Will my baby suffer birth defects?

It is important to recognize that the rate of birth defects in humans in the general population is about 3% of all births for major malformations and 6% if minor defects are included. Fortunately, 20-plus years following Louise Brown's birth (the first IVF baby), we now have ample data that children conceived through IVF have no increase in these rates of birth defects. Further follow-up on older children indicates that IVF children have done as well or better than their peers in academic achievement (probably a social bias) and have no higher rates of behavioral or psychological difficulties.

Will the hormones cause long-term health risks?

The only suggested long-term health risk of IVF is medications, and a possible association between these drugs and the risk of cancer, specifically ovarian cancer.

An important fact to keep in mind is that women who suffer from infertility and never conceive appear to have a slightly increased risk of ovarian cancer as compared to the general population (about 1.6 times the rate). As these are the women who use fertility medications, the medications themselves have been implicated in the cancer risk but have never been proven to be a cause of cancer. Since the initial concern was raised in a 1992 study by Whittemore and colleagues, several studies have addressed the issue more directly. These studies from Australia, England and Denmark all failed to find an association between fertility medications or IVF treatment and any higher risk of ovarian cancer.

An ongoing National Institutes of Health-funded study is specifically designed to address the question of whether fertility medications themselves may play a causal role in ovarian, breast or uterine cancer. While the study is still under way and needs another 5-10 years of follow-up to be conclusive, preliminary results suggest no association between fertility medications and risks for invasive cancers. At this time, we can say that there is no direct evidence that fertility drugs play a causal role in increasing a woman's risk of invasive ovarian, breast or uterine cancer.

Are the injections painful?

With the advent of newer fertility medications, many injections that were given intramuscularly can now be replaced by medications given as a little injection under the skin (subcutaneous). This method is similar to insulin injections of diabetic patients. Additionally one medication, which has been given as a subcutaneous injection (Lupron), can be replaced by a medication administered as a nasal spray (Synarel). Both medications are equally effective, and we leave this choice to you. There is only a one-time injection that is currently given intramuscularly (HCG), but this will soon be replaced by a subcutaneous preparation (available in early 2001).

Once the egg retrieval is performed, progesterone supplementation is used to prepare the lining of the uterus for the transfer of embryos. For most of our treatment cycles, we recommend using progesterone gel or suppositories. This protocol makes it possible to avoid injections during the second half of your IVF cycle.

Using our protocols at Pacific Fertility Center a woman may have to take only 10-12 days of subcutaneous injections and one intramuscular injection of HCG (soon to be replaced by a subcutaneous injection). That's it!

Are the procedures painful?

The only procedure that could be considered a minor surgery in the IVF process is the retrieval or harvest of the eggs from the ovary. During this procedure a needle attached to a vaginal ultrasound probe is passed through the wall of the vagina and into each ovary.

If you did not have any anesthetic for this procedure, it would likely be quite painful. In the modern world of IVF, we can take advantage of an array of excellent anesthetic medications that are administered through an intravenous line, are rapid in onset of anesthetic effect, and wear off quickly when the procedure is over. Our patients breathe on their own during the 10-20 minutes or so of the procedure, but sleep deeply enough to be completely unaware of any discomfort. After the procedure the patient wakes up relatively quickly and, at most, may feel some minor cramping in the ovaries that can also be treated with very safe medications.

At PFC, each patient at every egg retrieval procedure is closely monitored by a fully board certified M.D. anesthesiologist. This allows us to safely provide as much anesthetic as may be necessary to provide complete pain relief for the procedure.

If I live out of town, how long do I have to stay in San Francisco?

At PFC, we care for many patients who come for treatment from other parts of the US, and throughout the world. All consultations can be done by telephone (medical, nurse coordinator, financial), and communication with our staff throughout your treatment can be via telephone or E-mail. Many of the required screening blood testing and procedures can be coordinated with your local gynecologist or reproductive endocrinologist. If there is a local fertility center in your area, we may be able to have you start your stimulation treatment locally, and then come to our clinic about 5-7 days later. On the average, most patients need to be in San Francisco for 10-20 days.

Our staff can provide recommendations for local accommodations, restaurants, and sights to visit!

Should I travel?

Many of our patients have to travel various distances to return home after treatment.

Air travel in commercial aircraft is fine (pressurized aircraft). Drink lots of fluids while flying, since the circulated air can be quite dry, and dehydration should be avoided.

Car travel is also fine. Sitting for an extended period of time will not affect chances of pregnancy.

If you live out of town, most patients return home the day after the transfer. There is no medical reason to stay in San Francisco any longer.

Am I using up all my eggs if I do IVF?

In a natural ovulation cycle, the ovary selects one egg from a pool of approximately 100-1000 eggs. Those eggs which are not selected for that month undergo a natural cell death process called atresia. Fertility medications override the body's selection process, and cause many of these "rescued" eggs to grow (hopefully between 10-20 eggs). These eggs would otherwise undergo atresia. Therefore, you are not "using up eggs faster" by undergoing ovulation induction, but are "rescuing" eggs to use in that cycle, which otherwise would have expired.

Can I freeze eggs for future use?

Unfortunately, current technology does not allow us to freeze eggs, then thaw, fertilize and develop embryos efficiently. Therefore, egg freezing is not currently a viable option for fertility preservation. The best option for preserving future fertility is to freeze embryos (fertilized eggs). Hopefully, the egg freezing technology will improve over the next 5-10 years, so that this option could then be a viable method to preserve future childbearing.

What are my chances of pregnancy with frozen embryos?

In general, the success of frozen-thawed embryo transfer procedures depends on 3 things: the quality and survival of the frozen-thawed embryos, the age of the patient who produced the eggs, and the uterus of the woman receiving the embryos. For patients <37 years, the chances of pregnancy with frozen-thawed embryos is similar to fresh embryos. For patients >37 years, the pregnancy chances with frozen-thawed embryos decline.

Can I do a natural cycle frozen embryo transfer (FET)?

For most patients, frozen-thawed embryos can be transferred in either a controlled cycle (hormone injections required to prepare the uterus), or in a natural cycle (minimal medications). Patients with normal/regular menstrual cycles have the options of using a natural cycle for transfer of frozen-thawed embryos. We have extensive experience coordinating these types of cycles, and have a very successful FET program. Natural FET cycles save patients money (less medications and monitoring needed), time, and still provide a good pregnancy rate.

When do I need an egg donor?

Women who are unable to produce healthy eggs, but have a healthy uterus are candidates for egg donation with IVF. This procedure is the same as for IVF except the intended parents select a donor and use the donor's egg to create the embryo. Patients may seek egg donation services at Pacific Fertility Center's Egg Donor Agency or at an outside agency.

Under what circumstances is a Gestational Carrier (surrogate) appropriate?

A woman who accepts to bear (or be pregnant with) the child of another woman who is incapable of becoming pregnant using her own uterus. Women who need gestational carriers with IVF include those who do not have a uterus, have an abnormal uterine cavity, have had several recurrent miscarriages or have had recurrent, failed IVF cycles. "Surrogate" is an older term for what we now refer to as a "gestational carrier"