In Vitro Fertilization (IVF)
Archived Q&A and Reviews
- Considering a frozen embryo transfer while breastfeeding
- Considering IVF after repeated miscarriage
- IVF or donor sperm for low motility?
- Low sperm count - alternative to IVF?
- When is it time to consider IVF?
a couple of months ago, I was blessed to give birth to a beautiful baby who was conceived via IVF. We are now starting to think of when to attempt #2 - we still have some frozen embryos that are waiting to be transferred. We don't want to space the kids too far apart, also for health reasons (my pregnancy was not complication free, and subsequent pregnancies are bound to become more difficult as I age). Our concern is this: Do I need to wean the baby before the transfer? The wise google seems to think that most REs require this, but that it is not really necessary. The FET (frozen embryo transfer) would be regulated by hormones that I take, which are naturally occurring and would thus not harm the baby via milk. Of course I'll check with my RE, but I'd love to get some input first: Have any of you done a FET while still breastfeeding (if it was an RE in the Bay Area, I'd love to get the recommendation)? Have any of you thought of this, but were persuaded by the RE to wean the existing baby before? I'll appreciate any advise! Anon
Sure, it is not impossible to get pregnant via FET while breastfeeding, but why risk the reduction in success rates and why risk an abrupt end to your breastfeeding relationship? Correct,the hormones you have to take are not a contraindication for breastfeeding. BUT, taking the boatloads of estrogen necessary to build your uterine lining will significantly reduce your milk supply. Then, when you get pregnant, your estrogen levels will go sky high, your boobs will get extremely sensitive and your supply will dwindle. Breastfeeding with morning sickness is no picnic either. I say this because I got pregnant twice (naturally) while breastfeeding and miscarried both times. The first time my milk supply came back, the second time it did not. It was OK for us because my child was over 2 at the time, but it was bittersweet because we did not get a ritual to help her let go. Probably can't have it both ways
I transferred frozen embryos while breastfeeding my one-and-a-half year old. I consulted with my reproductive doc (Dr. Ryan) at Pacific Fertility in SF, and also with the lactation consultants at Kaiser Oakland, whom I really, really trust. They all gave the thumbs up, no one advised me to give up the breastfeeding. I also read up on the subject and felt assured that there were no safety issues with the hormones in the breast milk (I did all of the required hormone injections). The first two rounds of transfer failed but we got lucky with the last, and now have a beautiful, five year old boy who is healthy in every way (he has a seven year old brother, a healthy IVF baby).
By the way, I also nursed throughout the second pregnancy, even in the first three months during the injections, with support from the doc and lactation consultants. I don't believe that the first two ET rounds failed due to breastfeeding. We don't really know why they failed, except that I was taking Prednisone for RA symptoms at the time, and stopped for the transfers. The third time, my doctor advised me to keep taking my Prednisone--and it worked! We will never know, however, if the Prednisone (or lack of it) affected the outcomes. Best of luck with the transfer and the breastfeeding! Marie
We are considering doing IVF. I have a chromosomal translocation that means 50% of my pregnancies will end in miscarriages... this far 4 of 5 have ended in miscarriage. I get pregnant crazy easily, apparently I have the follicles/ovaries of a teenager (I am almost 38), and it seems the only reason I am miscarrying is the genetic problem. I already carried one baby to term (now almost 3) Two questions.
1. The success rate percentages for 38-40 are GRIM... but it seems like I don't/won't have a lot of issues most women have (I make a lot of eggs, etc) Why does IVF fail for women?
2. There is a place in Colorado that has a 41% live birth rate for my age group. No other place in the country touches their rates. It is hard to say no to that rate. Is it worth flying out there to do this or just any IVF place with a decent live birth rate? Anon
I would seriously consider consulting with Reproductive Science Center http://www.rscbayarea.com/ regarding IVF. They at one time had the highest success rate in the area (I am not sure if this is still true). The doctors are exceptional, compassionate and truly experts. I have nothing but praise for both Dr. Wilman and Dr. Hinckley in the Orinda office. Keep in mind that the CDC data on success rates includes those with a wide range of issues and I suspect you may get a more positive prognosis in person. RSC has info. seminars fairly regularly where they pass out coupons for half priced initial consultations. Dr. Wilman helped me with my first pregnancy and hope she will help me with a second- at age 38. Best of luck to you and your family! -Erika
First off, I'm sorry you find yourselves having to tread this ugly IVF journey. Its a tough road to travel. Your post is very upbeat, but the reality of IVF is that it is an emotionally and financially grueling journey. Its been an part of our lives for the past 4 years, so we're pretty familiar with all the positives and negatives it can bring.
As an IVF 'veteran' your first question makes me nervous. IVF isn't an exact science. Not everyone comes away with a baby, even when their infertility is 'unexplained', they produce many embryos and everything goes seemingly perfectly. There are many junctions along the way where the number of decent quality embryos you produce as a couple is reduced (last time we only retrieved 8 eggs, of which 5 fertilised, of which 3 made it beyond day 2 and of which only 2 were of reasonable quality......) Quality is key with IVF, so its not the number of eggs you can/may produce that is of relavance but rather the quality of those eggs, and the unfortunate reality is that with increased age, goes reduced egg quality, hence those 'grim' stats. The reality is that sometimes (often actually) it just doesn't work, for whatever reason.....and the why is largely unknown.
Wrt your second question I would be interested to know what the patient group is like that this clinic accepts? It certainly seems like a high success rate - what do they attribute it to? Unless you are very sure your chances are better then I would at least check out PFC and/or UCSF in SF (we preferred PFC incidently). I'm sure their opinions would be worth seeking as part of your decision making process? A couple of hundred dollars for a consult will fade into insignificance once you get stuck into an IVF cycle or two.
The process of IVF is pretty intense and involves a lot of fairly unpredictable appointments once you are in the stimulation phase. You probably need to be in Colorado for a couple of weeks at least, unless you could arrange your monitoring visits here in the Bay area, and just head to Colorado for the retrieval and transfer?
I hope I don't sound too negative. We have visited both the extreme lows and the ultimate high that IVF can bring, and it truely can work miracles, but please, please, don't assume you are immune to the lows, despite your history..... Its a long long way to fall when things don't go so well. Much much luck to you on your journey, IVF vet
If you have a chromosomal issue to get pregnant, but willing to go through IVF process, there is PGD (Pre-implantation Genetic Diagnosis) to find out which embryos may carry your affected chromosome with trans location.
We did ICSI (similar to IVF) with PGD for different reason at UCSF. I was like you, at the age of 41, I had ovaries of 20's. Still, my first two ICSI failed due to the quality of embryos, but on the third trial I was successfully pregnant (with multiples. Added bonus.)
I think IVF fails, just like natural pregnancy. I heard that many natural pregnancies fail due to various and probably still unknown reasons, so this medical technology is not certainly 100% guaranteed. That being said, success does happen too. When I was trying with ICSI, my doctor told me that my pregnancy rate would be only 10%, but we tried anyway. I am glad that I did at least try. ICSI and PGD suggestor
Hi, We've been doing IVF with Reproductive Science Center of the Bay area, and we have had a good experience (plain old unexplained fertility over here!) However, I have been reading a blog called here be hippogriffs http://julia.typepad.com/ and her husband has roberstons traslocation (13 pregnancies, 2 live births).
Anyhow,it seems like you might want to look at the PGD programs really throughly--the woman at the blog I referred you to had an erroneous PGD done at Shady Grove outside of DC, and then decided to go with a clinic that was local and convenient and had a successful twin pregnancy. From my extensive blog reading, and attending Google U, I'd say you have a pretty high chance of getting pregnant, and staying pregnant, as long as the PGD is accurate. You have a sense of what the anomaly is, unlike most of us who miscarry, so the PGD is really the most important thing.
If you do decide to stay local, I highly recommend Dr Susan Willman at Reproductive Science Center in Orinda/San Ramon. She is very smart, caring and honest about the likelihood of success. I think she is also the director of PGD at RSC. Best of luck to you--M/c's are awful. Sarah
Hello: I want to recommend CCRM in Colorado . Their success rates are excellent, and I am now pregnant. One thing that they offer which might be great for you is a type of pre-genetic testing (CGH) that tests all 46 of the chromosomes on 5 day blasts, so you know that you are only transferring normal embryos. The CGH rate for pregnancy is 80% for women of all ages! You might consider doing a phone consult with one of the doctors to see what they think. The downside is that you have to go there for a one day workup and do all of their tests, even ones you may have just done at your local clinic, and of ocurse, you have to be in CO for a couple of weeks, which makes it more expensive. Still, I think it is worth it. Their lab is excellent, and I think that is the big difference, in that they are able to get more 5 days blasts, which increses outcome. If you go to IVFconnections.com and go to IVF in the USA, then Colorado, you will see many threads, including a large one about CGH. Good luck, I know how hard the process is! Anon
I want to very enthusiastically recommend the IVF program at UCSF . We had Dr. Paolo Rinaudo and he was terrific. The other docs are great too, as are all their staff. They do a really good job of informing you about all of the considerations, risks, success rates, etc at every step of the way. I think that it would be wise for you to at least speak with them or attend their information session (once a month I think?) before you decide you need to go to Colorado.
As everyone else has said, there are a variety of reasons that IVF can fail. While producing enough eggs is important, the quality and size of the eggs is also important, the timing of everything is vital, what happens whether or not embryos are created and their quality, etc. etc. We learned that the lab folks are really the most imporant staff of an IVF Center, not the docs. The lab is the place where the magic merging of egg and sperm happens and it's a very specialized skill, especially with ICSI.
A couple of things to look at with success rate statistics: age of the women in the group, whether the group includes anyone who is ''high risk'' (part of that classification is age), and incidence of multiples. Some places get lots of live births because they implant lots of embryos. But having a pregnancy with multiples is high risk as well and not something to take lightly. anon
A friend of mine is looking at the possibility of undergoing IVF. They just found out her husband's motility is very low. One option at this time is using doner sperm with the IUI procedure. Their other option is to try IVF with her husbands sperm. She is wondering if anyone has gone through with the IVF procedures and looking back at it would have chosen the doner sperm as their 1st option instead.
My husband also has low motility and we pursued IVF. We had success on our first IVF attempt, so I would recommend going with your husband's sperm vs. a donor. However, you do not state what your husband's count and motility levels are and that could affect your decision. Speak to your IVF doctor and follow your heart. Good Luck!
My husband's sperm has very low motility (due to a spinal cord injury) and we chose IVF. We do not regret our choice. We were candidates for Intracytoplasmic Sperm Injection (ICSI) where they retrieve the sperm and the eggs and then inject a single sperm directly into each egg to increase the chances of fertilization. We conceived two healthy children this way (a now 6.5 year old from a fresh embryo and a now 3.5 year old from a frozen embryo). I know your friend was curious about negative IVF experiences, but I thought I would share our positive one anyway. She is welcome to contact me for more information if she wants.
Well, it's finally been confirmed. The reason why my husband and I haven't gotten pregnant within the last year is because he has an extremely low sperm count. My GYN has referred us to the RSC, but we already know we can't (and honestly refuse) afford to pay that amount of money. We already have one son (conceived naturally) and feel that in spending thousands of dollars to try and have another is just taking away from him and our plans. However, we would be in awe if a miracle were to happen. So we have opted to weigh it out and give it some more time. I remember reading previous listing discussing how others had attempted alternatives to IVF or other infertily treatments. I was hoping I could get some input or referrals from people who have gone through this and made the decision to try non- traditional treatments. Anon
Sorry to hear about your diagnosis. Thankfully assuming your partner is willing there's a lot that can be done to improve sperm count. There is a daily supplement called Proxeed which is very expensive, but apparently quite effective in increasing motilty and count. Go here for more details. http://www.malefertility.co.uk/proxeed/page4.html There is also a lot to be said for acupuncture and Chinese herbs. I don't have specifics but can recommend Dr Angela Wu in SF. Best of luck, I hope this helps.
My wife and I had a similar problem, I was diagnosed with very low sperm count. We started various infertility treatments - hormones (depo testosterone) and artificial insemination, with no luck. We stopped all treatments (for a period of several months) and were considering IVF when to our surprise we conceived naturally. We also conceived our second child naturally (and unexpectedly)nearly a year after the first was born. My points are: (1) Don't give up yet. (2) Doctors'/scientists' understanding of fertility is incomplete at best. Statistically, it should have taken us ~10 years to concieve naturally (for each child) based on the measured sperm counts. anon
My husband and I are in a very similar situation. We have a 3 year old daughter and have been trying to conceive for more than a year. We finally did some tests and found out that my husband has a very low ( 8 million) sperm count, low motility and very bad morphology. I also thought that IVF was very expensive. My husband went to see an urologist who prescribed vitamin E, zinc and carnitine (Proxeed). There has been a study in the Netherlands showing that zinc + vitamin E can increase the sperm count by up to 50%. My husband tried for 3 months and his numbers went from 8 to 12 millions. Unfortunately this is still very low. The low motility is also a killer. If the numbers are low unfortunately it is very difficult to save the situation. The urologist also suggested to tie a varicocele but again this procedure is of questionable value if the numbres are very low. So for us IVF with ICSI is the only option left. Hope this helps still trying to have a second child
Check out www.onna.org for a list of vitamins and herbs as well as info for how to maximize your odds. Have you read Taking Charge of Your Fertility? A must-have and she goes into how to time intercourse when sperm count is a concern. Also www.inciid.org for their bulletin boards for their alternative therapy board, moderated by a MD who could help with ideas for male factor supplements.
My husband and I have been trying for our second child for almost 2 years. After a miscarriage, we sought out a RE (reproductive endocrinologist) in San Francisco, Pacific Fertility Center. We have done 3 rounds of IUIs with injectible medications and they all failed. Our diagnosis is mild ovulatory dysfunction and borderline male factor. Help! Did you have success at other fertility clinics? When did you know you have to advance to IVF and was that the answer for you? Did you have insurance coverage? If yes, who? If no, how much was it and how did you afford it? Did you use alternative methods, ie acupuncture, vitamins/supplements, diet, exercise, etc. We don't have infertility coverage and would like to avoid IVF if possible. The procedure and the medications are so expensive. Any suggestions. Thank you for your help.
It seems to me that you need a Reproductive Endocrinologist that you can really work with. A good RE will answer questions about how likely you are to succeed with differing fertility techniques. (You should be comfortable enough with them that you value their advice over, say a mailing list ;-) I talked to several, and found one I liked.
I loved my RE, Dr. Susan Willman, who's in Orinda (925) 254-0444. I did try IUI's, but ended up with IVF, and now have two children. The decision to go from IUI to IVF depends on many factors, your diagnosis, but also your age, and what's important to you. The Center for Disease Control publishes the rates of IVF success by clinic, by the way. See http://www.cdc.gov/nccdphp/drh/ART00/index.htm
We paid for the IVF ourselves. None of the insurance offered us covered IVF. However, the insurance did cover many of the blood test before and medication (progesterone) after I got pregnant. If you're already using injectibles, you're already paying some of the costs of IVF. IVF Parent
I believe that it is important to pursue IVF as soon as it is feasible for you, since age factor is one thing that is always looming during infertility. You might want to have a second child, and you need the lead time.
We were lucky in that we had insurance to cover all of our attempts. My husband was employed by a company based in Massachusetts. When Dukakis was governor he mandated infertility insurance and we owe him a great debt of gratitude. There are a few other states that this is also the case for. He also worked for a California company that got infertility insurance and offered us a $25,000 cap, which paid for 2 tries.
I would join an online group called Fortility. They are incredibly knowledgeable about fertility issues and it is a great support group. You can reach them through surrogacy.org
Also, try looking into other clinics such as UCSF, Chetkowski, or other East Bay alternatives. Go for the doctor/practice that you like the best. It helps when your stress level goes up.
Dr. Wu in San Francisco is also amazing for fertility issues via acupuncture.
2 time IVF winner, 6 attempts anon
I'm sorry about your miscarriage. I too when through a number of miscarriages and many IUIs and drugs. Before you take the big (and expensive) step up to IVF I would recommend you try acupuncture and herbs. You may have already but you didn't mention it. There's a specialist in SF called Angela Wu who deals with fertility issues who has had tremendous successes. She'll get you to change your diet, take herbs and she's expensive but it worked for me and I now have a son. It won't hurt you and it can only do good.
Her phone number is (415)752-0170 and she has a website at: http://www.wushealingcenter.com/ Good luck! A very satisfied client
You don't mention your or your partner's ages, but they should be considered a factor when deciding your next options. In my case, my husband and I had been trying for more than five years, and we were both in our late 30s when we began fertility treatments.
My doctor's belief was that anything more than one year of trying without success constituted infertility. I believe the fertility clinic we had an IVF at used three years of trying as a baseline.
All our treatments were covered under Blue Cross PPO. But keep in mind that even the same carriers offer different coverage, depending on what the employer pays for. My husband's employer paid for very good benefits and covered fertility up to a set amount (I don't recall the amount); it didn't matter which type of medical fertility treatment was used. I don't know whether that included acupuncture and other alternative therapy.
My own OB/Gyn took us through six cycles of artificial insemination before he referred us to a fertility clinic in Palo Alto: Fertility Physicians of Northern California (http://www.fpnc.com/). It also has an office in San Jose. We live in the South Bay. The senior doctor there, G. David Adamson, is a pioneer in the fertility field.
Neither my doctor nor the clinic could find anything wrong with either of us, which in terms of pure statistics meant the odds were lower than other couples that we would conceive. That's because you can address a known cause of infertility. For instance, if the male partner has a low sperm count, ''cleaning'' or ''spinning'' the sperm combined with directly fertilizing the egg does wonders. Similarly, if a woman is not producing eggs, she can use donor eggs.
At the fertility clinic, we were offered the option of one cycle of artificial insemination with stronger fertility drugs (that I would inject myself) to increase my egg production or going right into in vitro. The difference was several thousand dollars in price. At this point I was 38, and it seems 37 is the magical cut-off point at which doctors tsk-tsk at you and say your odds of conceiving have plummeted. We figured that although IVF was more expensive, it would be even more costly to do another round of insemination FOLLOWED by IVF if the insemination didn't take.
So we opted for IVF. I'm happy to report that we were successful, and our son just turned 3. The funny thing is because no one could ever find anything wrong with either one of us, my doctor kept asking me about birth control, and I kept saying we were holding out hopes of having one more child. But by this time, we had exhausted our fertility coverage, and we were down to one income. So we just tried the old-fashioned way.
To put a coda on this, we're expecting our second child in March, and we did this one completely on our own. I believe a lack of stress from my being away from the working world may have a played a role. (On the other hand, I do have a toddler at home.) But go figure. Anonymous
I also went to Pacific Fertility Center in SF. We also did 3 medicated IUI's with them, and finally moved on to IVF. I think they are very conservative in that they suggest several IUI's before IVF--this is a testament to their honesty. If after several IUI's you haven't succeeded, then I think the choice is really yours (as it was ours) as to whether you want to make the financial and emotional investments that IVF requires. I have a 2 month old son thanks to IVF and the doctors at PFC. The most important thing is to trust your doctor and their advice--I was very pleased with everyone there and obviously, thrilled with the outcome.
One last comment--do consider seriously the payment options (''Plans'') they offer. We felt conflicted about our choice immediately after making it (basically one is ''insurance'', one is a one time shot, and one is a refund plan). We opted for the one time shot, but really felt as though we were gambling--not a nice feeling when you're dealing with something as unpredictable as conception... My two cents: Give it lots of thought so that you feel comfortable with your decision. Good luck to you! nina
Accupuncture & Chinese herbs regulated & shortened my cycle for the first time in my life, & I wasn't necessarily a ''believer''. Treatments can also be very soothing & relaxing. These can be expensive, but you might call Chinese medicine schools or Quan Yin in SF. Also, the idea that adoption leads to increased rates of conception due relaxing about having a baby & ''letting go'' may actually be better (or also) explained by changing hormones. I had started to miss periods for the few months before my (soon to be adopted) baby daughter moved in w/ me, but they quickly returned & became regulated, and I had clear signs of ovulaton. Research has shown hormonal changes in non-birth parents in reaction to babies. Is there a baby in your life you could bond with? (I'm sure the parents would be thrilled to have your help!).
Having said all this, you may want a 2nd opinion, especially depending on your FSH level, so as not to ''waste'' any more time-been there. I recommend Susan Wilman (RE) in Orinda.
I got a happy (different) ending, but dealing w/fertility can be so challenging. Good luck to you. Vicki
We did three IUI cycles before moving on to IVF. Unless there are identifiable reasons why the IUI's weren't working that could be addressed during future IUI's (like not enough follicles), it seems that IUI is not working for you. There is so much more control during an IVF cycle - they can really up your stim meds because there isn't the multiples risk (or as much of a risk) as with IUI. If you respond well, you may get enough embryos for more than one cycle, so the money you are putting into the stim meds goes further than with IUI. We got pregnant after our 2nd IVF. Have you talked thru IVF with your current RE team? THey should be able to help you understnad how IVF may improve your odds over IUI. Good luck!!! anon
I was in a similar situation and am so grateful I moved on to IVF. We were getting nickled and dimed doing IUI's, not to mention still spending a fortune on meds. (we did 1 clomid IUI, and 3 medicated). We did a shared risk IVF program through Dr. Susan Wilman in Orinda and got lucky the second time. We're still paying down the home equity loan, but its worth it.
If you want some onging support from very cool informed women, I recommend going to http://www.inciid.org/interinfertility.html There are two forums that could be useful: Infertilty waiting room and the IVF waiting room (see left column). These ladies saved my sanity. anon
You did not say your age, which is VERY important...2 years of trying at age 40 indicates you should run not walk to more advanced care. It sounds like you have tried the strategies pre IVF. IVF will cost about $10,000 for drugs, egg retrieval, and 1st round embryo transfer. If you have alot of good embryos, then 2nd and 3rd rounds should involve only the costs of frozen storage and embryo transfer (probably $1000). After all the failures with clomid, IUI, etc., I was happy to finally get to IVF, where I felt I had a better chance of success. We did get pregnant on the 1st round and went through UCSF (the docs have all moved on together to a new practice -don't know the name - the docs are Schriock, Givens, and Ryan). Again, if you are older, you should not waste any more time on unproven or less effective therapies. Anon
I tried for 3 years to have a baby, but was opposed to using fertility drugs. My sister in law recommended ''Eight Weeks to Optimum Health'' by Dr. Andrew Weil, as she had several miscarriages, did his program, and was able to carry her baby to term. I did this program and did also get pregnant and had a baby boy. I also had minor endometrial surgery which may have been the fix (hard to know as the doctor said that there wasn't much endometrius). I never had to try IVF, although I have two friends who did for their first child, and ended up having second children without planning them! Good luck! anon
It took me 4 years of medical intervention to get pregnant. I have Polycystic Ovary Syndrome. I spent about two years having a surgery and then using clomid and seeing bad doctors who weren't really paying attention. The second two years I was with a fantastic fertitlity specialist at Kaiser San Francisco, Dr. Seth Feigenbaum. I don't know how many cycles of Repronex injections we did but it took about two years so it was a lot. It was entirely free with my Kaiser coverage. Kaiser doesn't cover IVF so we were at the end of the line when Dr. Feigenbaum got a little more aggressive with my treatment and we have a beautiful 11 month old son now! Good luck! Danielle