there is no limit on the age of the recipient mother of frozen-thawed embryos. Since pregnancy complications, not related to the uterus, increase significantly with age and could compromise the mother’s and baby’s health, you must be 48 and 11 months or younger at the time of transfer of your frozen-thawed embryos at Bay IVF.

Are there increased birth defects in IVF or Donor Egg IVF babies?

There is an extensive number of published reports documenting no correlation between children conceived with medical intervention and birth defects. These are real and natural babies; they will kick, spit-up, scream, and keep you up all night just like any other baby.

Is the egg retrieval procedure painful?

Since we use powerful pain and relaxation medications, your egg retrieval should be very comfortable. Most patients will experience only minimal, if any, menstrual like cramping during the procedure.

What is unexplained (idiopathic) infertility?

Up to 25% of all infertile patients will have a diagnosis of unexplained (idiopathic) infertility. This diagnosis means that, in spite of exhaustive fertility evaluation, there is no apparent cause of infertility.

The majority of these patients do have infertility factor(s) involving the eggs, sperm, and the Fallopian tubes, but their testing has not yet uncovered this information. Infertility related to the egg quality factor represents most of the "unexplained" infertility since it is the most difficult one to diagnose.

In Vitro Fertilization is the most common treatment for patients with unexplained infertility. IVF can be used as an excellent diagnostic tool that will almost always establish the cause of one’s infertility and, at the same time, can often correct or bypass the problem and result in pregnancy.

Can endometriosis affect my fertility?

Endometriosis is a condition in which endometrial cells of the inner uterine lining can be found outside the uterus.

When there is a history of infertility, the female partner may have a laparoscopy. One-third of the time, endometriosis is found. The same incidence has been found in women undergoing laparoscopy for non-infertility reasons.

This finding, together with the lack of consistent scientific evidence that surgical or medical removal of endometriosis increases the probability of pregnancy, has led some clinicians to believe that endometriosis is merely a sign of another underlining cause of infertility.

A severe degree of endometriosis causes scarring around the Fallopian tubes and ovaries and can be an infertility factor.

When we examine and treat patients with the sole diagnosis of endometriosis, we commonly find undiagnosed egg, sperm, or tubal factors.

What is PCOS?

It is estimated that perhaps 5% to 15% of all women are born with some degree of polycystic ovary syndrome (PCOS). Most of these women will never know since they will be able to conceive. These women have a mild degree of PCOS.

Women with more severe PCOS will, at least temporarily, lose the regularity of their menstruations (become anovulatory) and may need medical help to conceive. In its most severe forms, the polycystic ovarian syndrome can make it quite difficult for a woman to ovulate and conceive even with ovarian stimulation.

This lack of ovulation is accompanied by a hormonal imbalance which, in some women, involves abnormal insulin production and glucose metabolism.

Polycystic ovaries are by far the most common cause of anovulation. The term "polycystic" refers to the increased number of ovarian follicles (not cysts) present within the ovaries of most women with PCOS.

How do you test egg quality?

We utilize a combination of transvaginal ultrasound examination of the ovaries and an assessment of reproductive hormones levels: Ovarian Reserve Assay (ORA) to estimate your "biological age." The results of these tests will determine the most appropriate treatment for you.

During your initial visit at Bay IVF, you will have an ultrasound examination of your ovaries to determine the number of antral follicles (seen as small dark circles) within each ovary. The number of antral follicles is related to the quality of the eggs. Ideally, there should be approximately a total of 20 antral follicles in both ovaries. Too few or too many antral follicles mean that normal quality eggs may be infrequent or even absent within the ovaries.

There must be a total of four or more antral follicles in both ovaries combined for the reproductive treatments to have a chance of success. The majority of women will have 12 to 24 antral follicles.

ORA assesses the likelihood that normal quality eggs can be produced. It consists of the measurement of Follicle Stimulating Hormone (FSH), estradiol (estrogen, E2), and Anti-Mullerian Hormone (AMH) blood levels.

FSH stimulates the ovaries to produce eggs. If the ovaries cannot produce normal quality eggs, the FSH level is increased. Estradiol production by the ovaries influences FSH secretion and is also related to the egg quality. FSH should ideally be less than 7.0 and estradiol less than 30.

What is a premature ovarian failure, and can it be overcome?

Premature ovarian failure refers to a loss of normal function of the ovaries before the age of 40. The ovaries can no longer produce normal quality eggs and female hormones estrogen and progesterone.

There is no known cure for premature ovarian failure, and most patients will need Donor Egg IVF treatment to conceive successfully.

Does uterine receptivity affect pregnancy?

Uterine lining receptivity does not have a profound effect on the success of infertility treatments. The issue of uterine lining receptivity and its effect on pregnancy is one of the most frequently asked questions by our patients.

Studies that would implicate the uterine receptivity as a major factor in infertility treatment success are lacking. On the other hand, there is evidence suggesting that the role of uterine lining receptivity as a decisive factor in human conception is limited.

Since women can have ectopic pregnancies (tubal, ovarian, cervical, abdominal), embryos seem to be able to implant in environments that would be considered hostile.

The probability of success of Donor Egg In Vitro Fertilization depends primarily on the donors’ egg quality, and the age of the recipient mother or her uterine receptivity is not an important factor.

What is ICSI, and what effect does it have on my embryos?

Intracytoplasmic Sperm Injection has allowed infertile men, who would not have been able to cause pregnancy in the past, to father children. ICSI does not have any TMC requirement and can be used even if there are only occasional sperm found in a semen sample. ICSI is also used for men with unproven fertility (never sired a pregnancy) and for couples with unexplained infertility.

In the ICSI procedure, a single live sperm is inserted directly into the center of an egg. Intracytoplasmic Sperm Injection requires a high degree of expertise and is performed with a special microscope and micromanipulators.

ICSI

 

ICSI has been used extensively in Advanced Reproductive Treatments since 1993, and tens of thousands of babies have been born worldwide using ICSI.

What is Assisted Hatching, and what effect does it have on my embryos?

Assisted embryo hatching is a laboratory procedure that creates a "weak spot" in the egg shell of an embryo. For selected embryos, this increases the likelihood of the embryo being able to hatch out, implant, and result in a baby.

Assisted Hatching is a microsurgical procedure. Using a specially designed laser, a tiny hole is created in the egg shell. This procedure does not harm the embryo.

I am over 40. Should I plan to do PGS?

You may consider adding Preimplantation Genetic Screening (PGS) to your In Vitro Fertilization or Donor Egg IVF treatment. If you do, you will not need to do amniocentesis if you conceive.

Adding PGS to these treatments has not been shown to improve the probability of a successful outcome, but it can reduce the probability of a miscarriage. Most couples decide not to combine the PGS procedure with their treatment.

Does acupuncture help with fertility?

Two recent studies found an increase in conception rate among women undergoing acupuncture. A third study did not find a statistically significant improvement. It is possible to conclude from the available studies that acupuncture is safe for women undergoing advanced reproductive treatments.

What if I miss a Lupron injection?

This will probably not disturb your treatment. If you realize that you missed a dose before your next Lupron injection is due, take the missed dose when you remember and continue with your regular schedule. If you realize that you missed a dose when your next Lupron injection is due, skip the missed dose, do not double-up, and continue with your regular schedule.

Can I take over-the-counter medications for a cold?

Yes, you can take Tylenol, Sudafed (regular), and Robitussin DM. Please contact our office if you need to take any other medications.

Can I take the flu vaccination during my treatment?

Yes, you can take the injectable form of the flu vaccine.

Can I eat sushi while trying to conceive?

Once pregnancy is achieved, we recommend that you do not eat uncooked fish (e.g., sushi) or undercooked shellfish, eggs, or meat.

I have a cat. May I change the litter box during my treatment?

To prevent becoming infected with toxoplasmosis, an infection that isn’t serious for you but can pose a danger to your developing baby. You should not change the litter of a cat litter box once you become pregnant. We also recommend that you use gloves and a mask when you garden. Be cautious around the sand in parks or playgrounds.

Can I dye my hair during my treatment?

Once your embryos have been transferred, we recommend that you do not dye your hair through the first trimester.

May I soak in a hot tub or sauna?

Once your embryos have been transferred, we recommend that you do not soak in a hot tub or use a sauna, due to the possible detrimental effect of high temperature.

Is bed rest recommended after an embryo transfer?

It is not recommended from the conception point of view. Recent studies showed that resting after embryo transfer decreases the probability of implantation. You should start moving around immediately after your transfer.

The embryo stays unattached in the endometrial cavity for two to three days before it implants. Exercising and normal daily activities will not inhibit the embryo from attaching. The biological quality of the embryo will decide whether or not it will implant and continue to develop into a healthy baby.

Will my insurance cover the treatment?

Insurance plans vary widely. To determine if you have coverage for infertility treatments, we can call your insurance provider for you to confirm what, if any, benefits are available.

 

Please use the following links for information about reproductive treatments at Bay IVF and to schedule a consultation.

 

Request Information
or a Consultation
with Dr. Polansky

 

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