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Frequently Asked Questions (FAQs)
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How long will treatment take? |
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Treatment usually requires approximately 4-6 weeks. A majority of assisted reproductive
treatments (ARTs), such as IVF, GIFT, and ICSI, begin with ovarian induction or
stimulation. Ovarian induction is a fairly time consuming process. The goal is to
obtain enough oocytes to use during assisted reproductive treatments.
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What are possible side-effects/complications of the stimulation
phase of my treatment? |
Sometimes a patient suffers from pelvic discomfort, which occurs due to the increase
in ovarian size as multiple follicles begin to enlarge. If the pain is severe, a
patient may be given analgesics.
A patient may also suffer from abdominal distention (swelling). This occurs when
patients have a dramatic response to ovarian induction. Too many follicles develop,
and the patient can become extremely uncomfortable. Patients with polycystic ovaries
are often at risk of excessively responding to drugs administered during ovulation
induction, and the problem can eventually progress to a condition known as Ovarian
Hyperstimulation Syndrome (OHSS). If ovarian hyperstimulation occurs, a patient
is advised not to panic since the additional stress may negatively affect treatment.
The condition is manageable, and doctors will provide the patient with the care
they require.
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What treatment will I need after egg collection? |
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After egg collection antibiotic tablets (Gentamycin or Pencillin) are usually administered
for four days to prevent infection of the genital tract. During the egg collection
itself, antibiotics are given through an intravenous line. Flagyl is also inserted
after the egg collection to provide additional antibiotic cover. Aspirin is used
to help improve blood flow to the uterus and facilitate implantation. Finally, progesterone
(possibly in the form of Cyclogest) is often given to patients to help prepare the
endometrial lining for implantation. This drug is often commenced on the day the
egg collection takes place and is given until the pregnancy test. If the test proves
to be positive, then the drug continues to be administered for twelve more weeks.
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What happens to the extra embryos that are not transferred? |
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Embryos of good quality can be preserved in liquid nitrogen for future use. Low
grade embryos will be discarded. Cryopreservation is an additional service, and
will be charged a separate fee.
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How many embryos are transferred? |
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During ARTs, a successful outcome is not necessarily guaranteed. Therefore, multiple
embryos are often transferred to increase the chances of implantation. The success
rate for ART procedures is approximately 40-50%. Usually three embryos are transferred,
however, two may be transferred if the couple has favorable factors or if triplet
pregnancy is unsafe. The factors that contribute to the decision-making process
are the age of the patient, the number of previous pregnancies and live births,
the cause of infertility and its duration, previous failed treatments, and the quality
of the embryos preserved. Often the number that will be transferred is discussed
during the treatment phase, and is confirmed on the day of the transfer itself.
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What should I do after the embryos are transferred? |
After the embryos are transferred, we recommend that the woman relaxes for the remainder
of the day and for the next couple of days. This is no way implies that the procedure
requires strict bed rest after its completion. Strenuous activity is not advised,
even though there are no scientific studies that show that excessive activity negatively
effects implantation or pregnancy.
A pregnancy test is usually carried out about 10-14 days after the embryos are transferred.
If the test is positive, an ultrasound is used to confirm pregnancy approximately
2-3 weeks later.
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What are the complications of early pregnancy? |
Patients may suffer from lower abdominal pain and swelling, which is often an indication
of Ovarian Hyperstimulation Syndrome (OHSS). If discomfort and pain are severe,
a patient should contact their physician. OHSS requires careful monitoring and management.
The woman may also find herself suffering from vaginal bleeding. The bleeding may
be continuous, like that experienced during menses, or spotting may occur. In either
case, the patient should seek medical care since this can indicate that implantation
failed.
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What could go wrong with my pregnancy?
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Biochemical pregnancy
This is a situation when the blood pregnancy test is positive, however, no sac is
visible on the ultrasound. Another ultrasound is usually repeated approximately
1-2 weeks after the first scan. If the result is negative, the patient is told to
stop all medication.
Ectopic Pregnancy
This condition refers to any pregnancy where the embryo implants outside of the
uterus. Ectopic pregnancies are extremely dangerous. A rising level of beta-HCG
hormone in the blood without the presence of a gestation sac is often an indication
of this problem. Pelvic pain and vaginal bleeding can also be accompanying symptoms.
If an ectopic pregnancy is suspected, then laparoscopy will be conducted to confirm
the condition. A patient suffering from an ectopic pregnancy will then be hospitalized.
The incidence of occurrence of ectopic pregnancies during ART is extremely low (3%).
Abortion
In both natural and artificially induced pregnancies, abortion is a possibility.
Normally, abortion occurs in approximately 20% of natural pregnancies. Investigations
will be carried out in order to deduce the possible cause of repeated miscarriages.
Information attained may help shed light on the reasons for infertility.
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What are the chances of multiple pregnancy?
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A well-known problem of infertility treatment is the increased probability of multiple
birth. Most assistive reproductive centers have singleton birth rates of 60-65%,
twin birth rates of 30-35%, and triplet or more birth rates of 5%. During assisted
conceptive treatments, multiple eggs are often transferred. This is done in order
to increase the possibility of implantation and pregnancy. However, it may also
have the negative side-effect of resulting in multiple births. It is very difficult
to find a balance between success and failure with these expensive, lengthy, and
often emotionally draining procedures. Therefore, in order to possibly realize a
dream, sometimes undesired consequences must be accepted.
Measures, such as blastocyst transfer, are being taken to try to reduce the possibility
of multiple birth. If a patient becomes pregnant with triplets or more, a doctor
can perform an embryo reduction procedure.
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Are there any long term complications of fertility treatment?
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There is no scientific evidence indicating that fertility drugs increase the probability
of ovarian cancer. However, it is still advised that these drugs only be administered
by a specialist in the field.
There is also no evidence proving that ovulation induction can cause early menopause.
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Will my baby be normal following assisted reproductive treatment? |
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Presently, the incidence of birth defects or abnormalities in children conceived
through the use of assisted reproductive treatments is similar to that of children
conceived naturally.
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What factors influence the success of infertility treatment? |
Age of the Female In women, fertility is age dependant. The older a woman becomes
the more difficult it can become to attain pregnancy. The probability of ARTs being
successful is about 30% for women under the age of 38 years of age. For woman above
38 years of age, this number decreases drastically to approximately 15%.
Cause of Infertility Certain causes of infertility are easier to treat than others.
Anovulation (lack of regular egg production) can be treated through hormonal therapy
and often proves successful. However, severe Fallopian tube damage, endometriosis,
uterine pathology (cysts, fibroids, polyps), and severe male infertility factor
can be very difficult to treat. Also, research is still necessary for certain areas
of infertility treatment. It can be difficult to ascertain the cause of problems
with implantation, and it can also be difficult to evaluate the genetic potential
of embryos to produce babies.
Duration of Infertility The longer the duration of infertility, the lower the chance
of attaining pregnancy. Therefore, even with infertility treatments couples suffering
long term infertility problems may find it difficult to ever become pregnant. Every
couple should ensure that they receive the most appropriate treatment in a timely
manner. Hayat promises to provide each couple with the most advanced treatment available
and with the emotional support needed.
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What are some of the problems that can occur with IVF?
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Ovulation Induction (OI)
The main problem that can occur during OI is Ovarian Hyperstimulation Syndrome due
to the administration of gonadotropins. OHSS is very rare, however it can be serious.
The ovary tends to enlarge due to excessive follicular development. This can cause
the patient to suffer from bloating, dehydration, and nausea. Fluid can collect
around the abdominal organs, and in severe cases around the heart and lungs. This
can cause blood clots and strokes. If the ovary becomes too large in size, it may
rupture and cause abdominal bleeding. In serious cases of OHSS, removal of abdominal
fluid is sometimes required.
Oocyte Retrieval
Problems during and after egg retrieval are rare, since the procedure is done under
the guidance of an ultrasound probe. However, in very few cases internal bleeding,
vaginal bleeding, and infection occur.
Insemination and Fertilization
Several problems can occur during this step in IVF. First of all, the sperm may
not fertilize the eggs within the first 24 hours. The unfertilized eggs do not have
an extremely long life span, therefore fertilization failure is a serious problem.
Re-insemination will usually not help, since eggs cannot usually be fertilized after
the first day. Another problem that can occur during fertilization is polyspermy,
or when more than one sperm fertilizes the egg. These embryos have abnormal chromosomal
numbers and cannot be used for transfer. If fertilization occurs normally, problems
can arise during cleavage. The embryo may stop dividing, and cleavage arrest may
take place. These embryos can still be transferred, since sometimes division begins
again within the uterus. Fragmentation of the embryo may also result. If fragmentation
is severe, the likelihood of pregnancy is reduced. However, if it is mild then transfer
can still take place. There is no evidence of mild fragmentation showing an increase
in the probability of children with abnormalities or birth defects.
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Are IVF injections painful? |
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Most of the injections can be administered sub-cutaneously, and therefore they are
not extremely painful. Also in some cases, nasal sprays are now available for medications
that previously required injections. The only injection that may prove slightly
painful is the HCG injection, which is given intramuscularly. Even progesterone
is available as a gel or suppository.
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Are IVF procedures painful? |
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The only procedure that may prove painful or be considered a minor surgery is the
egg retrieval process. However, the patient is usually given general anesthesia
during this process, and afterwards medication can be given to alleviate pain caused
by cramping.
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Can I travel after the completion of the Egg Transfer procedure?
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Travel in both cars and pressurized aircrafts is completely acceptable. The patient
is advised to stay hydrated throughout the flight. Patients can leave the day after
the egg transfer procedure.
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Am I using all my eggs by doing IVF?
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During a normal cycle, the ovary selects one egg from several eggs to complete maturation
and ovulation. The other eggs disintegrate, or undergo a process known as atresia.
Ovulation Induction simply allows the harvesting of the eggs that would have otherwise
disintegrated and died. As a result, a woman is not using up all her eggs by partaking
in IVF.
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