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IVF Questions

The FSH hormone used for stimulating the ovaries to produce eggs comes in a cartridge loaded into a special pen dispenser. You dial up the injection according to the dose prescribed and press the plunger to administer the injection. The needle used for the injection is quite fine hence the injection generally does not hurt much. It does produce a mild pain at the injection sites. You will be advised by the nurse to alternate the injection sites to minimise pain and complications. Speak with the IVF nurse if you are concerned.

Most of my patients start their IVF journey around 3-6 weeks after consultation. This could be because you may need some tests repeated (for you or for your partner), you are awaiting registration and counselling with Monash IVF or you are simply waiting for your period to occur so that you can commence FSH injections. On some occasions, I will need to see you for a review consultation before I will prepare treatment instructions for IVF.

Once you have completed the registration process with Monash IVF, you will need to attend a mandatory counselling session. Multiple sessions of counselling are required if you are wishing to use donor sperm or donor eggs. As of the 8th of July, 2020, patients undergoing IVF treatment in Victoria will no longer be required to submit child protection order checks or police checks.

After counselling has been completed and confirmed, your prepared treatment instructions will be given to one of our nurses at Monash IVF who will work with you through the entirety of the cycle. We generally have a ‘team’ of 2-3 nurses that will be involved in your care during the treatment. A nurse will meet with you prior to starting the cycle, demonstrate how to administer the drugs, answer any questions relating to your timeline and help simplify the process of starting. You have an opportunity speak with me or my rooms nurse Sue at any time to help answer any questions before or during treatment.

Once the treatment cycle has been completed and a pregnancy test has been completed you have a few options. If the result is positive, we will monitor you weekly for pregnancy tracking, request an early ultrasound and I will see you for a review after your ultrasound scan.

If the result of the cycle is negative, please get in touch with my Richmond rooms so that I can see you for review as soon as possible.

Sometimes, with a negative result, you may wish to just simply ‘take a break’.

We understand this process and journey requires a lot of support and we are here to help you.

Broadly speaking, you normally require time off work on the day of the procedure. You will feel some discomfort in the form of mild pain, bloating and cramps for one to two days afterwards. You should take things easy but do not need to confine yourself to bed or couch. Go about your daily activities but no strenuous exercise for a week. If your work is quite physical, then you may need to take two days off work after egg pick up.

Chinese herbs or any other herbs used to improve fertility chances through various means including by improving endometrial lining are best avoided when you start the injections in a stimulated IVF cycle. The beneficial effects of herbs on fertility are mostly anecdotal however there are some small studies demonstrating some benefits. However their mode of action is likely complicated and it is difficult to know if there would be any clashes with the IVF medications. In certain situations where growing an adequate lining proves to be very difficult despite trying all known medical formulations, herbs may need to be taken as there are no alternatives. At other times, herbs are probably safe when taken outside stimulated cycles or when using frozen embryos.

Yes you will be able to use these embryos at Monash IVF. Firstly you will need to organise for the embryos formed at other IVF centres within Victoria or Australia to be transported to Monash IVF. You will need to notify the other IVF centre of your intention to do so and sign some paperwork for the transferring process. You will also need to inform Dr. Leong of your plan to transfer these embryos so that the embryology department at Monash IVF will be informed about it.

It is not uncommon to feel pregnancy-like symptoms days after transfer because of some of the hormones you are using at the time. It is best to wait until the nominated date for a blood test to confirm pregnancy. Having the test earlier would lead to a false result.

The short answer to that question is 'NO'. This is a complex question and must be answered taking into consideration your unique individual situation. In Australia, many IVF centres would routinely transfer at the most two embryos back at any given time. However at Monash IVF, 80% of embryo transfers are single embryos. Our pregnancy rates per egg retrieval cycle using single embryo transfer of day five blastocyst are around 50% for women younger than 35 years old. Hence we now recommend that most women should have a single embryo transfer particularly if they have blastocysts cultured. Furthermore, pregnancy rates do not improve significantly even if two blastocysts are transferred and the rates for twins are unacceptably high. A twin pregnancy is a high risk pregnancy with increased risks for preterm birth and prematurity. Having said all of that, there may be instances where double embryo transfer may be warranted. Please speak with Dr. Leong.

You should be taking a reputable brand of multivitamins for pregnancy containing a safe dose of folic acid, iron, calcium and others. A preconceptual or pregnancy multivitamins is specially formulated for pregnancy. You should start this when you are trying to conceive. For the male, there are a few brands of multivitamins on the market and they contain anti-oxidants that may help to improve sperm function and quality. Please check with your pharmacist.

Laparoscopy questions

Generally speaking, you will require two weeks to recover from most laparoscopic surgery. Occasionally the recovery may be longer if there have been bladder or bowel resections. For simple and straightforward cases, a week off work may be all that is required. Recovery does not mean being bed bound. You should have a restful time at home in the first week. No lifting or bending forward during this time. You should be fairly mobile at home though. During the second week, you should attempt to take short walks around the house or block. If you want to resume sexual intercourse or your gym workout, please get clearance from Dr. Leong at the post-operative review visit. Please bear in mind that every case is different so please speak with Dr. Leong first.

You should still have the dressing left on for the incision site at the belly button. The dressing should be left on for a week. The other sites are usually closed with a tissue glue called dermabond. You should be able to feel the glue and see a bluish transparent sheen over the scars. You can shower normally with the dressing on and the glue attached. Do not rub or scrub the scars. Dab dry after the shower. The dressing at the navel will likely fall off in a week's time. If not, please peel it off. For the sites covered with dermabond glue, you do not need to do anything to them. The glue will come off in two to three weeks' time.

This is a common problem after laparoscopic surgery. It is due to the trapping of gas and irrigation fluid under the diaphragm after surgery. The fluid and gas irritate the diaphragm which has the same nerve supply for sensation as the patch of skin over your shoulder. So the irritation causes referred pain from the diaphragm to the shoulder. Whilst Dr. Leong will do his utmost to release all the gas and suck out the fluid after the surgery, unfortunately, gas and fluid do still remain trapped between the bowels and diaphragm. Once the gas is reabsorbed by the body in a few days time, the referred pain will disappear.

There is always a risk of laparoscopy turning into open surgery especially if complications were encountered or access into body cavities difficult due to severe adhesions or scarring. So, yes you should be prepared for the possibility of a larger cut on the abdomen if open surgery is performed. In reality, the actual chance of this happening is low depending on the surgeon, the nature of the case, the type of surgery performed and the patient's past history of abdominal or gynaecological surgery. Approximately 1% to 10% of laparoscopic cases may convert to open surgery. 

Applying antiseptic or any healing creams are generally not necessary after the dressings come off. Sometimes these creams may act as an irritant and actually make the scar worse. Once the scars have completely healed up (up to six weeks post operation), you could apply a moisturiser to soften them up. Scars do generally soften up over time. They may be slightly raised and inflamed around the edges during the initial healing process. This is quite normal. Occasionally they may weep a little and generate a small amount of yellowish discharge. This is to be expected and a wash in the shower and then dab dry with a clean soft tissue is all that is required. However if the discharge is copious and green and there is pain and redness beyond the margins of the wound, you may have developed a wound infection. Please see Dr. Leong as soon as possible.

Bowel preparation is very important for laparoscopic surgery because adequately prepared bowels have a lower risk of injury during surgery. However not all laparoscopic surgery cases will require a bowel preparation. For advanced cases such as myomectomy, severe endometriosis surgery and hysterectomy, a good bowel preparation is very important. There are different types of bowel preparations on the market. The one that Dr. Leong recommends is colocaps which works well, easy to take and generally well tolerated by patients. Please speak with Dr. Leong or his staff about it.

A good question. It depends on what was found at your last laparoscopy and what was done about it at the time. If endometriosis was discovered and treated adequately, pain usually improves after surgery (80% of patients will find improvement). Unfortunately depending on the severity of the endometriosis to start with and the completeness of the initial surgery, endometriosis generally does return over time even if one is to be started on certain medications such as the oral contraceptive pill. The pain associated with endometriosis may take on average one to two years to recur. The primary drivers for the cause of endometriosis never disappear after surgery. Unfortunately the effects of hormones such as oestrogen and the presence of other factors would make endometriosis likely to return over time in 50 – 80% of patients.

This is quite a common problem after surgery due to a number of factors, such as decreased fluid intake before and after surgery, the effects of anaesthetic and the side effects of powerful opioid medications such as codeine and morphine based analgesia e.g. tramadol. Occasionally the surgery itself can produce problems with bowel and bladder functions post operation. Make sure you drink plenty of fluids after surgery. Two to three litres of fluid a day is required. Once your pain is under controlled, start weaning off the opioid containing pain medications such as panadeine forte. Take the anti-inflammatory medication instead e.g. voltaren. Lastly you may try a gentle laxative such as lactulose or agarol to get your bowels moving again. If problem persists, please speak with Dr. Leong.

Yes, there are studies showing that fertility improves after endometriosis surgery for patients with mild to minimal diseases. For more severe cases, the beneficial effects on fertility are not as clear cut. However, laparoscopy may still need to be performed if pain is the major symptom.

Hysteroscopy questions

Yes Dr. Leong normally performs a hysteroscopy under general anaesthetic. It is quite unpleasant to be awake when having this procedure. There are usually no incisions required for this surgery. Please refer to the hysteroscopy section under services in this website.

Evidence does show that endometrial sampling by hysteroscopy and curettage performed a month or two before embryo transfer may improve implantation rates in IVF.

Yes, hysteroscopy is a day procedure. A diagnostic hysteroscopy takes less than ten minutes to complete. Patients can usually go home two hours post surgery. On the other hand, operative hysteroscopy may take about an hour to perform. Depending on what was performed and if there were any associated issues, you may require to stay in overnight for observation.

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