How you prepareBy Mayo Clinic staff
When choosing an in vitro fertilization clinic, you might have many options. The Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about U.S. clinics' individual pregnancy and live birth rates. Keep in mind, however, that a clinic's success rate depends on many factors, such as patients' ages, the number of embryos being transferred during each in vitro fertilization cycle and the number of cycles that have been done. If the expense of in vitro fertilization is a concern, ask for detailed information about the costs associated with each step of the procedure.
Before beginning a cycle of in vitro fertilization using your own eggs and sperm, you and your partner will likely need various screenings, including:
- Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH) in your blood on day three of your menstrual cycle. Test results can help predict how your ovaries will respond to fertility medication.
- Semen analysis. Your doctor will conduct a semen analysis — even if an earlier exam showed no signs of problems — shortly before the start of an in vitro fertilization treatment cycle to ensure that semen quality hasn't changed. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
- Infectious disease screening. You and your partner will both be screened for HIV, hepatitis B, hepatitis C and, in some cases, chlamydia.
- Mock embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to result in a successful embryo transfer.
- Uterine cavity exam. Your doctor will examine your uterine cavity before you start in vitro fertilization. This might involve a sonohysterography — a technique in which fluid is injected through the cervix into your uterus and ultrasound is used to create images of your uterine cavity — or a hysteroscopy — a technique in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.
Before beginning a cycle of in vitro fertilization, consider important questions, including:
- How many embryos will be implanted? The number of embryos implanted is typically based on maternal age and the number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually implanted — except for women using donor eggs. However, most doctors follow specific guidelines to prevent higher order multiple pregnancies — and in some countries legislation limits the number of embryos that can be implanted at once. Make sure you and your doctor agree on the number of embryos that will be implanted before they're transferred.
- What will you do with any extra embryos? Do you and your partner want to freeze and store embryos that aren't implanted for future use? Extra embryos can be stored for several years. Cryopreservation can make future cycles of in vitro fertilization less expensive and less invasive. However, not all embryos survive the freezing and thawing process and the live birth rate from frozen embryos is lower than the live birth rate from fresh embryos. Alternatively, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.
- How will you handle a multiple pregnancy? If more than one embryo is implanted in your uterus, in vitro fertilization can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
- Have you considered the potential complications associated with using donor eggs, sperm or embryos, or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the issues, such as the legal rights of the donor. You also may need an attorney to file court papers to help you become legal parents of an implanted embryo.
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