What do you wish you had asked pre-IVF?

[Anonymous]

We're about to start our first IVF cycle, and have a consultation with our doctor in a few days. I'm looking for advice/experience from others on what questions you wish you had asked at this point, factors you think are important to consider, and just general advice on what we should be doing at this stage to prepare ourselves. As background, I'm 32, DH is 33, and we've been TTC for five years with zero pregnancies. Our infertility is thus far unexplained. After trying for four years to get pregnant naturally using various methods (temperature tracking, acupuncture, less stressful job, diet change, and laparoscopy) we started treatments last year, and now have four failed IUI cycles behind us (two with Clomid, two with injectables). Any advice or suggestions would be much appreciated.

[Anonymous]

First of all, good luck embarking on IVF and I hope you're successful. I went through IVF 3 years ago due to male-factor infertility--thanks to ICSI, we had 11 viable embroys. We transferred three and had a healthy baby girl. (I assume your husband has been tested too).
Here are a few thinks to consider:
--this might sound silly, but if you're shopping around for a clinic, try to pick one that's convenient to your house. You will be there A LOT and a long drive will just add to the stress of the process. You obviously want to select a doctor you trust and who has a good track record, but do factor in the location.
--If you liked your acupuncturist, keep seeing him/her during the lead up to IVF. At the very least, it will be good for helping you relax. My acupuncturist was in the room with me at the transfer and did a treatment before and after. Who knows if it makes a difference, but why not try if you felt good about acupuncture in the past.
--In case you end up having extra embryos from your cycle (fingers crossed!) talk to your doctor about how they freeze them. My clinic froze my extras in pairs, so we have to thaw two at a time when we did a frozen embryo transfer. There's a recent study about the benefits of transferring one embryo at the time instead of 2 or 3, so you might want to make sure they freeze the extras individually so you have the option of doing one at a time later.
--Overall, I would just say to try not to let IVF take over your life. It's strange, intense process but if you just think of the shots etc as no big deal, your life will be much less stressful. I know it's easy for me to say, but I do think some people become consumed by the process and it doesn't seem healthy or helpful.
Good luck!

[Anonymous]

15:02, do you ming if I ask who your acupuncturist is who came in to do before/after transfer acupuncture? Were you at Shady grove or elsewhere? I ask because I know Shady Grove offers this, but as I am not at Shady Grove, I am hoping to find someone to do this for me at my clinic.

My last IVF attempt (successful at an out of town clinic) offered this and I feel like it can only help.

Thank you and sorry to go off-post topic.

[Anonymous]

At sg in Rockville they have an accupuncture office in the same building but no one came into the room with me

[Anonymous]

I'm sorry to report my acupuncturist is in Los Angeles, where I did my IVF cycle! I wish she was in DC--she's great.

[Anonymous]

I would call Kerri Westhauser. She might be willing to go to the transfer with you. She is wonderful!

http://kerriwesthauser.com/web/

[Anonymous]

make sure your doc is there for the whole time of your cycle, not just your procedures.

[Anonymous]

I wish I asked what their freezing requirements were. some clinics freeze any embryo regardless of quality, some have very strict requirements (must be 5, 6 day blastocyst.) When I had some embryos discarded because they weren't growing fast enough, I felt like someone literally ripped a baby out of my hands. I have friends who have kids who were "poor quality" when frozen embryos, so this really pissed me off.

[Anonymous]

Another question to ask is if they do Day 2 or Day 3 transfers of embryos, or day 5 transfers only. There is research that suggests more IVF success with embryos that can grow to the blastocyst stage (day 5-6) in the lab, but sometimes you may not retrieve enough embryos to feel comfortable pushing to that length of time. Some embryos will always arrest and fail to grow,that is just the nature of this procedure. Sometimes labs may not be skilled enough at the careful culturing procedures needed to grow embryos for five days. It's hard to know as a customer what's going on.

I have a friend who felt very uncomfortable that her RE's office (which is not local) would not even consider a Day 2-3 transfer in her case, but insisted on growing the few embryos she had for as long as possible, freezing them, and then doing a FET later. I don't believe her doctor was trying to give her poor care. Nevertheless, she wanted to try that cycle with a day 3 transfer, and it was very stressful for her to just be told, flatly, no you cannot.

Other questions: where is retrieval and transfer done? (Same office where you are monitored, or will you have to make arrangements to go to another office on those days?; Do you recommend or offer preimplantation genetic testing on embryos, and how much does that cost? Who will I see on monitoring days -- will it be you or do you rotate patients among other doctors? How can I communicate with you - do you respond to email?; do you recommend (or recommend AGAINST) taking nutritional or herbal supplements during a cycle?; what kind of protocol might you suggest for me based on my case, and how long would that take (it may be too soon for the doctor to know this, if he hasn't done a workup on you, but if he has, it's a question to ask); do you vitrify embryos or slow-freeze them (hopefully you will have embryos to freeze. Vitrification shows better thaw success than slow freezing.); at what stage do you freeze -- as one PP mentioned, some labs only freeze Day 5 embryos because they also handle the thawing process better. You may or may not be okay with this.

And of course, what success rate would you predict for me based on my health and my husband's health?

Hope you're seeing these suggestions before your consult. Good luck!

[Anonymous]

not so much a question but sharing of info. I wish the Dr had acutally asked my husband about meds he was on. They did NOT do this and its astounding. My husband has been on testoterone (prescibed by a urologist for very very low testosterone level). I happened to mention this when on the second IUI attempt his sperm count had dropped about 15 million from the previous month and about 20 million from the one 5 months before that. Immediately the dr said stop all testosterone cold turkey. It has the biggest impact on sperm count of any drug. He also said if they ever come up with a male birth control pill it would be testoterone based! (its counter intuitive cause on one hand, the test makes a man want sex a lot more but it also makes him more infertile). It really pissed me off (beginning of a long line of miscommunication at CFA). His sperm count has gone back up in the last three months as we prepare for our first IVF. My advice to you, volunteer everything even if you think they don't want to hear it. Its unbelievable what a dr or nurse forgets to bring up.

[Anonymous]

I wish I had asked what *will* work instead of being so focused on *why* it wasn't working.

[Anonymous]

I would've asked for assisted hatching on tries 1-3 unread of waiting for them to suggest it on try number 4. (gee thanks, kids. Can I have that 30k back!?) make sure they're giving it everything they've got from the get-go.