The Top 10 Questions to Ask Before Starting IVF
IVF is a big step, physically and financially, and you likely have questions before you commit but you just don’t know what to ask. Of course, how do you know what you don’t know?! The purpose of this blog is to inform you about the IVF process and provide you with some preliminary questions to ask your Reproductive Endocrinologist (RE). It’s important that you feel empowered and in-control when it comes to the decision of IVF. Don’t be afraid to ask questions and advocate for yourself, you always deserve to be in the know!
1. What testing has been completed that makes IVF a necessary procedure for me?
IVF is not typically the first option when it comes to Assisted Reproductive Technology (ART). You may have already gone through several unsuccessful IUIs, or you/your partner may have a specific circumstance that requires IVF. When it comes to blood work for eggs, a low AMH level and/or high FSH level is an indicator of low ovarian reserve and IVF may improve you ovarian response. For sperm, if there is hypospermatogenesis, IVF with ICSI (injecting the sperm directly into the egg cytoplasm) may be the best option for you. Do make sure your RE walks you through the evidence that supports the need for IVF in your particular case. Learn more about other hormone testing options.
2. What does IVF involve?
Ask your RE to go over the procedure with you, including how the medications are administered, the function of each medication (I get asked this one the most!), and how many appointments you will need. You or someone you know will need to be comfortable with the injections! You may also need to adjust your work schedule for the frequent cycle monitoring appointments. The egg retrieval procedure is indeed minor surgery so you should be advised as to how to prepare beforehand.
3. How much does IVF cost? Do you have funding available?
This one I’m sure is the most obvious question to ask, IVF is expensive! The funding gets confusing though. In Ontario, one IVF treatment cycle per female patient is funded. However, you are at the liberty of the waitlist at your fertility clinic. Depending on the fertility clinic, you may wait from 6 months to 2 years for your funding. The funding is based on a first come, first serve basis. In order to be eligible the person with the eggs must be under the age of 43. The funding does not cover the medications, but it does cover the cost of ALL of your embryo transfers. For example: if you produce 3 viable embryos from your IVF cycle, each embryo will be transferred one at a time; each of these transfers is covered by the funding.
4. What are the side effects?
You’ll want to ask about the side effects of the specific medications you are taking as well as the risk of ovarian hyperstimulation syndrome (OHSS) and egg retrieval. Long-term side effects are largely unknown (from my understanding), but you’ll want to know what to expect while taking the medications so you don’t have to resort to “Dr. Google” along the way.
5. What is the success rate of IVF?
The success is going to depend on your unique case, as well as your partner’s/donor’s, and both of your ages. The greater the number of high quality embryos produced, the greater your chances for a healthy live birth. The CDC has an amazing tool, based on their compiled data, to calculate your potential success rate. For example, the chance of live birth per embryo transfer between ages 38-40 is 27%. The chance of live birth per egg retrieval procedure between ages 38-40 is 19%.
6. Based on my lab work how many embryos do you think will be produced?
This is important for developing realistic expectations for the IVF process. Your RE should be able to predict this for you. To give you a real world example of a female age < 35 using stimulating medications: 10 follicles were retrieved, of these 10 follicles only 7 were mature and viable, of the 7 follicles 5 were fertilized, of these 5 embryos only 3 survived until day 5. That’s a total of 3, day 5 embryos to be transferred.
7. Do you advise day 3 or day 5 embryo transfer? Will the embryo transfer be fresh or frozen?
A 5-day-old embryo has more cells than a 3-day-old embryo; it is referred to as a blastocyst. Blastocysts are commonly higher quality embryos than embryos in the cleavage stage (day 3). They’ve survived an extra 2 days on their own! It is worth discussing which practice your RE uses. Frozen embryo transfers are now more common practice, as it gives your body a chance to rest before the transfer. This means you’ll wait until your next cycle to transfer the embryo, rather than right after egg retrieval. The research on live birth rates when comparing fresh and frozen embryos seems to show similar outcomes.
8. What medications will be used?
All IVF protocols typically follow the same algorithm, called the “antagonist protocol”. There are other protocols besides the antagonist protocol, but these are far less used.
The FSH medication options: Gonal F, Puregon, Rekovelle
The combined FSH/LH medication options: Menopur, Pergoveris, Luveris
The medications to prevent ovulation: Cetrotide, Orgalutran
The medications to improve egg quality: DHEA, androgel, human growth hormone (Saizen) - you’ll have to ask your doctor for these specifically
9. Do you offer PGS (pre-implantation genetic screening)?
This screening is completed on frozen (and then thawed) day 5 embryos. It is a test to determine whether embryos have an abnormal number of chromosomes. It can be used to prevent miscarriage or lack of embryo implantation. If an embryo has an abnormal number of chromosomes it will not be transferred. Not all clinics offer this technology, and it is an additional cost.
10. Do you welcome the support of acupuncture and naturopathic medicine during IVF?
Finally, the most important question of all! Choose an RE who supports a multidisciplinary approach to fertility. It can take a village to make a healthy baby and you deserve access to all tools in that village. Acupuncture and naturopathic medicine have been highly researched for fertility support. We can also help you navigate the IVF process and answer questions your RE may not have the time to answer. You should feel supported every step of the way.
References
Hatırnaz Ş, Kanat Pektaş M. Day 3 embryo transfer versus day 5 blastocyst transfers: A prospective randomized controlled trial. Turkish Journal of Obstetrics and Gynecology. 2017;14(2):82-88. doi:10.4274/tjod.99076.
Aflatoonian A, Karimzadeh Maybodi MA, Aflatoonian N, et al. Perinatal outcome in fresh versus frozen embryo transfer in ART cycles. International Journal of Reproductive Biomedicine. 2016;14(3):167-172.
Wong, K. M., van Wely, M., Van der Veen, F., Repping, S., & Mastenbroek, S. (2017). Fresh versus frozen embryo transfers for assisted reproduction. The Cochrane Library.
Mastenbroek, S., Twisk, M., van der Veen, F., & Repping, S. (2011). Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Human reproduction update, 17(4), 454-466.
