Q & A Sessions: In Vitro Fertilization
(IVF)
Our experienced Penn Fertility Care physicians answered
your questions about in vitro fertilization (IVF).
To learn more, read about our IVF
services.
Hopeless asks:
Earlier this year, my husband and I tried
IVF and had no luck. We desparately
want to have a child together. I
have a 15 year-old from a previous
marriage. Unfortunately, our insurance
does not cover it. Is there any financial
aid available? Also, is there any
other procedure that we could try?
I don't have any tubes tied so I
guess we are limited.
I seemed to make eggs fine (with
medications) and his sperm was excellent.
However, the egges we used didn't
grow to full blast and the doctor
said that this wasn't a factor. Can
you give us some sort of direction?
I'm out of answers and do not know
what to do next.
Response:
In order to address your problem properly,
a consultation would be necessary.
However, it seems that IVF may be
your only option. To schedule an
appointment with a Penn Fertility
Care specialist, please call 1-800-789-PENN
(7366) or visit pennhealth.com to schedule
an appointment online. |
Candy asks:
I have been under the care of a fertility
specialist for the past three years.
I have had three miscarriages. Two
of the pregnancies were achieved
through IVF and one through Clomid
and intercourse. I have had extensive
tests done to find out why the pregnancies
don't make it past the first trimester.
The longest pregnancy was nine weeks
(that was my first). The second pregnancy
ended at eight weeks with the last
HCG reading being over 7,000. The
third didn't make it past five weeks.
The doctors can't seem to find anything
wrong and tell us that we are "able"
to have children and to keep trying.
However, I am concerned that there
is something wrong that they haven't
found yet.
What would you do for a patient in
my situation? I even had the test done
that tells if clotting is a factor
in the misses. The embryos that have
been transferred have all been the
highest level on their scale. The only
thing they haven't tested is the miscarriage
tissue. I know this is a long statement
but we just don't know what to do next.
We are thinking of trying another doctor.
That is the reason for this question.
Kurt
Barnhart, MD, MSCE responds:
I am sorry for your losses. Now is
a good time to have someone with fresh
eyes look at your entire case. That
would allow an expert to see if all
tests have been performed to help you.
Overall, you still have a very good
chance of having a healthy baby. If
you do have a loss again, it does make
sense to have the tissue examined.
|
Michele asks:
I am wondering what steps are involved
in a frozen embryo transfer (FET)?
I have a one year old that was concieved
through in vitro fertilization (IVF)
and I have eight frozen embryos.
I was wondering how long a FET cycle
takes and what medications are involved?
Kurt
Barnhart, MD, MSCE responds:
I am so happy to hear about your
success with IVF. Protocol for an
embryo transfer differ a little bit
depending on the program. Our program
uses lupron to suppress your cycle
and them we rebuild the lining of
your uterus with estrace (pills).
We check your lining with an ultrasound
and blood work and if you are ready
to go we thaw the embryos. You then
start progesterone at least until we
find out if you are pregnant. Hopefully
you are, and then we continue the progesterone
until 10 weeks gestation. |
Meera asks:
I suffer from endometriosis and underwent
surgery for a bilateral ovarian cyst
five years ago. Now my husband and
I, both 29, have been trying for
conception for one year. My husband
has asthenozoospermia.
Is IVF the only option? Do foods
containing phytoestrogens help? What
are our success chances through IVF?
Samantha
Butts, MD responds:
Making the decision for any treatment
for infertility certainly requires
the help and consultation of a specialist
and if you have not seen one yet, I
would recommend making
an appointment. At that time, the
physician who sees you will be able
to interpret the entire health work-up
you've had, potentially make recommendations
for additional evaluation and the suggest
treatment options that would work for
you.
IVF as a first line treatment of infertility
is usually reserved for select patients
who have specific diagnoses, but depending
on how aggressive you want to be with
your treatment and your evaluation,
your physician can discuss with you
how appropriate IVF is for treatment.
I don't know of any good quality studies
looking at phytoestrogens for the treatment
of infertility. I would consult with
your physician before taking any treatment
that does not have an official indication
for infertility treatment.
If you would like to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or you can also request
an appointment online. |
Heather asks:
There is a lot of information available on the use of acupuncture (and herbs)
to enhance fertility and increase success rates of IVF. Does your office
offer or coordinate with such services? What is your belief about their effectiveness?
Response:
You are correct. There is quite a bit of evidence that such interventions do
help with IVF. I think it is clear that a woman that is relaxed, and has minimized
stress has a better chance of conceiving. What is unclear is what method will
work for each individual.
We do not coordinate acupuncture
at our office, but will happily try
to accommodate any arrangements you
make. We have had a number of women
arrange such procedures and happily
it has worked for a large number
of them. |
Karen RN asks:
I just recieved my day two FSH 9.8 estrogen 35. I'm starting my IVF cycle today,
finally after high FSH levels, 10.4 and 15.6. Prior to this blood test I
started taking grass wheat pills. I don't know if this helped or not. I would
like to continue to take them during the IVF. Can this cause any harm? Also
I would like to thank you for giving me the encourgement in your last response.
My second question of my protocol
for this cycle, which is my second
try (first one failed only able to
use two eggs). I have 1/4 of my ovary
left and I am 36 years old (endometriosis
is my problem). 450 gonalf in the
morning and two amps of repronex
in the evening. What do you think?
Response:
Although the manufacturers of wheat grass pills state that they may even be beneficial
before or during pregnancy (and probably are) since they may serve as sources
of folic acid, my general dictum is to avoid any unproven as "safe" medications
during pregnancy. Without seeing your history of the previous cycle, I cannot
offer any comment on the protocol. |
Cynthia asks:
I am a Penn employee with Keystone East health care. I am almost 39 and single.
With my clock running out I'm considering storing some embryos produced from
my eggs and donor sperm for the future. I'm not in a financial situation
where I can raise a child on my own right now but would like to keep the
option for the future.
What would the cost be to do this?
I notice that the PennCare program
which is an insurance option for
me covers one round of IVF. Would
this situation apply? If so, would
I have to wait until open enrollment
next year as I missed this term to
switch and currently have Keystone
East. By the time open enrollment
comes around again I will be nearly
40. I hope that you can answer some
of my questions.
Response:
Cynthia, your way of thinking is appropriate. I cannot answer the details of
the insurance coverage situation; however, most likely the PennCare option
would cover your procedure, but, I know, will not cover the freezing and storage
of embryos. Freezing and storage fees are relatively low when you consider
how expensive the actual IVF cycle and the medications are.
I would advise
you to make an appointment and come
in and see us. At that time we can
discuss the options and also review
the insurance coverage, so you can
make an informed decision soon. If
you would like to schedule an appointment,
please call 800-789-PENN (7366) or
visit pennhealth.com to schedule
an appointment online. |
Mary asks:
I recently had a cancelled IVF cycle because
only one antral follicle was seen with ultrasound.
I was on a non-lupron cycle (repronex 175
and follistim 225). My FSH and E2 have generally
been within the preferred ranges. Does the
one follicle mean I am no responding and
IVF is futile? Should I switch to donor
egg or if I simply switched my protocol
would it be okay?
Response:
I am sorry to hear that your last cycle
of IVF was not optimal. You ask a very difficult
question: basically you are asking how much
time and effort you should put into another
IVF cycle, especially if your chances of
success are "guarded." That is
a very personal question.
Of course, donor
egg will give you a much higher chance of
success (in our program 60 percent have a baby
with one cycle, and if you add in the babies
born with the frozen/thawed embryos from
the first cycle, the success rate is 86 percent).
However, there are obvious limitations of
donor egg.
Sometimes your own IVF cycle can be dramatically
improved by changing the protocol. You should
ask what will be changed, and why. Often
this conversion is much better in person.
We would be happy to help you with this
decision. If you would like to schedule
an appointment with a Penn Fertility Care
specialist, please call 800-789-PENN (7366)
or schedule
an appointment online. |
Mary asks:
I am 36 in good health and have had low
(<10) FSH and a good E2. I had mild endometriosis,
which was surgically removed. My first IVF
cycle (no Lupron) was just cancelled because
only one follicle was visible during ultrasound.
Does changing IVF protocols typically affect
IVF success rates?
Response:
I am sorry to hear about the cancellation
of your cycle. I am sure that was very frustrating
and disappointing. The specific IVF protocol
you use should be tailored to you and your
history.
Changes should be made to optimize
your chance of success. If the low response
can be correct (and I think it can), your
chance of success should still be high.
Sometimes a fresh pair of eyes helps find
a hidden issue so I would suggest getting
a second opinion. I wish you good luck. |
Julie asks:
I am due to start IVF since I have blocked
tubes (Hydrosalpinges). While doing the
routine blood tests, it turned up that my
hormones are all over the place which suggests
anovulation as well. I am 30 years old with
normal body weight and have regular 28 day
cycles.
I am confused, what may be causing
my anovulation since I don't have PCOS symptoms
and I am not missing periods. Does this
cause my my IVF chances to be reduced further
still? Is there anything I can do to help?
Response:
Anovualtion in itself will not decrease
your success with IVF. In fact, IVF is a
treatment for anovualtion. However, starting
IVF at the correct time in your cycle is
critical. Thus, having hormones that are
not predictable can affect your IVF cycle.
One note: the presences of hyprodalpinx
will decrease your success of IVF. Often
we recommend having them removed first.
You may want to consider a second opinion
to go over all of these factors in person. |
Rm3989
asks:
My husband and I have been trying to conceive
for two and a half years. After all the
appropriate testing with our doctor, we
have been diagnosed with unexplained infertility.
We've tried three cycles of clomid with
no luck and then went to injectable follistim.
We got pregnant on the first try, but unfortunately
miscarried at 11 weeks. Since then, we've
done two more cycles of follistim with no
success.
We feel it's time to move forward with
IVF, however, my reproductive endocrinologist practice is on IVF shut-down
the month of December, which is when we
would have the IVF procedure. Would it be feasible to switch to your practice
at this point, for us to have our records
transferred to your center now for you to
review, and then have the IVF procedure
done there within a month? Or would
you need to conduct your own testing beforehand?
Response:
I agree that it may be time for you to move
to IVF. However this is a big step, and
it should not be rushed. It should be optimized.
We are not currently closed, but it may
take 4-6 weeks to start and finish a cycle.
Please contact us by calling 800-789-PENN
(7366) if you would like more information. |
Lori asks:
I had my tubes tied and want to know if
they can be reversed or can I have invitro
done? I have two boys from my first marriage
and my second husband does not have any
children. I am 40 years old.
Kurt Barnhart, MD, MSCE responds:
In general the chance of having a baby with
IVF at age 40 is about 30%.
We could do some other blood tests to see
if your chances are different
from that percentage. That chance is likley
higher than the alternative of having your
tubal ligation reversed.
Assuming you are otherwise healthy, you
are a candiate for IVF as long
as you recognize the chance that it may
or may not work. It is best to
have these options explained to you by a
reproductive specialist in person. We would
be happy to talk to you further about all
of your reproductive options. |
Naomi asks:
I am 44 years old, and have had several
miscarriages (one loss was at eight weeks).
There are no sperm problems and I had tubal
surgery. Can I try IVF?
Steven
Sondheimer, MD responds:
In vitro fertilization (IVF), is the fertilization
of an egg by sperm outside of the body and
the transfer of the fertilized egg back
to the womb. As women approach their late
30's and 40's the number and quality of
eggs remaining in the ovary decreases. IVF
depends on a very healthy egg for the best
success.
IVF is seldom successful with the
eggs of a 44 year old. Even if fertilization
occurs, often the pregnancy does not continue
normally. Today many couples who are in
your situation consider alternatives such
as adoption or avail themselves of donor
eggs from a woman under age 34. You would
still carry the pregnancy. I hope this is
helpful and good luck with your decision. |
Shawna
asks:
I have had two children and after my second child decided to have a tubal ligation. Who would've guessed we divorced and I have since remarried. My husband now does not have children and we'd like to have a larger family. We would like to do this in vitro but neither one of us want to be on hormone medication to make this happen. Is there a way they can take my eggs without having to be on all the medication? I didn't have any complications conceiving the first two times.
Clarisa Gracia, MD, MSCE responds:
It is possible to perform IVF without having to stimulate your ovaries with hormone injections. Unfortunately, it is much less successful this way, even if you had no trouble conceiving on your own in the past!
If you were my patient, I would recommend using the medications. However, you should talk to your physician about the pros and cons to determine what is best for you. |
Lauren
asks:
I was reading about the whole IVF process and it said something about a needle to retrieve the eggs. Where does this needle go? Are you put to sleep during this? How long does it take? Are there side effects (i.e. weight gain, etc)?
Clarisa Gracia, MD, MSCE responds:
The needle is inserted through the vagina along with an ultrasound probe. This procedure is usually performed while you are asleep. The procedure takes between 20 minutes and one hour. Side effects from IVF include abdominal bloating, mild weight gain, enlargement of the ovaries.
Some women experience a complication called ovarian hyperstimulation which can required frequent monitoring, draining fluid from the abdomen and at times even hospitalization. If you go through the IVF process, your physician will explain the process thouroughly so that you understand all aspects. |
Papino
asks:
I am 35 years old with blocked fallopian tubes. I have just undergone an IVF cycle that was not successful. I had ovarian hyperstimulation syndrome (OHSS) and the doctor says this decreases one's chances of success. What should I do to ensure the next time I have higher chances of success.
Samantha Butts, MD, MSCE responds:
In vitro fertilization (IVF) is an excellent treatment for tubal factor infertility (blocked fallopian tubes) but is not perfect, even in patients who are young and have no other reasons for infertility. You should sit down with your physician and review the cycle at length focusing on any changes he or she would implement to improve your chances the next time.
Also, if you stimulated well enough to have frozen embryos, you could consider doing a frozen embryo transfer that would spare you the need to have to be stimulated again with fertility drugs. |
Robinhood asks:
I have three healthy girls. I had an ovary removed and tubal
a few years ago. Husband, children and I would like another baby. I am 30 and he is 35. Do you think IVF could be for us?
Samantha Butts, MD, MSCE responds:
In vitro fertilization is an excellent option for treatment of infertility in young women who have fallopian tube problems (either damaged or blocked due to surgery) or have had tubal ligation. I wasn't sure based on the wording of your question but if you have one remaining tube and ovary, IVF would be a more effective option than putting your remaining tube back together and trying to conceive naturally.
You should have a consultation with an infertility specialist to discuss these options, get information about the risks and benefits of each and then make a decision. |
Mary asks:
I am 40 years old and had my tubes tied after my third child two years ago.
All three children were c-section because of my factor V laiden deficiency
blood disorder. I administered two heparin shots daily during my pregnancies.
We want another baby and I would like to know what options I might have.
Is it possible to have a baby after tubes tied and everything else?
Penn Fertility Care responds:
In general after tubal ligation, in vitro fertilization is a successful procedure to obtain a pregnancy. The success rate is dependent upon your age and health history. We recommend that you have an evaluation by a fertility specialist as your next step. |
Kim asks:
Two years ago I was diagnosed with an elevated FSH, around 14, and poor
egg quality. After three failed IUIs with four amps of repronex I was
told that my chances are slim and that it would be best to use an egg
donor. It was also determined that I have one blocked tube and low
progesterone levels. At that point I stopped treatment. I have recently
remarried and we are anxious to start our family. I am 35 and my husband
is 44.
We were curious if there are any newer
treatments being used that may help with
using my own eggs. If using a donor is
still the best option, what is the wait
time in finding one through your office?
I remember that this process is a very time consuming one with all
of the monitoring that needs to occur. How often would I have to
be seen in the city or can I go to one
of the other offices for the majority of
my appointments?
Clarisa
Gracia, MD responds:
While a high FSH does predict poor in vitro fertilization (IVF) success,
this is not as true in younger patients such as yourself. It may be possible
for you to have a baby through IVF using your own eggs, though the success
rate is probably less than 25 percent/cycle. Alternatively your chances
are probably close to 50 percent/cycle using donor egg.
We have a donor
program at Penn Fertility Care and have active donors that are ready
to start the process. If you are interested,
just call the office and make an appointment
for a consultation. Typically the process
of choosing and screening a donor can take
four to six weeks. The IVF process itself
is a two-month process. The actual IVF
procedure for you involves taking injections
at home daily and hormone tablets. You will be required to go to one
to three visits for blood work and ultrasounds
during that time. (The donor will need
to come much more often for monitoring).
If
you are interested in learning more about this process, feel free to
contact us at 1-800-789-PENN (7366) or request
an appointment online. |
Lahdedah
girl asks:
Two years ago I gave birth to our fourth
child. He was delivered by caesarean and
I had my tubes tied at the time. Our baby
died nine months later. It has now been
15 months since his death and I really
want another baby. We want to do in vitro
fertilization. Can I still get pregnant?
Steven Sondheimer, MD responds:
Many couples inquire about fertility potential
after a sterilization procedure such as
a female fallopian tube ligation (aka tubes
tied) or male vasectomy. You should obtain
the old surgical records and consult with
an infertility specialist.
Often the best approach to pregnancy after
tubal ligation is through in vitro fertilization.
Even though you have had tubal ligation
dependant upon your age, your ovaries may
still be functioning normally and your
uterus may still be capable of carrying
a pregnancy.
If you would like to consult with a Penn
fertility specialist, please call 1-800-789-PENN
or request an
appointment online. |
Sha asks:
I just had an IVF procedure. In three days, I'm going to have blood
work to see if I'm pregnant. When I went to the bathroom, I noticed
a brown spot. I'm so axious to know if it means that I am not pregnant
and the procedure may not have been successful.
Response:
Unfortunately in this situation, we cannot provide an answer to your question.
Bleeding can mean several things including implantation spotting or miscarriage.
Our suggestion is for you to contact your ob/gyn or specialist.
If you would like to consult with
a Penn fertility specialist, please
call 1-800-789-PENN or request
an appointment online. |
Bill asks:
My wife and I have already been checked out. Our insurance
will not cover in vitro fertilization. Do you have any kind of financing
or know anyplace that does finance?
Lynn Dwyer,
Chief Administrative Director,
HUP-Reproductive
Surgical Facility:
To date we have not provided financing for IVF; however, we do provide
some self-pay discounts. We welcome you to come in for an IVF consultation
with one of our physicians and you can obtain financial information at
the same visit. |
Mary asks:
I am a 25 year-old female. I have participated in your egg
donor program three times. Now, I am looking into having a baby myself,
but my
tubes have been tied since 2003. So I am trying to see if IVF is good choice
for me. What do you think?
Response:
Thank you for being a part of our donor
egg program. Donating an egg to
a woman in need is an act of compassion and generosity. To answer your question. Tubal ligation
is meant to be permanent but occasionally
it can be surgically reversed. However,
the surgical reversal is not always successful.
Often the best approach to pregnancy after
tubal ligation is through in vitro fertilization (IVF).
If your ovaries are functioning normally,
and your uterus can still carry a pregnancy,
IVF could be an option for you. I recommend
that you see a specialist for an consultation
and evaluation to determine if you are
a candidate for IVF. If you would like
to see a Penn Fertility Care specialist,
please call 1-800-789-PENN or request
an appointment online. |
Sue asks:
I have just been through the IVF treatment. Everything was fine on egg collection day, the semen analysis was also fine. I got a phone call from the clinic telling me the eggs hadn't fertilized, they were not sure of the reason. How soon can I repeat the treatment?
Samantha Butts, MD MSCE responds:
You should not repeat the treatment until you have a frank discussion with your physician about what he or she believes was the reason for fertilization failure in your case. Sometimes we do not find a satisfactory answer but a discussion would give you an opportunity to ask questions and discuss potential adjustments that could enhance your odds of pregnancy in the future.
One option that is sometimes utilized when there is no fertilization on the day after egg retrieval is rescue ICSI in which sperm are injected directly into the egg. The fertilization rates vary with this treatment because it is routinely done on the day of egg retrieval (and typically for patients where the husband has abnormal sperm). |
Sheryl asks:
Is it possible to use IVF after a tubal and a vesectomy?
Penn Fertility Care responds:
In general, after tubal ligation in vitro fertilization is a successful procedure to obtain a pregnancy. The success rate is dependent upon your age and health history. We recommend that you have an evaluation by a fertility specialist as your next step. |
Judy asks:
I've just gone through an IVF cycle and I suffered from ovarian hyperstimulation, will this decrease my chances of success, also when should I expect a period if it doesn't work?
Samantha Butts, MD MSCE responds:
What we know currently about having developed ovarian hyperstimulation during your IVF treatment is that there is no definitive impact on the chances of achieving pregnancy. If this cycle is not a success the time until you get your period can vary but it often comes within a few weeks. |
Denise asks:
I have severe endometriosis and have been taking Depo Lupron shots for the past six months. I am wondering how long would I have to be without any forms of birth control before I could safely be impregnated through in vitro fertilization? I would also like to know if it is necessary that I have a full period after stopping the Depo before I can be impregnated through in vitro?
Kurt Barnhart, MD, MSCE responds:
I hope the Lupron worked to alleviate your symptoms from your endometriosis. There is not specific time you have to wait to start IVF after Lupron. All that has to happen is your fertility specialists have to be sure where you are in your cycle.
One concern is that your ovaries are suppressed by the Lupron (by design) and you may need a higher dose of medicine to stimulate them again. Good luck. |
Erin asks:
Regarding in vitro fertilization (IVF), if pregnancy fails after embryo transfer, will you definitely have spotting/bleeding?
Kurt Barnhart, MD, MSCE responds:
After an IVF cycle, you are usually on progesterone supplementation. That often prevents bleeding and spotting. You should have a pregnancy test (bleed test) checked at the correct time after your embryo transfer. If it is negative, you can stop the progesterone and you will get your period.
Some women get spotting before their pregnancy test, but that does not mean you are not pregnant. On the other hand, some women do not get spotting before the pregnancy test, but that does not mean you are pregnant. Good luck. |
Elena asks:
Would
you suggest we try another IVF procedure?
Our history is this: we have one child
conceived naturally (c-section), then could
not get pregnant. We tried four IUI's with no success;
then did three IVF's (pregnant on
third, but miscarried at 8-9 weeks); just
did FET which was negative. We are frusterated
and broke, but ready to try with new doctor.
What do you think? Obviously I can
get pregnant, right?
Steven
Sondheimer, MD responds:
I can imagine
how disappointed and frustrated you must
be after putting so much time, effort,
hope and money in to these failed assisted
reproductive technology (ART) cycles.
I do not have enough information about
you or your cycles to answer your question
with the amount of knowledge you deserve.
In general, I agree that you need to
have another medical opinion from a reproductive
endocrinologist who has lots of experience
with a successful IVF lab. If you would
like a second opinon, we would be happy
to evaluate you.
Thinking
outside of fertility treatment, I think
it would be reasonable to accept that
you have done all you could and IVF
has not worked. Continuing this high
tech process does wear on the body
and emotional health and is unfortunately even
less likely to achieve a pregnancy
now than when you started with high
hopes and an optimistic outlook. You
still may get pregnant without medical
intervention just as you did with your first
pregnancy.
If you would like to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or you can also request
an appointment online. |
Terri asks:
I was wondering if there are
any statistics on how long frozen embryos
are viable for? I underwent IVF with
your clinic one and a half years ago and, thanks
to your wonderful clinic, I have a beautiful
nine month-old little girl. I definitely
want to do it again, but I am wondering
if there is a time frame that is proven to be best for success. I
have seven frozen embryos. Thanks again for my little one.
Samantha
Butts, MD responds:
I am so happy to
hear about your little girl and that
our practice was able to help you conceive.
To answer your question, unfortunatly
there is not solid data on whether freezing
embryos for a short time is worse for
their viability than longer durations
of freezing.
What we do know is
that the quality of the embryos you
produce (and the odds of pregnancy) is
most strongly related to your age at the
time they were frozen rather than at the
time they are transfered. Therefore it
is probably best to do a frozen embryo
transfer when you are absolutely ready
and not feel the need to rush. |
Mel asks:
I got pregnant though IVF and am due in one month. My question may be a bit premature,
but I am 36 and want to have another child. How long after stopping breastfeeding
can I start to try again with a new IVF cycle?
Steven
Sondheimer, MD responds:
It depends on the type of infertility problem you have. In general, you could
start another IVF cycle immediately after weaning your newborn. Waiting until
your child is a at least one year gives you a chance to better nourish the baby
and seems to be associated with a bit bigger second child. |
Mary asks:
I just turned 40. I have two children,
the youngest is 14. After my son
was born I had my tubes tied. I had
no problems conceiving. I am considering
having my tubes untied and having
a third child. My husband is in his
late 20's and also has a child to
a previous marriage. Do you think
IVF is a better solution than a tubal
reversal considering my age? I am
in excellent physical shape and have
no health problems.
Steven
Sondheimer, MD responds:
I'd begin by having your husband
obtain a semen analysis and you to
have your blood tested to evaluate
for ovarian aging. If these tests
are normal then you should review
with your doctor the technique used
to "tie your fallopian tubes." You
should also review this information
with the doctor that you are considering
for your tubal reversal surgery.
You need to know their operative
experience, results and recommendations
based on your individual situation
and their experience.
If your surgeon's experience suggests
better than a 50 percent chance of
success, I think I would choose the
surgical approach; otherwise, IVF is
a good option. Remember, due to your
age, you are at greater risk of pregnancy
loss or carrying a pregnancy with Down's
syndrome than you were 14 years ago.
Also, the risk of tubal pregnancy is
increased after surgical reversal. |
Sarah asks:
I had my tubes tied in June 2000, and now I am in a new relationship. Is it possible
to have a baby through IVF and how would I go about getting information on
it?
Response:
Yes, it is possible to have a baby through IVF. The success
rate is dependent upon your age and health history. We recommend that you
have an evaluation by a fertility specialist as your next step.
If you would like information about
the IVF program at Penn Fertility
Care or if you would like to make
an appointment, please call 1-800-789-PENN
(7366) or you can request
an appointment online. |
Samantha asks:
Are there any statistics available regarding IVF success on women that have had
thyroidectomy and are on thyroid hormone replacement (i.e. Synthroid)?
Steven
Sondheimer, MD responds:
We are actually now looking at the question of subclinical hypothyroid problems
and IVF success. But that is not your question. So, to answer your question,
if you are on an appropriate dose of medication and well controlled I am not
aware of any affect of thyroidectomy with replacement on your IVF success. Be
aware that your thyroid medication needs may increase once you are pregnant. |
Lucy asks:
I have been seeing a fertilty specialist for about four months now. I just turned
37. I have had a laporascopy in which they found a touch of endometriosis,
some adhesions and a cyst which has all been removed to the best of their
ability. I have had one intrauterine insemination (IUI) with Clomid and a
second IUI with Gonal-f with no success. During the cycle with Gonal-F my
doctor discovered my FSH level were around 12.5 on day three of my cycle,
I also did not respond well to the injections, I only had two mature follicles
with about 1500 units of Gonal-F.
I have decided to go forward with
IVF in April but my doctor said my
chances of conceiving are in the "low
teens" due to my adhesions and
FSH level being elevated and also
a low sperm count is involved. My
doctor said he will have me on Clomid
and injectables to increase the amount
of eggs to give me more of a chance.
I trust my doctor completely but
just wanted another opinion on my
chances of conceiving with IVF with
ICSI.
Richard
Tureck, MD responds:
A follicle stimulating hormone (FSH) level of 12.5 on day three of the cycle
is a bit elevated (would like to see it below 11). From the information you provided,
the percentages your doctor quoted to you seem to be correct. |
Rachel asks:
I had an ectopic pregnancy last year which needed surgery. This month I have
the uterine dye test to see if my fallopian tube is still viable. Since I
only have one fallopian tube I'm a little worried that the ectopic damaged
my tube.
Am I considered high-risk for another
ectopic no matter what procedure
I get? I've been on hormones and
injectiables. The next step is in
vitro fertilization (IVF). Are my
chances better with IVF since the
egg is implanted? Or am I still high
risk for another ectopic?
Richard
Tureck, MD responds:
Even if the dye test shows that your tube is open, you are still at increased
risk for an ectopic pregnancy. IVF is less of a risk for an ectopic pregnancy,
but still may occur. |
Stephie asks:
I went through in vitro fertilization (IVF) in December and three embryos were
transferred. I did get pregnant with two of the embryos, but one went to
the only damaged tube that I had and the other went to the outer area of
the uterus. Unfortunately, both embryos had to be removed and along with
my only fallopian tube. My husband and I have decided to undergo another
IVF procedure, but are wondering what are chances are of getting a healthy
pregnancy.
Steven
Sondheimer, MD responds:
You have been through some very traumatic events and I am sure this has been
terribly stressful. None the less, if you and your husband should decide to undergo
another attempt at pregnancy with in vitro fertilization and embryo transfer
your chances of a successful pregnancy are probably as good as or better than
before.
I would need your whole set of records
including evaluation of your uterine
cavity to make a fully informed judgment.
Often a damaged fallopian tube can
be detrimental to embryo implantation
but now that tube is out. I wish
you the best. If you think it would
be helpful you could set up an appointment
to be seen at our office. We would
be happy to help you. If you would
like to consult with a Penn fertility
specialist, please call 1-800-789-PENN
(7366) or schedule
an appointment online. |
Sherry asks:
Will not taking birth control pills reduce eggs produced in my IVF cycle? My
doctor doesn't recommend that I use them. Should I find another doctor?
Steven
Sondheimer, MD responds:
There are different ways to stimulate follicular growth and egg number as part
of an in vitro fertilization program (IVF). In general, birth control pills do
not increase or decrease the number of oocytes (eggs) obtained. There are individual
variations with both patients and programs and so I would be comfortable with
a doctor who uses or does not use the birth control pill as part of your protocol.
Asking your doctor these questions is always a good idea. Do not be afraid of
discussing your concerns with your doctor. |
Icceey asks:
I had a bilateral tubal ligation and the tubes were cauterized. That took place
nine years ago. I want to be able to have another baby. I know of in vitro
fertilization and similar treatments. Those procedures are so expensive.
Are there any alternatives which are less expensive? If so what are they
and what's the cost?
Steven
Sondheimer, MD responds:
To answer your questions, there are no less expensive approaches regarding pregnancy
after tubal ligation. I would check with your health insurance company as well
as you and your husband's health benefit advisor where you work. Some policies
cover in vitro fertilization and some states mandate insurers to cover this type
of infertility treatment. |
Holly asks:
My husband and I have undergone three failed IUIs with clomid and HCG trig. Our
main issues are that my husbands count is around 10 mil and motility is between
15-30%. Can you tell me how much the chances of conceiving go up from a clomid
IUI cycle to an inject. IUI cycle?
We are weighing the options of going
straight to IVF or persisting with
a few more IUI cycles (unfortunately
cost and insurance has become a factor).
Both of us are 31 and so far I have
had no problems with my follicles.
Are IVF success rates usually around
50% for our circumstances?
Kurt
Barnhart, MD, MSCE responds:
You are asking a great question. You are really asking should I give it time
(and less recourses, hopefully) or be aggressive with a larger "investment" of
time for a much greater chance of working.
I think you need to be more aggressive.
Clomid IUI cycles have about a 8%
chance of working in any one cycle
Gondotropin IUI cycles (injectable
medication) have about a 17% chance
of working in any one cycle. IVF,
in your situation, has at least a
50% chance of working in one cycle.
Much also depends on how good your
husbands sample was "after the
sperm wash"
for the IUI. If there at least 4
million motile sperm your success
is as I described above. If it is
below that number the success of
an IUI is less than half of the above
numbers, while IVF is the same. You
would benefit from a new consultation
to go over all of your options. |
Terri asks:
I have had both of my ovaries removed along with my fallopian tubes. Is it possible
for me to have a successful IVF procedure?
Kurt
Barnhart, MD, MSCE responds:
You can carry a baby, but the baby would have to be conceived with "donor
eggs."
To be more specific, you would choose an
egg donor (we can find one for you through
our Donor
Egg Program, or you can find
one yourself). This donor would undergo
stimulation with fertility drugs to "make"
a number of eggs. We would then get those
eggs from the donor via an oocyte (egg)
retrieval. The eggs would be fertilized
with your partner's sperm and the embryos
would be but back in you. You would then
carry the baby.
The egg donation via IVF process
has greater than 50% chance of working
on the first try, and may result
in creating additional embryos that
can be cyopreserved (frozen). This
would allow for a second attempt,
if the first attempt failed or, if
the first attempt succeeded, you
could have try to conceive a second
child. Please feel free to make an
appointment to learn more about this
procedure by calling us at 1-800-789-PENN. |
Wondering asks:
Why is in vitro fertilization allowed to happen when often there are such high
risk pregnancies with triplets and so on?
Christos
Coutifaris, MD, PhD responds:
One of the risks of in vitro fertilization is multiple pregnancies. In recent
years, due to the increased success, we have been markedly decreasing the number
of embryos transferred in order to minimize or eliminate the risk of high order
multiple pregnancies.
These issues are routinely discussed
with each individual couple and the
decision of which and how many embryos
to transfer is made after appropriate
informed consent. In our program
over 95% of the deliveries are singletons
or twins. One more point i need to
add: Pregnancies conceived through
in vitro, does not make the pregnancy "high risk".
|
Naomi asks:
I am a healthy 22 year-old female who has been trying to conceive for about two
years now. I've tried taking my basal temperature and also invested $200
in a fertility monitor that is supposed to predict the best times to try.
Nevertheless, I still have no baby and I've wasted numerous amounts energy.
Can
my husband and I just go to a fertility
doctor and request in vitro fertilization
or do we have to wait some more? I
really need to know this because it's
also putting a strain on our relationship.
Christos
Coutifaris, MD, PhD responds:
Although in vitro fertilization may not be the best next step, there is no question
that you need to consult with an infertility specialist. If you have tried to
achieve a pregnancy for more than one year (which you have), an infertility evaluation
is warranted.
Before recommending treatment, a few
simple tests should be performed. These
can be planned with the help of a fertility
specialist. Please call 800-789-PENN
(7366) if you would like to schedule
an appointment for a consultation to
go over the process of a fertility
evaluation. You can also request
an appointment online.
|
Tray asks:
I have endometriosis and a blocked fallopian tube. I have had three attempts
at IVF; all three failed. If I use clomid will this help?
Samantha
Butts, MD responds:
My sense is that clomid seems like an appealing choice because of all you've
been through with IVF which is much more involved than doing clomid and artificial
inseminations. Based on the limited information you've provided though, it does
seem like it would be taking a step backward.
One of the major drawbacks of taking
clomid in your situation is your
blocked fallopian tube. If the ovary
on the side with the abnormal tube
is the one that responds when you
take clomid, you will not be able
to be inseminated that cycle. I would
recommend reviewing all of your IVF
cycles with your physician and having
an honest discussion about what if
anything can be done differently
and what your real chances are now. |
Kathy asks:
I recently went through in vitro fertilization with ICSI. Today was my first
blood test eight days after implantation. It was negative. However, I have
no normal montly symptoms for starting my period. Is there still a good chance
that I may be pregnant and if not when will my period be starting this month?
Steven
Sondheimer, MD responds:
I usually transfer day three embryos, which have resulted from fertilization
which occurred three days earlier. The day of fertilization by tradition is considered
two weeks pregnant. Implantation probably occurs a week after fertilization or
three or four days after transfer.
A pregnancy test is not positive
until the HCG produced by the early
pregnancy gets in to the mother's
bloodstream. A pregnancy test can
be reliable approximately two weeks
after fertilization which is 10 or
11 days after transfer of the embryos.
If a pregnancy test is obtained immediately
after transfer it will usually be
positive from the HCG injection given
earlier.
On the other hand, if you do a pregnancy
test too early, HCG, the pregnancy
hormone may not be detected even
with a normal pregnancy. So it is
best to do the pregnancy test at
the time recommended approximately
12 days after transfer. Best wishes
to you! |
Debra asks:
I am 49 years old and remarried. We want a baby of our own.
Am I too old to try in vitro fertilization?
Samantha
Butts, MD responds:
Please note, that my response is not meant to be discouraging, it is however
important to note that there are many factors to consider when trying to conceive
after age 40.
As a general principal, we try to
avoid strict cutoffs when making
determinations about who can and
cannot utilize IVF - every situation
is different. That being said, the
decision to proceed should be based
on the risks, benefits and potential
to succeed. After age 42, live birth
rates are considerably lower and
the chance of chromosomal abnormalities
(i.e. Down's Syndrome) is significantly
higher. Additional pregnancy related
risks with respect to fetal growth,
preterm delivery and maternal problems
go up significantly with age. All
of this sums up to risks to both
to the mother and the baby that are
not insignificant and that need to
be seriously considered when making
the decision to try to conceive.
Any woman trying to conceive in
her 40's should be cleared by her
physician and have a mammogram. She
should be assessed like any other
woman by a reproductive endocrinologist
who can get her health history and
counsel her accordingly. In some
cases depending on the health of
the mother, a preconception appointment
with a high-risk obstetrician may
also be necessary. After this workup
an informed decision about trying
to conceive can be made.
If you have further questions or
would like to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or request
an appointment online. |
Waiting and
Wishful asks:
I am 30 years old and have endometriosis and have received treatment over the
years, but still have painful menstruation. I also have a misshaped uterus and
have had three miscarriages. My ex-husband insisted on my tubal ligation in 1996
after our daughter was born because she was our third child.
I am now remarried
to a wonderful man who has no children
of his own and we would like to have
a child desperately. Finances and insurance
add to the physical obstacles. Can
we go straight to in vitro and do you
have payment plans to help with the
financial burden?
Luis
Blasco, MD responds:
Hello, IVF could be an answer to your problem however, tests of your uterus size
and contour would be necessary. We do have a financial counselor who would be
happy to meet with you to work through the financial issues. |
Tonia asks:
My doctor told me that IVF is not as effective if endometriosis is not removed
first. I had it removed, but am not at the point where I have exhausted other
options and need to move to in vitro fertilization (IVF). I am now concerned
that the endometriosis will return and if I need to have IVF, I will need
to have another surgery. Does removing endometrisis improve success rates
of IVF?
Christos
Coutifaris, MD, PhD responds:
Our practice has published that the presence of endometriosis decreases all the
parameters of an IVF cycle including the number of eggs retrieved, fertilization
rate, implantation rate, pregnancy rate and delivery rate.
However, there is no study to show
that pretreatment with surgery prior
to IVF makes a difference. Thus,
at the present time the published
evidence does not support surgical
treatment of endometriosis prior
to
proceeding to IVF. The most important
issue in this case is your age. If
you are over 35, I would recommend
proceeding with IVF sooner rather
than later regardless of the status
of the endometriosis. |
Kara asks:
My husband had a vasectomy years ago. Can sperm be taken from him and produce
a baby via in vitro fertilization?
Kurt
Barnhart, MD, MSCE responds:
Yes, it can. In fact in vitro fertilization is far preferable, and more likely
to succeed than trying to have it reversed by a urologist. The procedure your
husband would need is called PESA (percutaneous epidermal sperm aspiration).
A needle is placed in the epidiimus (just above the testis) and sperm are obtained.
The procedure is performed with your husband under sedation (not general anesthesia).
We at Penn Fertility Care would be happy to assist you with these procedures.
If you would like to schedule an
appointment with a Penn Fertility
Care specialist, please contact 1-800-789-PENN
(7366) or request
an appointment online. |
Kristie asks:
I had both fallopian tubes removed three months ago. Could I still become pregnant?
Steven
Sondheimer, MD responds:
With both fallopian tubes removed, you only can become pregnant by utilizing
in vitro fertilization technology. Since your ovary still has eggs, the eggs
can be removed and fertilized in a "test tube" or dish, incubated and allowed
to divide. The embryo or embryos are then transferred to your womb with a small
catheter inserted through the mouth of the womb, vaginally.
I have been helping women achieve
pregnancy with this approach for
over 30 years. You may be a very
good candidate to consider this but
would need to make an appointment
to review your whole medial history.
If you would like to schedule an
appointment with a Penn Fertility
Care specialist, please contact 1-800-789-PENN
(7366) or request
an appointment online. |
Tina asks:
I am on my second marriage and, when I was with my first husband, I had my tubes
tied after my second daughter was born (seven years ago). My husband now
has had a vasectomy (eight years ago). Is there any chance that we could
have in vitro fertilization or reversals?
Clarisa
Gracia, MD, MSCE responds:
In vitro fertilization is your best option. Sperm can be retrieved from your
husband's testicle or epididymis and used to fertilize your eggs. Then the embryos
can be placed in the uterus. Your age is an important factor in success, however. |
Shanelle W
asks:
I am 26 years old and have had two previous surgeries — one for appendicitis
at 22 months and one for adhesions at 12 years old. Now I have a tubal blockage
from the adhesions. I am about to undergo in vitro fertilization (IVF), and I
would like to know my chances of success.
Clarisa
Gracia, MD, MSCE responds:
It really depends on the program you are going with. Most programs have success
rates in your age group around 35-50 percent live birth per embryo transfer. |
Bashful asks:
I am 40 years old and had a tubal ligation when I was 21. I have three children:
ages 20, 19, and 18. I have recently remarried and I would really love to
have a child with my husband. My doctor says it is possible with in vitro
What are my chances of having another
child? And with a tubal ligation,
what are my chances of getting pregnant
the first try at my age? If I am
not a candidate for in vitro, are
my eggs still good to donate to someone
who wants to have a child?
Kurt
Barnhart, MD, MSCE responds:
In general the chance of having a baby with IVF at age 40 is about 30%.
We could do some other blood tests to see if your chances are different
from that percentage. That chance is likley higher than the alternative of having
your tubal ligation reversed.
Assuming you are otherwise healthy,
you are a candiate for IVF as long
as you recognize the chance that
it may or may not work. It is best
to
have these options explained to you
by a reproductive specialist in person.
For you to donate an egg to someone
else, the process would be very similar
to the one used if you wanted to
get pregnant yourself. We do have
an donor egg program at Penn Fertility
Care to assist those seeking donations
and those willing to donate. We would
be happy to talk to you further about
all of your reproductive options. |
praying queen
asks:
I had a laparoscopic myomectomy in May 2002 and I have not been able to get pregnant,
my husband and I want children together. Prior to my surgery in January 2002
I had a miscarriage at eight weeks.
After I had surgery the doctor said
the only way that I would get pregnant
is that I would have to do in vitro
and I can never have a vaginal delivery
with any pregnancy. What should I
do and is that true? It's 2004 and
I haven't gotten pregnant since 2002.
Also, how much is in vitro fertilization?
Is there any hope to my infertility
that maybe one day I may become pregnant?
Could you help me on this please,
if it's not too much to ask.
Richard
Tureck, MD responds:
Unfortunately, without reviewing your records, it impossible to give you an appropriate
answer to your question. If you would like a second opinion, we would be happy
to meet with you. For either an appointment or for more information regarding
our services including in vitro fertilzation call 800-789-PENN (7366). |
Amanda asks:
I have a friend who has started IVF. In the first cycle, she was given the medicine
Lupron and that wasn't working so they tried Gonal F. Only two eggs matured
so they cancelled the procedure. She waited two months to start up again
and they gave her Gonal F again. Now, no eggs are maturing, only two are
starting but not matured. They increased the Gonal F and she's waiting until
the next ultrasound in two days to see.
When she asked the doctor what else
can be done if the Gonal F doesn't
work, he said "I can't create
miracles." Is he right? Should
she stop hoping? Are there other
drugs? Any information would help.
I want her to go to you guys for
a consultation, what do you think?
Kurt
Barnhart, MD, MSCE responds:
It is a shame your friend's doctor was so glib. The process of getting enough
eggs to mature is a very difficult one. Sometimes a women does not have enough
eggs to respond to the medication. In that case the use of a younger woman's
egg (donor eggs) can dramatically improve the chance of having a baby.
However,
sometimes the number can be optimized
by using the medications in what
is called a flair protocol. Perhaps
it is time for a second opinion.
She can contact Penn Fertility care
by calling 800-789-PENN (7366). |
Ann asks:
I am 36 and my husband is 40. We have been diagnosed with unexplained infertility.
I have had laparoscopies for endometriosis and have gone through two rounds
of in vitro fertilization (IVF). The first time, there were no viable eggs,
and the second time, three were transferred with no success. Is it worth
trying IVF again, or are there any other options?
Steven
Sondheimer, MD responds:
These are such important questions. These unsuccessful treatments have surely
been very time-consuming and make it difficult to move on with your life to say
the least. Sometimes, patients have to set limits, even if their doctors still
have more ideas.
Having said that, I will try to
answer your question. I really do
not have enough information to give
you responsible advice. I would want
to know your repeated day three follicle
stimulating hormone (FSH) and estradiol
results. Also, what has been your
worst FSH level? Did you produce
multiple follicles? And how high
of an estradiol level did you achieve?
If
these results point to ovarian aging
as the probable culprit, I think
I would only attempt IVF again with
donor eggs from a young, healthy
donor. |
Sandy asks:
My husband and I are both 40. Two years ago I had my tubes tied after giving
birth to our second child. Now we wish we had not, we would like to have
an other child. Would in vitro fertilization work for us?
Richard
Tureck, MD responds:
The success of in vitro fertilization is dependent on many factors - hormonal
status in particular (follicle stimulating hormone - FSH) is very important as
an index of your particular chance for success. The older a woman gets the harder
it is to conceive.
At Penn Fertility Care, we believe
that even women over 42 with normal
ovarian reserve (as indicted by a
normal day 3-5 FSH) should be given
the opportunity to undergo an IVF
cycle. Other options for this sub-group
of patients are egg or embryo donation
or adoption. |
Desperately
Wanting asks:
I am a 30 year-old man with a wife of 34. She's been diagnosed that she cannot
naturally have children due to massive scar tissue in her tubes. Our insurance
does not cover IVF in the least bit, and the time it would take to save for the
proceedues is incredible. The laws being passed to aid those in need are not
enough and have too many loopholes.
Is there financial aid for such
proceedures? If not, is there another
form of preporaory medicine aside
from injectibles (as they are not
covered either)?
Christos
Coutifaris, MD, PhD responds:
Unfortunately, we have no financial aid plans for IVF treatment. Frequently we
participate in IVF | | |
