In the United States alone, more than a million babies were born thanks to assisted reproductive technology. In vitro fertilization (IVF) continues to gain popularity helping many achieve their dream of becoming a parent.
Dreaming of Baby speaks with Serena H Chen, MD, Director of Reproductive Medicine at Saint Barnabas Medical Center. Dr. Chen discusses the IVF process, including testing and medication, as well as provides insight on a very important question: how long does it take to get pregnant with IVF?
Daniela: Good afternoon and welcome to Dreaming of Baby! We have with us today Dr. Serena Chen with whom we shall be discussing in vitro fertilization (IVF). Dr. Chen is the Director for the Reproductive Medicine Division in the Department of Obstetrics and Gynecology at Saint Barnabas Medical Center and will be speaking with us about the process, tests, medication and procedures related to IVF. It’s a pleasure to welcome you with us, Dr. Chen, and we’re very much looking forward to our conversation. Before we start discussing this important subject, it would be great if you could introduce yourself as well as your experience in this field to our readers.
Serena H Chen, MD: Hi Daniela, happy to be here at Dreaming of Baby! I have been helping people to conceive for over 20 years and am a big advocate of empowering women and men to become knowledgeable and educated about their general and reproductive health so they can optimize their chances of having a healthy baby. I am also an expert on the new platform, MedAnswers.
What is IVF?
Daniela: Great, thank you, we’re all about empowering our readers at Dreaming of Baby! To start with, and for readers still unfamiliar with this subject: what is IVF?
Serena H Chen, MD: IVF stands for In Vitro Fertilization – which means fertilization that takes place outside of the body. Some people are familiar with the slang term “test tube baby” We create a pregnancy by obtaining eggs through a minor procedure, inseminating with sperm, making embryos in the lab, then selecting the best embryo for transfer to the uterus – hopefully resulting in a pregnancy. The first baby born via this procedure is Louise Brown, born in 1978, and who is now also a mother. Since then, approximately 7 million babies worldwide have been born via this technology.
Daniela: Wow, that’s a staggering figure! When does IVF become a treatment option?
Serena H Chen, MD: IVF is rapidly becoming more and more widely used. The vast majority of babies born via IVF are healthy and in combination with PGD and PGS (preimplantation genetic diagnosis and screening), IVF may actually lower the rates of birth defects and miscarriages. Typically, if someone is healthy and trying to conceive, they should be evaluated after 6 to 12 months of unprotected intercourse (6 months if 35 years old or older, 12 months if less than 35 years old). If a couple have normal tubes, regular periods, and normal sperm they may try conceiving with fertility pills like clomid and IUI or Intrauterine Insemination. If that does not work after 2-3 attempts, then usually we recommend IVF. If the sperm counts are very low or the tubes are blocked or if someone is at high risk for miscarriage or genetic disease then we may consider IVF immediately. The ASRM (American Society for Reproductive Medicine) recommends starting with IVF right away if you are 40 years old or older.
“The vast majority of babies born via IVF are healthy and in combination with PGD and PGS (preimplantation genetic diagnosis and screening), IVF may actually lower the rates of birth defects and miscarriages.”
What should I do before starting IVF?
Daniela: Thank you for this overview, Dr. Chen. For the couple struggling to conceive and who have been advised to consider IVF, what are the questions they should be asking before taking this decision?
Serena H Chen, MD: First, you should make sure to see a reputable reproductive endocrinologist. Resolve.org can help you find a good Reproductive endocrinologist in your area. Next you need a full evaluation. If you are considering IVF it may be helpful to consider testing the embryos for chromosomal abnormalities like Downs syndrome via PGS (preimplantation genetic screening). General health is critical for everyone trying to conceive, so we recommend screening for normal thyroid function, normal vitamin d3 levels, diabetes (pregnancy increases the risk for diabetes and obesity), genetic risks, anemia, infectious diseases, etc. Optimizing general health with a good diet, plenty of sleep, exercise, etc, can improve pregnancy outcomes from IVF and any fertility treatment. Some of the most common issues we see in the infertile population are infertility due to age and due to excess weight. All women trying to conceive should be taking folic acid supplementation (the RDA). Many women trying to conceive should get a flu shot during flu season and all couples need to avoid travel to Zika areas (cdc.gov).
Serena H Chen, MD: “All women trying to conceive should be taking folic acid supplementation (the RDA). Many women trying to conceive should get a flu shot during flu season and all couples need to avoid travel to Zika areas (cdc.gov).”
The IVF process
Daniela: Delving into the IVF process itself, what kind of testing and procedures should a couple expect? Would these differ in terms of age or other factors?
Serena H Chen, MD: Basic testing is the same for everyone. Some sort of evaluation of the uterine cavity and a check for blocked tubes should be done. Even though tubes are not used in IVF, if they are blocked and filled with fluid (hydrosalpinx) then this can lower the IVF success rate. We usually check for this with an HSG and/or a saline hysterosonogram. Some doctors will also do a hysteroscopy, especially if the HSG or the saline are not normal. The sperm should be evaluated and both partners should be checked for general health issues and sexually transmitted diseases. Hormonal levels like AMH or Antimullerian Hormone can give you an idea about the health of the ovaries and a pelvic sonogram can assess both the uterus, the ovaries and the uterine lining. Genetic carrier screening to test for mutations that could impact the child are also important as well as blood tests for prolactin, a hormone that can affect ovulation, thyroid testing, and basic testing for anemia and general health.
Daniela: As for the IVF procedure itself, does it require considerable downtime for the woman?
Serena H Chen, MD: It takes about 7 to 10 days of injectable medications to stimulate multiple egg growth and maturation. We need multiple eggs because many eggs are not going to make a baby. Obtaining multiple eggs allows us to select the best embryo to optimize the chance for pregnancy. The injections are given via very small needles just below the surface of the skin in the abdomen at home by the woman herself. A little ice on the skin beforehand should prevent any pain from the injections and most women do not experience any significant side effects. For the 7 to 10 days of injections we are seeing the woman every 1 to 3 days in the office for blood work and vaginal sonograms to assess the response to the medications. Once the time is right, then the egg retrieval is done under anesthesia on an outpatient basis. The retrieval takes about 10 minutes and since you are asleep, there is no pain. There is some discomfort and bloating after but usually you can go back to work about 24 hours after the procedure is done. I usually recommend patients take the day of the retrieval and the day after off from work. While you are on the medications leading up to retrieval you should be able to go to work each day.
Serena H Chen, MD: “The retrieval takes about 10 minutes and since you are asleep, there is no pain. There is some discomfort and bloating after but usually you can go back to work about 24 hours after the procedure is done.”
Daniela: Great, thank you, this will help many who may be worried about this aspect of the treatment. Many of our readers have expressed concern about possible risks of IVF – are there any particular risks that patients should be aware of?
Serena H Chen, MD: Well, living in NJ I tell people that there are minor risks – nothing is risk free, but the risks are much less than driving on the Garden State Parkway or having a baby! It is a needle procedure done under sonogram guidance – not a true surgery.
How long does it take to get pregnant with IVF?
Daniela: With regards to timelines, what is the average time it takes to fall pregnant with IVF?
Serena H Chen, MD: This is not an easy question as it varies with each patient. I have seen some data stating that on average it takes 2 to 3 egg retrievals to conceive with IVF but some patients can conceive with just one retrieval and some will take many more. In general, younger healthier patients will conceive more quickly than others. This is definitely a good question to ask your reproductive endocrinologist once your initial evaluation is done as they can give you an idea about whether your chances are above average, average or below average. The difficulty is none of us have a crystal ball so it is often very difficult to predict. IVF is very advanced today and most couples will eventually conceive if they can persist. The hard part is that this process can be very stressful and even couples with a good prognosis may often drop out of treatment before having a baby due to stress alone. This means that getting support is very important. Working on general physical and mental health can help. Friends and family may (or may not) be helpful and a therapist or support group as well as techniques like acupuncture (herbs are not recommended), yoga and meditation can be extremely helpful.
Serena H Chen, MD: “IVF is very advanced today and most couples will eventually conceive if they can persist.”
Daniela: Thank you for going in depth on a question that many ask on their journey to baby. It was a pleasure speaking with you today, Dr. Chen. On a final note, what would be your one piece of advice to readers about to embark on this journey?
Serena H Chen, MD: Keep doing what they are doing! Obviously if they are on Dreaming of Baby they are trying to become educated about their health, and that is a good thing! Just remember that you do need to see a doctor if you have concerns, since Dr. Google does not know your particular situation. So very good to read and become educated but you cannot treat yourself. Find a good doctor that can help you with this journey and be your healthiest self! We have lots of good information at our website www.sbivf.com. Also ASRM.org has great information for people trying to conceive. I try to educate people on Twitter and Instagram so I hope people will connect with me there! I am also on an exciting new platform MedAnswers – would love for people to download this new app that allows people all over the world to directly connect with physicians who are experts in reproductive medicine.
Daniela: Thank you, Dr. Chen, the insight you have provided will be helpful to many!