Frequently Asked Questions

Previously frozen embryos may be transferred during a woman’s natural cycle or in a controlled (artificial) cycle, depending on a number of factors:

Controlled cycle transfer. In a controlled cycle, hormone medications are given to prepare the uterus for transfer. This method is recommended for patients who have irregular cycles. Because the controlled cycle can be precisely timed, it is also advised for those who are on a set travel schedule. The medications commonly used for a controlled cycle are estrogen (either in an injectable or oral form) and progesterone (in either an injectable or vaginal form).

Natural cycle transfer. Patients who have a regular menstrual cycle may have the option of using their natural cycle for the transfer of frozen-thawed embryos. In this case, there is no need for hormone treatment, as the body’s natural cycle will prepare the uterus for pregnancy. In cases where natural cycle transfer is possible, this option allows for less medication and monitoring and thus is often relatively affordable for patients. We typically will monitor the natural cycle using home urinary ovulation predictor kits as well as ultrasounds. When the kit changes and/or a nice pre-ovulatory follicle is seen on ultrasound, we administer a single injection of Ovidrel (recombinant subcutaneous hCG) and the patient starts progesterone vaginal suppositories a couple of days later. The embryo transfer will occur 5-7 days after ovulation/hCG injection, depending on whether the embryos are frozen at a Day 3 or Day 5 stage.

For the transfer procedure itself, the embryo is thawed at room temperature, and then warmed to body temperature (37° C). As with a fresh embryo transfer, embryos are placed inside a special catheter (a very thin tube), which is guided through the cervix and into the uterus. Embryos are gently injected into the uterus and the catheter is removed. This procedure requires no anesthesia, and is done in a position similar to a pelvic examination for a Pap smear. After transfer, the woman rests for 15 minutes and then is able to go home, where a day of rest or very gentle daily activity is recommended.

In general, the success of frozen-thawed embryo transfer procedures depends on three factors:

The quality and survival of the frozen-thawed embryos. In general, we only freeze good quality embryos so the current rate of survival is greater than 90%.

The age of the woman who produced the eggs. In patients under the age of 37, the chances of pregnancy with frozen-thawed embryos are similar to a pregnancy with fresh embryos. In patients 37 years or older, pregnancy chances with frozen-thawed embryos decline in conjunction with declining fertility in general, but still can be quite good. As always it is best to discuss a woman’s individual situation with their physician.

The status of the uterus in the woman receiving the embryos. A healthy endometrial lining free of any interfering fibroids or polyps provides a sound environment for embryo implantation.

A woman’s ovaries house hundreds of potential eggs. Each month, during the natural ovulation cycle, the ovary selects just one egg from a pool of 100-1,000. Those eggs which are not selected undergo a natural cell death process called atresia. When a woman uses fertility medication, the body’s natural selection process is overridden, and a number of these otherwise unused eggs are allowed to grow. As many as 20 eggs may be stimulated in a given cycle. Thus when using fertility medication in the IVF process, not only is the woman not using up all of her eggs, but she is ‘rescuing’ eggs that otherwise would have undergone atresia.

While some research suggests a slightly higher incidence of birth defects in IVF-conceived children compared with the general population (4 - 5% vs. 3%), it is possible that this increase is due to factors other than IVF treatment itself.

It is important to recognize that the rate of birth defects in the general population is about 3% of all births for major malformations and 6% if minor defects are included. Recent studies have suggested that the rate of major birth defects in IVF-conceived children may be on the order of 4 to 5%. This slightly increased rate of defects has also been reported for children born after IUI and for naturally-conceived siblings of IVF children, thus it is possible that the risk factor is inherent in this particular patient population rather than in the technique used to achieve conception.

Research indicates that IVF-conceived children are on par with the general population in academic achievement as well as with regard to behavioral and psychological health. More studies are under way to further investigate this important issue.

Because the IVF process bypasses the fallopian tubes (it was originally developed for women with blocked or missing fallopian tubes), it is the procedure of choice for those with fallopian tube issues, as well as for such conditions as endometriosis, male factor infertility and unexplained infertility. A physician can review a patient’s history and help to guide them to the treatment and diagnostic procedures that are most appropriate for them.

IVF literally it means "fertilization in glass,” because the woman’s eggs and the man’s sperm are fertilized in a Petri dish. During the IVF process, a patient’s natural cycle is carefully manipulated through the use of fertility medications. These medications stimulate the ovaries to produce not one, but a number of mature eggs. At the right time, the eggs are retrieved from the ovaries. At this time, the male supplies a sperm sample (or a stored, frozen sample is used). The eggs and sperm are placed in a Petri dish and fertilized. At the proper time, the embryos are transferred into the woman’s uterus.

IVF is considered to be one of the most efficient forms of fertility treatment, in that it usually provides the highest rates of successful conception for any one treatment cycle. For patients with severe male factor infertility or significantly blocked fallopian tubes, IVF treatment is the only realistic treatment option. It is often recommended for older patients or when IUI and medications have not been successful.

For lesbian women, the options for conception include:

Sperm donation and intrauterine insemination using sperm from a bank, or from a known sperm donor, with or without the use of fertility-enhancing medications

IVF with donor sperm with one partner providing eggs and gestating the pregnancy

IVF with donor sperm with one partner providing the eggs and the other partner gestating the pregnancy, sometimes referred to as IVF Co-Maternity

If a sperm donor is required, we can provide referrals to reliable sperm banks. Depending on the age of our patients and other possible fertility factors, we may or may not recommend adjunctive treatment with fertility medications.

If the patient wishes to use a known sperm donor, there are several requirements, including compliance with all infectious disease testing as required by the FDA, a physical exam and psychological counseling for the donor and recipient couple. Additionally, we require freezing the sperm specimen in advance of the treatment cycle. We also strongly recommend a legal agreement when possible co-parenting relationships are expected.

For lesbian patients interested in IVF Co-Maternity, we will stimulate one partner to produce the eggs as per standard IVF treatment protocols. The final event for the egg-providing partner is the egg retrieval. While the egg-providing partner is undergoing treatment with the egg-stimulating medications, the other partner will take Lupron, estrogen injections and progesterone injections to shut off her own ovulation and prepare the uterus for receipt of an embryo. She will then undergo the embryo transfer procedure 3-5 days after her partner has had the egg retrieval procedure. The baby will have the genetic make-up of the egg providing partner and the sperm donor and the gestating partner will carry the pregnancy, give birth and breast feed the infant. We do recommend legal agreements so that both mothers can be listed on the birth certificate.

Single Embryo Transfer (SET) is an embryo implantation procedure in which only one embryo is transferred into the uterus. There are many advantages to an Single Embryo Transfer over a Multi Embryo Transfer. Single Embryo Transfers reduces the possibility of a miscarriage as well as the need for a clinical abortion. There is also a much smaller probability of conceiving multiple children at once, increasing your chances for a strong, healthy pregnancy.

Blood drawing: Discomfort and the possibility of developing a painful bruise at the needle site may occur. A blood clot in the vein may occur.

Ultrasound: This examination involves the use of a form of energy (sound waves) which at high energy levels may produce heat and tissue damage. At the extremely low energy levels utilized in diagnostic ultrasounds, no adverse effects have been observed to date.

Medications: Some of the risks associated with taking hormone medications to stimulate multiple egg production are common. Women may experience none, any or all of the following symptoms: nausea, vomiting, slight weight gain or loss, breast tenderness and enlargement, occasional vaginal bleeding, yeast infections of the vagina, vaginal discharge and wetness, hot flashes, night sweats, menstrual period cramping, headaches, fluid retention, and mood swings. Much less common side effects include appetite changes, nervousness, fatigue, and changes in sex drive. More serious but rare side effects include hypertension (high blood pressure), gall bladder disease, blood clots developing in the legs, lungs, eyes, brain, heart or elsewhere, heart attacks and strokes.

There is some evidence that treatment with fertility drugs could lead to an increased risk of cancer—in particular, breast, ovarian, and uterine (including endometrial) cancers. One must be careful in interpreting research studies of women taking fertility drugs. Since these cancers are more common in women with infertility, simply comparing women taking fertility drugs with women in the general population inevitably shows an increased incidence of cancer. When the analysis accounts for the increased cancer risk due to infertility per se, the evidence does not support a relationship between fertility drugs and an increased prevalence of breast or ovarian cancer. More research is required to examine the long-term impact fertility drugs may have on breast and ovarian cancer prevalence rates. For uterine cancer, the numbers are too small to draw conclusions.

Antibiotics: Most women will be given an antibiotic. The use of an antibiotic may cause nausea, vomiting, diarrhea, loss of appetite, rashes, sensitivity to the sun, allergic reactions resulting in shock, or blood disease including reduced platelets or fractured red cells (causing anemia or bleeding).

Ovarian Hyper-stimulation: Use of hormonal agents may result in the growth of ovarian cysts and/or mild to severe ovarian enlargement may develop, causing pain, internal bleeding, and severe disturbances of fluid and chemistry balances. This may require hospitalization. Blood clots are possible which could lead to strokes or other life threatening complications.

Aspiration of Eggs under Ultrasonographic Guidance: Pain of short duration is likely. There is a possibility of seeing blood in the urine for a day following the procedure. Perforation of blood vessels, bladder, bowel, bleeding from the ovary, and pelvic infection are possible.

Laparoscopy: Infection of the incision site or pelvic organs is possible. Perforation of bowel or bladder, internal bleeding, possible formation of scar tissue by attempted egg collection and/or manipulation of pelvic organs may occur.

Anesthesia: Sedation or general anesthesia may cause numerous possible adverse reactions from various drugs and procedures. A separate consent form, which you will sign before undergoing this procedure, outlines the risks involved in the use of anesthesia.

Embryo Transfer: This procedure may cause discomfort and may lead to infection or ectopic or tubal pregnancy which could result in hemorrhage, or excessive bleeding, and death.

Multiple Pregnancies: Replacement of more than one embryo will increase the chance of multiple pregnancies. Multiple pregnancies have an increased risk of premature birth, birth defects, maternal hypertension, low birth weight, and many other complications.

Psychological Risks: One risk is failure of the procedure to produce a pregnancy. If the procedures are not successful, you may be very disappointed. You also may experience frustration, anxiety, and/or depression, which may be severe. Mood swings may result from medications or from your psychological response to the experience of Fertility Preservation. Long-term psychological effects are unknown. Any psychological consultation associated with the treatment program is not intended to predict short or long term effects.

Risks: I understand that my frozen egg(s) may, upon warming/ thawing, degenerate. If this occurs, the egg(s) will not be inseminated and will not be replaced into my uterus. It seems that egg(s) and embryos either survive unharmed or die. To RBA’s knowledge, there is no indication at the current time that freezing of egg(s) increases birth defects. To date, children born as a result of egg cryopreservation have not had increased rates of abnormalities. It is possible that in the future more information in this area of concern may become known. I understand that there may be unforeseen risks or complications for me, a current or future male partner, or the egg(s) or embryo(s), fetus(es), or the child(ren) which develop(s) from this treatment. While it is difficult to anticipate any such risks, I acknowledge that I have been notified of their possibility.

During these two weeks, your ovaries will be stimulated to produce follicles, ovulation will occur and thereafter an insemination is performed. In vitro fertilization (IVF), takes a bit longer, lasting anywhere from 4-6 weeks prior to egg retrieval. The embryos are then transferred anywhere from 3-5 days later.