FREQUENTLY ASKED QUESTIONS BEFORE STARTING AN IVF TREATMENT
Which day is considered as the first day of my period when there is „spotting“ at the beginning?
Spotting is not the start of menstruation. The first day of menstruation is the first day of heavy menstrual bleeding. If the menstruation starts after 8p.m., the following day is considered as the first day of period.
When to start with injections‘ application?
The injections´ application starts second or third day of the second cycle (2nd or 3rd day of menstrual bleeding). In the case of so-called long protocol is starting of application clearly indicated in the schedule provided by your doctor.
How to store the medication?
Stimulant medication with the necessity of dilution (itself containing powder and dilution water – MENOPUR, Fostimon, Merional) can be stored in a dry place at room temperature, just as the Orgalutran and Cetrotide. To store in the refrigerator are recommended medications taken by injection pen – Puregon and Gonal (2-8 °C). Also Pregnyl, medication for ovulation induction, should be kept in the refrigerator. Ovitrelle – another medication used to induce ovulation, can be stored at room temperature below 25 °C.
How is it with medication‘s transport?
There is no problem to travel with stimulation medications. Even medication with the need to store in the refrigerator will last at room temperature, for a period not exceeding three months (Puregon) and 1 month (Gonal).
Is there best time in day for medication‘s application?
Most important is the regular application of medication – about the same hour every day. Preferable are morning hours.
In my injection pen there is left a bit of liquid, is it possible?
Each pen has a margin given by the manufacturer in a range about 75-100 units, so it is perfectly fine if you are left with something in the pen. This „reserve“ can be used in further stimulation.
I broke medication ampoule!
In the case of breaking the ampule, spilling its content, or uncertainty about the proper application, please contact us. We will advise how to proceed. It is essential to maintain applications´ continuity.
When during stimulation to go for ultrasound examination?
Ultrasound examinations are performed 6th – 7th day of stimulation, another ultrasound examination is usually 2-3 days afterwards.
Will be done some blood testing?
In case you are younger than 40, there is needed internal examination before anestesia and no blood testing. On the day of oocyte punction, you and your partner will be tested for possible occure of some infections. This testing is given by the law.
Is it important to applicate Pregnyl at the exact hour?
The right hour of Pregnyl application is crucial for the timing of eggs´punction (punction should take place 35 to 37 hours after Pregnyl application), therefore it is necessary to keep strictly to the schedule. In case you forget to apply Pregnyl, contact us immediately for further instructions. In case you do not apply Pregnyl at all or you do it wrongly, there will be retrieved no egg within the punction (!)
How to apply Pregnyl?
The Pregnyl is applied into a skin fold in the abdomen, the same way you applied FSH injections.
Intramuscular application, as described in the manual, is unnecessarily painful and does not bring a better effect on the maturation of eggs.
How many days of partner´s sexual abstinence is the best for sperm quality?
Recommended are two days of sexual abstinence to assure sufficient volume of ejaculate. There is no need for long-term sexual abstinence, because it can have a negative effect on sperm morphology.
Is there a way to help on better sperm quality prior to collection?
Sperm quality is a result of all affiliated conditions and effects within the last three months prior to collection. Therefore there is no need for any special regime in a short time prior to collection.
What to bring with me for oocytes‘ puncture?
For the egg retrival attend with an empty stomach (from midnight no eating, drinking and smoking), your partner, bring with you longer shirt or a nightgown, slippers and if you prefer your own hygienical pads you are used to – you may bleed slightly after retrival.
How long does the puncture take and how long will I stay at the clinic?
The actual procedure is performed under general anesthesia, its duration depends on the number of eggs, and usually does not exceed 10 minutes. Pain after the surgery is felt individually and it can be reduced with analgesics. About two hours after surgery, you will be released by the doctor. You are not allowed to drive after anesthesia.
What medications will I use after puncture?
The exact plan of the medication use is provided by the doctor after the retrival of the eggs. Most patients take progesterone (Utrogestan, Crinone). Some patients are prescribed with estrogen to support the endometrium (Estrimax, Estrofem). Taking other medications are always following the doctor’s instructions.
When exactly is embryo transfer done?
Embryotransfer is scheduled by physician in cooperation with embryologist and patient. Transfer is possible on the 2nd, 3rd and 5th day following puncture. About exact date and time of embryo transfer you will be informed by your coordinator with the information about the development of your embryos.
What should be the quality of embryos day by day?
Embryo´s quality can be assessed from the second day of their development. The two-day embryo should have 3-4 cells. The three-day embryo then 6-8 cells. The fourth day of development the embryo becomes a morula and its quality evaluation is difficult. Fifth date embryo becomes a blastocyst.
What to bring with me for embryo transfer?
There is nothing special you need to bring for embryo transfer. Make sure you have all signed consents with your treatment with you, also, if you wish to freeze embryos, bring signed consent for embryos´ cryopreservation.
How long the transfer takes itself?
Uncomplicated transfer takes 3-5 minutes. After embryo transfer you remain lying on the transfer surgery for about 10-15 minutes. Then you can go home.
May be partner with me at the transfer?
The presence of a partner during the embryo transfer is apparent (only if you wish otherwise).
How will I pay the treatment?
You will be informed about treatment´s price before starting the treatment. After the egg retrival you will be informed about related needed treatments and their costs. Final accounting for the treatment and payment itself will be on the day of embryo transfer. You can pay by cash or credit card. Payment via bank transfer is possible only after an agreement with your doctor and is made in advance.
Do I need to have full bladder before embryo transfer?
It is not necessary to have extremely filled bladder. However we recommend not to empty the bladder immediately before embryotransfer. Medium-filled bladder helps to straighten the uterus and thereby makes easier to transfer embryos into the uterus.
There is a slight bleeding after the egg retrival, is that normal?
Light bleeding or „spotting“ after egg retrival is common. It is caused by the penetration of the needle through the vagina during puncture of the ovaries. However, if the bleeding is growing or there are excluded blood clots, please contact us.
My stomach hurts, is it normal?
On the day of the puncture and the next day you may feel a slight pain in the lower abdomen. It is caused by enlargement of the ovaries by stimulating medications. Worsening pain on second or third day after the puncture may indicate the development of hyperstimulation and therefore we prefer you to contact us. Your doctor will most likely recommend a personal visit to the clinic.
Do I have to stay in bed after embryo transfer?
After embryo transfer there is not required to stay in bed. We recommend a regular daily routine with reducing stressful factors such as physically demanding sports or heavy manual work. It is not necessary to stay on sick leave.
When can I travel home after the embryo transfer?
There is no restriction for travelling after embryo transfer. Usually patients on the day of embryo transfer, no later than the following day, travel home using all possible ways of transport.
When is actually embryo „nesting“ in the womb?
Embryo is „nesting“ (NIDA) into the endometrium usually 6-8 days after fertilization, so in the next 24-48 hours after embryo transfer.
I have started „spotting“, is it normal?
Within 10 days after embryo transfer the „spotting“ may occure. It is caused by minor injury to the cervix during transfer and also by „nesting“ of embryo. The „spotting“ has no effect on the result. Heavy or prolonged bleeding, consult with your physician.
Do I still have to take all medicines?
Continue to take any medication that you were taking before embryotransfer – it is always at least progesterone (Utrogestan). If you were taking, prior to transfer, Estrimax, Anopyrin or Prednisone, continue their use as well.
I do not feel well after taking Utrogestan, what can I do?
If you use Utrogestan oraly, start using it vaginaly (the same dose) twice a day (morning and evening). If you are already using vaginaly, you can change to the progesterone gel (Crinone), or injections.
When should I take pregnancy test?
Take the pregnancy test two weeks after the embryo transfer, the exact date is stated in your medical report.
Urine pregnancy test is negative, what to do?
In case of a negative urine test you can take a pregnancy test from the blood to make sure of the result. If the negativity of the test is confirmed, discontinue all medications used in connection with treatment here.
I have a positive pregnancy test!
Continue to take all medication. If it is a urine pregnancy test, it is possible to confirm the result by blood test, but not necessary. Make your appiontment fot ultrasound examination – to be taken 14 days after the positive test.
I began „spotting“ what to do?
Do not stop using any medication. It is advised to keep resting regime. Increase the dose of progesterone (Utrogestan) by two tablets at noon.
In case you are „spotting“ before the pregnancy test date, wait and take pregnancy test when you are suppossed to. In case of the confirmed positive test make appointment for control blood test following three-days interval.
When to go for ultrasound examination?
Ultrasound examination is to be performed 3-4 weeks earliest after embryo transfer.
How many weeks am I actually pregnant?
Day of egg retrival is the 14th day of pregnancy.
How do I continue taking medications?
Take all medications unchanged (unless your doctor has instructed otherwise before transfer) until the first ultrasound scan, which is done 14 days after the positive pregnancy test.
I am in week 10, do I still take all medications?
We recommend taking all your medications unchanged until the end of the 12th week of pregnancy. Of course, each patient is taking differant medications and their withdrawal is always individual. The dosage of estrogen and progesterone can be after the 11th week reduced after consultation with the doctor by half and after 10 days of treatment end. The exact timing of the withdrawal of medication after successful IVF cycle, always consult with your doctor.
I have a negative urine test, but I am not bleeding. Is there still hope?
All urine tests are not sensitive enough, please try another urine test in two days, and if it is still negative and you start to bleed, your treatment was unsuccessful. If the test is negative and there is still no bleeding, or only very slightly , it is necessary to do pregnancy test from the blood.
Who should I contact for further instructions?
To consider your unsuccessful therapy, and determining other therapeutic strategy please make appointment to the doctor who made your treatment plan within 10 -14 days. You can make appontment by an e-mail or telephone.
Shall I contiunue taking medications?
If are pregnancies‘ tests repeatedly negative, all medications can be discontinued at once. The only exception is the use of prednisone at a dose of 10 mg (2tbl) per day. About how to discontinue this medication consult the doctor who prescribed it.
When can I start next treatment?
If there are, from the previous cycle with donated eggs, frozen embryos you can plan cryoembryo transfer already in the following cycle.
If you need a new treatment with donated oocytes, it can be performed with an interval of 3-4 months . Please consult your doctor about next steps.