5 Questions...I get about IVF

Certain questions often come up when I discuss IVF with patients. Not surprisingly a simple google search of "myths and misunderstandings of IVF" provides easy access to many listicles some from Fertility clinics and others from special interest groups/patient support group blogs.

I am still waiting for Buzzfeed to make its list. Oh wait, they sort of did.

Some of the more common questions I get are listed below after the break. The most important piece of advice is to encourage patients to ask questions and make sure they are getting satisfactory answers from their providers.
1. Can I exercise during the IVF process?

Yes, but...When the IVF process starts you are begin giving yourself injections to grow the available follicles in your ovaries. Over the course of a 8-12 day period, your ovaries are going to grow to as much as 10x their "normal" size. This can lead to fullness, bloating and overall discomfort. While not all women will experience this feeling patients are advised to reduce their exercise intensity during this time and to hold off on exercising the days leading up to their egg retrieval and the days through their embryo transfer.

Furthermore, patients are cautioned that intense activity could put enlarged ovaries at risk of twisting during the IVF process which can lead to severe abdominal pain and is a surgical emergency requiring surgery to "untwist" the ovary. 

2. I've never been tested for endometriosis? Should I be?

Depends on what your primary goal is: pain control or pregnancy. The answer depends on the individual patient and their medical history and ultimately health goal.

The gold standard for diagnosing endometriosis is by laparoscopy. Patients with a history of painful periods that improved while on birth control pills may be at risk for having endometriosis, but if, after discontinuation of birth control pills. 

Up to 50% of women who walk into an infertility clinic might have a diagnosis of endometriosis, but many of these woman are asymptomatic with the sole objective of getting pregnant. 

Most patients who walk into a fertility clinic are focused on getting pregnant and therefore fertility specialists tend to approach their treatment accordingly. Your doctor will evaluate your medical history to see if you are at risk and will advise accordingly. 

3. What are the side effects of IVF medications?

Check out this information sheet from the american society of reproductive medicine. Very thorough.  Still looking for more detail - check out the drug information pages from the drug companies themselves (Follistim, Gonal F, Menopur/Bravelle).

4. How do you select which embryos are transferred?

Briefly, non invasive techniques are preferred, but embryo biopsy and comprehensive chromosomal screening (PGS) of the embryos for aneuploidy is becoming more common, but may not be for everyone. All clinics will make a morphologic assessment of the embryos based on certain features that are common among embryos that are more likely to lead to pregnancy. Each clinic has slight variation so it is important to ask your doctor how they select which embryos to transfer.

5. So when do I start my IVF stimulation?

The time from initial visit to IVf start varies and it depends on what tests have or have not been done as required by your doctor. Typically some sort of uterine cavity evaluation should be performed, STD screening, semen analysis and an US to make sure your ovaries are accessible. These can be done in one cycle with the plan to start IVF stimulation with the subsequent menstrual cycle (~4 weeks later) Once the patient is medically clear they are schedule. Much if this timeline depends on where the woman is in her cycle when she has her initial visit and what testing she has had prior.