IVF FAQs

In vitro fertilization (IVF) is recommended in a wide variety of scenarios where traditional methods of conception or other forms of fertility care are not successful or feasible. Some common scenarios that call for IVF include:
- Blocked or damaged fallopian tubes
- Ovulation disorders
- Endometriosis
- Unexplained infertility
- Male factor infertility
- Advanced maternal age
- Repeated miscarriages
- LGBTQ+ family building
- Single aspiring parents
- Genetic disorders
- Fertility preservation
A physician can review a patient's history and help guide them to the treatment and diagnostic procedures that are most appropriate for them.
Like any medical procedure, IVF carries some risks. Common risks include:
- Multiple births (i.e., twins, triplets, etc.): At PFC, we often reduce this risk by utilizing the elective single embryo transfer (eSET) method, which involves transferring a single healthy embryo at a time. We recommend eSET for approximately 90% of our patients.
- Ovarian hyperstimulation syndrome (OHSS): Occurring as an overreaction to fertility medications, the risk of this condition can often be reduced through careful medication management and diligent monitoring.
- Birth defects: Some studies suggest a slightly higher incidence of birth defects in IVF-conceived children, however, the overall risk is still relatively low.
The prospect of daily injections can be overwhelming. While injections are a necessary part of IVF treatment, at PFC, we have designed our medication schedules and injection types to minimize discomfort and stress. Our nurses also carefully instruct and support every patient throughout this process. Medications that once had to be injected into the muscle have been replaced by medications given as a small injection under the skin (subcutaneous), including the hCG trigger shot, which is now available in a subcutaneous form called Ovidrel.

After egg retrieval, patients are given a progesterone hormone supplement to prepare the lining of the uterus for embryo transfer. For most patients, progesterone may be taken in a vaginal tablet or suppository form rather than an injection. In this way, injections may be avoided entirely during the second half of the IVF cycle. Progesterone vaginal tablets and suppositories have been proven to be as effective as progesterone injections.
Because anesthesia is used for egg retrieval, patients feel nothing during the procedure. Egg retrieval is a minor surgery, in which a vaginal ultrasound probe fitted with a long, thin needle is passed through the wall of the vagina and into each ovary. The needle punctures each egg follicle and gently removes the egg through a gentle suction. Anesthesia wears off quickly once egg retrieval is concluded. Patients may feel some minor cramping in the ovaries that can be treated with appropriate medications.
Many of our patients at PFC come from other parts of the US and throughout the world. Medical, nurse coordinator, and financial consultations for IVF all can be done by telephone or through our virtual HIPAA-compliant system; many of the required screening tests and procedures, including initial fertility stimulation treatment, can be coordinated with a patient's local gynecologist or reproductive endocrinologist. Those who have started stimulation treatment at home will travel to our clinic about 5-7 days later.

Most patients need to be in San Francisco for 10 days to three weeks. Our staff is always available to help and counsel out-of-town patients throughout treatment, via telephone or email.
The ovaries house hundreds of potential eggs. Each month, during the natural ovulation cycle, the ovary selects just one egg from a pool of 100-1,000. The eggs that are not selected undergo a natural cell death process called atresia. When a patient uses fertility medication in IVF, the body's natural selection process is overridden, and a number of these otherwise unused eggs are allowed to grow. As many as 20 eggs may be stimulated in a given cycle. Thus when using fertility medication in the IVF process, not only is the patient not using up all of their eggs, but they are 'rescuing' eggs that otherwise would have undergone atresia.
In general, the success of frozen-thawed embryo transfer procedures depends on three factors:
- The quality and survival of the frozen-thawed embryos. In general, we only freeze high-quality embryos so the current rate of survival is greater than 90%.
- The age of the patient. In patients under the age of 37, the chances of pregnancy with frozen-thawed embryos are similar to a pregnancy with fresh embryos.
  - In patients 37 years or older, pregnancy chances with frozen-thawed embryos decline in conjunction with declining fertility in general, but still can be viable. As always it is best to discuss a patient’s situation with their physician.
- The status of the uterus receiving the embryos. A healthy endometrial lining free of any interfering fibroids or polyps provides a sound environment for embryo implantation.
Previously frozen embryos may be transferred during a patient's natural cycle or in a controlled (artificial) cycle, depending on several factors:
- Controlled cycle transfer: In a controlled cycle, hormone medications are given to prepare the uterus for transfer. This method is recommended for patients who have irregular cycles. Because the controlled cycle can be precisely timed, it is also advised for those who are on a set travel schedule. The medications commonly used for a controlled cycle are estrogen (either in an injectable or oral form) and progesterone (in either an injectable or vaginal form).
- Natural cycle transfer: Patients who have a regular menstrual cycle may have the option of using their natural cycle for the transfer of frozen-thawed embryos. In this case, there is no need for hormone treatment, as the body's natural cycle will prepare the uterus for pregnancy. In cases where natural cycle transfer is possible, this option allows for less medication and monitoring and thus is often relatively affordable for patients. We typically will monitor the natural cycle using home urinary ovulation predictor kits as well as ultrasounds. When the kit changes and/or a pre-ovulatory follicle is seen on ultrasound, we administer a single injection of Ovidrel (recombinant subcutaneous hCG) and the patient starts progesterone vaginal suppositories a couple of days later. The embryo transfer will occur 5-7 days after ovulation/hCG injection, depending on whether the embryos are frozen at a Day 3 or Day 5 stage.
For the transfer procedure itself, the embryo is thawed at room temperature and then warmed to body temperature (37° C). As with a fresh embryo transfer, embryos are placed inside a special catheter (a very thin tube), which is guided through the cervix and into the uterus. Embryos are gently injected into the uterus and the catheter is removed. This procedure requires no anesthesia and is done in a position similar to a pelvic examination for a Pap smear. After transfer, the patient rests for 15 minutes and then goes home, where a day of rest or very gentle daily activity is recommended.
The ability to use a donor egg has enabled thousands of patients to become pregnant when they otherwise might not have had this opportunity. While a patient's eggs may not be viable, very often the uterus is completely healthy and capable of supporting a pregnancy. In these cases, egg donation with IVF has high success rates. This procedure follows the same protocol as IVF, except the aspiring parent(s) select a donor and use the donor's egg to create the embryo. Patients may seek egg donation services at Pacific Fertility Center's Egg Donor Agency or an outside agency.
Various medical conditions and personal scenarios may make it impossible for an aspiring parent to carry a pregnancy, but reproductive medicine provides a solution for this with the help of a gestational carrier or surrogate.

Gestational carriers are individuals who carry a child for aspiring parents who are unable to sustain a pregnancy. This is accomplished through IVF by creating embryos using genetic materials from the aspiring parents or donors, as needed. The resulting embryo is transferred to the gestational carrier’s uterus. With this process, the gestational carrier does not contribute any of their own genetic material to create the embryo.

A gestational carrier may be appropriate for those in the following situations:
- No uterus
- Abnormal uterine cavity
- Several recurrent miscarriages
- Recurrent IVF cycles have not produced a pregnancy
- Medical conditions would make pregnancy dangerous for mother and child
- LGBTQ+ family building, especially same-sex male couples
- Single aspiring parents