In Vitro Fertilization Answers
How long does an egg retrieval take?
Egg retrieval is a fairly rapid procedure. Obviously the length of the procedure depends on how many follicles are present. Also the accessibility of the ovaries will determine how long the procedure will take. Accessibility means how easy is it to reach the ovaries with the ultrasound probe, whether they have a tendency to move away from the probe and so on. The typical egg retrieval will take from 20-30 minutes.
Is the egg retrieval painful?
We do our egg retrievals under anesthesia so the patient is asleep for the procedure. Our anesthesiologists use medications which heavily sedate the patient so she is "asleep" however, she is not anesthetized so that breathing tubes are not necessary. The beauty of this approach is that the patient feels absolutely nothing, remembers absolutely nothing, and has few if any of the typical side effects of anesthesia such as nausea and vomiting.
Will the egg retrieval damage my ovaries?
The data we have available tells us that it does not. There have been many women who have undergone multiple egg retrievals. The fact that they have responded to stimulation on subsequent occasions and gotten eggs and pregnancies on these occasions implies that the ovaries are OK after egg retrieval. There have been some limited studies looking at the appearance of the ovaries in women who have had egg retrievals and subsequent laparoscopic surgery. In those patients, the findings were normal. Of course we simply have no data as to long term outcomes because IVF and egg retrievals have only been done since 1978, however our opinion, and that of the medical community, is that egg retrieval is a safe procedure where the benefits outweigh the risks.
Is bleeding expected after the egg retrieval?
Vaginal bleeding is not uncommon after an egg retrieval. Usually this bleeding is from the needle puncture sites in the vaginal wall. It is usually minor (spotting).
Is it normal to retrieve an egg from every follicle?
Not necessarily. Although we will usually get an egg from most mature sized follicles, most women will have a mixed group of follicles after ovulation induction. Some of those follicles will have immature eggs or post mature eggs which may not be identifiable so they will seem to have been "empty" follicles.
Is the embryo transfer painful?
The embryo transfer does not require any anesthesia. It is performed using a speculum that allows the doctor to see the cervix, (like a Pap smear) and is very similar in technique to an intrauterine insemination (IUI). Usually the woman feels only the speculum and nothing else.
Is bed rest recommended after the embryo transfer?
It is really not necessary from the conception point of view. In nature, the embryo floats freely in the endometrial cavity for a number of days before implantation and it will do the same in an IVF cycle. We do recommend that our patients take it easy following transfer, but routine work activities are certainly reasonable. If there is an increased risk of Ovarian Hyperstimulation, we will recommend prophylactic bed rest.
What are the chances of multiples with IVF?
When the above criteria are followed, approximately 25-30% of pregnancies are multiple. The vast majority of these are twin pregnancies. The rate of triplets is approximately 5% and that of quadruplets is much less than 1% when the above criteria are followed. These odds are related to the number of transferred embryos.
Can anything be done to improve embryo quality?
Ultimately the answer is no. If an embryo is of poor quality because it is genetically abnormal, there is nothing that can be done to salvage it. However, there are procedures which we do that can improve the chances of a borderline embryo. These include carrying aspiration of fragments as well as assisted hatching. It has been shown that procedures such as these can increase implantation rates in couples with a poor prognosis.
Is assisted hatching performed on all embryos?
In some cases yes. We have good data showing that in some groups (e.g. women over 38 years of age, previous failed IVF cycles, unusually thick zonae pellucida) assisted hatching will increase the implantation and pregnancy rates. There has only been one study carried out looking at the impact of performing assisted hatching on every single embryo of all couples and the conclusion was that it did not increase the expected pregnancy rates. Is summary, assisted hatching is certainly helpful in some cases but is probably not necessary in all cases.
What is done with any "leftover" embryos?
Embryos which are not transferred in the retrieval cycle are maintained in culture for an additional 2-3 days. Those embryos which progress to the blastocyst stage can then be cryopreserved, if that is the couple's wishes.
How soon after IVF can a pregnancy test be performed?
Since hCG is used to finalize egg maturation and to schedule egg retrieval, a pregnancy test (which is a measurement of hCG hormone in the urine or blood) will be positive for a number of days following egg retrieval. Some women will metabolize the hormone quickly and it will be out of the blood stream in a couple of days, while others may take up to 9 days to do so. Simultaneously, a pregnancy starts secreting hCG in measurable amounts in the blood approximately 1-2 days before the expected period. Keeping these two issues in mind, then, we recommend that a pregnancy test be performed 12-14 days after the egg retrieval
Is there an increased risk of birth defects related to IVF?
This issue has been looked at extensively. The simple answer is that there is no increased risk of birth defects after IVF. Human beings have an overall rate of birth defects of approximately 2% at birth. The rate has been shown to be the same for IVF pregnancies. There is some recent data showing that there may be a minimal increase in this rate among those pregnancies established by means of IVF with ICSI. The increase was found to be in the 1% range. For more information about the risks of IVF, please read this ASRM fact sheet: /media/assets/risks of ivf.pdf
Are there limitations on the number of IVF tries per couple?
We find that most couples will get pregnant within 2 tries. Occasionally, there may be a reason to do a third attempt but that is not common. More than this would really require extenuating circumstances such as a miscarriage due to a non-recurring reason.