As you begin and move along your path to pregnancy, hundreds of questions will surely arise. We've anticipated a few of them here for you in our collection of common questions and answers.
As more questions come up, we invite you to call Rhonda, our new-patient clinical liaison, at 888-300-2483. The more you know, the more comfortable you can feel as you move through your fertility journey.
The initial testing is useful in detecting large problems such as low sperm counts or blocked fallopian tubes. Approximately 20-25% of patients presenting with infertility will have normal testing (called “unexplained infertility”). This may be at least partly explained by an age-related decline in fertility. Often times we are able to obtain further information as to why you have not gotten pregnant through monitoring and may be able to help overcome this underlying infertility with treatment.
On average 2-3 weeks.
Yes, no restrictions.
Avoid the hot tub/Sauna during treatment and once pregnant.
We consider Day 1 of your period to be the first day of “full flow” (i.e. not just spotting that precedes your period). If you were asked to call your nurse on day 1 of your period, please only call during daytime hours (9am-5pm; weekends included). If after 5pm, please call the next morning.
This can be a result of medications give, or can be a sign of a possible hormonal or structural issue such as a polyp or fibroid. You should contact your team nurse if this occurs unexpectedly.
You should have a discussion with your Boston IVF physician about all medications that you currently take prior to starting treatment, but typically you can remain on most medications unless specifically asked to stop.
Limit caffeinated beverages to two 8 oz caffeinated beverages per day (or less than approximately 150-200mg caffeine) during treatment and when pregnant.
We strongly recommend the flu shot for all of our patients, as pregnant women can especially get very sick if they get the Flu. If your PCP has specifically recommended preservative free for you (this is rare), then you must get a preservative-free flu shot.
Please abstain for 48 hours prior to a semen analysis. There are no restrictions around intercourse after IUI. See below for further recommendations regarding abstaining from intercourse during IVF and embryo transfer cycles.
There are no restrictions or recommendations.
Although not routine, there are a number of potential reasons your physician may recommend for you to take baby aspirin during treatment; please discuss directly with them and only take aspirin if you are advised to do so by your physician.
We generally consider a total motile count of at least 5 million sperm (post-processing) as an adequate sample for IUI.
Yes. If pregnant, let the dentist know that they may give you Novocaine without epinephrine.
The data on the effect on IVF or pregnancy is quite limited. We recommend that you wait until the second trimester (or after pregnancy), or check with your OBGYN once you are pregnant.
No clear restrictions, but we recommend you go somewhere with good ventilation.
Yes, but let the therapist know that you are in treatment or pregnant beforehand.
Herbal supplements are not controlled and therefore we cannot recommend them. However, if you are on them, be sure to tell your doctor everything you are taking prior to testing/treatment.
NOTE: If you are taking a biotin supplement (often a hair/nails supplement), please discontinue this at least 3 days (preferably 1 week) prior to blood tests, as this can interfere with results.
Yes, there are many services available. Through the Domar Center at Boston IVF Waltham there are three psychologists who offer individual and couples counseling, acupuncture, The Mind Body Program and nutritional counseling with a registered dietician. Also there is a psychologist on staff at the Lexington Center and three social workers who consult with Boston IVF and offer individual and couples counseling at the Waltham Center and at their private practices.
Please let your Boston IVF team know if you have recently had or are planning any such travel and review the latest CDC guidelines for more information.
https://www.cdc.gov/zika/pregnancy/index.html
In general terms:
For purple areas on the map in the continental U.S. - avoid mosquitos.
For purple areas outside the U.S. - avoid travel.
It is usually within 7 to 10 days; if no period by then, contact your team nurse.
Usually within 2-5 days after the last pill; if no period, please contact your team nurse.
Without an immediate embryo transfer (freeze-all cycles, egg freeze cycles, etc.),a period will usually start 2 weeks after HCG-based trigger and about 1 week after a Lupron trigger.
Cetrotide and Ganirelix can be irritating and you may see redness at injection site; this is common and does not represent a true allergic reaction. Using ice at the injection site can help with discomfort and redness. It should go away within 24 hours. If you develop breathing changes or other serious signs/symptoms of a severe allergic reaction (very rare), call 911/go to the nearest emergency room immediately.
They are interchangeable vaginal progesterone preparations (except the dosing may be different).
Your doctor will decide on the best route for you to take progesterone. Sometimes it’s taken vaginally, sometimes intramuscularly, and sometimes both.
Yes.
NO! The “trigger” shot prior to egg retrieval is the one medication that is quite time-sensitive.
We recommend setting an alarm and reminders for yourself to take at the exact time you are advised (±15 minutes). If you take your trigger shot at a different time than advised, please contact your team nurse or the nurse on call, as your egg retrieval time may need to be changed.
You can take any of these NSAID medications as directed (whatever you typically take for menstrual cramps) for pain relief starting 6 hours after your egg retrieval, as we give an IV version of these during your procedure. Please discontinue the day before your embryo transfer (and do not take during pregnancy).
If you are having an egg retrieval, please stop these medications at least one day before your planned procedure since these medications can increase bleeding during surgery.
Tylenol (per package directions) is OK during treatment and pregnancy.
All trigger shots should be given SC like other IVF injections—ignore the box directions.
Contact your team nurse for specific instructions, but typically one missed oral medication dose like this will not affect outcome.
On average, results are received about three weeks from egg retrieval.
This should be discussed with your Boston IVF physician as they know your complete clinical picture. Success rates vary and must take into account several different factors like history, test results, diagnosis and age.
The studies on acupuncture before and after your embryo transfer or during any fertility treatment show mixed results on improving success rates. However, some patients may benefit and we recommend it if you’d like to try it. We have acupuncturists who specialize in this type of treatment in our Domar Center.
We suggest that you limit it to an occasional drink during treatment and avoid drinking alcohol once you are pregnant.
For frozen embryo transfers (depending on the type of cycle your physician prescribes), the lining of the uterus is sometimes prepared with estrogen followed by the addition of progesterone. For fresh IVF cycles, progesterone alone is usually sufficient.
Ovarian cysts are very common and associated with your normal menstrual cycle; usually they will resolve on their own. If there are any concerns your physician will discuss with you.
There are no flight restrictions while waiting for your pregnancy test. However, we do not recommend travel after a positive pregnancy test until we can do an ultrasound to assess for location/viability of the pregnancy-- typically 2-3 weeks after a positive result.
Of note, pregnancy (even early pregnancy) carries an increased risk of blood clots that, while rare, can be very serious if they happen. Prolonged travel and other periods of sitting/inactivity increase this risk, so be sure to stay active during pregnancy and travel to minimize your risk.
Refer to the full Boston IVF exercise guidelines that are based on the current literature but here are some helpful guidelines:
- Continuing exercise that you already routinely do is generally OK after IUI/relations/frozen embryo transfer
- The major restrictions are after an IVF stimulation cycle and egg retrieval, as this stimulation causes your ovaries to enlarge. This increases risk of ovarian torsion (when your ovary twists on its own blood supply, causing severe pain and ovarian tissue damage) so we advise NO high impact exercise such as running, HIIT, aerobics, etc. during treatment
- Walking is OK and recommended if you feel up to it!
Yes.
For an IVF/embryo transfer cycle (including frozen embryo transfers), we advise that you abstain from intercourse or use condoms during your treatment cycle until a pregnancy test to avoid a high risk multiple gestation pregnancy from a concurrent natural conception.
For an IUI cycle, you can have unprotected relations the day of your IUI and after (but this is not necessary for cycle success).
See above Q&A about intercourse before/after IUI/semen analysis.
There is no need to be concerned.
In order to maintain appropriate chain of custody, your partner will need to bring his sample to Boston IVF himself with a valid photo ID, or unfortunately the sample cannot be accepted.
Most transfers do not include anesthesia so you can drive yourself if needed. It your transfer does include anesthesia (which is rare), then you cannot drive for the rest of that day.
An empty bladder is best for vaginal ultrasounds and a full bladder is best for abdominal ultrasounds (including for embryo transfer).
Yes, if on a low setting.
Embryo grading tells us about the rate of embryo growth and integrity of the cells; however, it does not give us any genetic information about the embryo (if it is chromosomally normal).
This would require a discussion with your Boston IVF physician.
This is determined by a number of factors; you should discuss this with your physician.
As with natural conceptions, an IVF-derived embryo can split during early development (after embryo transfer) and result in an identical twin pregnancy.
The other possibility is if you have unprotected sex around the time of your embryo transfer and have a concurrent natural conception. This is why we recommend abstaining or using condoms while undergoing an IVF/embryo transfer cycle. Our goal is always ONE healthy baby at a time!
This is determined by multiple factors including your age and pre-conception testing. Please discuss with your physician.
The chance of implantation after transfer of a chromosomally normal (euploid) tested embryo is up to 60-70% (never 100%) and several factors may explain this. You will have a follow up appointment with your physician who will carefully review your treatment cycle details with you.
All reproductive age women have some chromosomally abnormal eggs (that would result in a chromosomally abnormal embryo); the proportion of abnormal eggs just increases with age.
We often see pink/red/brown spotting, which can be a small amount of blood from the egg retrieval/embryo transfer/IUI mixed with vaginal discharge and this is typically not concerning. You can also commonly see spotting related to vaginal/cervical irritation from vaginal progesterone application (if you are taking this medication) or after intercourse. If you have heavy bright red bleeding, please contact your team nurse.
Stick with cooked/pasteurized foods and low mercury fish during pregnancy. Also avoid alcohol.
Following a treatment cycle, we will draw one HCG level 10 days after embryo transfer (or 14 days after IUI). If it is positive, we will get one more 48 hours later. If there is an appropriate interval rise, the next step is an early OB ultrasound at 6-7 weeks gestation (which is actually just a couple weeks after your blood tests).
If a reassuring level is seen on the second HCG test, the further HCG levels are not needed and the prenatal ultrasound can be scheduled. If the HCG level is not rising appropriately, your team will follow serial levels to help determine if this is a viable pregnancy.
With any pregnancy there is a risk of an abnormal pregnancy/early pregnancy loss or an ectopic pregnancy (a pregnancy outside of the uterus). These scenarios can present with abnormally rising HCG levels and are followed closely by your team.
There can be several reasons for bleeding in early pregnancy and this would warrant a call to your team nurse, especially if bright red and heavy like a period. As above, light spotting in early pregnancy is very common and often not concerning.
We recommend not using CBD products of any kind during fertility treatment as it may affect outcome.
