UT Health Physicians

General ART Questions & Answers

Does ART damage the ovaries?

There is no evidence to suggest that oocyte retrieval damages the ovaries. There have been reports which suggests that infertile women who take fertility drugs and do not get pregnant have an increased risk of ovarian cancer. However, the control (comparison) populations may not have been selected accurately. The fertility drugs used in ART have been in use over 30 years, and other studies have suggested no increased risk.

Why is the success rate with ART low?

Studies of human reproduction indicate that for a couple with proven fertility, the likelihood of conception is only 20 percent per month. In couples with infertility, they still may have a chance of conceiving spontaneously, but it may only be 2-3 percent per month. ART affords couples with infertility factors higher chances for conception than the age-related expected fertility rate for conception per month.

We’re concerned about multiple births from ART. Should we just have one embryo transferred?

For most patients undergoing ART, transfer of a single embryo is likely to be recommended to reduce the risk of a multiple pregnancy. With the transfer of just one embryo, there is still a risk of multiples as that single embryo can split to create identical twins. This happens approximately 2% of the time. Any time more than one embryo is transferred, the chance is increased further for a multiple pregnancy.

The potential benefit of transferring more than one embryo needs to be balanced with the risk of a multiple pregnancy. Twin pregnancy and other high-order multiple pregnancies (three or more fetuses) significantly increase the risk of complications for both the mother and the babies. In a twin pregnancy, almost 3 out of 5 are born preterm (<37 weeks gestation). About 1 in 4 are admitted to the neonatal intensive care unit (NICU). They are 4 times more likely to have cerebral palsy and more likely to be stillborn, experience neonatal death, have birth defects, and have autism than single babies.

Due to a recognition of the risk of multiple pregnancy and the impact of transferring more embryos on this risk, the American Society for Reproductive Medicine developed guidelines for the number of embryos to transfer in ART. Subsequently, the rates of IVF twin births have fallen considerably from over 30% in 1998 to only 9.7% in 2018. High order multiple births fell from 7% to 0.2% over this same time frame.

Although we do not directly offer it, selective reduction may be available to couples who conceive multiple gestations. Unfortunately, this procedure may result in the loss of all fetuses and it does not completely eliminate the risks associated with multiple pregnancy. We can provide you with more information about this procedure.

Is there an increased chance of birth defects if I become pregnant through ART?

No. The risk of congenital anomalies in children conceived through ART is the same as the risk in the general infertility population. Chromosome abnormalities, such as Down syndrome also occur at a rate similar to the general population.

I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?

Although surgical reversal of tubal sterilization may be an option, IVF is a good option, especially in older women or in couples with male factor infertility. The overall success rates are similar for ligation reversal and IVF, although the results of IVFT are obtained more rapidly than ligation reversal. If ligation reversal has been attempted and has failed, IVF represents the best option. Cost and other factors involved in surgical reversal must be considered when making this decision.

Does insurance cover the procedure?

Unfortunately, most insurance plans do not cover ART procedures. Some programs cover portions of the therapy. Our staff would be happy to help you determine your level of coverage. We strongly recommend you do this prior to starting ART therapy.

How many days does the entire procedure take?

The entire procedure takes up to six weeks. However, we only need to see you intensively at the UT Health Physicians Fertility Center over a two-week period. These details are discussed here.

Can we have intercourse while attempting ART?

Yes. We recommend that the man abstain from ejaculating into the vagina for at least 72 hours preceding egg retrieval. Near the time of egg retrieval, the ovaries can be enlarged and tender, which can make intercourse uncomfortable.

What if I ovulate before the retrieval?

Virtually all cases of premature ovulation are now prevented by the appropriate use of medication to suppress ovulation. In rare cases in which ovulation suppression is not used, we perform an ultrasound prior to retrieval to make sure the follicles are intact. In the uncommon case of ovulation, we will not perform retrieval because the quality of the remaining oocytes is affected adversely.

Will scar tissue around my ovaries make it impossible to retrieve oocytes?

The oocytes can usually be retrieved by transvaginal aspiration even when the ovaries are covered with scar tissue. In rare cases, scarring pulls the ovaries out of the normal pelvic position. This condition can be identified before ART with ultrasound.

How much activity is recommended after ET?

We recommend a fairly quiet first 24 hours after embryo transfer. Thereafter, most patients resume their normal routines. Strenuous exercises should be avoided until a pregnancy test has been performed.

After embryo transfer, how long must we wait until we have intercourse without risk to the embryo?

No one knows for sure. We recommend abstinence for a minimum of 48 hours after transfer.