10 questions to consider before starting IVF

At Ovally, we talk to a lot of women and couples who underwent IVF before coming to us and didn’t have an entirely positive experience. In many cases, they didn’t have enough time with their doctors to comfortably make critical decisions, or had decisions made for them without knowing that they had a choice. Given the complexity of IVF, it’s very hard to know as first-time patients what questions to ask. As part of our IVF series, we’ve put together 10 questions to consider and discuss with your doctor as early as possible in the process:

1. Does it make sense to try IVF right away, or could intrauterine insemination and medication that supports ovulation medication be a first step? There’s a significant difference in success rates between the two treatments, but also in costs.

2. What are the clinic’s IVF outcomes for your age group?

3. Based on your pre-treatment tests, what’s the likelihood that you’ll need more than one cycle to retrieve enough eggs to have at least one embryo to transfer?

4. Will your eggs be fertilized using conventional in-vitro fertilization, or intracytoplasmic sperm injection (ICSI)? The male partner’s fertility plays an important role in whether not ICSI makes sense, and ICSI is not without risks. See a longer article on the topic here.

5. How long will your embryos develop in the lab? For 3, 5, or 6 days?

6. Will you do a “fresh” or “frozen” transfer? A fresh transfer means that an embryo will be transferred to your uterus after it’s completed its development in the lab. For a frozen transfer, your embryos are frozen for a period of time before being transferred.

7. How many embryos will be transferred? More embryos can increase the chance of pregnancy, but multiple pregnancies also carry significant health risks for both baby and mother.

8. Will you take hormones prior to your embryo transfer (i.e., will it be a medicated or unmedicated transfer)?

9. Does it make sense to do genetic screening (e.g., pre-implantation genetic screening, or PGS, for chromosomal abnormalities or pre-implantation genetic diagnosis, or PGD, for major heritable diseases)?

10. If you are offered add-on treatments, what is the evidence for their effectiveness? We discussed popular add-on treatments in this previous post.

If some of these questions don’t make complete sense yet, don’t worry. We’re going to dive deeper into each one of them in upcoming posts, so you have a better sense of the existing scientific evidence. Also, if there are any other important questions you’d add, let us know!

One thought on “10 questions to consider before starting IVF

  1. […] When is it advantageous to do ICSI? ICSI was designed to increase fertilization rates when there are issues with the sperm, i.e., in cases of ‘male factor infertility’. ICSI seems to be the most effective in those cases, though differentially so: While patients with azoospermia (without motile sperm) need to use ICSI, and patients with a low concentration of sperm typically benefit from ISCI by increasing fertilization rates, patients with sperm morphology (issues with the size or shape of the sperm’s head, midsection, or tail) don’t necessarily benefit from ICSI over conventional IVF. If there’s no male factor infertility present, there does not seem to be a benefit of doing ICSI over conventional in-vitro fertilization. While ICSI might still slightly increase fertilization rates in those cases, post-fertilization outcomes such as implantation rates and birth rates are not better than for a conventional IVF procedure. Some doctors may tell you that it’s necessary to use ICSI in order to perform pre-implantation genetic screening (PGS), a technique used to identify chromosomal abnormalities in embryos by taking a few cells from a developing embryo and performing a genetic analysis. However, the data do not show that ICSI embryos have higher rates of chromosomal normality or higher birth rates compared to embryos created through conventional IVF. If you’re trying to screen for specific diseases using pre-implantation genetic diagnosis (PGS), some doctors and researchers argue that it’s important to use ICSI for fertilization to get the most accurate genetic read. However, others have shown no misdiagnoses or contamination issues in genetic analyses of embryos that were created through conventional IVF vs. ICSI. More research is required on this question. What are potential risks or downsides of ICSI vs. conventional IVF? There are risks and potential downsides to using ICSI. One risk is to damage the egg as the sperm is injected into it. This only happens in a small percentage of cases (~5% of eggs at good labs) and is likely worth it if the expected fertilization rate improves significantly with ICSI in cases of male factor infertility. Without male factor infertility, the risk of egg damage likely isn’t worth it. There has been an ongoing debate about an increase in birth defects and urological issues (e.g., lower testosterone levels) in babies born from IVF using ICSI vs. conventional IVF. However, potential negative effects are not consistent across studies, and underlying fertility issues, such as male factor infertility, could play a role in explaining some of the defects and issues. What do I do as an IVF patient? We suggest you discuss the use of ICSI or natural IVF with your doctor prior to undergoing your IVF or embryo freezing cycle. Your doctor may know of even more recent, yet-to-be published research and of a particular reason for why ICSI or conventional IVF may be beneficial in your case. We recommend the following questions as a starting point. – Do we have male factor infertility based on our test results? – If so, what about the sperm is showing concerning results? Its motility? Concentration? Morphology? – Would you recommend using conventional IVF or ICSI? Why? – What are the risks of using ICSI in our case? – What are the benefits of using ICSI? – Would you recommend we go through genetic testing on our embryos? – To what extent do you think the benefits of ICSI would outweigh the risks in our case (e.g., a significantly higher fertilization rate)? – What is the incremental cost of performing ICSI vs. conventional IVF? See our list of other questions to ask prior to IVF treatment in this previous post. […]

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