1. Is There Any Age Limit For IVF?
All over the world, the generally accepted age limit to undergo an IVF procedure is the average age of Natural Menopause. This is usually interpreted as 50. Women are discouraged to undergo IVF in our centre, past this age.
After 45 years of age, less than 1% of women will have a life (live) birth when they use their eggs. Many women in this age group will consider the use of donor eggs, as the age of the egg donor determines the outcome of IVF, not the age of the women receiving the embryo. Thus, with eggs from a young donor (<35 years), women, even over 45 years of age, will have more than 50% chance of conceiving at Anmol Fertility and IVF centre (AFC).
As women age, it is important to understand that medical problems such as high blood pressure, heart problems, and diabetes, can make pregnancies much more complicated, and there is a higher risk of poor outcome.
2. How Do We Know It Is Our Egg/Sperm/Embryo?
At AFC, we have strict protocols in place to ensure there’s no mix up of reproductive MATERIAL. These strict quality checks & protocols are in accordance with the ICMR regulations, which is a national authority.
When you are first seen at our clinic, we will collect information which will help us in the identification process. You will often be asked for these identifiers by us. These factors include but are not limited to:
- Full Name
- Name of the Spouse
- Date of Birth
- Age ofBoth Partners
- Blood Groups of Both Partners
These identifying factors will be used when performing any tests or procedures or when collecting or transferring any reproductive material. There is a strict process of cross-checking this information with other staff members during procedures and in the laboratory.
3. Why Am I Not Getting Pregnant?
Approximately 1 in 6 couples has difficulty conceiving, with many achieving pregnancy through treatments such as ovulation induction and IVF. Sometimes there are factors solely related to either the male or the female. But, in about 1/3rd cases, both the partners have contributing factors.
There are several reasons why you may not be getting pregnant. These can include;
- Ovulation Disorders: This occurs when an egg is not produced from the ovary or is not produced at a regular time from the ovary. This may include disorders such as polycystic ovarian syndrome, premature ovarian failure, or reduced ovarian reserve. These may be, at times, genetically linked.
- Tubal Factors: There may be a blockage or damage to the small cells lining the fallopian tubes, which may prevent the passage of sperm or eggs. Sometimes this is caused by previous surgery or infection. Specifically, current or past history of tuberculosis or tuberculosis contacts needs to be explored.
- Endometriosis: This is a common disorder where the tissue, which is similar to tissue lining the uterus (endometrium), is on the outside (on the ovaries and ligaments which support the uterus) rather than being inside the uterus.
In severe cases, it may distort the anatomy and cause problems with fertility. It is likely that there are other mechanisms whereby endometriosis may reduce fertility, and this is an area of current research. Patients usually present with severe pain during or prior to menses, or at intercourse but even can be asymptomatic in some instances.
- Uterine Anomalies: Differences in the shape of the uterus,in rare cases, may contribute towards difficulty in conceiving. These are present since birth, and at times, may need surgical correction procedures.
- Male Factor Infertility: Sometimes reduced number of sperm, or abnormality in the movement (motility) or shape (morphology) of sperm or ejaculatory or coital disturbances may contribute to fertility problems. When there is a complete absence of sperms, further steps including genetic testing, or surgical retrieval procedures might be necessary.
- Unexplained Infertility: In many situations, we are still unable to precisely explain the reason for infertility without (with our)current methods of investigation. This is often referred to as ‘unexplained infertility’, faced in about 5-10 % of the infertility cases. This diagnosis may be particularly frustrating for couples, however, treatments are still available, and often successful in this situation.
4. What Will Increase My chances of Pregnancy?
- Frequency of Sexual Intercourse
Ovulation usually occurs 14 days prior to the onset of menstruation, and the date varies, based on the length of the menstrual cycle. In a 28-day menstrual cycle, ovulation usually occurs between day 12 and 14.
As sperms can survive for up to 4 to 5 days, and the egg can maintain its ability to be fertilised for about 12 to 18 hours after ovulation, alternate day intercourse is recommended, from day 8 to day 16 of the average cycle.
If the cycles are completely irregular, sometimes the average length of the consecutive 3 monthly cycles is taken into consideration and advice is given accordingly.
- Folic Acid
It is essential to start this medication one month before the treatment, and we recommend you take 0.5mg folic acid daily. In some circumstances, you may be advised by your doctor to take 5mg daily. Scientific evidence suggests that taking this vitamin in small doses can reduce the incidence of fetal spine abnormalities or spina bifida. If you do become pregnant, then Folic Acid medication needs to be taken at least during the first 12 weeks of pregnancy.
Smoking is harmful to your health in general. We strongly recommend that both partners give up their intake before planning to conceive. Smoking, additionally, may adversely affect the outcome of your treatment. There’s increasing evidence that smoking may also damage the genetic material in the sperm resulting in reduced rates of fertilisation and poorer quality embryos. There are smoking-related complications seen even during pregnancy like growth restriction, premature delivery of the baby etc.
Again, this is important for both partners. It’s advisable to limit your alcohol intake if you are trying for a baby. Alcohol not only affects the overall general health of an individual but also causes problems in sexual desires/ activity. Excessive alcohol consumption may also reduce sperm motility. So, the current advice is not to consume alcohol during pregnancy.
Information on caffeine and fertility is confusing at present, but we recommend you minimise its use while attempting pregnancy. Excessive caffeine intake is associated with ejaculatory disturbances in males. It even has effects during pregnancy.
- Diet and Exercise
A balanced diet with low fat intake and adequate exercise (around 20 to 25 minutes per day,7 days a week) are associated with good reproductive outcomes. A body mass index outside the recommended range (19-25) is associated with reduced fertility for women, and may also be the case for men. Obesity causes problems in conceiving and also miscarriages and other ill effects on the course of pregnancy.
Adequate vitamin balance, fruit & vegetables, and anti-oxidants optimize the overall health, and also positively contribute to good reproductive health.
Extreme weight, compromise your chance of fertility, increase miscarriage rates, and increase risks in pregnancy. Male if overweight may cause sexual disorders and further compromise fertility.
5. How Long Does it Take to Get Started with IVF? And How Much Time Does it Take for an IVF Process?
From the point of your initial consultation with our team at AFC, you may potentially start an IVF cycle within a few weeks. A proper treatment plan is charted out, which is tailored according to each case. Your physician will determine the appropriate time frame for your fertility treatment.
The initial consultation and diagnostic evaluation usually takes a week up to a month (depending on your menstrual cycle length and pattern, logistical and financial situation & details such as your travel schedule, availability etc.) Next, all diagnostic test results will be reviewed by the doctor. Consent forms are then signed, and after the financial settlements are done, you are set to start the IVF procedure.
Once the IVF cycle starts, you will need to take injections daily at the clinic for about 10 to 12 days, up to the time of oocyte or egg retrieval. During this period, the physician will see you periodically and adjust the dose of injections if need be and also do some blood tests (Follicular Monitoring).
Once the follicles (each of which potentially contain an egg) have reached a particular size, you will be given a final injection ‘ trigger’ and called in after about 36 hours for egg retrieval. This is done under short general anaesthesia and is a painless procedure.
Your husband or partner will be asked to accompany you and will need to give semen sample that day. You will be sent home after a couple of hours, there is no overnight admission. Embryos will be made with mixing the eggs retrieved from you and the semen sample of your partner that day in our laboratory at AFC.
Based on the individual case, you may be called in again after a couple of days, if we decide on the transfer of these embryos into your uterus in the same cycle. At times, it is better to freeze the embryos, which will be transferred into your uterus subsequently.
6. Does IVF Increase My Chances of Having Twins or Triplets?
This is a fairly common question asked by couples considering IVF treatment. Your doctor will decide the number of embryos to be transferred into your uterus, and the answer depends on many factors.
You also will be involved in the decision. If a single embryo is transferred, then it would be impossible to have multiple pregnancies. However, given the uncertainty of the single embryo successfully implanting into the lining of the uterus, usually many transfer more than one embryo into the womb. This is true, especially for those women who may be unable to afford additional IVF cycles.
Interestingly, one’s chances of giving birth from multiple embryo transfers are only slightly higher than with transferring a single embryo. Although, the odds of having twins or triplets will increase significantly. Roughly in 1 in 5 IVF cycles, there is a possibility of multiple pregnancies.
7. What Is The Success Rate of IVF On The First Try?
The success rate of IVF depends on many factors including your age, ovarian reserve, fallopian tubes, and lifestyle. On the first try, the success rate of IVF for women under 35 is higher compared to women above 45+ years. According to one study, 33% of women starting IVF had a baby in their first cycle. However, on average, women should try at least three IVF cycles to increase the odds of success.
8. What Should I Avoid During IVF?
Some of the things to avoid during the IVF treatment are alcohol, caffeine, smoking, artificial sweeteners, refined sugar, etc. Certain types of soft cheese (Feta, Brie, blue-veined cheese) should also be avoided as they contain bacteria which can cause infection. Eating raw or half-cooked seafood is also not recommended, as some of them might have high levels of mercury. Likewise, food products that make use of raw eggs like mayonnaise should be avoided, as raw eggs consist of a virus named ‘Salmonella Virus,’ which can cause food poisoning.
9. What Should I Eat After IVF Procedure?
While there are no hard and fast rules on what to eat after the IVF procedure, you need to eat healthily, so your body gets the right nutrients. Healthy fats and proteins are important. Eating vegetables, legumes, whole grains, lean meat is recommended. Also, avocados, almonds, walnuts, apples, and oranges are great options. Simply put, stick to fresh and whole foods to get the nutrients your body needs.
10. How Many Times Can You Try IVF?
There is no ‘specific number’ on how many times you can try IVF. However, as mentioned above, to improve the odds of success, women should at least try three IVF cycles.
11. I have had a failed IVF, what could be the reasons? What should I do next?
Some of the reasons for failed IVF cycle may be poor quality eggs, defective embryos, implantation failure, chromosomal abnormalities, and other unexplained issues. Here, it is important to note that not all IVF treatments may meet with success in the first try. However, the first failed IVF procedure may provide vital clues that may result in a successful second IVF cycle. Thus, as said before, a couple should try at least three IVF cycles to improve chances of pregnancy.
12. Can I Conceive Naturally After IVF?
Yes, it is possible, but there are no guarantees. Couples who have their first baby through IVF can have a second natural pregnancy. However, the chances are very limited in women who have been diagnosed with blocked fallopian tubes or men who have low sperm count. If the reason for infertility was unknown (as it happens in some cases), then natural pregnancy after fertility treatment is quite likely.
13. Is Miscarriage More Common in IVF?
No. IVF treatment does not contribute to miscarriage. However, like non-assisted (natural) pregnancies, miscarriage can happen after IVF. There could be existing conditions that could lead to early pregnancy loss such as genetic abnormality of the embryo, implantation dysfunction, chromosomal irregularities, among others. Miscarriage is generally not within your control. However, there are a few steps to lower the risk of miscarriage, which the IVF specialist may suggest during the consultation.
14. How Soon After IVF Baby Can You Try Again?
Ideally, there should be a gap of 2 or 3 years after your first IVF baby. However, for a higher success rate, couples should start planning for their second IVF baby, as soon as the first child is born. Age plays a major role, so you need to consider that. Couples can also consider freezing their embryos for future use, as with age, the quality of the sperm and eggs deteriorates. So, there is a high chance of conceiving with a frozen embryo than a fresh embryo.