Infertility Frequently Asked Questions

Frequently Asked Infertility Questions

Frequently Asked Infertility Questions

 

Q: What are the very earliest signs of pregnancy. I just finished the embryo transfer with my first cycle of IVF. I know I have to wait for two weeks before I can officially test to see if I’m pregnant, but what physical signs can I look for that might give me a hint? Sore breast? Nausea?
A: According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, other than missing your period there really are no reliable physical sign of pregnancy in the first two weeks after an embryo transfer. A few women may have an implantation bleed, but that is not a reliable predictor. You can listen to his full answer on the Creating a Family show Fertility 101.
Q: We are getting ready for our first and probably only IVF cycle. We can't afford to do this again and we need to do everything possible to make this work. What can we do to increase our odds of success with IVF?
A: You’ve come to the right place to ask about how to succeed with in vitro fertilization (IVF). We get this question a lot from our community, and have done a number of interviews with leading experts asking them this exact question. Watch this 7 minute video summary on Increase the Odds of Success with IVF.

Q: If we need a lubricant for intercourse, what type should we use that will not interfere with getting pregnant or maybe will even improve our chances? Is it best to use egg whites because they are natural?
A: According to Dr. Cappy Rothman, board certified urologist and specialist in male infertility, relying only on your own lubrication if possible is best since it is the perfect environment for sperm. According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology if a lubricant is needed, use either Pre-seed, Astroglide, or the liquid base form of KY Jelly. Do not use any lubricant with a petroleum base. Both doctors recommended against using egg whites.

Q: Will it help me to get pregnant if I raise my hips over my head after we make love? Any other tricks for getting pregnant before we go to the big guns-IVF?
A: Raising your hips will not increase your odds of conception. Just lying down after sex is enough since the vagina is tipped already and cervical mucus present during ovulation acts like a wick to draw the sperm up into the cervix. We strongly suggest getting educated on the basics of conception for those who it doesn’t come easy. There is no better place to start than listening to these interviews with top fertility doctors.

Q: How often should we have sex when trying to conceive?
A: You first need to determine when the woman ovulates. You can do this with an over the counter ovulation predictor kit or by tracking basal body temperature and/or cervical mucus. It is best to have intercourse every other day around the time the woman is ovulating. Sperm count is optimal with between 2 and 5 days of abstinence. If you are seeing a fertility doctor ask her if she suggests anything different. This information came from the Creating a Family Fertility 101 show with Dr. David Hoffman, board certified reproductive endocrinologist and former president of the Society for Assisted Reproductive Technology.
Q: I am significantly overweight and infertile. The stress of TTC (trying to conceive) is adding to my weight problem. I know it would be better for me to lose weight, but I’d like to know how much is it really a factor in infertility?
A: According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, studies have shown that being overweight reduces fertility, but only when your Body Mass Index exceeds 34. Being overweight, however, does complicate pregnancy. To hear his full answer listen to the Fertility 101 Creating a Family show.  For more about how weight affects fertility treatment and pregnancy, check out the following resources.

Q: Is there any evidence that alternative treatments (acupuncture, mind-body programs, etc.) or diet will help with infertility treatment or increase the odds of success with IVF?
A: Research on alternative treatments for infertility or complimentary treatments that can be used with fertility treatments, such as IVF, are not a robust as you might like, but we have done a number of Creating a Family shows interviewing some of the leading experts on alternative fertility treatment or complementary fertility treatments. We have also interviewed researchers on how diet can affect fertility and IVF.

Q: While I wouldn’t mind twins, we want to avoid triplets, quads, and more. Can we safely avoid higher order multiples in fertility treatment?
A: Most higher order multiples are the result of Intrauterine Injections (IUI), also known as artificial insemination, with injectable ovulatory stimulation medication, not IVF.

There is some debate in the infertility medicine community on whether an IUI with injectable medications can ever be done safely to avoid an unacceptable risk of triplets, quadruplets, quintuplets, and more. According to Dr. Robert Stillman, Medical Director of Shady Grove Fertility Center and Professor of Medicine at Georgetown Medical School, on a Creating a Family show about reducing the risk of multiples it is not really possible to do an IUI with injectable medications safely. You can of course monitor through ultrasound and cancel a cycle if too many eggs mature, but many women are hesitant to go forward knowing that they may well have to cancel the cycle and lose the money that has been spent on the medications. Dr. Stillman said that the ASRM and SART have not issued guidelines for how to safely do this procedure because they don’t exist. There are too many variables to accurately predict how many eggs will mature the first time. Other doctors believe it is possible to do medicated IUI cycles and limit the risk of higher order multiples, but it requires very careful monitoring and a willingness to “lose” the cost of the cycle (including the cost of the injectable gonadotropins if too many eggs are produced.

A great place to learn more about IUIs is by listening to this Creating a Family show on Clomid, Medicated IUI, or Straight to IVF? If your doctor recommends an IUI with injectable gonadotropins, Dr. Stillman recommends being prepared to either cancel the cycle if more than a few eggs are produced, or convert the cycle to an IVF cycle. Of course, this suggestion does not take into account the very real possibility that the reason a couple is doing IUI with injectables in the first place is that they either can’t afford an IVF cycle or have ethical objections to IVF.

To limit the risk of multiples when doing IVF, limit the number of embryos that are transferred. Many infertility clinics strongly encourage patients to consider a single embryo transfer if they have good quality embryos. Any remaining embryos can be frozen for a later IVF cycle. Frozen embryo transfers are now as successful as fresh embryo transfers, and some research would indicate that they are more successful.

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Dr. Ken Doka, Senior Consultant to the Hospice Foundation of America, and author of many books on grief, including Disenfranchised Grief, does not like the term “resolving grief” because it implies dealing with this pain as a one time event, wrapping it up, and being done with it. That is not the nature of grief. It is always with you, but you can come to terms with it in such a way to live a joyful productive life. For more suggestions on how to heal from the pain of infertility when the rest of society does not understand, check out these Creating a Family resources:

Q: We have religious objections to some things about fertility treatment. What options are open to us?
A: Obviously the answer to what type of fertility treatments are available if you object for religious reasons depends on the exact nature of your objections. In general, we find that most people are open to “simpler” forms of treatment such as clomiphene citrate (Clomid) or letrozole (Femara), with or without intrauterine insemination (IUI), but these treatments won’t work for everyone.

We discussed these beginning steps of fertility treatment in detail and for whom they work best the Creating a Family show Knowing When to Move up the Infertility Treatment Ladder, where we interviewed Dr. Jaime Knopman, Reproductive Endocrinologist with RMA of New York and Assistant Professor in the Department of Obstetrics and Gynecology at the Mount Sinai School of Medicine.

In vitro fertilization (IVF) is not necessarily out of the question. Some religions object to the fertilization of an egg outside of a woman’s body, which obviously rules out in vitro fertilization. Others have a general concern for “the sanctity of embryos” in the IVF treatment. In the past, we heard people worry over the loss of frozen embryos in thawing process, but with the cryopreservation techniques used now, this is much less of an issue.

The concern we hear most now from people who think they can’t do IVF for religious reasons is with creating excess embryos that they will not be able to use. For those people, IVF is definitely an option, but it may cost more. We discuss the options available for people who object to the creation of unused embryos in this blog: “Can I Do IVF If I’m Religious?“

Q: We have run out of infertility treatment options using my own eggs, and rather go to the expense of donor eggs we are considering using donor embryos. How do we find embryos and how much does it cost?
A: You have several options for finding donated embryos. In general, you can use an adoption agency that has an embryo donation program or you can use an infertility clinic that either specializes in embryos donation or a traditional clinic that may have embryos that have been donated.

No hard and fast rules exist for the differences between these three approaches, but often adoption agencies provide more support and education for both the donating couple and the receiving couple. They also may require some type of home study to give assurance to the donating couple that the family receiving their embryos is qualified to raise them. You may also have the option when using an agency of receiving information on the donating couple, including the ability to contact them in the future, if they and you want this option. Standard infertility clinics seldom have these requirements or provide these services. Specialized embryo donation clinics usually offer some or all of these services.

The cost of embryo donation (which is sometimes called embryo adoption) varies depending on the additional services or requirements, but it cost considerably less that a full IVF cycle and less than most domestic infant adoptions or international adoptions. Check out the following Creating a Family resources for much more information on these options, including specific information on cost:

Q: What are the advantages and disadvantages for going abroad for fertility treatment?
A: The primary advantage for going to another country for infertility treatment is cost savings, which vary depending on the type of treatment. The primary disadvantages are finding a fertility clinic abroad with success rates comparable to the US, lack of English, possible immigration issues getting the child back into the US depending on the type of treatment, and lack of knowledge about the egg donors or surrogates and how they are treated. There is much to think about before going abroad for infertility treatment. These resources are a good place to start:

Q: I honestly think I might smack the next person who asks me when I’m going to have children. We’re getting ready to go to a family reunion so I’ll probably hear it a lot. Any suggestions for a quick come-back.
A: Why yes! Check out the following:

You might also appreciate Creating a Family’s Infertility Survival Guide for Holidays, Family Gatherings & Baby Showers or the blog about Infertility & the Holiday.

Q: Is it possible to get a grant that will help cover the cost for fertility treatment?
A: Yes, there are grants available, but the competition is stiff. You can get more information on infertility treatment grants at:

Grants for Fertility Treatment & Affordability Programs Offered by Infertility Clinics (1 hour radio show with experts)
Grants for Infertility Treatment: Affording IVF (1 hour radio show with experts)
Grants for Fertility Treatment (video)
How to Get a Grant for Fertility Treatment (blog)

Q: We are thinking about third party reproduction (either donor egg, surrogacy, or donor embryo). Do we need an attorney to draft a contract? If so, how do we find one?
A: Yes, you absolutely need an attorney to make sure that you comply with the law and your rights are protected by contract. You should use an attorney that specializes in reproductive law, which is not the same as a family law attorney. Check out this Creating a Family Video on How to Find a Reproductive Law Attorney. We also have links to specific databases where these attorneys are listed on our Fertility Law page.
Q: We need resources to help explain to our child their conception via third party reproduction (donor egg, donor sperm, surrogacy, donor embryo).
A: Check out our Top Ten Tips for Telling Children About Donor Egg, Sperm, and Embryo. We also have an extensive list of children’s books that can help you explain third party reproduction to your child. Last but not least, check out these Creating a Family resources with parenting experts:

 

Image credit: linh tinh