Ask the Expert recap: Dr. Hirshfeld-Cytron

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A few months ago, we were fortunate to have Dr. Hirshfeld-Cytron, board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility with Fertility Centers of Illinois, answering member questions about surrogacy. 

Question: What is the biggest challenge intended parents face when going through infertility/IVF? What are your words of wisdom to all of your patients? - @Tisha

Dr. HC: I think the stress of trying to do "everything" right - as you can appreciate, a lot goes into this. Wisdom in early pregnancy is to take things day by day not week by week or month by month. Every day in early pregnancy is a BIG day!  For surrogates: RELAX. You are giving a HUGE gift to IPs, and most medications have wiggle room!

Question: Does in vitro fertilization put a woman at increased risk for anything? Could a pregnancy conceived via IVF impact a woman's future fertility? - @Kristina F.

Dr. HC:  There is some suggestion that there is a higher risk of hypertensive disease in pregnancy and cesarean section. Low dose aspirin in pregnancy for the gestational carrier is something to ask your doctor about to prevent hypertensive disease.

There is some thought of higher risk (although very low) isolated birth defects although this remains debated because infertility (majority reason IVF used) in of itself may hold higher risk of isolated birth defects. 

Follow-up: Thank you for your response @Dr. Hirshfeld-Cytron . I'm often asked if the various medications that are often part of an IVF protocol can impact future fertility negatively. For instance, would a pregnancy achieved at this time via IVF make conceiving naturally in the future if another pregnancy were desired harder?

Dr. HC: In general, there is no future impact on fertility.

Question: What is the likelihood an embryo would split after the transfer and does the quality or genetic testing of that embryo change that likelihood? - @Ashtin G

Dr. HC:  Great question! The risk is <1% and no, PGT (preimplantation genetic testing) doesn't change that. There was some thought in the past that AH (assisted hatching) increased the risk of certain types of twins but that is no longer clear by the data. 

Question: Can you explain the medications a gestational carrier may have to take, why she takes these, and if there are any common side effects from the medication? - @Tisha

Dr. HC:  Typically a gestational carrier takes medications to prepare the body for pregnancy. Initially, she takes something to suppress or prevent ovulation so the meds can create the optimal environment. This includes OCP (oral contraceptive pills) and Lupron. Side effects can be mood, headaches, and/or breast tenderness.

Estrogen is delivered as patch or oral or vaginally, and has similar side effects to OCP and Lupron (above).

Progesterone is delivered by injection or vaginally. Injection can create discomfort to the area when placed; ask your IVF nurse for tips! When delivered vaginally, progesterone can cause discharge. Progesterone itself can create symptoms described above and sometimes constipation.

Question: How many IVF cycles will a gestational carrier realistically need before achieving a positive pregnancy test? - @Ashtin G

Dr. HC: Realistically - I would suggest to plan for two IVF cycles.

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