Although most modern hair products are claimed to be safe during pregnancy, I would not take any risks.  Therefore, I do not recommend this during IVF treatment and the first three months of the pregnancy.

It does not harm IVF and pregnancy.  However, doing nail polishing or painting well-ventilated areas would be best.  The respiration of the fumes is not healthy.

We need to see you a few times during ovulation induction for IVF.  After the first visit, we may see you again after 7-8 days.  So you can travel during your free time if you come to the clinic with an appointment.  Besides this, it may be possible to organize some of your scans in a different city with a sister clinic.  This way, you may have a holiday as well during your treatment.

Although most clinics forbid intercourse during IVF treatment until the pregnancy test, no scientific evidence supports this.  Therefore, we do not ask our patients to refrain from intercourse during any part of IVF except on the day of embryo transfer.  However, it is crucial not to have intercourse during ovulation induction until the day of embryo transfer when we do IVF for single gene disorders or gender selection.  Although uncommon, some patients can get pregnant spontaneously happening embryos during IVF, and we do not want to risk an unhealthy embryo being implanted.

We refer to the egg collection day as fertilization day or day 0.  We can transfer embryos any day after fertilization; however, the idea in IVF treatment is to choose the best one among many embryos.  We have several tools to do so.  One of the best methods is to watch embryos for five days and select the best developing ones.  However, you may have a better chance of pregnancy when we transfer the embryos early if you have do not have more embyos than we can transfer.  Now, the culture media and the incubators are better than those before.  Therefore, waiting for day 5 to see the embryo progress may be wise, even if you have a single one.  It may give us an insight into your overall pregnancy chance.  If you fail to get pregnant in the first cycle, although you get a blastocyst, you may not need to wait for a blastocyst transfer in another cycle.  If you are coming from abroad for IVF treatment, you can save time and money with the early embryo transfer without changing your pregnancy chance if not improving it.

Unfortunately, some patients may not respond to drugs as we hope.  These are some of the reasons for cancellation.

There is no follicle response and consequently low estrogen levels after many days of drug usage.

Risk of ovarian hyperstimulation.  It is one of the most severe risks in IVF treatment.  Although we have some tools to prevent this, we must cancel treatment in some circumstances.

Sometimes, we do not retrieve any oocytes, although the response to the ovulation induction drugs is satisfactory.  Occasionally, we can get eggs, but none are suitable for IVF.  Finally, you may have poor embryos, so your embryo transfer may not happen.

There are several factors to making the right decision.  First, you and your partner should undergo an infertility consultation.  Some couples may need IVF even if their tubes are open due to severe sperm problems, age, or other reasons.  Therefore, a tubal reversal would be useless.

The method of tubal ligation is also important, and some ligation techniques are challenging to repair.

You should ask yourself how long you can wait to get pregnant after tubal reversal.  You may need at least one year to see if you can get pregnant, and then you may need IVF.  If you are already 39, you may not have that much time.  Nevertheless, it may be wise to do a reversal and start an IVF treatment.

It is also important to plan the number of children you want after the reversal.  IVF may be a better and even cheaper option if you want to have only one child.  Again if you desire to choose the gender of your next child, then you should consider IVF.

Many patients ask the same question, and some find it very pleasant.  However, we take multiple pregnancies as a complication of IVF and do our best to avoid it.  On the other hand, the risk of multiple pregnancies in any infertility treatment is higher than nature.  We may need to transfer two embryos in patients over 35 or after a few trials of unsuccessful IVF.  The idea is to increase the pregnancy chance, not to get a twin pregnancy, but it can happen.

There needs to be more scientific evidence about that, although it should work like other vaccinations such as flu.  The best approach is to postpone any non-emergency treatments during the pandemic.  However, if you cannot postpone your treatment any longer, I recommend completing your vaccine program before starting IVF.  If you are pregnant, you should avoid vaccination in the first three months because of a lack of evidence.  According to recent evidence, pregnant women are at increased risk of severe illness from COVID-19.

Additionally, pregnant women with COVID are at increased risk for other adverse outcomes, such as preterm birth.  If you think your risk of COVID is high, you may get the vaccination, and I believe the benefit is more than the risk.

Recent studies suggest an increased risk of congenital disabilities among patients who conceive through IVF compared to patients without fertility issues.  It is unclear whether patients with infertility have an inherently increased risk of conceiving babies with congenital disabilities or if the increased risk is due to the ART procedures themselves.  Research is ongoing to clarify these issues.  When comparing groups of infertile patients who conceive with ART to infertile patients who conceive spontaneously, there appears to be an increased risk of birth defects for those patients using intracytoplasmic sperm injection (ICSI), and those defects are still relatively rare.

The following list of immunizations or injections are OK during a cycle:

• Flu shot
• Hepatitis vaccine
• Chicken Pox immunoglobulin
• TB test
• Tetanus shot
• Allergy shots
• Novocaine (dental procedures)

The following list of medications are OK to take before or after embryo transfer:

• Cold medicines (Robitussin for cough/alcohol-free; Claritin, Benadryl)
• Tylenol
• Neosporin-type ointments over a cut
• Benedryl cream, caladryl, 1% hydrocortisone for rash
• MOM, Colace, Surfak, Kaopectate, TUMS or Rolaids
• Amoxicillin, Ampicillin, Erythromycin
• Bactrim – OK before pregnancy test
• Flagyl – OK before pregnancy test
• Do NOT take the following medications:
• Advil/Aleve/Aspirin
• Echinacea
• St. John’s Wort
• Gingko Biloba

In the case of fresh cycles, at least one month and in the case of a frozen cycle, you can try every month.

There are two commonly used protocols, the long and short (antagonist).  The short protocols start within the first three days of the menses, and the conventional long protocol begins on day 21 of the previous cycle.

Depending on the clinical case, each protocol has advantages and disadvantages.  Due to a few benefits, including the required time, antagonist protocols are commonly used, especially on PCO patients.

Yes, we do have the provision to be done under anesthesia.

It depends on the clinic.  Our clinic does not routinely encourage injections, except in selected cases.

You will visit the clinic around 2-4 times until you are ready for egg collection.

Several factors have been shown to reduce the quality of eggs and sperm, so you can do several things to minimize this risk and provide the best conditions possible for the development of your reproductive cells.  These types of cells are created over a long period, so lifestyle modification must be considered a long-term investment.

Smoking reduces a woman’s AMH value, is detrimental to a man’s sperm quality (increased sperm DNA damage) and has been shown to reduce fertilization and development potential, resulting in lower pregnancy rates.  Smoking other substances can also have a detrimental effect on fertility.

Excess alcohol affects sperm function.

Excessive body weight causes:

• Higher BMI, which could disqualify you from treatment
• Hormonal disturbances reduce the chance of an egg being released each month naturally and may reduce the quality of your eggs.
• A greater amount of drugs to be needed during treatment
• High miscarriage rates, increased risks to the mother during pregnancy (DVT, high blood pressure)
• An increased risk of the baby having spina bifida or a heart problem
• Evidence suggests that men with a high BMI, and therefore body weight, are more likely to have no sperm or low numbers of sperm than men of healthy weight.

We do not have good-quality scientific studies on diet and infertility.  However, foods with antioxidant properties, such as fruit and vegetables, are likely to benefit both eggs and sperm as they protect against oxidative stress, which can be harmful.  Avoid foods containing trans fats like hydrogenated vegetable oils and margarine, and try to eat unsaturated fats such as oily fish and nuts.  Eating a wide variety of healthy foods as part of your lifestyle connected to fertility is common sense.

Many “well-woman” and “well-man” vitamin supplements are available over the counter at a chemist.  They contain antioxidants, vitamins, zinc, selenium, and Omega 3, and they can be helpful, especially for men with lower sperm function.

Moderate and regular exercise can improve the activity of essential enzymes, which influence many of the body’s functions, including reproduction.  If you take any supplementary drugs or substances as part of your exercise regime, seek advice about their effects on your fertility.  Intense exercise and other potential sources of excessive heat, such as hot baths, saunas, and tight underwear, are best avoided by men hoping to use their sperm.

If taken before becoming pregnant and during the first 12 weeks of pregnancy, folic acid will reduce the risk of developmental abnormalities.  You need to take folic acid 400 micrograms (400 µg) every day in addition to what you get from your diet until 12 weeks gestation.  You can buy Folic acid from chemists, supermarkets and health food stores.

Similarly, Vitamin D (10µg/day) benefits the pregnant woman and her developing baby.

Check the labels and information leaflets with any over-the-counter medication you take regularly – some daily medications are advised against when you’re trying to have a baby.

Your AMH level helps predict how well your ovaries will respond to stimulation during an IVF cycle.  It can be used to tailor the stimulation drugs to an individual patient.  It can predict which patients may expect low or high egg numbers and even patients at a higher risk of ovarian hyperstimulation syndrome (OHSS).  Patients with a low AMH or antral follicle count have a lower pregnancy rate.  Still, the severity of this reduction is age-related, with patients ≥39 yrs having a significantly lower chance of pregnancy than patients with the same AMH who are less than 39yrs.  Patients with very low or barely detectable AMH levels can still get pregnant.  Patients with a low AMH (less than 3 pmol/l) also have an increased risk of failed fertilization across all age groups.

It will depend on the reason you need the procedure.  Men who have no sperm in their ejaculate due to a blockage have a higher chance of retrieving sperm than men who have testicular failure.  Retrieval rates range between 25-75%, but please speak to your doctor at your consultation for a more accurate estimation based on your diagnosis.

We will speak to every couple on the day of treatment about their sperm quality and discuss the best treatment option.  If numbers are extremely low or we fail to find sperm on the day of treatment, we may be able to do a surgical procedure to recover sperm for treatment.

If you are concerned that you may struggle to produce a sample on the day of treatment, please speak to an embryologist about freezing a sample before treatment which can be used as a back-up: this can help to alleviate stress on the day.  If we do not have a semen sample on the day of treatment, we may be able to extract sperm surgically or vitrify the eggs to commence treatment later.

For the best result, unless otherwise told, you should have intercourse one day before your wife’s egg collection.  The DNA fragmentation of sperm is less when a fresh sample is produced.  Therefore, men with high DNA fragmentation should give two samples on the same if possible.  Wash your hands and genitals before you produce the semen sample.  You must tell the clinic about any illness or medication taken in the last three months, as these things can affect your semen quality.

If producing a sample at the clinic is unsuitable or unsuccessful, or if you are concerned about difficulties, please speak to a staff member about alternative arrangements.  It may be possible to produce a sample at home, and we will provide an appropriately labelled sterile pot and a sealable plastic specimen bag for transport.  You must ensure that the sample is at a temperature between 20oC – 37oC (we suggest close to your body/inside jacket pocket) and within two hours of production.  You will also need a form stating that the sample is yours.  The spillage of the ejaculation can affect the results and subsequent treatment plans.

‘Blastocyst culture’ is the term commonly used to describe the culture of embryos until they are five days old.  A blastocyst has many cells and consists of two distinct cell types.  Around 30% of embryos will reach the blastocyst stage.

Embryos not transferred can be frozen if they are of suitable quality.  At the time of embryo transfer, the Embryologist will discuss with you the quality of the embryos for transfer and any remaining embryos and advise you if these meet the criteria for freezing.  On average, we freeze for approximately 25% of patients.

Frozen embryos are stored in liquid nitrogen at a temperature of -196°C.  It means they are held in a suspended state and do not deteriorate with time in storage.

We find approximately 80% of frozen embryos survive the freezing/thawing process.

There are many reasons why a patient may wish to consider egg freezing, and this may be prior to chemotherapy or treatment, rendering them prematurely infertile.  We also offer egg freezing for other women, such as those who may wish to preserve their fertility and have children later in life.  Please visit the Fertility Preservation page for more details.

The decision to continue or cease breastfeeding when undergoing fertility treatment is personal.

There are many variables to consider; therefore, this should be discussed with your fertility specialist before commencing treatment.

• Avoid raising the core body temperature.  Moderate exercise is encouraged.
• What you are used to should be safe if the intensity doesn’t reach extended breathlessness.
• A talk test is a good measure of keeping to a safe exercise intensity.
• Avoid water skiing, horse riding, scuba diving, marathons, bungee jumping or extreme sports.
• If you are used to having heavy sports, lower the amount of exercise, but no need to avoid it completely.

Before your first visit, you and your partner must complete a health questionnaire to help determine possible reasons for fertility problems and factors that may affect your ongoing treatment.

Your doctor will prepare a plan with you for further investigation and treatment.

We aim to move forward at a pace that is comfortable for you.  Some people may find the decision process straightforward; others may need additional time and appointments to help them.

Our counsellor is available for further discussion at any stage of assessment and management if you or your partner should have any concerns.

We will evaluate female patients attempting pregnancy from the age of 18 years old to 55 years old.  However, patients over 45 years old do not have a reasonable pregnancy chance with their own eggs.

We perform male infertility evaluations.  Please get in touch with our office for more information.

Although seeing couples together is beneficial, attending every visit together is optional, and it may cause more stress if getting time off work is difficult for both couples.  IVF treatment should be efficient so that patients can tolerate multiple trials in a short time if necessary.

It can vary depending on the number of referrals made to the unit.  However, we do not have a waiting list at the moment.

We have male and female staff performing ultrasound scans.  Although we do our best to fullfill your request, it may not be possible to have all of your scans by females.  However, a chaperone is always present during the procedure.

The hormone tests are blood tests, and the timing of these tests is based on which hormones are being tested.  Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) and oestradiol are often tested together on days 2 to day 4 of the period.  We prefer an AMH test to evaluate your egg reserve and this test can be done on any day of your cycle.  Please inform your doctor if you are on birth control pills or use any drugs recently.

You may be asked to repeat tests if they are more than 6 months old.  An up-to-date evaluation may be vital for decisions regarding doses and treatment protocol.

It depends on your case and response to the medications, but once stimulation commences, most people need ultrasound scans and blood tests 3-4 times before egg collection.  Before starting the IVF cycle, you will likely need several clinic visits, investigations, information sessions, etc.  However, if patients present enough data about their infertility history, previous tests and previous IVF trials, we can do almost all consultations online.

The length of time varies according to your individual protocol (decided by your clinician) and your response.  In general, you need stimulation injections for 10 to 12 days.  After embryo transfer, you will start at some drugs for luteal support, and if you get pregnant, this usually continues up until 6-8 weeks of pregnancy.  The luteal phase support lasts until week 12 of the pregnancy for frozen-thaw embryo transfers.

Everyone reacts differently to medication; the most commonly reported reactions are bloating, headache, injection site reactions, and abdominal tenderness.  Please keep well hydrated throughout your treatment cycle, and do not hesitate to seek medical advice if you are concerned.

Spotting after embryo transfer is common; please continue your medication and contact the nurses for advice.

We currently do not have a waiting list.  Once treatment is planned, you can start your ovulation induction in your next available cycle.

There is no language barrier for English-speaking patients, and we have enough staff to speak English fluently.  We may need a third party (agency or consultant) to coordinate your treatment and travel for other languages.

We can offer recommendations for accommodations (apartments or hotels) that are inexpensive and close to the clinic.  Many patients turn this into a vacation with treatment, so if you have the luxury of time, you may plan a few days of sightseeing locally or in nearby cities while you have your treatment.  The clinic can tell you when you need to be available or close to the clinic.  The rest of the time, you can enjoy the city.

You can engage the services of a local English-speaking driver to meet you at the airport and assist you with getting to and from your appointments.  Local public transportation options or taxis are fine too, and you may want to avoid driving in a foreign country when you are supposed to be relaxing after your transfer.  One way to find these services is to ask the clinic of your coordinator for a recommendation or contact a few local airport transportation services that serve English-speaking tourists.

Most patients do not need any sedatives during a transfer.  They may ask you not to wear any scents on the transfer day (this is for the embryos and staff who may have allergies).  Upon your request, we can offer a gown for you to wear during the transfer – but usually, it is enough to disrobe from the waist down and use a sheet to wrap yourself.  We request you rest for 10-20 minutes after the transfer before returning to your hotel.  We do not recommend bed rest, but a bit of limited activity for one day.

Yes.  It is a good idea to stay hydrated while flying, and carrying your luggage and lifting the weights you used to is OK.

We recommend a home pregnancy test 15-16 days after your egg collection.  If it is positive, you can do a blood pregnancy test 4-5 days after the first test to see the progress of the pregnancy.   You should get a scan to see the gestational sac two-three weeks after the first test.

We can do PGD (Preimplantation Genetic Diagnosis) for several indications, such as single gene mutation, aneuploidy screening, and sex selection.  The use of PGD increased dramatically in the early 2000s

The procedure does not appear to affect embryos’ or fetuses’ subsequent development, though more follow-up studies of children born after PGD are needed.  PGD requires the use of IVF, which involves some health risks.

Occasional false results have been reported, mostly due to “embryo mosaicism,” in which the embryo’s cells are not identical.  These and other errors can lead to the implantation of an embryo with the undesired trait.  Therefore, we recommend follow-up amniocentesis or chorion villus biopsy for single gene disorders.