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IVF AND IUI

What should we ask our IVF doctor? Ask any clinic, including us.

Most couples leave a consultation with the questions they meant to ask still in their head. This is the list to take with you, stage by stage, and the reason each answer matters.

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Written by the Jananam editorial team. Reviewed by Dr Vani Sundarapandian, MD, DGO, FRCOG (UK)

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Key takeaways

  • An IVF cycle is a series of steps, and each step has a number you can ask for.
  • If a cycle fails, those numbers show where it stopped, and that decides what changes next.
  • Ask why this plan, what it costs in writing, and what the evidence is for every add-on.
  • A good clinic answers without being pressed, and explains twice if you need it.

The short answer

Ask for your own numbers at every stage: eggs collected and how many were mature, how many fertilised, how the embryos grew, and how many were frozen. Ask why this plan, what it costs in writing, which add-ons have evidence, and when you would stop. At Jananam Fertility Centre, Chennai, the doctor goes through these numbers with you.

01

What should we ask before starting IVF?

Ask whether you need IVF at all, and if so, why this plan for you.

Both of you should be tested first: ovulation, tubes, womb, egg reserve and a semen analysis. The results often change the advice, and sometimes point to something simpler than IVF. Blocked tubes, a significant sperm problem, low egg reserve or several failed IUIs point towards IVF; a short time trying at a young age often does not. Then ask why this protocol, what response is realistic for your age and reserve, and how many cycles to plan for.

Your first consultation, for both of youIUI or IVF: which one is for us?
02

What should we ask during injections and after egg collection?

How the follicles are responding, and then how many eggs were collected and how many were mature.

During injections, ask how many follicles are growing and whether the dose or plan is being changed. After collection, ask for two numbers, not one: eggs collected, and eggs mature. Only mature eggs can be fertilised, so the second number tells you more. If a cycle is cancelled before collection, ask why, what the scans and blood tests showed, and what would be done differently next time.

03

What should we ask after fertilisation and on transfer day?

How many eggs fertilised normally, how the embryos grew, how many are being transferred and why, and how many can be frozen.

Ask whether conventional IVF or ICSI was used, and why. Poor fertilisation points somewhere quite different from good fertilisation followed by embryos that stopped growing. On transfer day, ask what stage and grade the embryos reached, why this number is being transferred, how many are suitable to freeze, and how thick the lining was. Write the numbers down, or ask for them in writing.

Honest note

ICSI should not simply be viewed as automatically better IVF. (Dr Vani Sundarapandian)

Reading your embryo reportICSI and PICSI
04

Which add-ons do you recommend for us, and what is the evidence?

Ask this about every extra test or procedure, and ask what the evidence says for someone like you.

Add-ons are extras added to standard IVF, such as endometrial receptivity tests, embryo glue or some embryo tests. The UK regulator, the HFEA, rates each one against the evidence, and for most patients none is rated as proven to raise the chance of a baby. Some are used in specific situations. Ask what the add-on is for, what the evidence shows, what it costs, and what happens if you say no.

Honest note

We have used ERA in more than 750 patients in the past, but in our experience it did not improve live birth rates sufficiently for us to continue recommending it. (Dr Vani Sundarapandian)

IVF add-ons, and the evidence
05

What should we ask if the cycle doesn't work?

Where the cycle stopped, what that means, and what will change next time.

Few eggs collected, poor fertilisation, embryos that stopped growing and good embryos that did not implant are four different problems with four different next steps. Ask which one it was, and whether the plan changes. Ask when you can start again: Dr Vani's view is that the most common mistake is "Couples wait too long to resume treatment after a failed cycle." Ask, too, what would make the doctor recommend stopping.

IVF didn't work. What next?When to stop IVF
06

What should we ask about cost, people and support?

What the price includes, who does each procedure, and who you call between appointments.

Ask for the full price in writing, including medicines, freezing, storage and frozen transfers. Ask who will scan you, collect the eggs and do the transfer, and whether the lab is on site. Ask who to call with a question on a Sunday evening. If you don't understand an answer, ask again: no good doctor minds explaining twice. If explanations are always rushed, that tells you something about the clinic.

What decides the costThe Jananam Standard

At each stage, the number to ask for.

Take this to every appointment. Write the answers down, or ask for them in writing.

COLUMNS
  • Stage
  • Ask
  • Why it matters
STAGE
Injections
ASK
How many follicles are growing? Is the dose changing?

Shows how your ovaries respond, which guides this cycle and the next.

STAGE
Egg collection
ASK
How many eggs were collected, and how many were mature?

Only mature eggs can be fertilised.

STAGE
Fertilisation
ASK
How many fertilised normally? IVF or ICSI, and why?

Poor fertilisation needs a different change from poor embryo growth.

STAGE
Embryo growth
ASK
How many embryos, at what stage and grade?

Shows whether the problem, if any, came later in the lab.

STAGE
Transfer
ASK
How many are being transferred, and why that number? How thick is the lining?

Transferring more embryos raises the chance of twins, which carries risks.

STAGE
Freezing
ASK
How many were frozen, and on what terms?

Frozen embryos are future transfers without another egg collection.

SOURCE
Stages as described by the HFEA (UK fertility regulator), In vitro fertilisation (IVF).

When to call us

When to call us

  • You are starting IVF and want to go through these questions before cycle one.
  • You have had a cycle and were never told how many eggs were mature or how many fertilised.
  • You were offered an add-on and nobody explained the evidence.
  • A cycle failed and you were told to repeat the same plan without a reason.
  • Severe tummy pain, a swollen tummy with breathlessness, or heavy bleeding with dizziness after egg collection or transfer: call 108 or go to the nearest emergency department, then call us on +91 89399 94244.

Questions couples ask

Still unsure? Ask us on WhatsApp — a real person replies.

Am I entitled to a written summary of my IVF cycle?

Yes, it is reasonable to ask for one, and it is your own medical information. It should list eggs collected and mature, fertilisation, embryo growth, transfer and freezing. At Jananam you get it after each cycle. [CONFIRM]

What should I ask at my first IVF consultation?

Ask whether both of you have been fully tested, why IVF rather than something simpler, why this protocol, what response is realistic for your age and reserve, and what the full price is in writing.

How many embryos should be transferred?

Usually one, because each extra embryo raises the chance of twins, which carries risks for mother and babies. At Jananam: "We do not transfer more than two embryos under any circumstance. Single embryo transfer is preferred for tested euploid embryos at any age, and usually under 38 with a good blastocyst."

How many IVF cycles should we plan for?

There is no fixed number, so plan for the possibility of more than one. Frozen transfers from the same egg collection count as part of the same attempt, and the doctor should explain what your first cycle showed before the next.

Should both partners come to IVF appointments?

Yes, where you can. Decisions affect both of you, a male factor is part of the reason in about half of couples, and hearing the explanation together saves one of you relaying it.

Is it rude to ask for a second opinion?

No. A clinic that is confident in its plan will not object, and a written summary of your cycle makes a second opinion far more useful.

Dr Vani Sundarapandian

Reviewed by

Dr Vani Sundarapandian

MD, DGO, FRCOG (UK) · Founder, Jananam Fertility Centre

Written by the Jananam editorial team from guidance Dr Vani gives on our video channel, and reviewed by Dr Vani Sundarapandian, MD, DGO, FRCOG (UK), 20 years exclusively in reproductive medicine. Her positions are quoted in her own words.

Sources (4)
  1. HFEA (UK fertility regulator): In vitro fertilisation (IVF)
  2. HFEA (UK fertility regulator): Treatment add-ons with limited evidence
  3. HFEA (UK fertility regulator): Finding the right fertility clinic for you
  4. NHS: IVF

Where to next.

More on this topic

Bring your questions. We'll answer every one.

Send us your list on WhatsApp, or bring it to your first consultation. A real person from Dr Vani's team replies during clinic hours (Mon to Sat, 9am to 5pm. Sunday closed.).

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