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Boston IVF's Frequently Asked Questions

General Fertility & Family Building FAQs

All of our initial testing came back normal; why am I not getting pregnant? Show more

Approximately 20-25% of patients presenting with infertility will have normal testing (called “unexplained infertility”). This may be partly explained by an age-related decline in fertility. Often, we can obtain more information as to why you have not gotten pregnant through monitoring and may help overcome this underlying infertility with treatment. The initial testing is useful in detecting problems such as abnormal sperm parameters or fallopian/uterine defects.

When will my genetic blood test for carrier screening be available? Show more

On average 3-6 weeks

Can I swim during treatment (pool, ocean or lake)? Show more

Yes, there are no restrictions.

Can I use my hot tub or sauna during treatment? Show more

Avoid the hot tub/sauna during treatment and once pregnant.

Is this really my period? What is cycle day 1? Show more

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 call during daytime hours: 9am-5pm; weekends 9am-3pm). If after 5pm, please call the next morning.

Why am I bleeding between periods, is this normal? Show more

This can be a result of medications given 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

Should I stay on all my prescribed meds during treatment for high blood pressure, thyroid, depression etc.? Show more

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. Please consult with your team before starting any new over-the-counter medications or prescription medications.

Can I drink coffee during treatment or other caffeinated beverages? Show more

Limit caffeinated beverages to two 8 oz caffeinated beverages per day (or less than approximately 150-200mg caffeine) during treatment and when pregnant. This includes tea, soda, coffee, and caffeine tablets.

Do I need to get a flu shot? Does it need to be without preservatives? Show more

We strongly recommend the flu shot for all 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.

Do I need to get the COVID vaccine? Show more

We recommend getting the COVID vaccine and boosters for all our patients that are trying to conceive or currently pregnant.

Does it help to have an orgasm the night before my IUI? Or after the IUI? Show more

There are no restrictions or recommendations

Why do I need to take low dose aspirin? Show more

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.

Is it okay to go to the dentist? Show more

Yes, you can proceed with routine dental work as oral hygiene is important in pregnant is important to tell your dentists that you might be pregnant as if you require Novocaine, it needs to be without epinephrine and if you require x-rays you need to wear proper protection as radiation can be harmful in early pregnancy.

Can I get Novocaine at the dentist? Show more

Yes. If pregnant, let the dentist know that they may give you Novocaine without epinephrine

Is it OK to get my hair colored? Show more

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. This includes henna.

Is it OK to get a manicure and pedicure? Show more

No clear restrictions, but we recommend you go somewhere with good ventilation.

Is it OK to get a body massage? Show more

Yes, but let the therapist know that you are in treatment or pregnant beforehand.

Is there a restriction on herbal supplements? Show more

Herbal supplements are not controlled or regulated by the FDA 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.

Are there any services available to help me (and my partner if applicable) through this very stressful fertility journey? Show more

Yes, there are many services available. Through the Wellness Center at Boston IVF Waltham there are psychologists and social workers who offer individual and couples counseling, acupuncture, The Mind Body Program and nutritional counseling with a registered dietician.

Medication FAQs

When am I going to get my period after Provera/Prometrium? Show more

It is usually within 7 to 10 days; if no period by then, contact your team nurse.

When am I going to get my period after OCPs (birth control pills)? Show more

Usually within 2-5 days after the last pill; if no period, please contact your team nurse.

When am I going to get my period after my trigger injection? (Lupron vs. HCG/Ovidrel) Show more

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.

I have a rash/reaction after injecting Cetrotide®/Ganirelix®…what should I do? Is this ok? Show more

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.

Is there any difference in effectiveness between Crinone and Endometrin? Show more

They are interchangeable vaginal progesterone preparations (except the dosing may be different).

Why do I have to do progesterone in oil injections? Show more

Your doctor will decide on the best route for you to take progesterone. Sometimes it's taken vaginally, sometimes intramuscularly, and sometimes both.

Is it OK if I take my stimulation meds (Gonal-F;/Menopur) a few hours late tonight because I'm going to a concert? Show more

Yes.

Is it OK if I take my “trigger” shot (HCG/Ovidrel/Lupron) a few hours late tonight because I’m going to a concert? Show more

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/physician on call, as your egg retrieval time may need to be changed.

Can I take ibuprofen/Motrin®/Aleve® (NSAIDs) after egg retrieval for pain? Or still only Tylenol? Freeze-all cycle vs. Fresh embryo transfer? Show more

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). Tylenol (per package directions) is OK during treatment and pregnancy.

The label on the HCG trigger says to take IM (intra-muscular), but the nurse told me SC (sub-cutaneous) like all my other IVF cycle meds. Which do I do? Show more

All trigger shots should be given SC like other IVF injections—ignore the box directions.

I missed my dose of birth control, estradiol, Crinone, Clomid, letrozole; should I double up? Or just keep going? Show more

Contact your team nurse for specific instructions, but typically one missed oral medication dose like this will not affect outcome.

What if I need to get more medication? Show more

Your team typically sends your medications to your preferred specialty pharmacy or local pharmacy (if applicable) with refills available. You are able to contact them directly to coordinate pick-up or delivery of the medications.

IUI/IVF FAQs

Will I need to be off from work on the day of my IUI? Show more

No, you may resume your normal schedule for that day unless you take an anxiolytic for procedures. Bedrest after the IUI does not increase pregnancy rates.

What can I expect the day of the IUI? Show more

Your partner (if applicable) is responsible for providing a sperm sample that morning, no later than 1 hour before your scheduled procedure. It is important to have a photo ID and insurance card (if applicable). If using a frozen sperm sample, the sample will be thawed in the morning prior to your scheduled arrival time. The IUI is booked in a 20-minute appointment but typically takes about 30 seconds to perform once cervix visualized with speculum. It is normal to experience cramping and light spotting after the IUI.

When will my PGT (embryo biopsy) results be available? Show more

On average 3 weeks from egg retrieval. This may seem like a long time to wait, but this is not wasted time. During this time, you can expect to get a period following the retrieval (7-14 days after trigger injection) and we recommend that you contact your nursing team to see if you need to update any testing and ensuring you have a follow up consult scheduled to review PGT-A test results and discuss starting a frozen embryo transfer cycle.

What are the success rates for me? Show more

This should be discussed with your Boston IVF physician as they know your complete clinical picture. Success rates vary and must consider several different factors like history, test results, diagnosis and age.

Is acupuncture helpful? Is it recommended? Show more

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 Wellness Center in Waltham, MA.

Can I have a glass of wine during my treatment cycle? Show more

We suggest that you limit it to an occasional drink during treatment and avoid drinking alcohol after timed intercourse, intrauterine insemination or embryo transfer.

Why do I need to take progesterone and estrogen after my embryo transfer? Show more

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.

What does it mean that I have a cyst on my ovary? Is this bad? Show more

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 Boston IVF physician will discuss with you.

Can I fly during IVF stimulation? Can I fly/travel after embryo transfer during the 2 weeks wait before my first pregnancy test? Can I fly/travel after I find out I’m pregnant? Show more

The general recommendation is to avoid travel while pursuing fertility treatment; this includes local travel as well as domestic/international travel. If you have to travel during treatment, please consider that treatment requires multiple in-office visits often with little notice. It is important to be able to come into the office on your scheduled visits so we may optimize timing. Additionally, there are risks associated with travel during early pregnancy as well as financial implications if you must seek a visit with a health care provider that is out of network. It is recommended that you do not travel for at least 24 hours after your egg retrieval or any surgical procedure that requires anesthesia and until your first OB ultrasound to assess location and viability of the pregnancy, which is typically scheduled 2-3 weeks after a positive pregnancy test. 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.

Is it ok if I exercise/run after IUI? After ET or FET? Show more

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!

Is it ok for me to lift my toddler while on stimulation medication and after the egg retrieval or embryo transfer? Show more

Yes.

Can we have intercourse during fertility treatment? Show more

For an IVF/embryo transfer cycle (including frozen embryo transfers), we advise that you abstain from intercourse during your treatment cycle until a pregnancy test to avoid a high-risk multiple gestation pregnancy from a concurrent natural conception and to reduce the risk of ovarian torsion or post-operative infection/complications For an IUI cycle, you can have unprotected intercourse the day of your IUI and after (but this is not necessary for cycle success). Your doctor might even recommend that you have intercourse the day of your trigger injection for IUI. See above Q&A about intercourse before/after IUI/semen analysis.

Can I just bring in my partners sample for him? Show more

To maintain appropriate chain of custody, your partner will need to bring their sample to Boston IVF themself with a valid photo ID, otherwise the sample cannot be accepted.

Do I need a ride home after my embryo transfer? Show more

Most transfers do not include anesthesia so you can drive yourself if needed. It your transfer does include anesthesia (which is rare) or an oral anxiolytic, then you cannot drive for the rest of that day.

Do I need a full/empty bladder for a vaginal/abdominal ultrasound? Show more

An empty bladder is best for vaginal ultrasounds and a full bladder is best for abdominal ultrasounds (including for embryo transfer).

What is embryo grading? What does it mean as far as being genetically normal? Show more

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).

For treatment with IUI/IVF/ IVF with PGT-A: what are my chances of success? Show more

This would require a discussion with your Boston IVF physician.

What is the risk of miscarriage with IUI/IVF/FET? Show more

This is determined by a number of factors; you should discuss this with your Boston IVF physician.

I had one embryo transferred; why am I pregnant with twins? Show more

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 intercourse around the time of your embryo transfer and have a concurrent natural conception. This is why abstinence is recommended during a treatment cycle. Our goal is always ONE healthy baby at a time!

What’s the chance of having an abnormal embryo with PGT-A? Show more

This is determined by multiple factors including your age and pre-conception testing. Please discuss with your Boston IVF physician.

I had PGT-A done and a normal embryo was transferred; why didn’t I get pregnant? Show more

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 Boston IVF physician who will carefully review your treatment cycle details with you.

I’m under age 40-- why are my embryos abnormal? Show more

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.

Pregnancy FAQs

I’m pregnant and spotting. Is this ok? Show more

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.

If I am not pregnant after my cycle, can I try again right away? Show more

It depends on the clinical situation. Please reach out to your team to determine as there might be additional testing your physician will want to complete. Additionally new treatment plans, require new financial authorizations and new prescription medications which takes time. It is very likely to have a rest cycle or rest month.

Can I eat fish/sushi/unpasteurized cheese/dairy? Show more

The general recommendation is to stick with cooked/pasteurized foods and low mercury fish during pregnancy. Also avoid alcohol. We recommend you consult the following reputable resources: - Pregnancy | FDA (https://www.fda.gov/consumers/womens-health-topics/pregnancy) - Pregnancy | Pregnancy | CDC (https://www.cdc.gov/pregnancy/index.html) - Home Page – MotherToBaby (https://mothertobaby.org/) - Pregnancy | ACOG (https://www.acog.org/womens-health/pregnancy)

How many hCG levels (blood test for pregnancy) do I need? Can I get another hCG level just to be sure? Show more

Following a treatment cycle, your physician will order one hCG level 10-12 days after embryo transfer (or 14 days after IUI). If it is positive, level will be obtained 48-96 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, 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 until an ultrasound can be performed.

Why is my hCG rising abnormally? Why do you need to follow so closely/what is the risk? Show more

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.

My hCG levels are normal; why am I bleeding? Show more

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.