Fertility Week 2022: An IVF Expert Answers Our Community’s Top Questions

As part of Fertility Week 2022, embryologist & IVF expert Jessica Manns is answering your top questions about IVF (in vitro fertilization):

1. What should I ask at my first IVF appointment?

2. What are the side effects of undergoing IVF?

3. Is there anything that I'm doing (or not doing) that could impact IVF success?

4. How long will IVF take?

5. Is it true that IVF pregnancies and deliveries have more complications than natural conception?

Click the links above to jump to each question!

1. What should I ask at my first IVF appointment? 

Your first IVF appointment can be overwhelming, but knowing how to prepare can help relieve some of the anxiety associated with it. Before your appointment, I recommend creating a list of questions to discuss with your doctor and, if applicable, discussing your fertility goals with your partner.

One of the most important topics that you should discuss during your initial consult is your success rates. It’s important to know your clinic’s overall success rate, but it’s more important to know your clinic’s success rate for your age, diagnosis, and medical history. Be as specific as possible when asking for success rates so you have a fair idea of what to expect.

It’s also important to discuss your timeline: 

• Will you need diagnostic tests? If so, which ones? 

• How long does it take to get the results? 

• Is there a waitlist for IVF at the clinic? 

• How many months of birth control does your doctor recommend before beginning IVF?

•  When can you expect to have an embryo transfer? 

Be sure to consider any future events, such as weddings or vacations, that may interfere with your IVF timeline.

Another popular topic is medications. There are various stimulation protocols that doctors recommend, but these protocols can vary from person to person:

• What protocol is best for you based on your medical history, and why? 

• Are there options to change your protocol if your IVF cycle does not go as intended? 

• How much will these medications cost?

It’s also important to know how to communicate with your clinic:

• What is the best way to contact the clinic, especially after office hours? 

• What if you have an emergency and need to get in contact with someone? 

You can also discuss how you might be able to optimize your treatment:

• Are there things that you should or should not be doing to improve your chances of success? 

• Are there supplements you should be taking? If so, how much and how often do you need? 

• Is your current weight within normal limits? 

• If not, how can you achieve a better weight before you begin treatment? 

• Are there medications that you shouldn’t be taking?

And finally, please remember to advocate for yourself. If your doctor mentions something that doesn’t make sense, ask about it and get as much information about it as possible. If you want more information on something, as your doctor his/her opinion about it. Advocating for yourself can be the difference between a successful and unsuccessful cycle. Further, if you do not feel comfortable at your IVF clinic, consider making an appointment at another one, if possible. You will be spending a decent amount of time at your IVF clinic, so it’s important to feel comfortable with and confident in your entire care team. 

2. What are the side effects of undergoing IVF?

Though each woman has a unique experience, it’s common to experience at least some side effects that come with IVF treatment. Often, IVF medications are the primary cause of IVF side effects. These medications, which are typically injected, are meant to hyper-stimulate your ovaries so multiple eggs mature. In doing so, these medications essentially place your body in a temporary menopausal state. Therefore, it’s not uncommon to experience perimenopause-like symptoms such as hot flashes, mood swings, and vaginal dryness. Other common side effects of IVF medications include breast tenderness, nausea, headaches, lightheadedness or dizziness, abdominal bloating (which can cause weight gain), abdominal pain or cramping, and injection site bruising, inflammation, rash formation, pain, or tenderness. Less common side effects include blurred vision and ovarian torsion (the ovary twists and its blood flow is restricted).

Following the egg retrieval procedure, it’s common to experience mild abdominal pain and tenderness from the procedure, light spotting, bloating, mild cramping, and constipation. Some women develop infections from the procedure, but this is not common. 

In some cases, ovarian hyperstimulation syndrome (OHSS) can occur following egg retrieval. In these situations, an abnormal response to IVF medications causes the ovaries to swell with fluid, which can sometimes leak into the body. This can cause mild abdominal bloating (which can cause weight gain), tenderness, pain, and cramping, as well as nausea and vomiting. Severe cases of OHSS are rare but may cause shortness of breath, severe abdominal pain, and rapid weight gain. Talk with your doctor if you experience any of these symptoms following your egg retrieval.

There are not many common side effects associated with embryo transfers. In rare cases, severe vaginal bleeding and abdominal pain may occur. Let your doctor know if you experience any of these symptoms. If pregnancy does result, it’s common to experience light vaginal bleeding or spotting, mild cramping, fatigue, and breast tenderness.

In addition to the physical side effects. it’s also worth noting the mental and emotional side effects of IVF treatment. The IVF process has been known to cause stress, anxiety, feelings of guilt and shame, mild to moderate depression, and feelings of loneliness. Though these feelings are valid, please seek help if you experience any of them.

3. Is there anything that I'm doing (or not doing) that could impact IVF success?

Yes! There are many ways to impact IVF success. First, let’s consider what we need in order to achieve IVF success: good quality eggs, sperm, and embryos, as well as a healthy uterine environment for embryo implantation and growth. So, how can we make these things happen?

Let’s start with what we can do to improve IVF success.

1. Get the right nutrients in your diet

Our bodies require a number of nutrients to function optimally. Though many of these nutrients are obtained through our diets, most people aren’t obtaining enough essential nutrients through their diets alone and require supplements to obtain enough essential nutrients. A lack of essential nutrients can severely impact IVF success. For example, oxidative stress is a condition in which excess free radicals exist in the body, which can bind to other molecules and cause severe health issues, including infertility. Vitamins and other nutrients are known as antioxidants, which bind to these free radicals to reduce oxidative stress. This, in turn, creates more suitable environments for sperm, egg, and embryo development. In fact, multiple studies have found that men who increased their intake of certain essential nutrients, either through diet or supplements, were very likely to increase their sperm count, motility, and overall quality. These essential nutrients can also help regulate menstrual cycles and ovulation in women, which can improve fertility and IVF success. However, it’s important to begin obtaining enough essential nutrients as early as possible since it takes roughly 90 days to begin observing their effects. Speak to your IVF specialist or doctor about whether taking supplements is right for you. 

2. Maintain a healthy weight

Maintaining a healthy diet can also help you maintain a healthy weight and studies have found that people who are underweight or overweight are more likely to have decreased IVF success. For example, women with an abnormal BMI are more likely to have abnormal menstrual cycles and ovulation, hormonal imbalances, ovarian dysregulation, and decreased responses to IVF medications. Men with abnormal BMIs are more likely to have increased sperm DNA fragmentation and abnormal sperm production.

3. Exercise regularly 

Studies have also found that maintaining a regular, healthy exercise routine can also improve IVF success. Exercise can decrease stress levels, increase sex hormone production, and improve blood flow to reproductive organs. More importantly, it can increase antioxidant activity in our bodies, which can help decrease oxidative stress.

4. Get 7-8 hours of sleep a night

Finally, getting enough sleep (7-8 hours each night) has been shown to improve IVF success. An adequate amount of sleep helps regulate hormone levels, regulate menstrual cycles and ovulation, and improve sperm production (through adequate testosterone production).

Now,  let’s focus on what can decrease our IVF success. In other words, what shouldn’t we do?

We’ve already mentioned how being underweight or overweight, not eating a healthy diet, not getting enough essential nutrients, and exercising too little or too much can affect our fertility. But here are some other things that can decrease the chances of IVF success:

1. Smoking

It’s also been proven that smoking tobacco can decrease IVF success by interfering with normal hormone production, reducing the production of good-quality sperm, and increasing sperm DNA fragmentation. Smoking tobacco may also decrease a woman’s egg count and quality. On a positive note, these effects can often be reversed shortly after you stop smoking tobacco.

2. Alcohol 

Like tobacco, alcohol intake can also decrease IVF success. Studies have found that even a small amount of alcohol can decrease sperm production, interfere with normal hormone production, and deregulate menstruation and ovulation. Further, alcohol intake increases the incidence of erectile dysfunction, low sex drive, and relationship stress.

3. Stress 

Speaking of stress…you guessed it. Stress increases the levels of the hormone cortisol in our bodies, which can interfere with normal hormone production, menstruation, and ovulation. Further, studies have shown that people with high levels of stress are more likely to require IVF to achieve a healthy pregnancy. We know that infertility can cause stress, but it seems that stress can also cause infertility. Luckily, there are a lot of ways to deal with stress (such as maintaining a regular exercise routine). However, please reach out to a professional if you are experiencing extreme stress, anxiety, depression, or other extreme emotions.

4. STIs 

It's also important to avoid sexually transmitted infections (STIs), such as chlamydia and gonorrhea. These infections can cause pelvic inflammatory disease, which in turn can cause Fallopian tube inflammation, scarring, and blockages. Fortunately, many cases of gonorrhea and chlamydia can be treated with antibiotics, though some more severe cases may require further interventions. Many IVF clinics will test both partners (if applicable) for STIs prior to their IVF cycle.

5. Toxins

Finally, it’s important to decrease exposure to toxins, as these can also decrease IVF success. Common chemicals known as endocrine-disrupting chemicals (pesticides, phthalates, BPA, and DES) interfere with normal hormone production and may cause ovarian cysts and uterine polyps. Heavy metals (lead, arsenic, mercury) have been shown to decrease fertilization and implantation rates, decrease sex hormone production, and increase sperm DNA fragmentation. Other examples of toxins include GMOs and parabens. If possible, attempt to avoid these toxins to improve IVF success.

4. How long will IVF take?

There are a few ways to answer this question.

Let’s say that you had your egg retrieval and had mature eggs. Those eggs would be inseminated on the same day as the retrieval and would be given 6-7 days (depending on your clinic’s protocol) to grow. Here’s what that timeline might look like:

IVF Day 0: Most clinics refer to the egg retrieval day as IVF day 0

IVF Day 1: The eggs are checked for fertilization

IVF Days 2-4: If fertilization occurs, the embryos are given a few days to grow

IVF Day 5: There are a few things that can happen: 

• The embryos can be transferred during a fresh transfer, biopsied, and/or frozen

• If any embryos are still growing, they will be given another day (or 2) to grow. If they grow, they can be biopsied and/or frozen on around day 7 

Some clinics culture embryos until IVF day 7, while others only culture until IVF day 6. So, the IVF process itself takes roughly 6-7 days. It’s also worth noting that it can take roughly 2 weeks to receive PGT results, if applicable.

But there is more to the IVF process than what occurs in the IVF lab. Before an egg retrieval can occur, IVF medications are normally administered so that multiple eggs can mature for the IVF cycle. If you are planning to do IVF, you should contact your IVF clinic when you begin your period. This is known as cycle day 1, or CD1. A few days later, you will likely return to the IVF clinic for baseline monitoring and may begin administering IVF medications. This is known as stim day 1. You will return a few times before your egg retrieval and may begin to administer more medications. Many women will administer stimulation medications for 9-12 days, at which time they will administer a trigger shot. This triggers ovulation to occur, but your egg retrieval will be scheduled ~36 hours after the trigger is administered. So, your egg retrieval may not occur until 2 weeks (or more) after your period. 

So, let’s add it up. Your egg retrieval occurs roughly 14 days after your period starts. Then, the IVF cycle takes 6-7 additional days.

Your frozen embryo transfer also correlates with your menstrual cycle. You may administer medications that help your uterine lining thicken prior to the FET. While some women elect to begin their FET cycle right after their IVF cycle (as in 2 weeks after their egg retrieval), many women elect to wait 1-2 menstrual cycles in between so their bodies can rest before the transfer. This also allows enough time to receive PGT results.

It's also important to note that your IVF cycle may not occur right away. This means that it may take a few months to begin your IVF cycle after your initial IVF consult. For example, your doctor may order you some diagnostic tests to be performed, or your clinic may have a waitlist for IVF.

Long story short, the IVF cycle (in the embryology lab) takes 6-7 days, but the entire IVF treatment can, at times, take months to complete. This varies from person to person, so it’s worth reviewing with your doctor at your initial consultation.

5. Is it true that IVF pregnancies and deliveries have more complications than natural conception?

This is a question that I receive a lot. And, truthfully, it’s a difficult question to answer.

A lot of the data says yes. There are multiple studies that have linked IVF with pregnancy complications, premature birth, and congenital abnormalities such as cleft palates. So, is there a relationship? It’s possible. Let’s consider some other factors that may cause these complications.

First, many women who require IVF have underlying fertility conditions. IVF may help these women achieve a pregnancy, but it cannot remedy the underlying conditions. For example, women with endometriosis or PCOS are more likely to have preterm deliveries than women without endometriosis or PCOS.

Second, more women are waiting to begin their families. In many of these cases, these women require IVF in order to achieve pregnancy. Unfortunately, there is an increased risk of embryo aneuploidy (being abnormal) when women are over 35 years of age. If the embryos do not undergo PGT, there is a higher chance of transferring an abnormal embryo, which can cause pregnancy complications and genetic abnormalities.

Finally, it’s more common to have multiple births with IVF than through natural conception. Transferred embryos can split, resulting in twins (or more). Further, some transfers are performed with multiple embryos (though this is becoming less common), which can result in multiple births. Multiple births can cause a number of health issues, such as preterm birth, for both the pregnant woman and the babies.

So, it’s possible that IVF can be directly linked to complications, but it’s also important to consider the other possible factors for these complications, as well. Perhaps it’s a combination of multiple factors that causes these complications.

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Jessica Manns has been an embryologist since 2018 and is the face behind Explaining IVF. She said: “I love my job. I created Explaining IVF as a way to educate everyone about IVF and infertility. My goal is to provide accurate information in a patient-friendly manner so people can make informed decisions about their health and treatment. In my free time, I enjoy traveling and spending time with my family.”

You can find Jessica on Instagram @explainingivf. 

Have a question about IVF or TTC? Leave it in the comments!

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