By Barry R. Witt, MD, Illume Fertility
For new patients, stepping into a fertility clinic is like entering a whole new world. There is a lot to learn. Patients considering in vitro fertilization (IVF) likely have a long list of questions to ask a reproductive endocrinologist, and limited time to get answers.
In order to make the most of the first fertility consultation, patients should take time to prepare beforehand. Here are 10 of the most important questions about IVF to ask at a first appointment:
1. Is there a specific diet you recommend for fertility?
Many believe that a healthy diet rich in fruits, vegetables, healthy fats, fish, and whole grains — the so-called "Mediterranean" diet — is most beneficial and would be considered a “fertility diet.” Speaking with a fertility-savvy nutritionist can help guide the best diet when trying to conceive.
2. What can I expect from a typical IVF cycle?
Ask your doctor to break down the basics of IVF. While specific fertility clinic protocols may vary, the general treatment process usually remains the same: ovarian stimulation, egg retrieval, fertilization, embryo development, embryo transfer, and bloodwork to confirm whether or not the IVF cycle has been successful.
3. What is your clinic's IVF success rate?
Some fertility clinics prominently feature their success rate data, while others require a little more prodding to find. While you might already have a sense of a clinic's stats before your first appointment, it's a great time to ask the doctor about success rates in relation to your age and diagnosis.
4. Is IVF the right treatment pathway for me?
IVF can be used to overcome a variety of fertility issues, including blocked or damaged fallopian tubes, male factor infertility, ovulation disorders and unexplained infertility, among others. It can also be used by LGBTQ+ couples or single individuals wishing to have a child.
Despite its wide application, IVF does not guarantee a successful pregnancy. Rates vary depending on factors such as age, cause of infertility, and clinic protocols.
Not all people who struggle to conceive require the help of IVF. Your doctor should want to perform a comprehensive evaluation to rule out certain issues before recommending IVF as the only treatment option. You might also want to ask:
What are some potential scenarios where IVF would not be recommended?
What other fertility treatment options does your practice offer?
Does your practice have genetic counselors on staff?
5. How many IVF cycles should I do?
The answer depends on many factors, including how your IVF cycles have been going, the prognosis for success in subsequent cycles, and how many children you wish to have. There is no absolute limit, but additional IVF cycles might be beneficial if your prognosis for getting healthy embryos is still good, but pregnancy hasn’t happened yet. Patients planning on having more than one child might consider doing more than one IVF cycle to store additional embryos for future use.
6. What fertility tests are necessary to determine IVF suitability?
Before beginning any kind of fertility treatment, conduct a series of diagnostic tests to assess current ovarian reserves, the health of fallopian tubes and uterus, hormone levels, and other factors that might impact fertility. Common fertility tests include:
Hysterosalpingogram (HSG)
Sonohysterogram (SHG or SIS)
Semen analysis (for male partner)
7. What lifestyle changes are recommended before starting IVF?
Making certain diet and lifestyle changes before beginning treatment can improve your chances of success. These adjustments aim to enhance overall health, optimize fertility, and ensure your body is in the best possible condition for an IVF cycle. Both partners (if applicable) should consider these changes, as they can impact egg and sperm quality, as well as the ability to carry a pregnancy to term:
Maintain a healthy weight
Eat a balanced diet
Limit or exclude alcohol
Stop smoking or vaping
Exercise regularly
Manage your stress levels
Review medications and supplements
Examine relevant environmental factors
8. What vitamins or supplements can I take to increase my success with IVF?
A prenatal vitamin with folic acid is the most important supplement to take, since it prevents certain birth defects. Other supplements might be helpful, especially antioxidants. Speak with a doctor, nurse, or nutritionist about their recommendations.
9. If I want twins, will you transfer two embryos?
It is recommended to transfer back a single embryo in most cases, especially in patients under age 38 or those who are transferring embryos that have undergone testing and been found to be normal. Twin pregnancies are much higher-risk, and are often complicated by premature delivery. This can leave children with significant impairments, including lifelong challenges such as cerebral palsy or autism. It can also cause higher-risk pregnancies with a greater chance of hypertensive disorders and gestational diabetes. It is safest to have children one at a time.
IVF used to cause a high amount of twin pregnancies, but this is no longer true. As a result of a concerted effort to reduce multiple pregnancies with IVF by transferring a single embryo at a time, the twin rate has become very low — less than 6% nationally in 2021.
10. Should I have my embryos genetically tested?
If the genetic parents of the embryos are carriers for a heritable disease, then you should absolutely consider testing the embryos to avoid having a baby with a serious or life-threatening condition. If you simply want to screen your embryos for chromosomal abnormalities, the benefits of PGT increase with the age of the woman providing the egg. Chromosomal testing is most often recommended for women over 35 because it can help reduce the risk of miscarriages that result from reproductive aging.
A detailed discussion about this testing with your doctor, and possibly with a genetic counselor, can help you make this decision.
It's no secret that the fertility treatment process can be overwhelming. Never be afraid to ask your doctor and team detailed questions and ask for support and resources. Being an informed participant on your IVF journey will help you feel more empowered, prepared, and confident as you take these next steps.
Dr. Barry Witt is double board certified in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology, with over 30 years of experience helping families grow in Connecticut and New York. He currently practices medicine at Illume Fertility.
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