Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.
Alana Stewart, who was conceived using donor sperm, began an online forum for donor children called AnonymousUS in 2010. The forum welcomes the viewpoints of anyone involved in the IVF process.[121] Olivia Pratten, a donor-conceived Canadian, sued the province of British Columbia for access to records on her donor father's identity in 2008.[122] "I'm not a treatment, I'm a person, and those records belong to me," Pratten said.[119] In May 2012, a court ruled in Pratten's favour, agreeing that the laws at the time discriminated against donor children and making anonymous sperm and egg donation in British Columbia illegal.[122]
Initial blood work, cycle tracking and fertility analysis is done. To begin IVF, your doctor or fertility specialist will evaluate your hormone levels and menstrual cycle to determine what medications and plan of action may be needed. You may also undergo a transvaginal ultrasound to examine your ovaries and reproductive system, ensuring that they are healthy.
^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
Availability of IVF in England is determined by Clinical commissioning groups. The National Institute for Health and Care Excellence recommends up to 3 cycles of treatment for women under 40 years old with minimal success conceiving after 2 years of unprotected sex. Cycles will not be continued for women who are older than 40 years old.[156] CCGs in Essex, Bedfordshire and Somerset have reduced funding to one cycle, or none, and it is expected that reductions will become more widespread. Funding may be available in "exceptional circumstances" – for example if a male partner has a transmittable infection or one partner is affected by cancer treatment. According to the campaign group Fertility Fairness at the end of 2014 every CCG in England was funding at least one cycle of IVF".[157] Prices paid by the NHS in England varied between under £3,000 to more than £6,000 in 2014/5.[158] In February 2013, the cost of implementing the NICE guidelines for IVF along with other treatments for infertility was projected to be £236,000 per year per 100,000 members of the population.[159] 

IVF may be used to overcome female infertility when it is due to problems with the fallopian tubes, making in vivo fertilisation difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such situations intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg. In these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.
^ Tan K, An L, Miao K, Ren L, Hou Z, Tao L, Zhang Z, Wang X, Xia W, Liu J, Wang Z, Xi G, Gao S, Sui L, Zhu DS, Wang S, Wu Z, Bach I, Chen DB, Tian J (March 2016). "Impaired imprinted X chromosome inactivation is responsible for the skewed sex ratio following in vitro fertilization". Proceedings of the National Academy of Sciences of the United States of America. 113 (12): 3197–202. Bibcode:2016PNAS..113.3197T. doi:10.1073/pnas.1523538113. PMC 4812732. PMID 26951653.
Heavy, as in a pad and a tampon still doesn’t feel like enough. Certain medical conditions, like thyroid problems or kidney disease, can cause excessive menstrual bleeding, medications (such as anti-inflammatory drugs or anti-coagulants) may as well; or the reason may be a condition linked to infertility. In a normal menstrual cycle, the hormones estrogen and progesterone work together to regulate the buildup of the lining of the uterus—that’s the stuff that sheds during your period. But if, for example, your ovaries don’t release an egg, the dominoes are tipped: your body produces less progesterone, hormones become imbalanced, the lining in your uterus over-develops, and you end up bleeding extra heavily. Fibroids in your uterus can also cause heavier or longer-than-normal periods; some types of these benign tumors can block fallopian tubes or interfere with the implantation of a fertilized egg. Up to 10 percent of infertile women have fibroids, according to the American Society for Reproductive Medicine. If you soak through at least one pad or tampon an hour for more than a few hours, see your doctor.  This is the worst health advice gynecologists have ever heard.
Luteal support is the administration of medication, generally progesterone, progestins, hCG, or GnRH agonists, and often accompanied by estradiol, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum. A Cochrane review found that hCG or progesterone given during the luteal phase may be associated with higher rates of live birth or ongoing pregnancy, but that the evidence is not conclusive.[79] Co-treatment with GnRH agonists appears to improve outcomes,[79] by a live birth rate RD of +16% (95% confidence interval +10 to +22%).[80] On the other hand, growth hormone or aspirin as adjunctive medication in IVF have no evidence of overall benefit.[30]

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Progesterone elevation on the day of induction of final maturation is associated with lower pregnancy rates in IVF cycles in women undergoing ovarian stimulation using GnRH analogues and gonadotrophins.[23] At this time, compared to a progesterone level below 0.8 ng/ml, a level between 0.8 and 1.1 ng/ml confers an odds ratio of pregnancy of approximately 0.8, and a level between 1.2 and 3.0 ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7.[23] On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation.[23]
On or after the day of your retrieval, and before the embryo transfer, you'll start giving yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots!) Sometimes, though, progesterone supplementation can be taken as a pill, vaginal gel, or vaginal suppository.

There is no one-size-fits-all solution to infertility, and the path you take will be unique to your specific case, but there are some common starting points. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular infertility treatments available today. Understanding what they are, who they are intended for, and what the success rates are for these two options will give you a place to begin your conversations with your fertility expert. Here’s what you need to know.
Obesity: The obesity epidemic has recently become is a serious issue, particularly in industrialized nations. The rising number of obese individuals may be due in part to an energy-rich diet as well as insufficient physical exercise.  In addition to other potential health risks, obesity can have a significant impact on male and female fertility. BMI (body mass index) may be a significant factor in fertility, as an increase in BMI in the male by as little as three units can be associated with infertility. Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. A relationship also exists between obesity and erectile dysfunction (ED). ED may be the consequence of the conversion of androgens to estradiol. The enzyme aromatase is responsible for this conversion, and is found primarily in adipose tissue. As the amount of adipose tissue increases, there is more aromatase available to convert androgens, and serum estradiol levels increase. Other hormones including inhibin B and leptin, may also be affected by obesity. Inhibin B levels have been reported to decrease with increasing weight, which results in decreased Sertoli cells and sperm production. Leptin is a hormone associated with numerous effects including appetite control, inflammation, and decreased insulin secretion, according to many studies. Obese women have a higher rate of recurrent, early miscarriage compared to non-obese women.
West states that the "hardest thing about secondary fertility issues is that you want a sibling for your child." Fiona, who has a son of five and has been trying to conceive a second child for two years, says she can no longer look out of the window at her son playing in the garden. "It breaks my heart. He just looks so alone out there. All I want is a sibling for him but I don't think it's going to happen."
We also care about not only your physical well being, but also your emotional health. In fact, these issues as important enough to us that one of our core team members is a psychologist. Julianne Zweifel is an expert in addressing the mental aspects of secondary (and primary) infertility and she can promote emotional well being in a way that few others have the training or experience to do. If you should feel you do not wish to talk a specialist, but are struggling emotionally, please at least let other team members know-the more we hear from you, the easier it is for us to help.  
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