Welcome to the FAQ section of the Sims Patient Resource Area.
It is in this section that we hope to address the kinds of questions that ordinarily cannot be answered in the main section of any IVF website.
The team have worked together to prepare some of the more frequently asked questions we receive from patients, however we welcome contributions from all patients as it is your needs we hope to address. We have split the queries, into two sections, medical and non-medical. We hope you find this content useful during your treatment with us and encourage you to provide feedback and highlight gaps in the information provided so that we can continually enhance this resource.
Q: I have been experiencing some vaginal bleeding (slight spotting) while on the pill (OCP). Should I stop?
A: No. Breakthrough bleeding while on OCP is actually quite common, and not generally worrisome unless it becomes very heavy or lasts more than 7 days. Please call the clinic if you are concerned.
Q: I have had a brown discharge while on Crinone Gel / Cyclogest. Is this normal?
A: Brown discharge on Crinone Gel/Cyclogest is regarded as normal, unless this discharge becomes bright red or becomes a heavy bleed.
Q: I have been asked to bring a Flagyl suppository to my egg collection procedure. How do I administer it?
A: Do not worry. The Flagyl suppository will be administered by the doctor during the egg retrieval procedure while you are sedated, so you do not have to self-administer this.
Q: My partner is having an egg collection and I will be producing a sperm sample that day. At what time will I be required to produce the sample on the day?
A: Once the female is taken to theatre, the male will be taken to the collection room to produce the sperm sample.
Q: My doctor has requested that I complete a list of tests and investigations. When will I get my results?
A: In many cases, we will proceed with an outline plan of treatment from the initial consultation and your doctor may recommend testing or investigations to be performed in addition to the plan. However, even in these circumstances we will review your results one month after this to modify or fine tune your planned treatment. Do not worry about waiting for these results. If any results require urgent attention, you will be informed by your physician immediately.
Q: If my period starts earlier or later than I expected, and I started OCP (“the Pill”) earlier or later than expected, will the dates of my treatment cycle need to be changed also?
A: No, the treatment outline that you have been given will usually still be followed.
Q: What are my chances of succeeding in having family?
A: Most patients who have fertility treatment will ultimately succeed - and of the minority who do not, most will get a diagnosis to explain why things have not been working. It should be noted that the process of fertility testing has many limitations. This means that some couples will require at least one cycle of IVF in order to discover important information about reproductive function.
Q: Does lifestyle matter?
A: With the exception of some major and profound issues like few sperm or poor egg quality, the answer is yes. Many studies have reported that stress can significantly affect reproductive outcome. This means no smoking and that alcohol should be limited to less than three units/wk (for both male and female). Caffeine or painkillers (except paracetemol for the female) should probably be avoided. It is also worth considering a fertility supplement for both male and female, (such as NHP Fertility Plus).
Q: What abstinence period is required when males produce their sample at Sims IVF?
A: It should be between 2-4 days for all samples. This is an absolute requirement for DNA fragmentation, because if this is not followed the appointment will have to be rescheduled.
Q: Can I have intercourse while I’m in the IVF programme?
A: To reduce the risk of ovarian torsion, it is recommended to avoid sexual activity if you are on stimulation medications. You will not be comfortable yourself because of growing follicles and the tenderness associated with enlarged ovaries.
Q: Does weight matter with regards to my chances of achieving a pregnancy?
A: There is strong evidence to suggest that extremes in BMI (body mass index) will adversely affect IVF success. If you are either extremely underweight or overweight, please talk to your doctor about ways to address this safely under medical supervision.
Q: I am finding fertility treatment very stressful. What can I do to help my anxiety?
A: Stress certainly antagonises fertility treatment; during IVF many patients explore acupuncture or meditation and these may actually improve reproductive outcome. You can also access the clinic counsellor who can discuss stress reduction techniques and coping mechanisms. Sometimes just speaking to someone can help! Sims IVF also offers a mind/body programme. Have a look at the mind/body programme link on our homepage.
Q: I know that every women trying to conceive should be on Folic acid. How much folic acid should I be taking?
A: Usually 400 mcg/day unless you have a condition called MTHFR. You can obtain folic acid from your pharmacist.
Q: How much exercise should I be taking while I am on the IVF/ICSI programme.
A: While you are on your stimulation medications until your pregnancy test you are advised only to take light exercise, moderately brisk walking.
Q: Do I take all of my medications on the morning of embryo transfer?
A: Yes, apart from the Crinone gel if it is prescribed. Depending on the time of your transfer you can either take the morning dose of Crinone afterwards or just wait and take a single dose that evening.
Q: Will I get a call every day regarding the progress of my embryos?
A: No. We have found over the years that contacting patients on a daily basis with updates on their embryos actually increases the stress of treatment and as such we have a standard protocol in place to try to minimise that stress.
DAY 3 Transfers.
If you are having a Day 3 transfer then you will be contacted by the laboratory on Day 1 with your fertilisation results (Egg collection day is regarded as Day 0) at this point you will be given an embryo transfer time for two days later. The laboratory will not contact you again before you attend for embryo transfer unless there is a problem with the embryo development. A member of the embryology team will then come and chat to you prior to your transfer about the stage and quality of your embryos.
If you are having a Blastocyst transfer then as with day 3 you will be contacted by the laboratory on Day 1 with your fertilisation results (Egg collection day is regarded as Day 0). At this point you will be informed of an approximate time that an embryologist will call you on Day 4 (3 days later). The reason we wait until Day 4 to call is that there is a significant developmental transition for the early embryo between Day 3 and Day 4 and we can provide you with more accurate and detailed information regarding your embryos once we have observed this transition taking place. On Day 4 an embryologist will call you with an update. However, with blastocyst cycles, the embryos decide the transfer time which may be Day 5 (the next day) or Day 6 (two days later). If the embryologist advises you that your transfer will take place on Day 5 they will give you an embryo transfer time. If the embryos require an extra day of culture, the embryologist will organise to call you the next day with your embryo transfer time. There is no way to predict the embryo transfer day in blastocyst cycles in advance with around 15% of cases requiring day 6 transfers.
You would be advised of any changes to the above schedules by the embryologist calling you on Day 1 with fertilisation results.
Q: Can I produce my semen sample offsite?
A: Possibly. It is very strongly encouraged by Sims that all males produce their samples for analysis or treatment in the clinic. This is to ensure that the sample reaches the laboratory in the shortest possible time with little chance of problems occurring. However, Sims understands that it may be impossible for some men to produce a sample onsite and in those cases alternative arrangements will be made. Unless there is an underlying medical condition it is however usually recommended that the male try producing his first sample onsite at Sims and only then if he is unable to produce will the alternative arrangements be discussed.
Q:Will the embryo transfer hurt?
A: Not normally. If you have had an SIS without issue then it is unlikely that there will be any complications at embryo transfer. The procedure itself should only last between 10-15 minutes. It is similar to having a smear test done so whilst not perhaps the most comfortable procedure there should be no pain. If your SIS raised any issues then you will be given medication to help relax you and prevent you feeling any discomfort at transfer.
Q: I've been told I need a full bladder for embryo transfer. How full is full enough?
A: This differs for everyone, however the recommendation is to empty your bladder around 2 hours prior to your embryo transfer time then drink a litre of water/juice soon afterwards. You should then top up your bladder as you feel necessary over the next two hours. By the time of your embryo transfer you should feel as if you could go to the toilet if you were asked to but you shouldn't be so full as to be uncomfortable. If you drink too much or your bladder fills too quickly then please go to the toilet and release the pressure but try not to empty your bladder completely and you can always drink some more to top up if needs be. As with all medical procedure there can be delays if a previous patient has complications. Again in these cases if you are delayed please manage your bladder accordingly and go to the toilet to release some urine if needed. In these situations please do not wait for a member of staff to ask if your bladder is too full as they will not know how comfortable or uncomfortable you are. If in doubt please ask one of the nurses!
Q: Can my partner attend the embryo transfer?
A: Yes. Partners are encouraged to attend and are welcome to stay for the whole procedure or they can leave after the discussion regarding the embryos with the embryologist.
Q: Can I drive myself home following embryo transfer?
A: In most cases yes, unless you are advised beforehand that you will be given medication for your transfer. However, in rare cases (<1%) unforeseen complications do arise where we may have to give some medications to help with the transfer. Therefore, you should always have an alternative travel plan in case of this eventuality.
Q: It's after 4:30pm and the phones at Sims clinic are off for the night. I haven't received the call I was expecting regarding my embryos. What should I do?
A: Don't panic! Although the phones are only in service until 4:30pm, there is at least one member of the embryology team working until 7:00pm and you will get your call. On busy days, as you can appreciate, looking after the embryos takes priority over phone calls and as much as we will try to call you as early as we can, sometimes a call before 4:30pm is just not possible. Please do not call the medical emergency number because you have not received your phone call from the lab as a member of staff will stay and finish all calls regardless of how late that might be.
Using Donor Sperm or Donor Egg
Q: How do we choose a sperm donor?
A: You provide characteristics on the provided donor sperm characteristics form and return it to the clinic. The Laboratory Manager will then allocate a donor to you based on the information you have provided. If there are any issues with this process then he would be in touch with you.
Q: Can we choose our own sperm donor.
A: No. Unfortunately there are many confounding factors in donor selection that currently prevent us from allowing patients to choose a donor themselves. These include but are not limited to:
- Donor sperm samples are available in many different qualities and come prepared for use or unprepared. Each type of treatment requires differing amounts of sperm based upon the quality of the sample available with some samples being completely unsuitable for a specific type of treatment.
- A sperm donor may have reached their pregnancy limit in Ireland.
- A sperm donor may not have reached their pregnancy limit but may be close to it and be allocated to another patient. In this case a clinic would be reluctant to allocate to any additional patients.
Only the Laboratory manager will have all of the relevant information at their disposal in order to make an appropriate selection.
Q: Are all sperm donors anonymous?
A: No. There are two types of donor, anonymous and identifiable (non-anonymous). An anonymous donor will, as the name suggests, remain anonymous to both you and any children you have through the use of his samples. An identifiable donor will be anonymous to you as parents but any child born through use of his samples can, if he or she wishes, at the age of 18, be provided with identifying information. This Identifying information can then be used to trace the donor or obtain further details.
Please note that Identifiable donors come at a significant increased cost to anonymous donors.
Q: What information is available about the sperm donor?
A: There are two different types of both anonymous and identifiable donors. Those with just a basic profile and those with an extended profile.
The information available on a basic profile sperm donor comprises of: Hair colour, Eye colour, Height, Weight, Blood group and Occupation at time of donation; NO other information is available to either Sims as a clinic or to you as patients.
The information available in an extended profile is much more detailed, comprising of several pages of both physical characteristics and insights into the donor's personality.
Extended profile donors are more expensive than basic profile donor by approximately 30%. By default, all donor selections at Sims will use donors with basic profiles. If you wish to use a donor with an extended profile in your treatment at Sims then please make your wishes known to the staff.
Q: Will the sperm donor be used exclusively in my treatment?
A: No. The samples which are allocated to you will be used exclusively in your treatment but other patients (either at Sims or in another IVF clinic) may also be using the same sperm donor.
Q: How long does it take to order sperm from my donor?
A: It depends on your requirements. If you have any specific requests or you wish to use a donor such as an identifiable donor or a donor with an extended profile, which are both in shorter supply but higher demand, then it make take longer to find you a suitable match. However, most donor selections currently take no longer than 8 weeks to complete and most take in the region of 4 weeks. The one exception to this is where an Identifiable donor with an extended profile is required as these donors are currently in extremely short supply. Suitable matches are extremely difficult to make with this donor type and you may need to be more flexible in your requirements to avail of one. If you request this type of donor, then Sims IVF can make no commitment to a timeframe regarding donor availability, which will normally take far longer than 8 weeks.
Q: If I am successful, how do I reserve sibling sperm samples for future use?
A: If you are successful in your treatment and wish to reserve further sibling donor sperm samples, the first thing you should do, as soon as you are ready to do so, is contact the clinic. Sibling samples are reserved directly with the sperm bank and are not brought over to Sims until required for use. This is for several reasons:
- You are advised to reserve as much sperm as you think you may require for all future treatments. The more children you wish to have the more you should reserve. It is impossible to predict how many attempts it will take to achieve your goals; for 1 further child it may only take 1 more attempt or it may take several. If you complete your family and still have straws reserved in storage with the sperm bank, they will be happy to refund you 75% of their cost as they can then re-sell them to other patients. If samples are brought over to Sims then there would be no possibility of a refund in the future.
- Sims does not have space to store all of these samples long term. As time goes on and more and more patients have successful outcomes, more and more require to reserve sibling samples. Patients do not necessarily come back for further treatment immediately and as such sibling samples tend to be stored for several years. Sims has a small storage facility but this would not be able to cope with the volume of samples that patients would require to store long term.
- If for whatever reason you decided to change clinic (for example you move home or even emigrate) it is a more straightforward and less costly process to ship the samples to your new clinic from the sperm bank rather than from Sims.
Q: Can I change my sperm donor?
A: Yes. But how often depends on which treatment you undergo. If you have IVF or ICSI treatment then only enough donor sperm for a single treatment attempt will be ordered in for you. This means that if the treatment unfortunately unsuccessful then, if you wish, you can request that the donor be changed on your next treatment attempt. If however you are undergoing IUI treatment then we order enough sperm in for 3 IUI treatment attempts. This means that you can only change donors once you have completed 3 rounds of IUI (you can change your donor sooner than this but this would be at your own cost and would delay treatment).
Q: Can I use someone known to me as a sperm donor?
A: No. Sims are not licensed to procure, process or store sperm for donation.
Q: I have sibling samples stored at another clinic. Can I ship them to Sims for treatment?
A: Possibly. If a donor is still available with the sperm bank and that sperm bank is on the license of Sims IVF, then normally the cheaper option is to purchase new straws. If straws are unavailable from the sperm bank, the clinic is within the EU and is licensed under the EU cells and tissues directive then it should be possible to transfer the samples. For unlicensed clinics within the EU and for those clinics outside of the EU it may or may not be possible to ship the samples and this will be considered on a case by case basis.
Sims IVF will not accept donor sperm samples under any circumstances from another clinic unless they are for sibling use, i.e. you must have already had at least one child using the donor before we would consider shipment.
Q: I have been asked to sign a consent form regarding donor sperm/eggs. I'm concerned because it states that there is a risk of contracting an infectious disease when using donated samples. What are these risks?
A: Whilst all donors are tested for communicable diseases there is no way to eliminate 100% of risk. Providing you with this information is in part a legal requirement and although the risk is minimal, we would be negligent in our care of you if we did not inform you and receive your informed consent.
For example, most HIV-tests measure the antibody to HIV in blood. However, after initial infection, antibodies take several weeks to develop to a level where they can be detected in an individual’s blood. That’s the reason why donor sperm must be keep in quarantine for 6 month after donation and would not be released for use until after the donor is retested at this time. After 6 months probably >99% of infected individuals (nobody know the precise figure) would seroconvert and would come back positive in the test. However, a tiny percentage of individuals do not seroconvert, even after 10 years.
For egg donation, our testing regime is different and tests for the DNA/RNA of the virus rather than the antibodies produced in response to it. This means that the test can be performed reliably at a much earlier stage and the triple testing regime developed by us at Sims IVF is the gold standard by which other clinics within the EU are recommended to be measured.
Another risk is the test-method. There is always a risk of “false negative” results. This is inherent in any testing regime and since no test is 100% efficient is outwith our control.
Finally there is a risk that test-results are mixed or wrongly recorded by staff, either at the test laboratory or by us. However, there is a double witnessing process in place in all laboratories and institutions that Sims IVF works with and indeed at Sims IVF, so the risk of such failures is extremely small.
Q: Is there a risk of a donor (sperm or egg) passing on a genetic disease to a child?
A: There is of course a risk of transmission of hereditary diseases from a donor to a child as there is from a recipient to a child. However, the risk is no higher from a donor than the risk within the general population and is arguably less. In the general population about 2-3% of all children are born with an issue caused by their genetics. However, this number increases to 5-6% when issues are discovered as a child gets older.
All donors are tested to ensure a normal chromosomal complement (46XX for females, 46XY for males) but we cannot and will not screen for any or all genetic diseases unless there is a reason to do so. For example, if we know a male is a carrier of a genetic disease and his sperm were to be mixed with the eggs of a donor, we could test the donor for that disease to minimize the chances of an affected child. However, if the male has no reason to believe he is a carrier then the donor would not be tested.
If you are aware that either you or your partner is a carrier of a genetic disease it is imperative that you inform your doctor of this at the earliest possible opportunity.
Q: How do I claim back tax back on my medical expenses?
A: Once all invoices have been paid, you can send in copies of all your invoices/receipts for that year along with the attached Med 1 Form. Any information also needed, will be on the link below. http://www.revenue.ie/en/tax/it/leaflets/it6.html
Q: What are the payment terms of our European Egg Donation Programme?
A: The first installment is due after sperm freeze and before sperm shipment. When the selection of your anonymous oocyte donor is complete, the second installment will then be due.
Q: For non-donor cycles, when does the deposit of €1200 have to be paid & when does the balance have to be paid?
A: The IVF deposit is paid when the provisional dates of your IVF cycle have been established. The balance is due at the time of your baseline scan. Please note that you cannot be confirmed for an egg retrieval until the IVF balance has been settled in full.
Q: What payment types are accepted at Sims IVF?
A: Sims Clinic can take payment of cash, personal cheque, bank draft, bank transfer, and credit card/laser card.