Am I A Good Candidate for IVF Treatment?

Frequently Asked Questions: Fertility FAQ

Learn from our list of Frequently Asked Questions from New Hope Patients

  1. How does age affect my ability to get pregnant?

    The prime reproductive age range for women is between 16 and 28, although one can usually count on good quality eggs until the age of 38. From ages 39 to 44, women may retain viable eggs, but have a lower probability for a successful pregnancy. If you are not ready to start your family right away, you may want to consider some of our fertility preservation treatments. We are also always happy to talk with potential patients and discuss options and find solutions that match their personal needs. Please consider contacting us for a consultation.

     

  2. How does FSH affect my ability to get pregnant?

    When ovaries have difficulty producing mature eggs, the brain releases a hormone from the pituitary gland called FSH, which stimulates the ovaries and encourages the body to produce more eggs. For a woman in her prime reproductive years, a normal FSH level is typically under 10, while an abnormal level is considered to be anything above 25. Measurements between 10 and 25 are generally classified as borderline. Because higher FSH levels are correlated with lowered egg production, many clinics turn away women with high FSH levels. Although the probability for pregnancy decreases as FSH and age increase, we understand the possibility or pregnancy still exists as long as a woman is still ovulating. At New Hope Fertility Center, our advanced protocols and technology allow us to accept women no matter how high or low the FSH level.

    Through techniques such as Mini-IVF™ and Natural Cycle IVF, we are able to focus more on the quality of eggs rather than the quantity of eggs. Numerous women have become pregnant through their customized fertility care at New Hope after being turned away or told they could never conceive by other fertility centers time and time again. Each time this happens, we reaffirm our belief that all it truly takes is one good egg.

    Please consider contacting us for a consultation.

     

  3. Can I still do IVF even though my cycles are irregular?

    Yes, but the course of treatment will depend on the reasons for the irregularity. If you have diminished ovarian reserve or slow follicular development, your treatment and monitoring schedule may be adjusted. Please consider contacting us for a consultation.

     

  4. If I have no antral follicles visible on an ultrasound at the beginning of my cycle, will I still produce an egg?

    It is a definite possibility but it will likely take longer for the follicles to mature. If you are thinking of trying to get pregnant, please consider contacting us for a consultation.

     

  5. I have had two ectopic pregnancies, and, as a result have had my fallopian tubes removed. Do you have treatment for me?

    Yes. IVF treatments would be an excellent solution for someone who has had two ectopic pregnancies and subsequently had to have their fallopian tubes removed. We have a variety of IVF treatments to consider, and in your case — if your primary issue is a tubal issue, and you feel that you have good quality eggs or sperm, Natural Cycle IVF (NIVF) is an excellent option because there is little to no risk involved (since we don’t use medications or alter hormone levels at all). Please consider contacting us for a consultation.

     

  6. I have had my uterus and/or appendages removed. Could I be a good candidate for IVF?

    Unfortunately if you don’t have your uterus, fallopian tubes, or ovaries, IVF would not be an effective treatment for you. We would suggest looking into using an egg donor and gestational carrier. More information on egg donor program can be found here and information on gestational carriers can be found here.

     

  7. Could long flights affect the risk of miscarriage?

    Generally speaking we don’t associate flying with any miscarriage problems — and there are no scientific/medical studies that we know of that would suggest that this was something to worry about.

     

  8. Does New Hope recommend ICSI even for healthy sperm?

    No, it’s not necessary.

Health Disorders and Trying to Conceive

  1. I am trying to get pregnant, but have been told that it is harder for me because I once had Chlamydia. I have been treated and am fully recovered. How come I am still affected by the Chlamydia even though it is gone?

    In women, untreated infection can spread into the fallopian tubes and cause the tubes to become blocked at the ends. This is known as hydrosalpinx. They can also develop scar tissue around the fallopian tubes that makes it more difficult for the tube to pick up the egg at the time of ovulation. These particular problems can lead to infertility and an increased risk for ectopic (tubal) pregnancy. We would be very optimistic about an effective fertility treatment with IVF for you based on the information you provided and would love to talk to you about a wide variety of IVF options (Conventional IVFMini-IVF™, or Natural Cycle IVF (NIVF)). Please consider contacting us for a consultation.

     

  2. I have Chronic Autoimmune Hepatitis. Could I be a good candidate for IVF?

    Chronic Autoimmune Hepatitis (AIH) is often associated with liver damage and can contribute to fertility problems. One of the classifications of AIH is positive Anti-Nuclear Antibodies (ANA). While anti-nuclear antibodies are present in small amounts of the population (roughly 5%), high amounts of these antibodies are linked to fertility problems, including unexplained infertility and miscarriage. In fact, many women with high levels of anti-nuclear antibodies are unable to conceive or to carry a pregnancy to term. Irregular anti-nuclear antibodies levels are also linked to implantation failure and miscarriage due to the inflammation of the uterus and placenta connected with anti- nuclear antibodies. An abnormal presence of these cells in the body is also linked to a low pregnancy success rate for methods of assisted reproduction, especially intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) — however these are still options that we could talk to you about. Please consider contacting us for a consultation.

     

  3. I have Ascherman’s Syndrome. Could I be a good candidate for IVF?

    Asherman’s syndrome is the term used to describe the presence of scar tissues (adhesions) between opposing endometrial surfaces inside the womb cavity. The adhesions can be mild or severe, causing significant damage to the womb cavity. Scar tissues inside the womb may interfere with embryo implantation during IVF treatment and ICSI treatment as well as increasing the risk of miscarriage. Mini-IVF™ may be a good option for you, but a lot would depend on the severity of the syndrome and how extensive the scarring is. Please consider contacting us for a consultation.

     

  4. I recently had a hysteroscopy and was told that I have emdomedtriosis. Would I be a good candidate for IVF?

    Endometriosis is a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility. IVF is one of the recommended treatments for women who suffer from infertility because of endometriosis. IVF treatments may be a good option for you, but a lot would depend on the severity of the syndrome and how extensive the scarring is. Please consider contacting us for a consultation.

     

  5. I was told that I had myoma detected in my uterus. Could I be a good candidate for IVF?

    Many studies have been conducted to study IVF success after the treatment of uterine myomas and most conclude that, if properly treated, IVF treatment should be able to result in pregnancy. Please consider contacting us for a consultation.

Fertility Medication

  1. How many days will I be on stimulation medication before retrieval?

    Most women are usually on medication for 9-13 days.

     

  2. Do fertility drugs cause cysts?

    Occasionally, depending on the previous type and dosage of medication used in the previous month. Sometimes a follicle that did not mature in one cycle may evolve into a cyst which appears the following cycle. Additionally, an hCG injection can sometimes facilitate cyst formation. Cysts do not necessarily mean that you cannot begin another cycle.

     

  3. I have heard that Femora is a cancer drug. Why do you prescribe it to treat infertility?

    Both clomiphene citrate (Clomid), and letrozole (Femora) are oral medications used to stimulate ovulation. Letrozole is emerging as a viable alternative to clomiphene citrate for women undergoing ovulation induction and ovarian stimulation, although no broad scientific studies have established the drug’s efficacy as the first course standard treatment. Several preliminary studies have shown letrozole to be useful, producing few side effects, especially for women whose uterine lining may be thinned out by clomiphene citrate. As to its exact mechanism, letrozole falls in the category of drugs known as nonsteroidal aromatase inhibitors, meaning it is highly specific in suppressing estrogen synthesis. Aromatase is an important enzyme prompting the creation of estrogen. If the body makes less estrogen, FSH level increases, follicular development increases, and ovulation is stimulated. Letrozole was originally developed for breast cancer treatment, as certain types of breast cancer cells slow their growth in response to decreasing estrogen levels. Some time ago, one journal published an article about a study in Canada in which a very limited number of patients showed an increase of neural tube defects in the fetuses of women who had taken letrozole. However, there have been several subsequent larger studies which did not substantiate these findings. Since letrozole does not block the estrogen receptors, it is less effective than clomiphene citrate in preventing LH from surging. Therefore, on rare occasions, premature ovulation can occur, which is why we monitor our patients taking letrozole more frequently. We have also observed that clomiphene citrate works better for our younger patients, but we do not have conclusive data to support this yet. Generally, clomiphene citrate is used for women who are freezing embryos, whereas letrozole is used for older women who are doing fresh embryo transfers. At New Hope Fertility Center, we evaluate each patient’s individual needs and circumstances and choose medications accordingly. Letrozole has shown to be particularly helpful for a subset of women whose endometrial lining may become thin while taking clomiphene citrate. As an anti-estrogen, clomiphene citrate can limit the development of the endometrial lining, which we believe makes it more difficult for an embryo to implant. For reasons that aren’t quite yet clear, letrozole appears less likely to affect the uterine lining. Furthermore, letrozole has a short life span in the body, whereas clomiphene citrate can last for 4-6 weeks following an oral dose. At New Hope Fertility Center, we are pleased with the results seen so far with letrozole and we look forward to seeing the outcome of studies that are underway to further assess its efficacy as standard treatment.

     

  4. I have heard that Clomid is bad for older women. Why do you use it for older women?

    The fertility care specialists at New Hope Fertility Center do not believe that Clomid is bad for older women. Older women do even better with natural and low stimulation cycles with the use of Clomid. Bear in mind that Gonal-F and Follistim are man-made FSH themselves. Repronex contains natural FSH, extracted from menopausal women because their FSH is very high. Clomid works by tricking the pituitary gland, causing a woman’s body to produce additional FSH. In older women or “poor responders,” we usually find high baseline FSH or “day 3” FSH due to lower ovarian reserve. These women generally produce higher FSH in response to Clomid, as demonstrated by responses to so-called “Clomid Challenge Tests.” Clomid also provides gentler stimulation than injectables, and therefore does not recruit follicles that are not ready for the antral stage. This results in higher quality of the eggs retrieved and allows eggs which are not ready to have additional time in the ovaries. Clomid allows the woman’s body to select the best eggs instead of just more eggs, letting the embryologists and lab incubator select the best specimens through in vitro embryo development.

     

  5. I have heard of studies that link Clomid to birth defects and other ailments. What is your take on these studies?

    The sample size for studies like these have historically been very small, so it’s hard to draw conclusions from them. The population used in these studies usually has fertility issues, medical issues, and advanced age — so right off the bat, you are looking at women who are very different from the general population — so the factor-link structure is poor for a study like this.

     

  6. How do you know I won’t ovulate before my retrieval? If I don’t take Lupron, how can this be controlled?

    During the middle of a woman’s menstrual cycle, when the lead follicle reaches 16-18 mm in diameter, the estrogen level reaches its peak. This estrogen peak triggers the estrogen sensor – the receptors in the brain – through so-called “positive feedback,” and tells the highest hormone-producing command center (the hypothalamus) to produce Gonadotropin Releasing Hormone (GnRH), which in turn tells the intermediate command center (the anterior pituitary) to produce Leutenizing Hormone (LH). The surge of LH triggers the final maturation of the egg. In conventional IVF, lupron (GnRH analogue) is used to down regulate (disable) the hypothalamus from producing GnRH in order to prevent a sharp increase in LH. Clomid, an estrogen antagonist, blocks the estrogen sensor, which then blocks the positive feedback loop so the hypothalamus does not receive the signal to release a larger amount of GnRH. Clomid works as efficiently as Lupron in preventing premature LH surge.

     

  7. Why do you use a nasal spray to trigger ovulation, instead of an hCG injection?

    Due to the fact that natural LH(Lutenizing Hormone that triggers ovulation) is short-lived and very expensive to produce synthetically, conventional IVF uses a hormone from the human placenta called Human Chorionic Gonadotropin (hCG), or Ovidrel (synthetic hCG), as alternatives in order to induce final egg maturation, or the “triggering” of ovulation prior to egg retrieval or IUI. The problem with hCG is that due to its long half life, it lasts much longer in the human body than natural LH and is more potent. Furthermore, in order to properly induce final oocyte maturation, a large amount of hCG (typically 10,000 IUs) is required, which is roughly the equivalent to double the amount of total gonadotropins a patient typically receives in a conventional daily injection protocol. HCG not only induces ovulation, but also stimulates small follicles which might then be recycled only to become cysts in the following cycle. It is common to find cysts in patients after cycles using hCG injections. On the other hand, using a GnRH agonist called Synarel (synthetic Lupron) in a diluted form taken as a nasal spray, serves to stimulate the pituitary to produce a surge of LH, resulting in timed ovulation. It is high enough to induce ovulation in larger follicles, but too short-lived to stimulate small follicles. This allows the body to cultivate those smaller follicles for upcoming cycles rather than stimulating them prematurely and causing them to become cysts. This increases the likelihood of the production of healthy eggs and also allows women to cycle repeatedly without taking breaks. This is especially advantageous for older patients and those with limited ovarian reserve.

     

  8. I have heard that using OCPs (aka BCPs) can cause over suppression and cause my ovaries not to respond. Why do you use OCPs for some women?

    Some of our patients are given OCPs to regulate their cycles. Oversuppression is not a concern, because once FSH starts to stimulate antral follicles, the follicles will grow. OCPs may just slow down the response time. Also, OCPs serve to suppress the ovaries prior to the start of a cycle, making it more likely for follicles to develop together rather than producing a dominant follicle that is ready for ovulation before the other follicles have a chance to mature. In order for an egg to develop in the ovary and then be released, several hormonal events must take place. An area of the brain called the hypothalamus is responsible for regulating the hormonal signals that start the process. The estrogen in the pill shuts off these signals from the brain that tell the ovary to develop and release an egg. Without these signals, the egg does not develop and is not available to be released (ovulated) and pregnancy cannot occur. In addition, the pill has a few other effects on your body that decrease the likelihood of pregnancy. One of the hormones in the pill, progestin, makes the mucous thicker in the cervix and tubes so that it is more difficult for sperm to pass into the uterus and more difficult for the egg to move down the tube. Also, the progestin in the pill causes changes in the uterine lining that hinder implantation of the fertilized egg. When used in fertility care, the pill’s ovarian suppression characteristics serve to “quiet” the ovaries. This is meant to allow a stimulated cycle to begin with all of the follicles at the same stage of development. Hopefully, this prevents a “lead follicle” from developing and increases the chances of having more follicles mature at the same time. BCPs do not negatively affect fertility. There is no evidence to indicate that BCPs have anything but a short-term effect on the body. If someone has been on the pill for an extended period of time, there is no reason to wait after stopping the pill in order to begin fertility treatment. In fact, it is advantageous to begin a stimulated cycle immediately after stopping the pill. Many people express concern about “over-suppression” with the pill. In some women, the pill has a more suppressive effect than in others, but the only result of this is that it may take some more time for the hormone levels to reach the point where stimulation becomes effective.

     

  9. Why do you add some injectable FSH for some women during a cycle?

    When a patient does not produce enough additional FSH with Clomid or Femora (most often these are patients with low baseline FSH), we sometimes add additional FSH to the protocol to help follicular development. This, of course, depends on the hormonal circumstances for each individual patient. That is why we customize treatment for each patient.

Egg & Embryo Freezing

  1. What is vitrification?

    Vitrification is a flash freezing technique that has up to 98% survival rate for eggs (oocytes) and embryos, compared low survival rate found with the traditional slow-dunk method. At New Hope Fertility Center, we prefer single embryo transfers to avoid the complications of multiples (twins, etc.). That means you may produce more embryos than you transfer each IVF cycle, and thanks to vitrification’s more than 90% egg and embryo survival rate, you can count on your extra preserved embryos for future use. Whether you are a single woman preserving your fertility, a couple delaying or timing child bearing, or a woman undergoing cancer treatment, you will find vitrification an invaluable option for egg freezing and embryo banking.

     

  2. I have heard that freezing embryos causes damage. Why do you do so many frozen embryo transfers?

    Freezing embryos using a traditional “slow-dunk” method can damage them, and the thaw-survival rate can be lower than 50%. Our lab at New Hope Fertility Center was one of the first in the U.S. to use a flash-freezing technique called vitrification. The use of vitrification for human embryos was pioneered by the Kato Clinic in Japan, with which we are proud to be affiliated. With this technique, ice crystals do not form during the freezing process, leaving no damage to the embryos when they are thawed. Our frozen embryo survival rate is as high as 98%.

     

  3. I’m 38. My husband and I are trying to get pregnant at another clinic using conventional IVF and conventional egg freezing techniques. We have tried three times over eight months since there was wait time between cycles, but so far have been unsuccessful. I want two additional children. Is this possible? I’m worried I may be running out of time.

    At 38, the national live birth rate is 29%  for fresh embryos from Non-Donor Oocytes (as reported by SARTCORSONLINE) if 2.3 embryos are transferred.. If you want two children in the future and you continue with conventional IVF and a conventional freezing method, you would typically plan 3 IVF attempts for each child (so 6 attempts total), meaning that you will need roughly 18 embryos. With the traditional slow-dunk freezing method only half of your embryos will survive, meaning you’ll need to have produced double the embryos (36). We recommend you bank these embryos during your next few cycles before getting pregnant (meaning, don’t do any transfers until you have 36 embryos in your bank). Why? Because if you get pregnant at 38 the earliest you can start retrieving embryos again is 39, assuming you will start right away. The older you get the lower the quality of your eggs is, and the lower your likelihood of getting pregnant is. The big question is whether or not you should continue to use conventional IVF. If you decide to use your next few cycles to bank embryos, then Mini-IVF™ would be a better option for you since there is no wait time between cycles, diminishing the risk involved in having to wait and losing quality eggs as you get older. Additionally, if you chose a clinic that used our vitrification method for flash freezing (as opposed to conventional slow-dunk freezing), you would need to freeze only half the embryos, only needing to produce 18. If you are thinking of switching to Mini-IVF and vitrification, please consider contacting us for a consultation.

Male Factor Infertility

  1. My husband and I think that he may have very little sperm (azoospermia). Can he still get me pregnant?

    Azoospermia can only diagnosed and treated with sperm aspiration. If this is indeed the case, then the only way to use the sperm would be through IVF. Please consider contacting us for a consultation.

     

  2. My husband had a semen analysis that showed large amounts of sperm morphological problems. Can this be treated with IVF?

    IVF and ICSI would be good solution for low quantities of viable sperm. We would encourage you to contact us for a consultation.

     

  3. Would you recommend ICSI even for healthy sperm?

    No, it’s not necessary.

     

  4. Is it true that ‘natural selection’ helps the fittest sperm fertilize our eggs — whereas ICSI may use weak sperm?

    The premise that natural selection works with sperm is somewhat speculative. Additionally, we choose robust sperm when we use ICSI, so this would not really be an issue even so.

The New Hope Difference

  1. What is your methodology regarding IVF and older women?

    Our methodology involves the use of less medication and drugs — we work with your body to proceed as naturally as possible and retrieve your best, healthiest eggs. We work with each patient as an individual to customize a plan based on your unique cycle and hormone levels.

     

  2. Why don’t you put people to sleep during egg retrievals? Doesn’t it hurt?

    Because a majority of our patients do minimal stimulation IVF, most patients produce only a few (but the high quality) follicles, making for a quick egg retrieval process. We use a small, more flexible needle than most doctors, which is less invasive and causes less discomfort. When a patient produces a large number of follicles in each ovary, the highly stimulated ovary is large and tender, making retrieval painful; however, with minimal stimulation, ovary size remains very similar to that in a natural cycle making them less sensitive and easier to puncture during retrieval. Since most of our patients are awake doing the procedure, we are able to explain each step so that they can understand and follow along without any mystery. The patients also know immediately how many eggs are retrieved. We have a monitor set up with a view from the microscope, so that the patient can see the embryologists working as it is happening. Most patients tolerate these retrievals fine. All we recommend is taking 500mg of Tylenol one hour before the procedure and a small amount of valium a half hour before the procedure to help you relax without putting you to sleep. If a patient has a particular problem and needs to be sedated for some reason, we will do so. There is an additional cost for IV sedation since an anesthetist is required to be present. We will talk to you about the options in order to help you make a decision you are comfortable with.

     

  3. Is New Hope Fertility able to do ovarian transplants?

    Yes, we can do ovarian transplants, but would need some kind of indication for why this was the necessary course of action. Please consider contacting us for a consultation.

     

  4. Does New Hope Fertility test for things like Duchenne Muscular Dystrophy and Charcot-Marie-Tooth Disease in their Preimplantation Genetic Diagnosis (PGD)?

    Yes, we can test for Muscular Dystrophy as well as Charcot-Marie-Tooth Disease in our PGD screening. A full list of genetic diseases that PGD can screen for are listed here.

     

  5. Does New Hope Ferrility recommend PGD?

    In an ideal world we would recommend PGD for everyone. You are in good hands at New Hope so an embryo biopsy will not damage the eggs. The pros are that you learn a lot about your embryo and can make maximally informed decisions. The cons are primarily the cost, and to a lesser extent, the 1.5% error rate — so while you can have confidence in the findings, they still aren’t infallible.