Policies & Procedures

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1. Are the procedures involved in IVF painful and am I awake during these procedures?
   
   The preparation for an IVF cycle includes the drawing of blood for various precycle laboratory tests and also an evaluation of the cavity of the uterus called the saline sonogram which can be done in your gynecologist's office and with minimal discomfort. Once you are ready to start the IVF process you will start on birth control pills followed by two to three weeks of injectable medications. Almost all of these injections are now administered subcutaneously with a short needle and discomfort should be tolerable. After the embryo transfer there are intramuscular injections especially of progesterone which may be more uncomfortable and are required to be given in the upper outer quadrant of the buttocks.
   
   The main procedure involved in IVF is the egg retrieval and this is performed through the vagina with ultrasound and a fine needle. Patients at Zouves Fertility Center are asleep during this procedure and are cared for by a team of anesthesiologists who are available to us seven days a week. The procedure is known as unconscious sedation which is not a general anesthetic. Patients are not awake, they have no pain with this procedure and they wake up very quickly with the egg retrieval lasting 10-15 minutes.
   
   The embryo transfer procedure is a little different from a pap smear or a gentle IUI and very occasionally when there are specific problems with the cervix, a light anesthetic may be required for the embryo transfer.
2. How do I manage stress, grief and loss during a cycle?
   
   There is no question that the whole process of infertility represents a tremendous loss of control over what should be a basic function and this causes initially denial then anger and depression and adds to the stress of therapies like in vitro fertilization. At ZFC we have available to us Shelley Tarnoff, LMFT, JD, our Clinical Counselor. You will have the opportunity to speak with Shelley during the early stages of your IVF cycle so that you may best use certain practices and procedures to cope with the stress of assisted reproduction. In addition, Shelley is available to help during phases of grief and loss especially with a negative pregnancy test and also after pregnancy loss be it early on or unfortunately even later on in the pregnancy.
   
   It is impossible to eliminate stress completely and each one of us needs a certain amount of stress in our lives to keep us vital. The important factor is our response to this stress and we need to learn coping strategies which prevent us from reacting in a way that is detrimental to the whole aim of of therapy which is to establish and nurture a pregnancy.
3. What is the attitude of ZFC to alternative treatments like acupuncture and Chinese herbs?
   
   These alternative therapies have been available for many thousands of years and we support patients seeking these alternative therapies during in vitro fertilization. Acupuncture administered by an experienced practitioner who is aware of your participation in assisted reproduction can facilitate relaxation as well as optimize ovarian response and implantation. Under the guidance of an experienced practitioner, herbs geared towards assisting implantation and known to be safe in pregnancy are permitted bearing in mind that certain herbs are used to shrink endometriosis and fibroids and may not be appropriate when trying to establish an implantation. In addition, certain herbs may thin the blood and when added to aspirin and heparin may be potentially dangerous.
4. What is the policy of ZFC on storing embryos for patients?
   
   Patients who produce good quality embryos in excess of those used for the fresh embryo transfer can elect to have these additional embryos stored either as day three cleaved embryos or as blastocysts on day five or six. These embryos will be stored for a period of one year at which time we will ask the patient to make a decision about these embryos. If you plan to use these embryos for a frozen transfer, then this one year storage may be extended for an additional year while final preparations are made for the frozen embryo transfer. Patients who are uncertain about proceeding with the frozen/thawed transfer may elect to transfer their embryos at the end of one year to a permanent storage facility either here in California or in the Midwest where they will be held awaiting your decision.
5. What can be done with our frozen embryos if we choose not to do another cycle?
   
   Patients or couples with frozen embryos at ZFC may choose to use them, transfer them out to a permanent storage facility, or these embryos may be donated to science in which case they will never be used to make a baby or they may be donated to another couple working with ZFC who require both an egg and a sperm in order to be successful. These donations to other patients are anonymous and in keeping with our policy of nondiscrimination will be assigned to patients or couples after appropriate counseling and screening and with appropriate medical indications.