Questions and Answers

Q:	Does ART damage the ovaries?
A:	There is no evidence to suggest that oocyte retrieval damages the ovaries. There is one report that suggests that infertile women who take fertility drugs and do not get pregnant have an increased risk of ovarian cancer. However, the study did not collect information on the type of drugs used, and the control (comparison} population may not have been selected accurately, since infertile women are known to carry an increased risk of ovarian cancer. The fertility drugs used in ART have been in use over 30 years, and other studies have suggested no increased risk. In most cases, the age of menopause does not appear to be altered after ovarian stimulation.
Q:	Why is the success rate with ART so low?
A:	Studies of human reproduction indicate that for a couple with proven fertility, the likelihood of conception is only 20% per month. ART affords couples with infertility factors similar chances for conception.
Q:	We're concerned about multiple births from ART. Should we just have one embryo transferred?
A:	Any time more than one embryo is transferred, the chance for multiple pregnancy exists. In fact, about 30% of births from ART are twins, a rate much greater than in the general population (1 in 80 pregnancies}. Triplets and quadruplets have also been conceived through ART. However, the majority of ART pregnancies (nearly 70%) are singletons, and the chance of any pregnancy with ART increases up to a point with the number of embryos or oocytes transferred. Success rates appear to peak on average with transfer of two to four embryos, depending primarily on the age of the woman. We will discuss the options and implications of transferring fewer than four embryos, but in general we will not recommend transferring just one. In some programs, selective reduction is available to couples who conceive multiple gestations. Your physician can provide you with more information about this procedure. Identical twins can also occur with ART, the result of two babies from one egg, so even transferring only one embryo does not guarantee an singleton pregnancy.
Q:	Is there an increased chance of birth defects if I become pregnant through ART?
A:	No. The risk of congenital anomalies in children conceived through ART appears to be the same as the risk in the general population. Chromosome abnormalities, such as Down's syndrome also occur at a rate similar to the general population.
Q:	I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?
A:	Although surgical reversal of tubal sterilization might be a better option, IVF-ET is still a consideration, especially in older women or in couples with male factor infertility. The success rate is greater for ligation reversal than for a single cycle of IVF-ET, although the results of IVF-ET are obtained more rapidly than ligation reversal. If ligation reversal has been attempted and has failed, IVF-ET represents the best option. Cost and other factors (such as type and location of the ligation) involved in surgical reversal must be considered when making this decision.
Q:	Does insurance cover the procedure?
A:	Unfortunately, in most states, most insurance plans do not cover ART procedures. Some programs cover portions of the therapy. The IVF staff can help you determine your level of coverage. We strongly recommend you do this prior to starting ART therapy.
Q:	How many days does the entire procedure take?
A:	The entire procedure takes approximately six weeks. However, we only need to see you intensively over a two-week period. These details are discussed in the "Step by Step" sections. -
Q:	Can we have intercourse while attempting ART?
A:	Yes. We recommend that the man abstain from ejaculating for at least 48 hours preceding egg retrieval. This precaution assures that the semen sample for ART is of optimal quality. Near the time of egg retrieval, the ovaries can be enlarged and tender, which can make intercourse uncomfortable.
Q:	What if I ovulate before the retrieval?
A:	Virtually all cases of premature ovulation are now prevented by the use of GnRH analogs (Lupron®, Synarel®, Cetrotide® or Antagon®). In rare cases in which GnRH analogs are not used, we perform an ultrasound prior to retrieval to make sure the follicles are intact. In the uncommon case of ovulation, we will not perform retrieval because the quality of the remaining oocytes is adversely affected.
Q:	Will scar tissue around my ovaries make it impossible to retrieve oocytes?
A:	No, the oocyte can usually be retrieved by transvaginal aspiration even when the ovaries are covered with scar tissue. In rare cases, scarring pulls the ovaries out of the normal pelvic position. This condition can be identified with ultrasound before ART is undertaken.
Q:	How much activity is recommended after ET?
A:	We recommend a fairly quiet 24 hours after ET. Thereafter, most patients resume their normal routines. Strenuous exercises, running, etc. should be avoided until a pregnancy test has been performed.
Q:	After embryo transfer, how long must we wait until we have intercourse without risk to the embryo?
A:	No one knows for sure. We recommend abstinence for a minimum of 48 hours after transfer.

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