1. Are there any restrictions on physical or personal activities during an ivf cycle?
- Smoking: Stop smoking before ovulation induction begins. It is best to discontinue tobacco at least 3 months prior to an IVF cycle. If you cannot stop “cold turkey”, seek the care of your primary care physician. By products of tobacco have been demonstrated to be toxic to the oocyte (egg). Numerous studies have also demonstrated that smoking during pregnancy results in reduced birth weight and fetal compromise. There is some data that smoking can also lower pregnancy rates. We strongly recommend that all women, especially those undergoing fertility treatment, cease smoking.
- Drinking: Alcohol is a drug, and should be avoided during infertility treatment and pregnancy. Please do not drink alcohol from the time fertility medications are initiated until the pregnancy test.
- Medications: If you are taking any medication, prescription or over-the-counter, please inform your physician. Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation. A prenatal or multivitamin will be prescribed; if you are not taking a vitamin with folic acid, please inform the ART nurses. Also, please note: DO NOT USE HERBAL SUPPLEMENTS DURING YOUR IVF CYCLE.
- An IVF cycle can be an emotional and stressful time for you and your partner. It may be helpful to have supportive personnel to speak to, such as friends and family, a clergy member, or a psychologist/therapist.
- Heavy exercise such as aerobics, jogging, weight lifting etc. are prohibited during ovarian stimulation and until the pregnancy test results are known.
- Acupuncture is permitted prior, during and after your IVF cycle but herbal supplements are absolutely prohibited.
2. How does the art laboratory operate and what safety measures are taken? What will happen to the eggs and sperm after retrieval?
On the day before the oocyte (egg) retrieval, oocyte culture dishes are labeled with the patient’s name, date of birth, and ART identification number. The number and size of the ovarian follicles determines the number of dishes prepared (one dish for each large follicle). The dishes are filled with a rinsing fluid in the outer well for removing blood and other extraneous cells from the egg, and a nutrient fluid for the culture of the egg is in the center well.
The dishes are then placed in the embryology incubator for warming to body temperature. The incubator also adjusts the pH of the culture media to the human body. A large amount of rinsing media is equilibrated in the incubator. Media is also equilibrated in the andrology laboratory for processing of the sperm.
One of the more important and useful IVF laboratory instruments is the mobile IVF chamber. It is a pediatric isolette (incubator) on wheels that has been modified to contain a scanning microscope. Prior to the egg retrieval it is warmed to body temperature and put at the normal neutral pH of the culture dish media. These conditions avoid any abrupt changes the eggs might encounter outside the body. The chamber has two small doors on each side. The embryologists place their hands on one side to identify eggs and move dishes. The OR nurse uses the opposite doors to pass test tubes containing the follicular fluid to the embryologist.
Upon arrival in the operating room the patient’s identity is verified by the embryologist, physician, and safety nurse. They also verify that the culture dishes are correctly labeled. At the time of surgery the mobile chamber is loaded with the equilibrated petri dishes for receiving the follicular fluids.
The physician aspirates the fluid from the ovarian follicles into a test tube. A nurse passes the test tube, through the IVF isolette chamber door, to the embryologist. The embryologist then dispenses the fluid into a large dish and rapidly scans it under the microscope. The egg complex is usually visible to the naked eye, but microscopic verification is always done. The oocyte is removed from the large dish by pipette, rinsed in the outer well of the culture dish and placed in the center well for culture and the addition of sperm (insemination). The presence of an egg in the follicular fluid is reported to the physician.
After all of the eggs have been aspirated, the mobile chamber is moved to the embryology laboratory for a more critical assessment of the oocytes, insemination with sperm, and culture.
The maturity and health of oocytes are assessed after an incubation period. Oocytes are graded as mature, intermediate, immature, or degenerate. Oocytes judged mature are incubated 1 to 4 hours before insemination. Less mature oocytes are incubated until they reach maturity, and then inseminated. Approximately 100,000 motile sperm are added to the media surrounding the oocyte in the center well of the culture dish. Dishes containing egg and sperm are then returned to the main embryology incubators for culture.
The male will be asked to collect a semen sample after the oocyte aspiration. The andrologist escorting him to the collection room will identify the patients partner from his identification bracelet prior to collection and will write both names on the outside of the specimen container after collection. The partner will be asked to verify that both names are correct.
Approximately 30 minutes after collection, when the semen liquefies, a semen analysis is performed. The sperm is prepared for insemination.
Twenty to twenty-four hours after retrieval, the oocytes are transferred to fresh dishes that were equilibrated on the day of retrieval. Oocytes are then microscopically examined for pronuclei formation, the sign of fertilization. The pronuclei are the decondensed DNA of sperm and egg nuclei. They appear microscopically as two light spheres within the egg. Oocytes possessing more than two pronuclei are discarded. These abnormal fertilizations are typically naturally aborted.
Fertilized oocytes are returned to the main embryology incubator for 24 hours. At that time the embryos are transferred to fresh dishes where the cell stage and overall health of the embryos are microscopically evaluated. The embryos are either transferred on day 3 or placed into new dishes with a specialized culture media to allow for progression to the blastocyst stage.
3. When is the pregnancy test performed?
The blood pregnancy test is performed 14 days after the egg retrieval.
4. What happens if I become pregnant?
If pregnant, you will be asked to return to the office for repeat blood work and eventually an ultrasound to ensure an ongoing successful pregnancy. After a fetal heartbeat has been confirmed, patients are referred to an obstetrician for the remainder of the pregnancy.
5. If I am not pregnant, when can we try again?
Usually we ask that patients wait one or two complete menstrual cycles before beginning another ART cycle. Sometimes tests are required that may delay subsequent cycles.
6. Will I need a high risk ob because I conceived with an art procedure?
A high risk OB is only needed when there are complications that put the mother or baby at increased risk, or in the case of multiple births. Other than a higher incidence of multiple births, ART does not increase the risk to the fetus.
7. Is there a higher miscarriage rate for art patients?
The miscarriage rate is about the same for ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.
8. What can be done to improve sperm quality?
Sperm quality on the day of egg retrieval is often related to what happened in the male’s body 3 months ago. This is because sperm development takes 3 months. Listed below are guidelines to help ensure the semen specimen is of the best possible quality.
- A fever of 101 degrees Fahrenheit or higher within 3 months prior to ART treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. If you become sick during the ART cycle, please notify the ART nurse, and take Tylenol to keep your temperature below 101 degrees Fahrenheit.
- Discontinue alcohol and cigarette use before and during ART treatment. Do not use any “recreational”/illegal drugs.
- If any prescription medication has been taken during the last 3 months, notify the ART nurse.
- Do not sit in hot tubs, spas, Jacuzzis, or saunas during or 3 months prior to the ART cycle.
- Do not begin any new form of endurance exercise during or 3 months prior to the ART cycle. Physical activity at a moderate level is acceptable and encouraged.
- Avoid all testosterone, DHEA, and Androstenedione/Androstanediol hormone containing supplements. NO GYM SUPPLEMENTS!
- Tell your infertility physician if you have ever had genital herpes, or suspect you may have been exposed to genital herpes in the past. Also tell your physician if you have pre lesion symptoms, develop a lesion, or have healing lesions before or during the ART cycle.
- Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the ART cycle. The ART nurse will have your specific instructions from the Andrologist.
9. How do we decide how many embryos to transfer?
Your physician will discuss this with you at the time of consent signing, but we usually follow the recommendations of The American Society for Reproductive Medicine guidelines:
- Under 34 years old = 1-2 embryos
- 35-37 years of age = 2-3 embryos
- 38-40 years of age = 3 embryos
These numbers may vary depending on individual diagnosis and clinical circumstance.
10. Am I depleting my store of eggs by undergoing an art cycle?
A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and ART procedures have no measurable “lowering” effects.