As you begin and move along your path to pregnancy, hundreds of questions will surely arise. We've anticipated a few of them here for you in our collection of common questions and answers.
As more questions come up, we invite you to call Rhonda, our new-patient clinical liaison, at 888-300-2483. The more you know, the more comfortable you can feel as you move through your fertility journey.
Whether or not you are experiencing infertily depends on your age and the amount of time you have been trying to conceive through unprotected intercourse. Women under 35 who have been unable to conceive after one year of unprotected intercourse, women over 35 who have been unable to conceive after 6 months, women age 40+, and men with low sperm counts are advised to speak with a fertility specialist as soon as possible. A fertility consultation will bring piece-of-mind and a structured plan to remedy any concerns you may have.
It's often easier said than done, but it is important to remain hopeful. There are a number of fertility treatments available today that present options for even the most rarest of infertility cases.
Our technologies are more accurate and innovative than ever before. We regularly diagnose and treat complicated cases. Our fertility laboratory features many of the brightest minds in reproductive medicine - including 30 scientists, PhD’s, embryologists, and lab technicians who focus exclusively on on ways to improve embryo development and success rates.
Without a doubt, the very first step is to meet with a Boston IVF fertility doctor. During your hour-long appointment, we will begin the process of evaluating the factors that could be affecting your fertility health.
As a general rule of thumb, if you're within the time frame that your age specifies for infertility, you might plan on visiting your OBGYN for a checkup. If it's been over one year without success, or if you are over the age of 35, a fertility specialist may be able to better serve you.
If you fit into the umbrella definition of infertility, it is an excellent idea to meet with a fertility specialist so that you can start to explore other options. If you under the age of 35 and have been trying to conceive for one year without success, over the age of 35 and have been trying to conceive for more than 6 months, or if you or your partner are experiencing medical concerns, such as PCOS, endometriosis, low sperm count, or prior miscarriages, it is time to see a fertility specialist.
IVF is the process of growing multiple eggs, retrieving them through an out-patient procedure in our clinic, and fertilizing them in our lab to produce as many embryos as possible.
3-5 days later, the embryo are transferred back into the uterus.
Each process of IVF is called a cycle. One full cycle takes about 2.5 weeks, depending on your menstrual cycle.
Because an imprecise dosage of hormones can lead to discomfort or injury, our doctors take measures to accurately diagnose each patient and determine an appropriate dosage of hormone treatment.
Your safety and comfort is always our primary concern!
Absolutely not. It's a question we receive often. Patients often ask if IVF will deplete their egg supply, or in some way influence their long-term fertility.
There is no connection between premature menopause and IVF.
There is no standard number of embryos that are implanted for all patients. Many factors that go into the decision of how many embryos to transfer, including your age and medical history. However, in order to offer the highest chance of a safe and successful pregnancy, we always look to minimize the risk of multiple births (twins, etc), which often means implanting as few eggs as possible.
It's important to discuss your goals with your MD. If you want a single pregnancy, the approach to your cycle may be different than if you’re planning on a large family requiring several embryo transfers. The latter may indicate a cycle that creates a larger number of embryos available for freezing and use in future cycles, while the former may require lighter stimulation, reducing the number after the cycle is complete.
Your age is a great predictor of the number of eggs that you have. Generally speaking, the older you are, the fewer eggs remain. At birth, baby girl has 2 million eggs. 400,000 eggs remain at puberty. 100,000 remain by age 30. By age 45 or 50, that number usually drops to 0.
This is all natural, and is associated with increased rates of embryo abnormalities, miscarriage, and infertility.
Whether you want to get pregnant now or wait, it's a good idea to know where your fertility levels stand. Data definitively shows that egg quantity and egg quality begin to gradually decrease after age thirty. Yet it’s also important to know that everyone is different. We see women who experience infertility in their twenties, as well as women who are incredibly fertile in their late thirties.
One test that can tell you where you stand is an AMH blood test, which gives an accurate count of your remaining egg supply.
Female fertility begins to decline in a woman's late twenties, and the continued loss of eggs associated with this decline results in increased rates of miscarriage, chromosomal (genetic) abnormalities, and infertility (especially for women older than thirty-five).
Egg freezing affords a woman the opportunity to use ‘younger’ eggs whenever she decides she would like to become pregnant. This allows her to avoid the decreased fertility and increased miscarriage rates associated with advanced age. It's an empowering opportunity to pause your biological clock so that you can choose to build your family when you are ready. There are many reasons a woman might not feel ready to become pregnant “right now” — no matter the reason, freezing your eggs preserves them so that they maintain their health and youth until you are ready to start your family.
By freezing your eggs, you greatly increase your chance of a successful pregnancy in the future. For example - if you freeze your eggs when your 32 and use them at age 42, your success rate is that of a 32 year old.
Absolutely. Male and female partners each play a role in achieving pregnancy, and infertility can impact both sexes. Because of this, we evaluate both men and women, and we offer treatments for both male and female infertility. We offer a full range of treatment for men infertility
Overall, don’t automatically assume infertility is just a female issue. In 35% of all infertile, heterosexual couples - the male partner is either the sole cause or a contributing cause of infertility. In fact, infertility affects men and women equally. If a couple has trouble becoming pregnant, we strongly recommend that both partners be tested to ensure a comprehensive, faster diagnosis.
Your initial consultation at Boston IVF is an hour long conversation with your physician. He or she will gather complete information about your medical and fertility history, ask questions about your fertility goals, determine potential fertility obstacles, and then begin to develop your individualized treatment plan. This appointment is an opportunity to ask any questions you have about your potential treatment options and infertility. You'll also meet the rest of your fertility team, which your financial coordinator, who will help you navigate the insurance process by acting as a liaison between yourself and your insurance company, and your nurse.
You will need to bring with you a valid ID and your medical insurance card. You may also bring your partner/husband/wife, but this is not required.
It's possible that you'll find, during your initial consultation, that lifestyle changes are enough to help you become pregnant. Other cases may be more difficult, and fertility treatments may be necessary.
Infertility is extremely stressful on individuals and relationships. We have in-house psychologists and social workers who are equipped to assist you through all of the unique emotions and psychological hardships that come with infertility, including uncertainty of outcomes, dealing with fertile friends and family, the possibility of unsuccessful treatment cycles, and stresses associated with ongoing medical treatment.
All of our doctors are experienced in treating patients with polycystic ovary syndrome (PCOS). There is no one treatment for patients with PCOS who are looking to become pregnant — instead, your doctor will work with you to create an individualized treatment plan. Our in-house nutritionist, Hillary Wright, specializes in PCOS and is a great resource for healthy lifestyle changes that can complement your fertility treatment.
We offer both preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD) for those interested in genetic testing. Through PGD and PGS, patients are able to greatly reduce the risks of miscarriages, chromosomal abnormalities, and genetic disorders. Genetic testing also opens up the option of sex selection.
Our committed staff is made up of phlebotomists, administrative assistants, doctors, nurses, financial coordinators, embryologists, all working in harmony with the same mission. Our staff are more than just employees — we're dedicated, specialized, long-term employees working with a team approach: as a patient, you will get to know not only your doctor, but your nurse, administrative assistant, and financial coordinator. You will also have an opportunity to work with our in-house acupuncturists, psychologists, and nutritionist.
At Boston IVF, your fertility team treats more than your reproductive system — we see and treat the whole patient.
The initial testing is useful in detecting large problems such as low sperm counts or blocked fallopian tubes. Approximately 20-25% of patients presenting with infertility will have normal testing (called “unexplained infertility”). This may be at least partly explained by an age-related decline in fertility. Often times we are able to obtain further information as to why you have not gotten pregnant through monitoring and may be able to help overcome this underlying infertility with treatment.
On average 2-3 weeks.
Yes, no restrictions.
Avoid the hot tub/Sauna during treatment and once pregnant.
We consider Day 1 of your period to be the first day of “full flow” (i.e. not just spotting that precedes your period). If you were asked to call your nurse on day 1 of your period, please only call during daytime hours (9am-5pm; weekends included). If after 5pm, please call the next morning.
This can be a result of medications give, or can be a sign of a possible hormonal or structural issue such as a polyp or fibroid. You should contact your team nurse if this occurs unexpectedly.
You should have a discussion with your Boston IVF physician about all medications that you currently take prior to starting treatment, but typically you can remain on most medications unless specifically asked to stop.
Limit caffeinated beverages to two 8 oz caffeinated beverages per day (or less than approximately 150-200mg caffeine) during treatment and when pregnant.
We strongly recommend the flu shot for all of our patients, as pregnant women can especially get very sick if they get the Flu. If your PCP has specifically recommended preservative free for you (this is rare), then you must get a preservative-free flu shot.
Please abstain for 48 hours prior to a semen analysis. There are no restrictions around intercourse after IUI. See below for further recommendations regarding abstaining from intercourse during IVF and embryo transfer cycles.
There are no restrictions or recommendations.
Although not routine, there are a number of potential reasons your physician may recommend for you to take baby aspirin during treatment; please discuss directly with them and only take aspirin if you are advised to do so by your physician.
We generally consider a total motile count of at least 5 million sperm (post-processing) as an adequate sample for IUI.
Yes. If pregnant, let the dentist know that they may give you Novocaine without epinephrine.
The data on the effect on IVF or pregnancy is quite limited. We recommend that you wait until the second trimester (or after pregnancy), or check with your OBGYN once you are pregnant.
No clear restrictions, but we recommend you go somewhere with good ventilation.
Yes, but let the therapist know that you are in treatment or pregnant beforehand.
Herbal supplements are not controlled and therefore we cannot recommend them. However, if you are on them, be sure to tell your doctor everything you are taking prior to testing/treatment.
NOTE: If you are taking a biotin supplement (often a hair/nails supplement), please discontinue this at least 3 days (preferably 1 week) prior to blood tests, as this can interfere with results.
Yes, there are many services available. Through the Domar Center at Boston IVF Waltham there are three psychologists who offer individual and couples counseling, acupuncture, The Mind Body Program and nutritional counseling with a registered dietician. Also there is a psychologist on staff at the Lexington Center and three social workers who consult with Boston IVF and offer individual and couples counseling at the Waltham Center and at their private practices.
Please let your Boston IVF team know if you have recently had or are planning any such travel and review the latest CDC guidelines for more information.
In general terms:
For purple areas on the map in the continental U.S. - avoid mosquitos.
For purple areas outside the U.S. - avoid travel.
It is usually within 7 to 10 days; if no period by then, contact your team nurse.
Usually within 2-5 days after the last pill; if no period, please contact your team nurse.
Without an immediate embryo transfer (freeze-all cycles, egg freeze cycles, etc.),a period will usually start 2 weeks after HCG-based trigger and about 1 week after a Lupron trigger.
Cetrotide and Ganirelix can be irritating and you may see redness at injection site; this is common and does not represent a true allergic reaction. Using ice at the injection site can help with discomfort and redness. It should go away within 24 hours. If you develop breathing changes or other serious signs/symptoms of a severe allergic reaction (very rare), call 911/go to the nearest emergency room immediately.
They are interchangeable vaginal progesterone preparations (except the dosing may be different).
Your doctor will decide on the best route for you to take progesterone. Sometimes it’s taken vaginally, sometimes intramuscularly, and sometimes both.
NO! The “trigger” shot prior to egg retrieval is the one medication that is quite time-sensitive.
We recommend setting an alarm and reminders for yourself to take at the exact time you are advised (±15 minutes). If you take your trigger shot at a different time than advised, please contact your team nurse or the nurse on call, as your egg retrieval time may need to be changed.
You can take any of these NSAID medications as directed (whatever you typically take for menstrual cramps) for pain relief starting 6 hours after your egg retrieval, as we give an IV version of these during your procedure. Please discontinue the day before your embryo transfer (and do not take during pregnancy).
If you are having an egg retrieval, please stop these medications at least one day before your planned procedure since these medications can increase bleeding during surgery.
Tylenol (per package directions) is OK during treatment and pregnancy.
All trigger shots should be given SC like other IVF injections—ignore the box directions.
Contact your team nurse for specific instructions, but typically one missed oral medication dose like this will not affect outcome.
On average 3 weeks from egg retrieval. This may seem like a long time to wait, but this is not wasted time. During this time, we have to wait for your period and then start the frozen embryo transfer cycle.
This should be discussed with your Boston IVF physician as they know your complete clinical picture. Success rates vary and must take into account several different factors like history, test results, diagnosis and age.
The studies on acupuncture before and after your embryo transfer or during any fertility treatment show mixed results on improving success rates. However, some patients may benefit and we recommend it if you’d like to try it. We have acupuncturists who specialize in this type of treatment in our Domar Center.
We suggest that you limit it to an occasional drink during treatment and avoid drinking alcohol once you are pregnant.
For frozen embryo transfers (depending on the type of cycle your physician prescribes), the lining of the uterus is sometimes prepared with estrogen followed by the addition of progesterone. For fresh IVF cycles, progesterone alone is usually sufficient.
Ovarian cysts are very common and associated with your normal menstrual cycle; usually they will resolve on their own. If there are any concerns your physician will discuss with you.
There are no flight restrictions while waiting for your pregnancy test. However, we do not recommend travel after a positive pregnancy test until we can do an ultrasound to assess for location/viability of the pregnancy-- typically 2-3 weeks after a positive result.
Of note, pregnancy (even early pregnancy) carries an increased risk of blood clots that, while rare, can be very serious if they happen. Prolonged travel and other periods of sitting/inactivity increase this risk, so be sure to stay active during pregnancy and travel to minimize your risk.
Refer to the full Boston IVF exercise guidelines that are based on the current literature but here are some helpful guidelines:
- Continuing exercise that you already routinely do is generally OK after IUI/relations/frozen embryo transfer
- The major restrictions are after an IVF stimulation cycle and egg retrieval, as this stimulation causes your ovaries to enlarge. This increases risk of ovarian torsion (when your ovary twists on its own blood supply, causing severe pain and ovarian tissue damage) so we advise NO high impact exercise such as running, HIIT, aerobics, etc. during treatment
- Walking is OK and recommended if you feel up to it!
For an IVF/embryo transfer cycle (including frozen embryo transfers), we advise that you abstain from intercourse or use condoms during your treatment cycle until a pregnancy test to avoid a high risk multiple gestation pregnancy from a concurrent natural conception.
For an IUI cycle, you can have unprotected relations the day of your IUI and after (but this is not necessary for cycle success).
See above Q&A about intercourse before/after IUI/semen analysis.
There is no need to be concerned.
In order to maintain appropriate chain of custody, your partner will need to bring his sample to Boston IVF himself with a valid photo ID, or unfortunately the sample cannot be accepted.
Most transfers do not include anesthesia so you can drive yourself if needed. It your transfer does include anesthesia (which is rare), then you cannot drive for the rest of that day.
An empty bladder is best for vaginal ultrasounds and a full bladder is best for abdominal ultrasounds (including for embryo transfer).
Yes, if on a low setting.
Embryo grading tells us about the rate of embryo growth and integrity of the cells; however, it does not give us any genetic information about the embryo (if it is chromosomally normal).
This would require a discussion with your Boston IVF physician.
This is determined by a number of factors; you should discuss this with your physician.
As with natural conceptions, an IVF-derived embryo can split during early development (after embryo transfer) and result in an identical twin pregnancy.
The other possibility is if you have unprotected sex around the time of your embryo transfer and have a concurrent natural conception. This is why we recommend abstaining or using condoms while undergoing an IVF/embryo transfer cycle. Our goal is always ONE healthy baby at a time!
This is determined by multiple factors including your age and pre-conception testing. Please discuss with your physician.
The chance of implantation after transfer of a chromosomally normal (euploid) tested embryo is up to 60-70% (never 100%) and several factors may explain this. You will have a follow up appointment with your physician who will carefully review your treatment cycle details with you.
All reproductive age women have some chromosomally abnormal eggs (that would result in a chromosomally abnormal embryo); the proportion of abnormal eggs just increases with age.
We often see pink/red/brown spotting, which can be a small amount of blood from the egg retrieval/embryo transfer/IUI mixed with vaginal discharge and this is typically not concerning. You can also commonly see spotting related to vaginal/cervical irritation from vaginal progesterone application (if you are taking this medication) or after intercourse. If you have heavy bright red bleeding, please contact your team nurse.
Stick with cooked/pasteurized foods and low mercury fish during pregnancy. Also avoid alcohol.
Following a treatment cycle, we will draw one HCG level 10 days after embryo transfer (or 14 days after IUI). If it is positive, we will get one more 48 hours later. If there is an appropriate interval rise, the next step is an early OB ultrasound at 6-7 weeks gestation (which is actually just a couple weeks after your blood tests).
If a reassuring level is seen on the second HCG test, the further HCG levels are not needed and the prenatal ultrasound can be scheduled. If the HCG level is not rising appropriately, your team will follow serial levels to help determine if this is a viable pregnancy.
With any pregnancy there is a risk of an abnormal pregnancy/early pregnancy loss or an ectopic pregnancy (a pregnancy outside of the uterus). These scenarios can present with abnormally rising HCG levels and are followed closely by your team.
There can be several reasons for bleeding in early pregnancy and this would warrant a call to your team nurse, especially if bright red and heavy like a period. As above, light spotting in early pregnancy is very common and often not concerning.