Preparing for your IVF Treatment


Fertility Workup for Infertile Couples

Male:

1. General physical examination
2. Blood chemistry examination: CBC, ABO Bl.Gr., Rh Bl. Gr., Anti HIV, Anti HCV, VDRL, HBsAg, Hb typing
3. Semen analysis

Female:

1. General physical examination and BMI measurement
2. Pelvic examination and Pap smear of cervix
3. Transvaginal ultrasound on day 12 of menstrual cycle
4. blood test on day 2 of menstruation for: FSH, LH, Prolactin and Estradiol
5. Blood test for: CBC, ABO Bl.Gr., Rh Bl.Gr., Anti HIV, Anti HCV, VDRL, HBsAg, Hb typing, Rubella IgG, Thyroid function fest, CA 125

The work-up tests have to be done prior to the stimulation cycle of IVF (recommend to do 1-3 months prior to the stimulation cycle)
 

Treatment option

• Actually in IVF-procedure, it will take about 4 weeks duration aligned to your menstrual cycle.
• Patient who is undergone IVF by short protocol will start the program on her day2 of menses and complete the embryo transfer around her day17-19 of menses.
• Patient who is undergone IVF by long protocol will start the program on the 7 days before her menses and complete the embryo transfer around her day17-19 of menses.
• To shorten your stay in Thailand, we are able to cooperate with your local clinician / IVF expert to support your initial part of the program in your home country thereafter to come to BKK about Day9 of your menses to complete the program. This will take about 10-12 days in Thailand.
• Male partner / Husband is required for sperm collecting on the day of egg pick up, or he is able to come in advance at any day before egg pick up for sperm collecting then freezing in our freezing unit.
   

As with all couples attempting to achieve a pregnancy, you should focus on your own general health and lifestyle. It makes sense to be aiming for a healthy approach to life, but often advice in this area can be confusing and is not always supported by hard evidence. It is worth discussing any health concerns and medications you or your partner are taking with your doctor. Some medications have an effect on the production of sperm for the man, and for the woman there may need to be a change of medication before or during pregnancy.

Smoking

As there is strong evidence that female smokers have reduced fertility and a higher miscarriage rate, this is the time to stop. Smoking during pregnancy has adverse effects on the growing baby and can contribute to many childhood illnesses. It is important to avoid smoking on the day of egg collection, as smoking can lead to anaesthetic difficulties. Husbands/partners should also stop smoking as there is increasingly clear evidence about the harmful effects of passive smoking.

Alcohol

While it is not possible to set "safe" limits of alcohol consumption, higher intakes are known to be harmful to the developing baby. The National Health and Medical Research Council (NH&MRC) recommends no more than two drinks per day for women and four for men, with at least two alcohol-free days per week, and considers abstinence to be desirable during pregnancy. We lack specific information about alcohol and infertility, except that a heavy intake in men can affect sperm production. It is important to be moderate in the second half of the menstrual cycle if pregnancy is possible, and in the weeks following a positive pregnancy test, as this is when the baby is developing. But there is no need to feel tortured with guilt if an occasional drink is taken.

Diet

A normal well-balanced diet, with plenty of leafy green vegetables for folic acid, is encouraged. The NH&MRC recommends that women take folic acid supplements of 0.5mg daily for the month before pregnancy and until the pregnancy is over 12 weeks, in the hope of reducing the risk of neural tube defects (most commonly spina bifida) in their babies. Although the effectiveness of this is not totally proven, there is good evidence linking folic acid with a reduced incidence of such abnormalities in high risk women. Women who take anti-epileptic medication and those with a family history of neural tube defects should take 5mg of folic acid daily.

If you are significantly overweight or underweight this can adversely affect fertility, it is worth considering your diet and perhaps discussing this with your doctor with the aim of getting dietary assistance.

Caffeine

High caffeine intake has been linked with female infertility in some research studies, but the reason for this is not obvious. Therefore it is worth considering a moderate coffee intake if you are trying to get pregnant.

Exercise

Regular moderate exercise is totally acceptable. There is some evidence that strenuous exercise performed more than four times a week during pregnancy can have adverse effects. Frequent strenuous exercise, such as some athletic training programs, can also affect the body's hormone balance and thus the woman's fertility.

Emotional

Direct relationships between stress and fertility have not been established; certainly some people conceive at times of high stress in their lives, while others will respond with ovulation disorders or a decreased libido. It makes sense to reduce stress in your life while undergoing IVF and trying to achieve a pregnancy. There are times before or during treatment that you may feel quite emotional or stressed; remember our counsellors are always available and are experienced in helping individuals and couples deal with difficult emotions and situations.

Medical Tests

Prior to commencing the IVF program your consultant will order several routine tests. Each woman will have her rubella (German Measles) immunity checked (even if vaccinated in the past as immunity can fall). If the level is too low, a vaccination will be performed before attempting pregnancy, and a wait of 6 weeks is usually recommended before conceiving. Rubella can have devastating effects on the developing baby during pregnancy, and the disease is still prevalent in the community. You will also be screened for varicella (Chicken Pox). This virus can also harm the pregnancy and it is now possible to vaccinate if you have no natural immunity. We will ask both partners to be screened for syphilis. This is an uncommon but very serious disease which has profound effects on the pregnancy if not treated. It is easily treated with antibiotics.

Both partners will be checked for Hepatitis B and C, and for HIV. A small particle of the hepatitis virus may remain in the blood and/or other body fluids for many years after the initial (often unsuspected) hepatitis infection. The presence of hepatitis B or C, or HIV, may have significance for your future health, as well as for your partner, and for those who process your blood and semen samples.

If the woman has not had a Pap smear in the last couple of years, it is worth having one during this time and it should be repeated every two years - more often if abnormalities are found. Each month the woman should check her breasts for lumps or irregularities, and have her doctor check her breasts annually. It is worth considering that infertile women have a slightly increased incidence of cancer of some reproductive organs, and so these checks are important to your health.

The rational for IVF treatment and gender selection

The following information are about technical limitation of gender selection by IVF program. Please read carefully.

• The technology available now cannot separate sperm X and Y from each other completely since they are so similar and the only difference among them is chromosome content.
• We have to let those sperms fertilized with eggs and developed to 8 cells stage or blastocyst stage embryo before we can perform biopsy procedure on those embryos.
• The biopsy procedure will take one cell from 8-cells stage embryos or 3-5 cells from blastocyst stage embryos in order to check by FISH technic to tell whether each embryo has normal XX, or normal XY.
• The FISH probe used will be able to detect chromosome X,Y,13,18 and 21 within the cell tested.

The chance of embryos tested may be as follow:

• All female (XX) embryos
• All male (XY) embryos
• Male and female embryos with good quality both male and female
• Male and female embryos with poor quality male embryos
• Male and female embryos with poor quality female embryos
• Male and female embryos with poor quality both gender
• Embryos with abnormal chromosome 13,18 or 21
• Embryos with abnormal sex chromosome eg. XO,XXY, XXYY

The purpose of this information is to give you an idea about gender selection procedure, limitation of technology, and possible outcome.

Fate of eggs and embryos in IVF & PGD program:

• The goal of ovarian stimulation is to get around 8-12 eggs from stimulation and ovum pickup
• From 8-12 eggs retrieved, after fertilization, 75%of eggs will turn into embryos: 6-8 embryos
• From 6-8 embryos, 60 % will develop to blastocyst stage embryos.
• From 3-4 good quality blastocysts, there should be one or two desire embryos for transfer.
• The chance of success from transferring 1 or 2 good quality embryos is 35-40%

If you have any questions regarding the above information, please feel free to contact Dr. Viwat Chinpilas, Our Clinical Director through this form