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IVF & ICSI TREATMENT – FAQ’sINTRA-UTERINE-INSEMINATION (IUI) – FAQ’sFROZEN EMBRYO REPLACEMENT – FAQ’s
IVF & ICSI TREATMENT – FAQ’s
HOW MANY EMBRYOS SHOULD BE REPLACED?
This would all depend on a combination of the following factors:

  • Cause of infertility.
  • Previous failed attempts.
  • Age of the female patient.
  • Quality of the embryos transferred.
  • General health of the female patient.

It is always difficult to say beforehand how many embryos should be transferred and most often the decision is made on the actual transfer day itself when the embryos are assessed. Patients quite often feel a great need to transfer as many as possible in the hope that at least one would become

viable. The problem is inherently when more than two become viable. With any triplet pregnancy there remains a great risk to both the health of the mother and the babies. Patients should therefore weigh up the risk of a multiple pregnancy and an informed decision, made with the help of the doctor on the day, is the best way.

Those patients not wishing to have other than a singleton pregnancy should ideally inform the centre beforehand so that the embryos can specifically be cultured on to day-5 (blastocysts), as the success with the transfer of a single blastocyst is very encouraging.

WHAT DO WE DO WITH THE EMBRYOS NOT REPLACED?
If there are at least two or more embryos of a suitable quality left then these can be frozen for indefinite and used at a later stage. It does not matter for how long the embryos are frozen and this will not impair any future success. The success rate for frozen embryos however is not as good as compared to when ‘fresh’ embryos are transferred. Patients should also be aware that not all embryos will necessarily survive the thawing process. For these reasons patients should be realistic about their chances of success with frozen embryos, nevertheless, many babies have born this way. The risks for foetal abnormalities are no greater than for people conceiving naturally. The success rate with frozen embryos also decline for older women, so much that it is not really advised for women aged 40 years and above.

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WHAT CAN I DO, AND NOT DO AFTER THE EMBRYO TRANSFER?
There is no golden rule to follow except to try and minimize any potential stress and to be as relaxed as possible. This is the time to ‘pamper’ yourself, perhaps take two days sick leave from work, have a massage, etc. there is no need to stay in bed and various studies have shown that there is no difference in the outcome with women lying flat in bed compared to those returning to work. Going to work is often a good idea, as it takes one’s mind off from thinking about the outcome of the treatment.

Albeit there are also various opinions as to whether a couple is allowed to resume intercourse, we suggest that patients refrain from having intercourse until the time of the pregnancy test, which is it is positive couples may again have intercourse.

As for taking medication, alcohol and anything ‘prohibited’ during pregnancy – the important thing is to do everything in moderation. It is best to consult the doctor or your pharmacist if you consider taking certain medication. Folic acid is advised to all expecting mothers and to continue at least until the 12th week of pregnancy. Should you consider taking a multivitamin supplement then Pregnavit M® is a good choice, as it also contains folic acid. It is advisable not to take more than one multivitamin, or in conjunction with other supplements, as too much can also not be good.

CAN I CONTINUE TO EXERCISE?
Ideally not for the first two weeks from the time of the transfer, as having a sauna too, too much strain on the body, etc., can potentially impair the normally physiology of the body and for this reason patients are advised instead to do light exercise such as walking for relaxation more than anything else.

WHAT IF I START TO SPOT OR BLEED BEFORE THE PREGNANCY TEST IS DUE?
Although in most cases this can be a negative sign, there are women who have some bleeding at the time of their pregnancy test and who can still be pregnant. Alternatively it can also be associated with the loss of one embryo that didn’t continue to develop and the body’s reaction to this, or in other cases so-called implantation bleeding. Patients should therefore still present for their pregnancy test, which is always done 14 days from the time of the egg collection and not earlier.

WHAT IF MY PREGNANCY TEST IS POSITIVE?
You should continue with the progesterone and any other medication you might be taking. A follow-up pregnancy test will be performed three days later to confirm the viability of the pregnancy. An ultrasound scan can be performed 2½ weeks from this date.

I AM PLANNING A WELL DESERVED BREAK – CAN I FLY / TRAVEL?
Flying itself has no impact on the potential outcome, even if you are already pregnant. As long as you have not had bleeding during the pregnancy, this would then be contra-indicated to flying. It is also important to consider where you will be heading for your vacation, as a deserted island would be the last place you could expect medical assistance of international standards if anything was to go wrong with the pregnancy, i.e. a threatening miscarriage. Malaria areas require you to have anti-Malaria tablets, which would not be recommended during pregnancy. Should you contract Malaria during pregnancy then there is a great risk of a miscarriage and for this reason patients should instead postpone visits to these areas.

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I AM FEELING BLOATED AND SORE – IS THIS NORMAL?
Most women will report this following the egg collection and even at the time of the embryo transfer. Some women may develop a degree of OHSS (Ovarian Hyper Stimulation Syndrome), which is often noted with younger patients who made a large number of eggs. The bloatedness and abdominal distention comes from fluid moving outside the normal body cells and filling in the abdominal cavity, which can lead to abdominal distention and discomfort. Should this be the case then it is important to remember that the symptoms are related to the treatment and best to consult the doctor. It helps to take lots of fluid, at least 3 litres per day and also milk to restore the protein loss.

Many patients also report that around the time of the embryo transfer it feels like they are having a bladder infection, or a period (menses) is about to begin. These symptoms are normal and are as a result of the progesterone administered at the time and not because of anything else.

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TIMEFRAME OF IVF & ICSI TREAMENT

Referring to the first day of your menstruation (menses / period) as day-1; the following applies to the treatment and when you are required to present at the centre.

DAY OF CYCLE

3 The first ultrasound scan is performed.
Patients are issued with the medicine, which kindly note, should also all be paid for at the time of your visit. An invoice from the doctor is also issued at the time, which must be settled in full before the next visit.
Patients will continue with daily injections that are all self-administered and therefore patients travelling from far can again return home this same day and is not required to stay in Pretoria until another 6 days.
9 Another scan is performed to determine the ovarian response. Depending on the response, the dosage of the stimulation drugs may be altered. Patients continue for a further two days and are again seen on day 11.
Normally we can give a good indicator at this stage, as to when we think the most likely day for the egg retrieval will be.
11 Another scan is performed to determine the ovarian response. Depending on the response, the dosage of the stimulation drugs may be altered. Patients continue for a further two days and are again seen on day 13.
13 For most patients this is the final visit at the centre and the completion of ten days of injections for egg stimulation. There is less that 10% chance that patients might have to continue for a further two days with the stimulation, which is if so then the rest of the table will move on with 2 days. However in most cases this is unlikely.
Should the response be adequate then patients will receive a special injection administered on this evenings and 36 hours from the injection time the eggs are collected.
15 This is the day the eggs are collected and always at 10h00 during weekdays and around 09h30 on weekends.
This is also the day when the mal partner / husband is required for the first time, and to produce a fresh sperm sample. We strongly recommend that those men who would be travelling far to present on this day, i.e. perhaps flying from other countries, should ideally arrive at least one full day beforehand. This is to avoid unwanted stress from tight schedules, which could result in some men having problems to produce on the required day.
18 or day-20 The embryos are replaced three days after the egg collection. In some cases where there are many embryos and we opt to culture them to blastocyst then the transfer will be five days after the egg retrieval instead. We can only give an estimate of this two days after the egg collection and not earlier. It could be ideal to arrange for some leave, and if required a sick note can be issued. Try and arrange for the first two days off from work so that you can be completely relaxed and away from a stressful environment.
Day after the embryo transfer Patients are welcome to fly back home again.
INTRA-UTERINE-INSEMINATION (IUI) – FAQ’s
WHAT CAN I DO, AND NOT DO AFTER THE INSEMINATION?
There is no golden rule to follow except to try and minimize any potential stress and to be as relaxed as possible. This is the time to ‘pamper’ yourself, perhaps take two days sick leave from work, have a massage, etc. there is no need to stay in bed and various studies have shown that there is no difference in the outcome with women lying flat in bed compared to those returning to work. Going to work is often a good idea, as it takes one’s mind off from thinking about the outcome of the treatment.As for taking medication, alcohol and anything ‘prohibited’ during pregnancy – the important thing is to do everything in moderation. It is best to consult the doctor or your pharmacist if you consider taking certain medication. Folic acid is advised to all expecting mothers and to continue at least until the 12th week of pregnancy. Should you consider taking a multivitamin supplement then
Pregnavit M® is a good choice, as it also contains folic acid. It is advisable not to take more than one multivitamin, or in conjunction with other supplements, as too much can also not be good.

CAN I CONTINUE TO EXERCISE?
Ideally not for the first two weeks from the time of the transfer, as having a sauna too, too much strain on the body, etc., can potentially impair the normally physiology of the body and for this reason patients are advised instead to do light exercise such as walking for relaxation more than anything else.

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WHAT IF I START TO SPOT OR BLEED BEFORE THE PREGNANCY TEST IS DUE?
Although in most cases this can be a negative sign, there are women who have some bleeding at the time of their pregnancy test and who can still be pregnant. Alternatively it can also be associated with the loss of one embryo that didn’t continue to develop and the body’s reaction to this, or in other cases so-called implantation bleeding. Patients should therefore still present for their pregnancy test, which is always done 14 days from the time of the egg collection and not earlier.

I AM PLANNING A WELL DESERVED BREAK – CAN I FLY / TRAVEL?
Flying itself has no impact on the potential outcome, even if you are already pregnant. As long as you have not had bleeding during the pregnancy, this would then be contra-indicated to flying. It is also important to consider where you will be heading for your vacation, as a deserted island would be the last place you could expect medical assistance of international standards if anything was to go wrong with the pregnancy, i.e. a threatening miscarriage. Malaria areas require you to have anti-Malaria tablets, which would not be recommended during pregnancy. Should you contract Malaria during pregnancy then there is a great risk of a miscarriage and for this reason patients should instead postpone visits to these areas.

FROZEN EMBRYO REPLACEMENT – FAQ’s
IS TEHER ANY INCREASED RISK TO FOETAL ABNORMALITIES BECAUSE OF THE FREEZING PROCESS?
To date many studies have been done and there are no overwhelming evidence to suggest that children are at an increased risk for abnormalities relating to the treatment and the freezing process. This means that abnormalities can still occur, but this could anyway have happened as a result of natural conception and not because of the treatment.
WHAT IS THE SUCCESS RATE?
This will depend largely on one or more of the following factors:

  • The younger the patient the better the chances.
  • If a pregnancy was achieved from a fresh transfer of which the frozen embryos were part of at the time.
  • Previous successful IVF treatment at any time.

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The overall chance for a pregnancy is however less than with a fresh transfer. In the best of circumstances one could expect a pregnancy rate (per embryo transfer) of round 20% with live birth rate per treatment cycle commenced of around 15%.

WHY HAVE THE EMBRYOS REPLACED IF A PREGNANCY DID NOT OCCUR WITH THE FRESH TRANSFER?
There are cases where patients did not achieve success with the fresh transfer but become pregnant with the frozen embryos. As long as there are embryos there is always a chance to become pregnant and ant chance is worth taking. The embryologist will also only freeze remaining embryos if they meet with a certain minimum criteria at the time and therefore only good quality embryos will have been frozen in the first instance. Because of this one always remain hopeful that any frozen embryo could potentially result in an ongoing pregnancy.

WILL ALL THE EMBRYOS SURVIVE THE THAWING PROCESS?
The thawing (defrosting) of the embryos is a very delicate process that requires skill and dedication from the embryologist. Not all embryos however will survive the thawing and on average around 75% or more of the frozen embryos will remain intact and suitable for transfer. The thawed embryos are left in special culture medium so that their progress any further development over the next few hours, and in some case up to 24 hours from the time of thawing, can be monitored. Those embryos that showed an increase in the number of cells from the time it was frozen will stand a better chance to result in a pregnancy. This is however different for frozen day-5 embryos, called blastocysts, as their cells have already formed one large cell mass and therefore we judge their development on different criteria.

HOW MANY FROZEN EMBRYOS SHOULD WE REPLACE?
Albeit there is always a risk of a multiple pregnancy when too many embryos are replaced, we know that the potential per frozen embryo to become a viable pregnancy is smaller than with fresh embryos. For this reason we can opt to replace more than would have been the case with a fresh transfer.

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HOW SOON CAN I HAVE TREATMENT WITH FROZEN EMBRYO REPLACEMENT AFTER A CYCLE OF IVF TREATMENT?
For patients who are on option ‘B’ and ‘C’ treatment can commence immediately following treatment with IVF. As for the ovaries will not be undergoing stimulation there is no need for a so-called ‘resting period’ following the IVF treatment. In cases of treatment with option ‘A’ it is best to wait at least one month following the IVF treatment so that the body could restore its normal physiological pattern, allowing natural follicle development, ovulation and normal hormone function.