HMC’s Infertility and IVF Online Q&A
Many couples who wish to conceive and have children face obstacles along the way. Most obstecales are related to fertility issues of either the mother or father, gynecological diseases, or older age. For many couples, IVF (in vitro fertilization) gives the hope of starting a family.
This week we hosted a live Q&A session on HMC’s Facebook page, where users had the opportunity to ask questions regarding IVF and infertility freely, and receive answers from one of Israel’s leading IVF experts – Dr. Ofer Gonen.
Dr. Ofer Gonen is a leading Israeli IVF and infertility specialist with over 20 years of clinical experience. He is also a senior physician at public Israeli hospital's IVF Department, and maintains a private clinic at Herzliya Medical Center.
In case you missed the Q&A this time, here are some of the questions that Dr. Gonen answered:
Q: what is the advised age limit for a woman to attempt IVF? Can a woman who has reached menopause go through an IVF treatment?
A: The upper limit for IVF is 44-45, and during menopause - only with egg donation
Q: I’m 33, not married and thinking about freezing my eggs for future pregnancies. What is the optimal for egg conservation? Is there a limitation on the period of time that the eggs can be kept frozen without “expiring”?
A: The younger the patient is when the eggs are retrieved and frozen – the better. Egg quality declines with age, so I recommend you go through the procedure as soon as possible. Regarding the limitation on the freezing time – it is still unknown how long the frozen egg stays vital, some say up to seven years is acceptable.
Q: If you gone through IVF twice without it resulting in pregnancy, can you still try again? What can be done to get a positive result?
A: It is recommended that you continue treatment, since your physicians can learn a lot from the results of every cycle, and can adjust the treatment protocol to achieve better results.
Q: What can one do to assure the survival of the fetus after it is transferred to the uterus?
A: Successful treatment result depends mostly on the quality of embryo, and the condition of the uterus. Women can go back to their normal lives after the transfer.
Q: Can I still engage in all the regular physical activities during the treatment?
A: Yes, but you should avoid extreme workouts.
Q: What does it mean if I notice blood spotting after the transfer?
A: there are several options. It can be implantation bleeding, inadequate luteal hormonal support, and sometimes, topical injury from the insertion of the vaginal suppositories.
Q: What are the main side effects or risks I need to consider?
A: The risks of IVF are minor, and can be related to the anesthesia or to the invasive procedure. There are typical complications of fertility treatment such as ovarian hyper-stimulation and multiple pregnancies.
Q: Are there any medications that I should avoid when going through IVF?
A: Medications that are anti-thrombotic can increase the risk of bleeding during the procedure, and should be avoided (aspirin) or temporary discontinued (heparin or clexane).
Q: I am 36 and did not have luck getting pregnant the natural way, but with no apparent medical reason, what chances do I have with IVF? Is there a limit to the age in which I can do that?
A: Age is the most important factor affecting the success of IVF. The age of 36 is an age with relatively high success rates, so it is recommended to go ahead and start treatment, since the chances of conceiving dramatically decline when you get older.
Q: Can the remaining embryos which are not transplanted be saved for the next try?
A: The remaining embryos can be frozen to use in the next cycle, assuming they are of high quality.
Q: If IVF did not work for me, are there any other options to get pregnant?
A: If you went through several IVF cycles and did not conceive, and the issue is with the number of eggs, or their quality (related to older age), you can consider an egg donation.
Q: I went through an IVF cycle 2 months ago, and I did not get pregnant. How soon can I try again? If it still doesn't work, how many more cycles can I go through?
A: There is no actual need to wait between cycles; however, most physicians would prefer to wait one month between cycles in case there are ovarian cysts. The success rate of a healthy young woman to conceive in an IVF cycle is around 35%; therefore, it is very likely that you will need more than one cycle.
Q: Can women with endometriosis go through IVF?
A: IVF is the recommended treatment for women with moderate to severe endometriosis who wish to conceive.
Q: Is the IVF procedure painful? The egg retrieval? The embryo transfer?
A : IVF should be carried out under anesthesia, unless there are very few follicles, then the aspiration can be done without anesthesia, and it is not very painful. The standard operation is performed under anesthesia. Embryo transfer is not painful and is similar to a standard gynecological examination.
Q: What could be the problem when one has repeatedly done IVF with no positive result? The fetus do not attach to the uterus.
A: The problem might be in two factors - the embryo quality or endometrial receptivity. If the women is young and with good quality of embryos, it is more likely that there are issues with the uterus or the tubes that lower the chances of conceiving. In extreme cases, even surrogacy might be the solution. However, before going in that direction, several techniques might improve receptivity.
Q: I have heard some doctors claim that IVF induced conception may help to cure or suppress endometriosis and its painful symptoms. How true is that?
A: All pregnancies can suppress the activity of endometriosis, IVF related or not.
Q: Does the ovarian stimulation during IVF has a special impact on women diagnosed with ovarian cysts or endometriosis?
A: There is no doubt that repeated hormonal stimulation will worsen the condition of endometriosis and might increase the size of endometriomas. Nevertheless, IVF is still the best treatment method for women with moderate to severe endometriosis who wish to conceive.
Q: Is the hormonal treatments harmful for my body or for our (future) child?
A: IVF children have a slightly higher risk of malformations. However, it is still debated whether it has anything to do with the treatment, or related to the treated population itself. The hormonal impact on the mother (such as breast cancer or ovarian cancer) is controversial. The added risk, if exists, is very minor.
Q: Why is it that the number of IVF cycles performed decreases the chances each time? Does a person who did not go through IVF in the past stands a higher chance of getting pregnant than somebody who went through several cycles?
A: Most likely, the patient with better egg quality or better embryos will conceive faster and the patient with repeated implantation failure might suffer from lower embryo quality or poor endometrial receptivity.
Q: Can someone with fibroids in the uterus or tubes go through IVF?
A: Yes, but if there are fibroids inside the uterine cavity or big ones in the uterine wall, then it might be recommended that they will be removed prior to IVF.
Q: Can couples that both their genotype is AS be able to have healthy children through IVF?
A: There are IVF units that can check the embryos prior to the transfer to the uterus, and make sure that the genetic problem was not transferred. In the next few months, such a capability will also be provided by Herzliya Medical Center. A genetic consultation is always required prior to IVF/PGD.
Q: What is the statistics for IVF in Israel? What are the advantages of your clinic?
A: The Israeli statistics are the same as in the US. Generally, the results are divided based on age groups; until the age of 36 the chances of a successful treatment are 35-40%. At the age of 36-42, those chances drastically decline to 10%. Therefore, the chances of success are very individual. At HMC you have the advantage of choosing a physician that will escort you through the entire process and, of course, the advanced technologies and a high-tech laboratory.
Q: On what day of the menstrual cycle should I perform the hormonal tests for fertility?
A: The FSH test, allowing the assessment of the egg reservoir is performed on the third day of the cycle. Other tests, such as AMH and follicles US, are performed at the beginning of the cycle.
Q: When is IUI recommended instead of IVF?
A: IUI is recommended to couples who have not been able to conceive without an apparent reason or in cases of a mildly low sperm count. If after several courses of IUI the couple did not conceive – IVF is recommended.
Q: If my partner or I have hepatitis – do we have to treat it before starting an IVF cycle? What other diseases can stand the way of IVF?
A: Performing IVF with an infectious disease is very problematic, because it compromises the equipment. Therefore, here In Israel, we do not offer IVF to patients with hepatitis B or C or patients with HIV. Please get tested before you arrive to the clinic in order to make sure you are compatible for treatment.
HMC will continue hosting live Q&A sessions with leading physicians to better serve our patients and the public. If you have any questions regarding IVF or wish to receive a medical quote, please contact us today.