Frequently asked questions
What does the abbreviation CREI mean on a doctor's business card ?
Not all IVF doctors choose to undertake extra specialist training in infertility. The Certificate of Reproductive Endocrinology and Infertility (abbreviated as CREI) is the most advanced form of training an infertility specialist can undertake and the only one recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Following a national selection process, gynaecologists are eligible to undertake a fully supervised 3 year training programme, which includes a compulsory research component as well as a written and oral examination. During this 3 year period gynaecologists undertake very advanced skills training in endoscopic surgery, microsurgery, and all aspects of the treatment of male and female infertility. Following the successful completion of their training CREI subspecialists are reassessed every three years.
They must also be able to show they continue to perform the majority of their clinical work in this field to retain their qualification. The CREI training program and its ongoing credentialing is designed to ensure that patients who chose a CREI specialist will be offered the best and most up-to-date infertility treatment possible.
Can we choose the sex of our IVF baby?
It is technically possible for us to determine the sex of embryos before they are transferred to the uterus. However, in Australia, as in most other countries, sex-selection is only allowed on valid medical grounds. For example, if there is a significant risk that a serious medical condition will be passed on only to male embryos while female embryos would be healthy, then an application for sex-selection on medical grounds can be submitted to the Victorian Assisted Reproductive Treatment Authority (VARTA).
Does IVF reduce the number of eggs I have, resulting in early menopause?
That is a common misconception. In a natural cycle, ten or more small follicles will start growing at the beginning of the menstrual cycle, but only the leading one will fully mature and ovulate. The other follicles will die off and disappear. The stimulation used in IVF encourages all the recruited follicles to grow to full maturity, so there is less wastage of eggs from follicles that would normally be lost in a natural cycle. The turn-over of eggs is not higher with stimulation of the ovaries and menopause does not come earlier.
Do I have to rest or be extra careful after the embryo transfer?
When women conceive naturally, they usually don't know they are pregnant until they miss a period. This is at least a week after the embryo has implanted, so in naturally conceived pregnancies women generally continue with their normal activities, including work, travel and sport, without adverse effects on their early pregnancy.
Is that also true for women who can't conceive naturally? Well, there is indeed very strong evidence from good medical studies that bed rest or being extra careful after the embryo transfer makes no difference at all. So, the important point is not to feel guilty if the implantation doesn’t occur because continuing normal activities does not lower your chances.
Should I take DHEA to improve my egg count?
In the US DHEA supplements are freely available without a prescription. It is often used by body builders in the mistaken belief that it will boost muscle growth. DHEA supplements are also promoted by some doctors for the treatment of a whole range of illnesses.
Unfortunately, there is so far no robust evidence to support any claims regarding health benefits. In particular, the use of DHEA to promote better egg quality in women with a low ovarian reserve has been overhyped. The very few studies that have been done so far have been of poor scientific quality and most of them were carried out by researchers with a commercial conflict of interest.
There is not only the concern that there is no real benefit of DHEA supplementation, there are well-known risks too. Doctors that do prescribe DHEA usually require women to be on this supplement for a prolongued period of time, typically at least 3 months. There is obviously a real risk that valuable time is wasted in these women who already have a rapidly dwindling egg reserve. In addition, prolongued use can lead to significant side effects such as: oily skin and acne, hair loss, deepening of the voice, high blood pressure, headaches, insomnia, and raised cholesterol levels.
Why am I not allowed to transfer more than two embryos?
The Reproductive Technology Accreditation Committee has a set of guidelines which all IVF clinics have to follow to keep their accreditation. One of these guidelines states that no more than two embryos should be replaced in one transfer. The guidelines also provide a strong recommendation to transfer only one embryo in most cases. The principle reason for the guideline is two-fold.
Firstly, patients often assume that their chance of a pregnancy will be two times higher if they put two embryos back rather than one. This is incorrect. The chance of a pregnancy following a double embryo transfer only increases by a very small amount.
Secondly, the risk of a multiple pregnancy following a double embryo transfer is more than ten times higher than after a single embryo transfer. Sometimes embryos split after the transfer, which leads to identical twins, and on a rare occasion this has led to quadruplets after a double embryo transfer. Multiple pregnancies are much more at risk to develop complications. These complications are usually associated with the preterm birth of the twins, which increases the risk of the newborns to develop a range of severe problems. Twin births are associated with a 6 - 10 times higher risk of cerebral palsy (brain bleed at birth leading to spasticity).
What are the possible health risks of IVF?
Generally speaking, IVF treatment is considered safe when supervised by a qualified specialist. Complications and long-term health risks to the mother are rare. New stimulation protocols have further reduced the risks, such as ovarian hyperstimulation syndrome (OHSS). Bleeding and infection after the egg collection occur in fewer than 5 in 1000 women.
Women sometimes worry about the possible long-term health risk such as cancer. Most of the studies that have been done are reassuring. There is no conclusive evidence that fertility drugs increase the risk of developing cancers.
There appears to be a slightly higher rate of birth defects in babies born after IVF. This may be related to the cause of infertility but also to the use of IVF treatment. Careful long-term monitoring of the health of IVF babies is continuing world-wide.
The Victorian Assisted Reproductive Treatment Authority has put together an excellent patient brochure that provides more detailed information on the possible health effects of IVF.