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I have endometriosis. Can that affect my fertility? Will I need to do IVF?
Though difficult to quantify, endometriosis is a relatively common condition, affecting roughly between 10-15% of women. It can have a variety of symptoms or may be insidious without any obvious signs. As regards fertility, it is estimated that around 30-40% of women with endometriosis do indeed have difficulties in conceiving. Although it has yet to be proven exactly how endometriosis can lead to low fertility, it is believed numerous factors come into play in this mechanism. Of course, at a more severe stage of the disease, anatomical factors impact on natural conception, such as symphysis around the fallopian tubes or large endometriotic cysts in the ovaries. Without having much information in your specific case, I can’t exclude the possibility of your fertility being affected by endometriosis. Despite that, there are solutions that can help. Endometriosis laparoscopy surgery can improve the chances of pregnancy both natural and IVF. Also, with the modern assisted reproduction protocol we can further increase the success rate through individualized treatment. When you decide to have a child it would be a good idea to consult a specialist reproductive gynaecologist for guidance on your attempt.
My partner and I decided to have a child, but I very anxious that we might not manage it. Should we take some prenatal screening?
You shouldn’t get anxious as you’re at the beginning of your efforts and often being hasty doesn’t help matters. Try then to rid yourself as much as you can of any stress from your everyday life. In any case, 85% of couples who try to get pregnant manage in the first year of their efforts. As far as prenatal screening goes, it’s a little early for you to resort to taking a whole series of diagnostic tests, which might be expensive and unnecessary in your case. On the other hand, the annual check up with your gynaecologist is very important, especially when you’ve got pregnancy in mind. I think that an ultrasound check of the uterus and ovaries together with a blood test, a mammography and a Pap test suffice for an evaluation of your health. If after a year of trying you haven’t reached your goal, then it would be advisable for you to consult a specialist at an assisted reproduction centre.
In the first month of free sexual contact I became pregnant, but I had a missed abortion in the 6th week. Four months have passed since the ablation. What do you recommend? Should I take tests? I am scared of having another try.
I completely understand your anxiety over the next pregnancy after your awful missed abortion episode. But rest assured, such things are not rare with between 10-25% of clinically recognised pregnancies not being completed. And you should also know that 90% of women who experience a missed abortion go on to have a healthy child next time around. I recommend that you continue trying without tests for the time being and without worrying. If the same happens in your next pregnancy then it would be a good idea to visit your doctor or a specialised centre to establish the cause and to find a solution to the problem.
Exactly which tests should a woman do regarding the health of her vagina and uterus before going for implantation? I’ve heard that about a culture which should take place during the period.
It is true that a healthy vagina, and particularly uterus, plays an important role in embryo implantation and success in IVF. The condition of the vagina can be assessed through a clinical test and secretion culture of both from the vagina and the ectocervix (vaginal part of the cervix). This test should not though be taken during the period as it lessens its reliability. On the other hand, an evaluation of the state of the uterus requires more specialized tests. Firstly an ultrasound check will assess the texture and morphology of the uterus. Also an endometrial culture can be done, except it must not derive from period material. I would suggest that you do a biopsy at a specialised centre a few days after the end of the period. Thus, should any microbes be found in the uterus, they can be dealt with.
What are the advantages and disadvantages of a couple having a child through artificial insemination and how will it affect their lives?
The issues you raise open up an enormous discussion but we will try to cover the main points. Artificial insemination is a tool we have at our disposal to help couples with fertility problems to achieve their goal of pregnancy and a healthy child. Its big advantage is that we can monitor every stage of the reproductive process and can pinpoint where the problem lies through specific tests. Once we know the cause of the problem, we can recommend solutions and increase the chances of success. On the other hand, the main down side of IVF is the cost, not only in financial terms but also emotionally. This is a procedure that a couple must manage psychologically since it requires time and determination which may well impact on their everyday lives. For that reason, the IVF centre you choose must have a service for psychological support from a psychologist specialised in assisted reproduction.
What is the procedure used for the frozen oocyte method?
The procedure for cryopreservation of eggs, or oocytes, once more starts with ovulation induction. However, following oocyte collection we do not proceed to insemination but to their cryopreservation. This method is particularly effective for achieving pregnancy following these oocytes’ thawing and insemination, when cryopreservation has been performed by vitrification, the most up-to-date method available.
After the embryo transfer, how long must I wait for the results?
Don’t depend on any symptoms of pregnancy. We recommend that you do an hCG test around 15 days after embryo transfer to find out the result of the attempt. Until that time have patience and try not to get anxious.
Is a preimplantation screening vital for IVF or should it only be done when the parents carry a hereditary condition?
Preimplantation screening is one of the tools we use in assisted reproduction to help couples who need it. It should however be carried out when there are specific indications and not on everyone without exception. Indeed it is employed on couples with a hereditary disorder so we can ascertain the condition of the embryos. In this case, a PGD (preimplantation genetic diagnosis) is performed in which specific genetic disorders are tested for, such as thalassaemia and cystic fibrosis. Thus, only the healthy embryos are transferred to the uterus. However, PGS can also be of help to other couples. Couples suffering repeated miscarriages or failed IVF attempts as well as women of an advanced reproductive age can benefit from checking embryos for chromosomal abnormalities. Our mission once again is to transfer only healthy embryos so as to increase the chances of success
Can I have IVF treatment with foreign eggs? Will the baby take any features from my DNA?
It is a fact that egg donation has helped many women to experience the joy of pregnancy and motherhood. In this procedure eggs from a suitable donor and spermatozoa from your partner would be used. This means that the embryo will not take any genetic material from you. However, the endometrial life greatly influences the embryo. Research has proven that the environment of the uterus determines the state of health of a human until adulthood. On the other hand, the child will of course take elements of your character, since our personalities are formed during our upbringing and are not determined genetically. For that reason, I think that you should place great importance on the choice of the Assisted Reproduction unit you choose so that you’re sure that the necessary genetic and psychological checks are carried out on the donor. At Embryolab, the donation programme follows strict selection and control procedure.
Once the IVF treatment succeeds will the birth always be carried out through caesarean section?
The manner of birth is not determined by the manner of fertilisation, but by the course of the pregnancy, whether or not complications arise and by the course of the child birth itself. Therefore birth by caesarean section is by no means inevitable after IVF. Of more importance is that you give birth safely, whether that be naturally or by caesarean, and return home with a healthy child.
Could you please give me some information on natural cycle IVF?
The incorporation of natural cycle IVF protocols has gained quite a lot of interest in recent years. In this procedure, we monitor the first half of the woman’s cycle without the use of any medication and we end with egg collection when conditions are right to activate oocyte maturation. Fertilisation then takes place in the lab together with embryo transfer so as to gather a specific number of eggs and increase the chances of success. Though natural cycle IVF may sound attractive since no medication is used, we should not forget that it does have certain disadvantages. It is a procedure that needs time to get results, a fact that makes it both time consuming and often exhausting for the couple. Also, when medication is not used there is always the risk of us not having any eggs in the end or that we don’t get natural ovulation in time, often creating in the meantime a lot of stress for the couple. Natural cycle IV is a useful tool but doesn’t suit everyone. A specialised reproductive gynaecologist can advise you if this will be appropriate for you and help you make the right decision.
I’m 40 years’ old and have been married for 3 years. We’ve been trying to have a child and I’m thinking of trying artificial insemination. I have heard though that it has a low success rate. Am I wasting more time?
Endometrial insemination has been used since the early days of assisted reproduction in various forms. It can offer a better success rate compared with natural conception, especially for couples who don’t have any serious problem, though it does lag behind IVF treatment quite markedly. Also before you opt for insemination, you should know that there are certain pre-requisites, such as passable fallopian tubes and a good spermogram, for there to be success. If you and your husband meet these pre-requisites, you can try for a while with this method. But since you are already 40, this time should be fairly brief. For that reason we suggest that after one or two attempts - if unsuccessful - so as not to give up or get discouraged, go on to IVF. In this way you won’t have lost much time and you will have used all the tools at our disposal today in assisted reproduction.
I am 41 and my husband 42. I’ve been trying to get pregnant for the last two months. Does it make sense for me to start an IVF course right away?
Many couples wonder when is the time to seek help for assisted reproduction. Regarding your case, of course natural conception isn't ruled out. However, the most important prognostic indicator both for natural conception and with IVF is the woman's age, since the likelihood of becoming pregnant after 40 decreases greatl. For that reason we suggest you soon do an initial evaluation at Embryolab. A simple series of tests for yourself and your spouse can trace your reproductive profile. Having those in mind, a gynaecologist specialised in reproductive medicine can design an action plan so you don't waste any time.
I’m 33 and my husband 34. We started trying to have a baby almost 17 months ago with no result. The ultrasound test didn’t show any symptoms of endometriosis. Is a value of 20.1 on the CA-125 with a maximum of 35 an obstruction to conceiving?
It is true that endometriosis can be an insidious threat to a couple trying to realise their dream as it would appear to affect some 10-15% of women at a reproduction age, and this rate increases for women facing fertility difficulties. Unfortunately, the value of the CA-125 index is somewhat limited, and I would say in your case the CA-125 is value is rather questionable. On the other hand, many women with endometriosis have no clinical signs or clear symptoms, apart from fertility problems. A definitive diagnosis of the condition can only be made with laparoscopy and a histological examination of the suspect areas. We would recommend that you don’t make any rushed decisions. An evaluation at Embryolab will provide you with a specific assessment. Based on the information you have given us, it is unlikely that endometriosis is the source of your problems. Even if the opposite is proven to be the case, modern protocols and IVF methods can help you to achieve your goal.
My doctor recommended Pregnacare Conception for as long as we were trying and I’ve been taking it. Do you have any comment on this supplement? Is it effective? Should I continue with it?
Like other similar preparations on the Greek market, Pregnacare Conception is a good food supplement with ingredients that may help a woman’s body in her attempt at pregnancy. We would suggest she keeps using it during her efforts.
What is the average amount of time for trying to conceive? I know that once a year has passed, it would be good to take tests, but are there any facts on the average length of time for trying?
As you can understand, no one can say with accuracy how long the attempt should last. However, you should know that 85% of couples succeed in natural conception within one year of trying. If your efforts are unsuccessful after a year, it might be a good idea to visit a specialist assisted reproduction centre to investigate the matter. If however you are over 35, we suggest that you make that visit before a year of trying has passed.
My work involves many trips roughly each month of 5-6 hours flying time from Greece. If I get pregnant, I’ll try to stop these trips at least for the first three months, but I can’t do this beforehand as I’ll lose my job which I of course need. If however I am pregnant before I realise it and go on a flight, will this affect my pregnancy? Is it crucial? I can’t stop travelling all the time I’m trying…
Flying, irrespective of the time involved, does not affect the outcome of IVF nor does it affect a likely pregnancy. Just bear in mind that during IVF you might need more frequent ultrasound checks. Travelling indeed is recommended as it lowers anxiety and can produce positive results, mainly when combined with vacation and rest.
I have heard about a certain ovulation test. Is it a good idea to have it and how is it done?
The ovulation test is a special kit which measures the LH hormone in the urine, which is secreted during follicle rupture, and is a way to schedule targeted contact. That given, it is not always reliable. You can use it for a few months but don’t let that be the reason you delay your visit to a specialised gynaecologist if your efforts fail.
I am 32 years old and for about a year now my husband and I have been trying for a second child. Our first child is 2 years old. What would you advise me to do? To keep trying on our own or to consult a specialist and proceed with IVF?
Many couples struggle to have a second child and a first successful pregnancy. In such cases it is likely that a problem has arisen which hadn’t previously existed. In your case after a year without results, I would suggest that you seek help from a specialized assisted reproduction centre. This does not mean that you have to start IVF treatment immediately. First you must establish what the problem is that is preventing you from having a second pregnancy. It would therefore be recommended that both you and your husband undergo a series of specialized tests indicated by your doctor. It is quite likely that your problem can be solved without resorting to IVF. In most cases like yours, the prognosis is better since you’ve already got one child. If you do eventually need IVF, then your treatment will be targeted on your specific problem.
Sadly both my partner and myself have thalassaemia, which at the thought of a child of ours being born with health problems fills us with dread. Would artificial insemination be the appropriate solution?
Yes, indeed IVF treatment when accompanied by preimplantation genetic diagnosis (PGD) is the right path to take to minimize the likelihood of the child carrying a hereditary condition, such as thalassaemia. Through the preimplantation diagnosis we aim to check embryos for the hereditary disease that concerns us so that only the healthy enoes are transferred to the uterus. As with all medical examinations however they can never be 100% accurate. For that reason, we advise that you also do the detailed examination in the first three months of pregnancy so that you can feel that bit calmer about your child’s health. As regards the cost, that would depend on the treatment opted for in your case. Of course I imagine that for you the quality of the services takes precedence over the cost.
I had three weeks’ delay and following a negative test result and negative hCG, I began taking primolut this morning, but a short while ago I felt rather indisposed. I imagine that I don’t need to continue, am I right? Just that one pill will already have had some effects, right? How can I calculate the fertile days from now on (30-day cycle-apart from the last one I mentioned)?
It’s not necessary to continue with the pill from the moment you feel indisposed and have a negative hCG result. Also, that one single pill is not likely to cause any untoward effects, nor should it affect your cycle. On the other hand, the fact that you had a 3 week delay may be a random event or may conceal the existence of an ovarian cyst. For that reason I would suggest you do an ultrasound check with your doctor, who can explain the situation. A woman’s fertile days are determined by the moment of ovulation. That can take place within a period between 7 and 21 days from the beginning of the period and is not always stable even for the same person. Based on the information you have given me, I believe that your ovulation occurs between the 15th and 18th day from the start of the period. There are on the market ovulation kits which can help you to roughly determine your fertile days. Remember though that these tests are not always reliable. If you’re having trouble to get pregnant, go and visit a gynaecologist specialised in assisted reproduction in Embryolab’s team clinic so you can get the right advice.
I am 34 years old and my partner is 42. We are thinking about having a baby and have been having free contact from last month (without insisting on the fertile days). On 14 March my period came. I’m wondering how often we should have contact and afterwards from what time to seek consultation. Also, am I only likely to get pregnant on the fertile days?
Good luck in your efforts you’ve started with your partner. Sexual contact plays a very important role in a couple’s life, since it makes for an emotional and spiritual bond. Thus their frequency, even for the purposes of reproduction, must be determined by desire and mood and not mean another factor for stress in your relationship. As regards the time element in which natural conception can result, yes it is true pregnancy is most likely around your fertile days. A necessary prerequisite naturally is that ovulation is occurring those days. Of course the time of ovulation varies from woman to woman and also between the cycles of the same woman. There are some commercial ovulation tests which can help you to roughly calculate your fertile days so as to focus on having contact on those days. However, don’t rely entirely on that as they are not always reliable. If after some time of trying without success, you should consult a specialist at an assisted reproduction centre.
I am 35 years old and me and my partner have just started to have free contact. I don’t know how much time will pass before I get pregnant, but are then certain things I should look out for, should do or avoid? For example, are alcohol and coffee allowed? Should I start taking some food supplements?
We wish you all the best in attaining your goal quickly and having a healthy child. During the time that you are trying, we suggest you continue to have a balanced life without resorting to pursuing extreme habits. Of course you can consume coffee and alcohol in social situations, but keep it to a moderate level. A glass or two of wine a week will not affect your efforts, and indeed might help you to reduce your stress in your everyday life. On the other hand, smoking can be a serious impediment as it impacts on the reproductive profile both on yours and your partner’s. A balanced diet combined with exercise and avoiding smoking is the best way to improve you attempt. As for the food supplements, there are a number which support your efforts. You can of course add some help in your diet after having consulted a gynaecologist specialised in reproductive medicine.
With only one healthy fallopian tube, can I get pregnant?
I am 33.5 and have been trying with my partner of the same age for a year now to get pregnant. I have had a salpingography and one of my tubes is blocked, but the other one is fine. My hormone tests were also good. In general we follow a healthy life by keeping fit and eating well. My husband’s sperm was diagnosed with having low motility (though not tragically so), and now he is coming to the end of a three-month treatment of vitamins and will then repeat his spermogram . My question is this: is it worth waiting another year in the hope of a natural conception or should we proceed with IVF? Are there still chances of a natural conception? ANSWER: It is very encouraging to hear that your follow a healthy lifestyle, and that a balanced diet and exercise play a very important role in the reproduction process. Of course you shouldn’t exclude natural conception in your case, since you are a young couple without any severe problems, as you say. Provided your partner’s second spermogram is good, you should continue in your efforts for some months yet. It is true however that the majority of couples who try to have children manage it in their first year. If your efforts still come to no result in the meantime, don’t get disappointed and take drastic decisions. In this case a specialist at Embryolab can give you advice on your next steps. As a start, endometrial insemination in combination with mild ovulation stimulation may help you to increase your likelihood of pregnancy.
I am 42 years old and for the last six months after marrying my partner (3) we have been trying to have a child without success. I have had a prenatal diagnosis and am in general well. What do you suggest?
Since your check didn’t turn up any particular problems, the next step is for your husband to undergo tests (spermogram and sperm culture) to exclude the male contribution to your situation. You should know that the fertility of a couple is affected by age. Unfortunately, the reproductive potential of a woman decreases with age, particularly for the woman, less do for the man. It is also important that the age factor in reducing fertility is a natural event and is related both to the number of eggs located in the ovaries as well as with their quality. After six months without success in your efforts for someone in your age group, it is advisable that you seek the causes and help of a specialist in assisted reproduction. Modern methods of IVF can help you achieve your aim.
After a long spell of using the contraceptive pill (5 years) and then stopping to allow the body to recover is it possible to become pregnant? If not, when does the next period come?
Taking the contraceptive pill is safe in 98% of cases while being used. Once they have been stopped they are no longer effective. Thus in the cycle after they have been stopped, pregnancy is possible. You should also remember that the Pill hormonally suppresses the mechanism which regulates ovary function. The time ovary function needs to recover varies from woman to woman and may be as long as 60 days. Therefore, I would suggest that you wait a little while for the ovaries to recover for you to have a period. If however the situation continues, go and visit your doctor.
Recently my husband was diagnosed as having non-obstructive azoospermia. Our urologist recommended a biopsy. If spermatozoa are found in this way, what are the chances of them being capable of fertilization? If no spermatozoa are found and we proceed with a donor can I avoid IVF and have insemination? I am 34 years old and my test results are normal.
It would be a good idea for your husband to take a series of tests so as to find the cause of the non-obstructive azoospermia and to evaluate to what extent it is reversible. One solution to your problem is in fact for him to have a testicular biopsy. I would suggest that you do a more contemporary method of testicular biopsy called microdissection-TESE or micro-TESE. This is performed by a specialist urologist who with the help of a microscope and an experienced embryologist can perform a targeted biopsy. Therefore the chances of finding useable spermatozoa are increased and injury to the testes is appreciably limited during the operation. If this method yields spermatozoa capable of fertilization these are capable of fertilization at a rate higher than half of the cases using ICSI. However, if the biopsy doesn’t find any spermatozoa, the solution is to be found in sperm donation. If indeed you decide to go ahead thus and provided your test results are normal, you can begin your attempt with insemination.
I am 48 years old and together with my partner we recently decided to have a baby. We went to a IVF centre where we discovered that I had total azoospermia and my wife is at the premenopause stage. It was proposed that we go ahead with embryo donation. How can we assure the health of the donors so as to assure the health of the child? Also, how safe is the whole procedure for my wife (45 years old). Might it perhaps be better for health reasons to look at adoption?
Embryo donation is a sound approach to your problem. Making the right choice of an assisted reproduction unit you can trust is of great importance. The good condition of the donors eggs must be safeguarded by rigorous blood, genetic and psychological tests. As each centre applies different selection criteria, make sure that it is as stringent as is needed to put you at ease. As regards the sperm donor, the same strict selection criteria must be applied, and also the same detailed check which will prove his good health. You should also be aware that pregnancy is a period placing high demands on the woman’s organism. For that reason, we would suggest that you visit your family doctor so he or she can assess to what extent your wife can manage the demands of a pregnancy. Of course there are many cases of women at this age who proceeded with embryo donation, had a problem-free pregnancy and bore a perfectly healthy child. On the other hand, adoption is also a wonderful act of love which also offers the joy of bringing up a child. Above all however it is a personal choice and a decision which the couple must jointly make.