Please scroll through the categories to the left locate the question you are looking for, or feel free to e-mail us if you cannot find the question or answer you are looking for. If you are a patient with a question about your current care at New Hope Fertility Center, please contact the office directly or fill out a patient reqest form.

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

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

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

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

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

5. 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? 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.