General anesthesia is not mandatory. Different doctors use different types of anesthesia. I strongly recommend that you talk with your Reproductive Endocrinologist about this specific concern. I imagine she/he will be able to work with you to work out a solution you would feel comfortable with. You might also find that once you become more educated on what is involved, you will feel more comfortable with a sedation/anesthesia option that you feared. If this concern has kept you from scheduling an appointment with a RE, then by all means schedule one and be completely honest about your concerns.
I asked this question of Dr. Cappy Rothman on the September 10, 2008 Creating a Family radio show. He recommends Male Fertility Supplement by Coast Reproductive. I have done no independent research on the efficacy of this supplement and would also caution you to discuss this with your husbands urologist, and if he decides to take it, make sure to tell your RE and embryologist.
I posed this question to Dr. Cappy Rothman on the Sept. 10, 2008 Creating A Family radio show. He responded that vasectomy reversals are quite successful, and although success does depend on time, you could expect a good result after eight years. However, vasectomy reversals are not a quick fix and given your wife’s age, time is not on your side. Dr. Rothman recommended that you consider a sperm aspiration followed by IVF. A sperm aspiration can be done under local and you should get enough sperm for several IVF attempts. To hear his response and not rely on my paraphrase, listen to the Sept. 10, 2008 show on the radio page.
Dr. Marcelle Cedars answered this question on the Aug. 13, 2008 Creating a Family internet radio show. She said that with treatment, PCOS patients have about the same chance of getting pregnant as someone without PCOS. You can listen to this show by going to the radio page of this website.
The list of clinics I referred to is the CDC list that tracks success rates for IVF. (Go to my Infertility resource page and click on success rates.) Unfortunately, they don’t track success rates of egg freezing, probably because it is still considered experimental.
I don’t know of an independent source for the success rates or how many egg freezing cycles a clinic does, but this is how I would approach it. First, I assume if you listened to the April 30, 2008 Creating a Family show, you understand that the odds are not necessarily in your favor, and you shouldn’t postpone a pregnancy with the expectation of sure success. Second, if it were me, I’d be interested in going to a clinic whose clinicians are publishing in the peer reviewed journals on egg freezing. I list a couple of these articles under “egg freezing” on my infertility resources page. The hard part is getting access to these journals. You can probably rely on just the abstract, which are more readily available on the internet through a simple google search. If you can access a university library e-journal collection, that is your best bet to get the full articles. If not, most public libraries have access to a some medical journals for free. Ask them to do a search for you. Make sure to look for the most recent research. Then call the clinics the authors are associated with and ask how many cycles they did in the past two years and what their success rate is. The problem you will run into is that most people who freeze eggs don’t want to thaw and use them within just a few years, so pregnancy rates may be hard to come by.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, other than missing your period there really are no reliable physical sign of pregnancy that come up that early. A few woman may have an implantation bleed, but that is not a reliable predictor. I include a rating of the sensitivity of OTC pregnancy tests under Infertility Resources on this website. You can listen to the Sept. 17 show at the radio page.
I’ve posed this question to two experts on the radio show Creating a Family: Dr. Cappy Rothman, board certified urologist and specialist in male infertility, on the September 10, 2008 show on male infertility and to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Infertility 101 show. Dr. Rothman recommended relying only on your own lubrication since it is the perfect environment for sperm. If a lubricant is needed, Dr. Hoffman suggested either Pre-seed, Astroglide, or the liquid base form of KY Jelly. Do not use any lubricant with a petroleum base. Both doctors recommended against using egg whites.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, studies have shown that being overweight reduces fertility, but only when your Body Mass Index exceeds 34. You can listen to this show at the radio page.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, the OTC ovulation predictor kits are all about the same. The kits available by prescription are able to predict ovulation within a narrower range of time, but for most people, this is not necessary. You can listen to this show at the radio page.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, raising your hips will not increase your odds of conception. Just lying down after sex is enough since the vagina is tipped already and cervical mucus around ovulation acts like a wick to draw the sperm up into the cervix. You can listen to this show at the radio page.
According to Dr. David Hoffman, board certified reproductive endocrinologist and past-president of the Society for Assisted Reproductive Technology, on the Sept. 17, 2008 Creating a Family radio show, it is best to make love every other day during the woman’s fertile time of the month. Sperm count is optimal with between 2 and 5 days of abstinence. I list resources for tracking the time of ovulation under infertility resources of this website. You can listen to this show at the radio page.
According to Dr. Robert Stillman, Medical Director of Shady Grove Fertility Center and Professor of Medicine at Georgetown Medical School, the answer is no. You can of course monitor through ultrasound and cancel a cycle if too many eggs mature, but many women are hesitant to go forward knowing that they may well have to cancel the cycle. IUI with injectable ovulation stimulating drugs are the primary source for higher order multiple births (triplets and up). Dr. Stillman said that the ASRM and SART have not issued guidelines for how to safely do this procedure because they don’t exist. There are too many variables to accurately predict how many eggs will mature the first time. Dr. Stillman recommends being prepared to either cancel the cycle if more than a few eggs are produced, or convert the cycle to an IVF cycle. Of course, this answer does not take into account the very real possibility that the reason a couple is doing IUI with injectables in the first place is that they either can’t afford an IVF cycle or have ethical objections to IVF. In many ways, these couples are between a rock and a hard place. To hear Dr. Stillman’s full response, listen to the Jan. 14, 2009 Creating a Family show.
Good question. In the past, transferring at 3 days was the standard. Now that culturing medium and embryologist skill are advancing, it is possible to grow the embryos to the blastocyst stage at day 5. The problem is that many embryos don’t survive the 5 days in the Petri dish, so some reproductive endocrinologists are now recommending transferring more embryos, but doing it at the 3 day mark. Other embryologist, think that the natural selection that takes place in the Petri dish from day 4 and 5 makes for stronger embryos more likely to implant and grow into a baby. I have heard both views on the Creating a Family show. To hear an articulate assessment of the transfer at day 3 argument, listen to the September 17, 2008 Creating a Family show where I interviewed Dr. David Hoffman, Board Certified Reproductive Endocrinologist with IVF Florida and past president of the Society for Assisted Reproductive Technology (SART), about the most common myths surrounding infertility and IVF. The argument in favor of day 5 transfer is expressed by Dr. Robert Stillman, Medical Director of Shady Grove Fertility Center and Professor of Medicine at Georgetown Medical School on the Jan. 14, 2009 Creating a Family show.
As a general rule, it should cost you nothing as the donating couple. The receiving couple picks up all testing and shipping costs, and often your past cryopreservation (frozen storage) costs. It is not possible to recoup any of your infertility costs. Listen to the Jan. 28, 2009 Creating a Family show on embryo adoption. We addressed the costs for the donating couple at length. Also, the May 28, 2008 Creating a Family show was devoted entirely to the topic of couples deciding to donated their unused embryos.
We did a Creating a Family show on male infertility on September 10, 2008 where we covered some of this information. (You can find the show link on The Big List .) I would assume that your RE is suggesting IVF combined with Intracytoplasmic Sperm Injection (ICSI). This procedure, where a single sperm is injected into the egg, has revolutionized the treatment of male infertility since very few sperm are needed. Most REs still recommend that men refrain from smoking, drinking, hot tubs and other activities that can increase the temperature of the testes such as wearing tight bike shorts or long bike rides.
I’m sure that I’ll get into trouble with the manufacturers of male fertility supplements, but if you are right about the cost, I would save my money since very few sperm will actually be needed for ICSI. That is, however, just my opinion.
Each clinic has their own rules, but I can tell you that most clinics would not exclude you. Let me suggest a couple of Creating a Family radio shows that I think would be helpful. The May 20, 2009 show on fertility tourism and the July 8, 2009 show on surrogacy. You might also want to watch the Creating a Family video on Surrogacy and our surrogacy page at this website.
Infertility 
