Fertility treatments can be overwhelming, and it is common for the individual undergoing these treatments to have questions. We asked our Clinical Care Coordinators to compile a list of frequently asked questions and their answers to help you prepare for your fertility journey.
- What did I do to become infertile?
It is common to feel guilty about an infertility diagnosis and to think that it was caused by something you did, something you ate, or something you were exposed to. While there may be contributing factors, infertility is typically unprovoked. You may have a genetic predisposition to early ovarian insufficiency or perhaps lower semen parameters. Timing may also impact your fertility as age is the number one obstacle that women face with respect to their reproductive health.
- What are my odds for success with the most common treatments?
Low tech treatments such as intrauterine insemination (IUI) produce results close to natural fertility. If a woman is under 35 years old, IUI has a success rate between 10 and 20%. If a woman is between 35 and 40 years old, IUI has a success rate of less than 10%.IVF success rates also vary by age. If a woman undergoes IVF with Preimplantation Genetic Testing for Aneuploidy (PGT-A) she achieves a pregnancy more than 50% of the time once she has a normal embryo.
- How long is a typical fertility treatment cycle?
A fertility treatment cycle is timed around the start of a woman’s menstrual period and the timeline depends upon the treatment you are pursuing. For example, the intrauterine insemination (IUI) procedure occurs approximately 2 weeks after your period.However, the timeline for In Vitro Fertilization (IVF) is different. An egg retrieval typically takes place two weeks after the start of your period, but the actual embryo transfer will follow one of two different timelines.If you choose to do a fresh embryo transfer, the transfer will happen 5 or 6 days after the egg retrieval.If you choose to have a frozen embryo transfer, the transfer can happen approximately 4 weeks after the egg retrieval; however, it may happen later as you determine with your physician. A frozen embryo transfer allows for preimplantation genetic testing for aneuploidy (PGT-A) and occurs after you receive the results of your embryos’ genetic screening.
- What exactly is PGT-A and why is my doctor recommending it?
PGT-A is Pre-Implantation Genetic Testing for Aneuploidy and is offered during an IVF cycle. In this process, viable embryos (fertilized eggs) that you’ve created are biopsied. An embryologist at your clinic removes the shedding “trophectoderm” cells that would have become part of the placenta. The embryos are frozen, and the cells are processed and sent to a genetics lab. An embryologist will determine if the embryo is chromosomally normal or abnormal. Most people have 23 pairs of chromosomes that they inherited from their parents. Sometimes in embryo development there are duplications (trisomies) or deletions (monosomies) of chromosomes, which can cause pregnancy loss. PGT-A allows your physician to select the embryo most likely to result in a higher chance of pregnancy and lower chance of miscarriage.
- Should I undergo genetic carrier screening if my embryos will also be screened?
We have thousands and thousands of genes that reside within our chromosomes. These genes make us the unique individuals we are. Quite often, a mutation can happen in one or more of our genes causing us to be carriers for certain diseases (i.e. cystic fibrosis, spinal muscular atrophy, beta thalassemia and many more). To be a carrier only means we have the gene mutation, but we do not have the actual disease or any symptoms. However, if a male patient has a gene mutation (is a carrier) and his female partner is a carrier for the same gene mutation, then there is a 1 in 4 chance (25%) that a child born from his sperm and her egg would not only be a carrier of the gene mutation but also have the disease. Expanded carrier screening allows for the identification of common gene mutations and can help identify which genes should be specifically tested. Preimplantation genetic testing for monogenic/single gene defects (PGT-M, formerly known as PGD) can be performed on those embryos to attempt to identify those which would lead to children who express that particular genetic disorder.
- What activity restrictions do I have during treatment?
Always follow your provider/clinic guidelines for activity restrictions during treatment. As a rule of thumb, during the stimulation portion of your egg retrieval cycle, you should limit physical activity to walking, swimming or other low-impact physical exercises. Avoid yoga or any exercise that involves jumping and twisting at the waist or any jarring movements. Your ovaries may become swollen and feel heavy during this portion of treatment, and there is a slightly increased risk of ovarian twisting or “torsion.” Patients with torsion present with severe pain and nausea, and they may require surgical intervention.
- What are the side effects of the medications? How am I going to feel?
While it’s true you will feel some side effects of the hormonal medications used during an IVF cycle, these effects are not too different from what you most likely feel during a regular menstrual cycle. Bloating, breast tenderness, and a mild emotional response are the most common side effects to expect, with an increased tendency toward those effects with higher doses and/or longer time on the medication.
- Is an egg retrieval painful? Will I need to take time off from work?
The egg retrieval is a surgical procedure that is usually performed in less than 15 minutes. You will receive IV sedation/anesthesia for your procedure and therefore won’t be able to work or drive that day. However, this procedure is most frequently described as uncomfortable with mild to moderate cramping that typically lasts for a maximum of 24-48 hours. Most often this pain can be controlled with an over-the-counter pain reliever.
- How many embryos should I transfer?
You should discuss how many embryos to transfer with your fertility provider. Progyny wants to ensure our members have the best chance for success and to minimize risk to both the member and their baby. Progyny follows ASRM’s recommendations for a single embryo transfer, which promotes a single gestation pregnancy and reduces the risk of multiples (twins, triplets, etc.). Women who are pregnant with multiples are considered high risk and have an increased chance of complications during and after pregnancy.
- If my treatment cycle is not successful, how long should I wait before I try again?
If your IUI treatment isn’t successful, you’ll usually be able to start again with your next menstrual cycle, as long as a negative pregnancy test is confirmed. If your IVF treatment isn’t successful, your physician may advise waiting one month in between cycles to allow your body to return to baseline, or to allow the hormones to go back to normal. However, these decisions are clinic-specific and patient-specific.
For more information, contact your dedicated Patient Care Advocate or email email@example.com