IVF Frequently Asked Questions

 

How are people of color treated in the Czech Republic?

The Czech Republic is very liberal when it comes to race. Many of our IVF patients are African-Americans, Indian and mixed-race and they tell use they didn’t have any issues during their stay in Czech. In fact, some couples tell us they were treated like celebrities because different skin colors are not frequently seen in Czech, and they were perceived as exotic.

 

Can I have frozen sperm shipped to the clinic in Brno?

Yes, you can. You can read about how I have traveled with a dry shipper from Atlanta, GA all the way to Brno, Czech Republic at: http://www.myivfalternative.com/diary-2008 under October. It was hard as the shipper had to be kept upright at all times and when you are traveling with suitcases, it wasn’t easy. Having the frozen specimen shipped is the best way. I have used company called Xytex and I dealt directly with Angela. I highly recommend them for any of your tissue storage/shipping needs as they are the least expensive and easiest to deal with.

Angela Beausejour
Xytex Tissue Storage (XTS)
Xytex Cord Blood Storage (XCB)
Tissue Bank Coordinator

1100 Emmett Street
Augusta GA 30904
1-800-277-3210
706-736-9720 (fax)
tissues@xytex.com

 

Why do I need to get a treatment date from the clinic for my IVF with donor eggs?

When undergoing IVF using your own eggs, at My IVF Alternative we tell you to choose the best 14 days that will best work for your schedule, and the IVF clinic will work around your schedule.

As IVF with donor eggs is a more difficult procedure, and more people are involved (the donor and the recipient’s schedules need to be synchronized) the In vitro fertilization clinic will review your medical questionnaire and your questionnaire for OD recipient and provide you with a treatment date when they can offer you the best donor matching your requirements. We try to accommodate your treatment dates at least for a particularly requested treatment month, but that cannot always be guaranteed.

Your medical needs are of the upmost importance, and the IVF clinic excels in its ability to provide exceptional medical care, giving every patient the time and attention they deserve.

 

How can I select 2 weeks in advance if I don’t know where I will be in my cycle?

It is very easy. We ask all our patients undergoing IVF treatment to start any brand of Monophasic birth control pills (BCP) after all of their tests are done. Thanks to this BCP, you are in charge of your cycle. BCP will not only help your body prepare for your treatment but it also give us the option to shorten or lengthen your cycle as needed to fit your travel dates without any problems. Monophasic BCP is the only kind of BCP that can do that. That is why you don’t have to worry and calculate when you should go so that you ovulate on time. You just pick the best two weeks that work for you and the Monophasic BCP will help your cycle and your body to cooperate.

 

Why are we given estimated dates of my/donor’s egg retrieval?

Because we are working with human bodies, and because we want to provide you with the best IVF treatment in regards to having mature quality eggs instead of sticking to a time schedule, we give you estimated dates and discuss with you in person what you can expect. Your stay in Czech is calculated with this variable in mind. Our In vitro fertilization patients appreciate this approach.

 

What if my husband or I get sick during an IVF cycle?

Please call our office for instructions. Most colds or upper respiratory infections will not be a problem. Most over the counter medications and antibiotics are safe to use with the fertility drugs, but check with us first.

 

What is the average number of embryos transferred?

The doctor will make the decision after discussing this with you. Generally, two or three embryos will be transferred, but the number may vary slightly depending on the quality of the embryos and the age of the female partner.

 

Why must I get a blood pregnancy test after an IVF cycle?

We must show documentation that a blood test was performed to verify pregnancy status. Many IVF patients will often have implantation bleeding and assume they are not pregnant when in fact they are.

 

What are Monophasic birth control pills?

In these, all doses of estrogen and progestogen are exactly the same for 21 days of the 28-day cycle. The last seven days are filler doses - pills containing no active drug that are included to allow you to keep to a daily schedule.

Oral contraceptives usually are packaged containing 21 days of active tablets along with seven days’ worth of inert sugar pills. The oral contraceptive is taken for three weeks of the cycle, followed by seven days of sugar pills to keep on a 28-day cycle. Women usually have their period within a couple of days of starting the sugar pills.

If a woman continued to take the active pills and not use the sugar pills, she presumably would not menstruate. Many gynecologists have been advising women for years about this. Women use this technique to "skip" a period. It is important to note that this can be done only with monophasic birth control pills. Many gynecologists recommend that the "skipping" be done for no more than three to four months in a row.

Examples of monophasics include: Alesse, Brevicon, Demulen, Desogen, Genora, Levlen, Levlite, Loestrin, Lo/Ovral, ModiCon, Necon, Nordette, Norethin, Norinyl, Ortho-Cyclen, Ortho-Novum, Ovcon, Ovral, Portia and Zovia.

 

What do hCG levels mean?

Just like most of you, once I got my hCG results back, I wanted to know what they meant. Were they too low for a good pregnancy? I have done some research and combined some findings below. This information is from the Advanced Fertility Center of Chicago:

HCG, or human chorionic gonadotropin, is a hormone made by the pregnancy that can be detected in the mother's blood or urine even before the woman's missed period. This hormone is what we look for with a "pregnancy test".

HCG is first detectable in the blood as early as 7-8 days after ovulation by very sensitive hCG assays (research assays). In real life, blood pregnancy tests will be positive (> 2 mIU/ml) by 10-11 days after hCG injection or LH surge.

In general, the hCG level will double every 2-3 days in early pregnancy.

85 % of normal pregnancies will have the hCG level double every 72 hours.

HCG levels peak at about 8-10 weeks of pregnancy and then decline, remaining at lower levels for the rest of the pregnancy.

There is a large variation in a "normal" hCG level for any given time in pregnancy.

Pregnancies destined to miscarry or to be ectopic (tubal) pregnancies tend to show lower levels (eventually), but often have normal levels initially.

Some normal pregnancies will have quite low levels of hCG - and deliver perfect babies. Caution must be used in making too much of hCG "numbers". Ultrasound findings after 5-6 weeks of pregnancy are much more predictive of pregnancy outcome than are HCG levels.

For women that have had an hCG injection as part of their infertility treatment, the hormone will take about 5-14 days to clear from the woman's system, depending on the dose and the individual woman. This can causes problems with interpretation of pregnancy tests done earlier than 14 days after an hCG injection.

hCG levels from normal singleton pregnancies

Levels are listed for various days after the ovulatory hCG injection or LH surge First (same as Third) International Reference Preparation was used (Second IRP gives lower values)

"High" is highest seen in this group of pregnancies
"Low" is lowest seen in this group of pregnancies
"#" is the number of tests done for that day in this group of pregnancies

These values are from a group of 53 normal singleton pregnancies (a very small group). Because this is a very small group of patients and because lab assays vary, it is important not to rely on these values to try to determine whether your pregnancy is viable, single, twin, etc. Check with your physician about your own levels

NORMAL SINGLE PREGNANCIES

Day after HCG or LH	Average mIU/ml	High mIU/ml	Low mIU/ml	#
14	48	119	17	12
15	59	147	17	18
16	95	223	33	23
17	132	429	17	21
18	292	758	70	19
19	303	514	111	23
20	522	1690	135	13
21	1061	4130	324	12
22	1287	3279	185	22
23	2034	4660	506	13
24	2637	10000	540	16

The information in the table above is part of a study carried out by Dr. Sherbahn that compared hCG levels from single, twin and heterotopic (combined intrauterine and ectopic) pregnancies.

HCG levels from normal twin pregnancies

Twin pregnancies tend to show higher hCG levels on a given day of pregnancy. However, there is a large variation in hCG levels between pregnancies, and much overlap exists between single and twin pregnancies.

Levels are listed for various days after the ovulatory hCG injection or LH surge

First (same as Third) International Reference Preparation was used (Second IRP gives different values)

"High" is highest seen in this group of pregnancies
"Low" is lowest seen in this group of pregnancies
"#" is the number of tests done for that day in this group of pregnancies

These values are from a group of 29 normal twin pregnancies (a small group). Because this is a very small group of patients and because lab assays vary, it is important not to rely on these values to try to determine whether your pregnancy is viable, single, twin, etc. Check with your physician about your own levels

NORMAL TWIN PREGNANCIES

Day after LH or HCG	Average mIU/ml	High mIU/ml	Low mIU/ml	#
14	68	313	56	7
15	38	159	26	9
16	146	803	112	12
17	154	542	52	8
18	360	1760	200	9
19	499	2509	215	13
21	963	5859	631	10

The information in the table above is part of a study carried out by Dr. Sherbahn that compared hCG levels from single, twin and heterotopic (combined intrauterine and ectopic) pregnancies.

What Do the Numbers Mean?

The problem is, once an IVF pregnancy is confirmed, you need to know if it progressing along normally.  Keeping track of hCG numbers is one way of measuring fetal viability.  This information is from Conceiving Concepts: hCG is measured in milli-international units per millimeter (mIU/ml).  hCG is first detectable in the blood as early as seven or eight days after ovulation by very sensitive hCG assays.  Blood pregnancy tests will be positive (> 2 mIU/ml) by 10 or 11 days after hCG injection or LH surge, and levels vary with gestational age during pregnancy.

There is a large variation in a "normal" hCG level for any given time in pregnancy.  Caution must be used in making too much of hCG "numbers."  Ultrasound findings after five or six weeks of pregnancy are much more predictive of pregnancy outcome than are hCG levels.  You won't expect to see a gestational sac or the fetus until the hCG level reaches at least 1,200 mIU/ml.

However, a single hCG level cannot indicate a normal pregnancy.  In a normal pregnancy there is a regular increase of the hCG, so you need to see more than one value before you can better understand what's going on.  Additionally, a single value cannot always tell you how far along the pregnancy is, because of the wide range of blood hCG levels in pregnancy.  To illustrate the limitations of looking at a single measurement, here is a sample reference list for hCG levels in singleton pregnancies, based on days past ovulation (DPO):

• At 14 DPO, avg hCG level is 48 mIU/ml, with a typical range of 17-119 mIU/ml.
• At 15 DPO, avg hCG level is 59 mIU/ml, with a typical range of 17-147 mIU/ml.
• At 16 DPO, avg hCG level is 95 mIU/ml, with a typical range of 33-223 mIU/ml.
• At 17 DPO, avg hCG level is 132 mIU/ml, with a typical range of 17-429 IU/ml.
• At 18 DPO, avg hCG level is 292 mIU/ml, with a typical range of 70-758 IU/ml.
• At 19 DPO, avg hCG level is 303 mIU/ml, with a typical range of 111-514 IU/ml.
• At 20 DPO, avg hCG level is 522 mIU/ml, with a typical range of 135-1690 mIU/ml.
• At 21 DPO, avg hCG level is 1061 mIU/ml, with a typical range of 324-4130 mIU/ml.
• At 22 DPO, avg hCG level is 1287 mIU/ml, with a typical range of 185-3279 mIU/ml.
• At 23 DPO, avg hCG level is 2034 mIU/ml, with a typical range of 506-4660 mIU/ml.
• At 24 DPO, avg hCG level is 2637 mIU/ml, with a typical range of 540-10,000 mIU/ml.

Accordingly, the key to interpreting the true value of hCG measurements is to look at their progression.  In general, the hCG level will double every two to three days in early pregnancy.  Approximately 85 percent of normal pregnancies will have the hCG level double every 72 hours.  However, as you get further along in your pregnancy and the hCG levels get higher, the expected doubling time increases.

• For hCG levels <1200 mIU/ml, the expected doubling time is 48-72 hours.
• For hCG levels 1200 to 6000 mIU/ml, the expected doubling time is 72-96 hours.
• For hCG levels >6000 mIU/ml, the expected doubling time is >96 hours.

HCG levels peak at about eight to 10 weeks of pregnancy and then decline, remaining at lower levels for the rest of the pregnancy.  Here is a sample listing of expected hCG levels based on time after conception:

• 0-1 week: 0-50 mIU/ml
• 1-2 weeks: 40-300 mIU/ml
• 3-4 weeks: 500-6,000 mIU/ml
• 1-2 months: 5,000-200,000 mIU/ml
• 2-3 months: 10,000-100,000 mIU/ml
• 2nd trimester: 3,000-50,000 mIU/ml
• 3rd trimester: 1,000-50,000 mIU/ml
• Non-pregnant females: <5.0 mIU/ml
• Postmenopausal females: <9.5 mIU/ml

 

How do I interpret Sperm analysis?

If you’ve wondered what those numbers and percentages mean on your partner’s sperm analysis, here’s a guide you can use for interpreting the results. Please remember that your doctor can best tell you what the sperm analysis mean for your IVF treatment.

Normally, seminal fluid is clear to milky white in color, thick and sticky (viscous) in consistency, has a pH (acidity) level between 7.8 and 8.0, and contains few or no white blood cells (leukocytes).

The World Health Organization (WHO) has developed the following values for normal semen analysis:

• Total volume – greater than 2 mL
• Concentration – at least 20 million sperm per mL
• Morphology – at least 15% normal sperm
• Motility – greater than 50% sperm with forward movement, or 25 % with rapid movement within 1 hour of ejaculation
• White blood cells – fewer than 1 million per mL
• Further analysis (sperm mixed antiglobulin reaction [MAR] test) shows adherent particles in less than 10 % of sperm

 

Baby Aspirin and IVF?

Aspirin (Acetylsalicylic acid) is among the most commonly used drugs. Low dose (baby aspirin) is being taken more and more to reduce such things as heart attacks and strokes. There is increasing data to suggest that taking a single baby aspirin each day can improve pregnancy outcomes with fertility treatments such as In Vitro Fertilization.

Why would a baby aspirin improve pregnancy rates?

There are several theories:

Aspirin has a positive affect on the body’s immune system and the associated antibodies which may interfere with the embryo’s ability to attach to the lining of the uterus.

• Baby aspirin may help improve blood supply to various organs. This might help both men and women to:
  
  • improve the quality or number of eggs produced by the ovaries
  • improve the quality and volume of sperm produced by testicles
  • improve the lining of the uterus
  • and/or help keep the blood vessels of the placenta open
  • help overall during a long international flight to Czech

Should I take a baby aspirin?

• We suggest that patients take baby aspirin unless it is medically contraindicated for them. Please check with your doctor before taking this medication.

How much should I take?

• Take one baby aspirin per day. This may say “low-dose” or “baby” aspirin on the label and should contain between 78-100mg of aspirin per tablet.
• Do not take a full dose aspirin or a nonsteroidal medication such as Ibuprofen instead
• More is NOT better. Taking more than one baby aspirin a day may decrease your fertility and be dangerous to your health.
• If you have any questions about the dose of the aspirin you have selected, please ask your pharmacist or one of our staff.

We suggest that you start taking a baby aspirin now (as opposed to starting only when on fertility drugs) to achieve the potential maximum benefits as well as to see if you have any side affects prior to being in the middle of fertility treatment.

Risks?

Taking one low-dose baby aspirin a day is very safe and well tolerated. It is not common to have a true allergic reaction to aspirin.

When is it NOT safe to take a baby aspirin?

Do not a take a baby aspirin if you have any history of the following:

• Significant bronchospasm or rhinitis
• Nasal polyps
• Asthma
• Allergic skin reactions
• Bleeding disorders
• Allergies
• Sensitivity to aspirin or Ibuprofen
• G6PD

Are there any other concerns when taking baby aspirin?

• Your blood may be slightly thinner. We suggest that you keep pressure on your blood draw sites for longer than you usually would.
• Low dose aspirin is safe in early pregnancy. Your doctor will tell you when to stop the aspirin. We suggest that you do not continue taking aspirin after the first trimester unless you are taking it for medical reasons.
• Please limit your alcohol intake while taking aspirin. It may cause problems with your stomach and intestine.
• If you get an upset stomach or have concerns about ulcers, coated baby aspirin is available and should be as effective.
• While you are on the baby aspirin, we suggest that you limit the following: curry powder, gherkins, licorice, paprika, prunes, raisins, tea and significant use of non-absorbable antacids such as Maalox or Rolaids.

If you have any questions, please do not hesitate to ask your doctor.

 

When should I test for hCG levels?

For patients after a 3 day transfer, the earliest should be 12 days post ET.
For patients after a 5 day transfer, the earliest should be 10 days post ET.
If the initial test comes back negative, we encourage patients to have their levels checked 2 days later as it may take this extra time for the hCG levels to be detected in the blood stream. We have had several patients testing negative initially and then 2 days later had a positive pregnancy test and their pregnancies were full term.
Spotting or bleeding should never be interpreted as a failed cycle! Keep taking your meds and contact us.

 

Do I have to be on a complete bed rest after my ET?

No. Although our IVF patients like to come back to their hotel rooms after their ET and watch a movie for a few hours.
Afterwards, they go out to eat and finish their souvenir shopping. I tell my patients: “Don’t do anything you would regret later!”
If you are used to drinking a cup or two of coffee, keep indulging in it; if you would like to have a sip of wine, go for it.

 

Can my expenses with My IVF Alternative be tax deductible?

Yes, but please check with your CPA. Our CPA in Atlanta has always told us that all of our medical expenses, not covered by our health insurance company, are tax deductible. And if we have to travel to get our medical treatment, all of our expenses are tax deductible: airfare, accommodation, taxi, food even the money Jeremy lost in the Czech casinos!
Keep you hard made money and start your baby’s college fund with it. Go with My IVF Alternative for a tax deductible European vacation.

 

How many of my embryos will the clinic freeze?

There is no limit on how many embryos you can have frozen, however, Reprofit follows Dr. David Gardner’s (http://www.houstonivf.net/houstonivf/about/DrGardner.asp) grading system and freezing recommendations. Reprofit wants to make sure that the embryos that they tell you were frozen are healthy and strong enough to be thawed and transferred. They don’t want to give anybody a false hope of freezing all of their surplus embryos and then have nothing to transfer upon the patient’s long and expensive travel back to Czech.

Statistically, only about 30% of embryos reach the blastocyst stage (that is why the doctors may recommend you a 3 day transfer). Some embryos stop developing or start fragmenting. Reprofit will freeze only grade 1 and grade 2 embryos. Please understand that we need to wait for the embryologist to assess the embryos on day 6 (following your fresh embryo transfer) to determine which ones, if any can be frozen. Therefore, it is not such a simple math – i.e. if you have 6 embryos on the day of your embryo transfer and you decide to transfer the 2 best ones, it doesn’t mean that the other 4 will automatically be frozen. Even if they look great on the day of your embryo transfer, they may not be suitable for freezing the next day. You will receive your embryo freezing notice within 7 days of your embryo transfer.

 

Why is treatment in Czech so much cheaper than in the US?

I get this question a lot and as much as we are told by our IVF clinics how much the “going rate” is, we should be asking: "Why is it so expensive in the US?"
I don't think that spending several thousands of dollars for IVF in Czech is cheap but it is more reasonable and that's what the cost of IVF should be.
You can read in my IVF diary 2008 that when I went through my IVF treatment in Atlanta, GA; before the IVF clinic knew we had coverage, our IVF treatment at Georgia Reproductive Specialist would have been about $24,000 total. But since we had insurance coverage for IVF, the negotiated rate for IVF between the insurance company and the clinic was less than $6,000!!! Still more than in Czech but this number sounds more reasonable, don't you think?
So my answer to you is, IVF is not "cheap" in Czech but the IVF in the US is WAY over priced!

 

What does a sample treatment protocol look like?

Download the example of treatment protocol here

 

Privacy during ultrasounds.

The clinic’s staff and us at MyIVFAlternative do everything possible to respect your privacy and intimacy during your treatments at the IVF clinic.

As most US patients are used from their OB/GYN or fertility clinic’s visits that they are escorted to an exam room and offered a gown to change into and await the doctor’s arrival, we have a little different system.

First you and your partner meet with your doctor in his office to discuss your IVF treatment and ask any questions. When ultrasound follows, you will be shown a door that leads to a private changing room where you will undress from the waist down and use a sheet (provided) that you will wrap around your waist (the sheet comes to about your knees). You will then leave your changing room through another door where your doctor (and possibly your partner) will be waiting for you to perform your trans vaginal ultrasound (in most cases). After the exam is complete, you will again go through your changing room back into the doctor’s office for any comments.

 

Am I allowed to bring a gift for my egg donor?

If you are considering bringing a gift for your egg donor to the IVF clinic, please limit them to small gifts that are not personal. All gifts are subject to verification by the IVF clinic’s staff as anonymity must be maintained.

 

What is ICSI and how can it help me?

ICSI is intracytoplasmic sperm injection into the female egg. This process has been developed to help couples achieve the highest chances for fertilization.
Simply put, a single sperm gets a “piggy back” ride into the egg. Here is what ICSI procedure looks like: (www.vaunshdharaivf.com/treatments_icsi.html)

ICSI

 

What do my embryos look like on each day of their cultivation in the laboratory?

Upon fertilization, embryos go through a very rapid growth. Here are their stages in pictures from various laboratories world-wide:

Day 1 - fertilization
Day 2 - 2-4 cells
Day 3 - 6-10 cells
Day 4 - morula
Day 5 - blastocyst, expanded blastocyst or even hatching blastocyst

Day 1: Fertilization:
Embryologists check each dish to see if fertilization has occurred to create zygotes. About 24 hours after insemination, the zygotes typically begin dividing. This early stage of division or “cleavage” gives an indication of the strongest embryos.

Day 2 to 3: Splitting cells and growing embryo:
This is what your embryos can look like within the first three days of fertilization, when you call in to follow up on your embryos’ development, you will know how many cells your embryos have:

Day 3:
If you are having PGD done, biopsy on your embryos is done today:
blastomere biopsy

You can also do an embryo transfer on day 3 as you can clearly see the cells in the embryos and determine which ones are healthy and strong for transfer.

Day 4: Morula and compacted morula:
Why don’t we give out information on your embryo development on day 4? Because day 4 is a transition from a few cell embryo (about 10 cells) to a blastocyst (about 60-120 cells). There is not much to see or tell about the embryo. See for yourself:
1.pic : Morula, 2.pic : More advanced stage - Compacted Morula
 

See what I mean? Not much to report on our baby, is there? ;o)

Day 5 or 6: Blastocyst:
The cells start to become distinguished and separate into placenta cells and fetal cells, called a blastocyst or blast for short.
1.pic : Blastocyst, 2.pic : More advanced stage - hatching expanded blastocyst
 

 

Do you help only American patients?

No. Since May 2006, we have assisted patients from all over the world and we “have babies” in every continent of this world.

A lot of information on our website is from Mag’s personal experience and struggle with infertility. Since she lives in Atlanta, USA, her experience is compared to the care received in Brno, Czech Republic.We are happy to give our experienced guiding hand to anyone who asks for it.

 

What is an AMH test and why do you recommend it?

This test is recommended for women planning to use their own eggs during their IVF treatment:

AMH is an Anti-Mullerian Hormone and this test is most commonly used by fertility specialists as another and maybe more accurate indicator of a woman's fertility than just FSH alone, more specifically in regards to ovarian reserve.

Especially with patients that are border line or of advanced maternal age or their past response to IVF stimulation has been low or past miscarriage etc, this test can be a further indicator of one's ovarian production.

This test is certainly not required but if you really want to get as much information we can get from your body as possible before deciding which treatment to follow, I would highly recommend this test. Test results of 1.0ng/ml and above are what we are looking for for patients considering to use their own eggs. AMH test can be done on any day of a woman's cycle.

 

Donor egg patients – why do you ask about blood type?

Finding out your and/or your partner’s blood type is another measure we take to find you the best donor match. For some couples, completing their family via IVF with egg donation is not an easy decision (family background, religion, laws of the country where they reside, their plans not to tell their child(ren) details of their conception, etc.) Therefore, we offer the possibility of blood type and Rh factor matching as well.

What if I don’t know my or my partner’s blood type?

If your egg donor’s blood type is not important to you, there is no need to know your blood type as from medical stand point, your donor can be of ANY blood type. Remember, you are born with a certain blood type and Rh factor and when you are choosing your mate, your first question isn’t what their blood type is and if you are compatible that way ;o) Some reproductive immunologists also believe that the more different the donor is from the recipient (including the blood type) the better chances for a success.

But if you do want to find out what your blood types are, you can check with your family doctor or OB/GYN if they have those records in your file. If not, you can ask for a simple blood test to determine your blood type.