Frequent questions

After how long should I worry if I'm not pregnant?

Investigations should be started after 1 year for women under 35 years of age.

After 35 years, contact your doctor if 6 months have passed without success.


How long can I take Clomiphene or Letrozole before switching to other treatments?

If infertility is caused by lack of ovulation (anovulation), it is recommended 3 – 6 cycles of treatment with this type of treatment, before considering other options.



How important is the time of insemination?

Insemination should be scheduled shortly before ovulation. After ovulation, it may be too late. Oocytes degenerate if not fertilized in the first 12–20 hours after ovulation




Are the injections painful?

The vast majority of injections are given subcutaneously and are not painful.






What does low ovarian reserve mean?

When the reserve of oocytes left in the ovaries is small, it does not mean that a pregnancy can no longer be obtained, but that there is no more time to wait.

For IVF, reduced ovarian reserve is associated with lower success rates because fewer embryos are obtained. The possibility of embryo selection decreases, as does the probability of having additional embryos for freezing.






How is the quality of embryos evaluated?

The quality of embryos is assessed according to certain criteria: the appearance and number of cells in each day, the evolution or stagnation in evolution from one day to another, the degree of fragmentation.

The morphological evaluation of the embryos in the laboratory allows the estimation of the implantation chances and the selection of the embryos with better potential.

The morphological criteria do not show whether the embryo has a genetic defect or whether it will have a malformation during its subsequent development in the uterus.






On what do the chances of success of an IVF cycle depend?

The success rate depends on a multitude of factors, the most important being:

  • Age of patients, especially women
  • Number of oocytes collected (Ovarian reserve)
  • Number and quality of embryos obtained

The cause of infertility is important, as it influences the above factors. There can be a high chance of success in infertility with severe causes if the age is young. In cases without identified causes, the chances may be low if the age is advanced or the ovarian reserve is reduced.

Clinical protocols, experience, technological methods used are also important.






If I live in another locality, how long will I have to stay in Bucharest?

In the Gynera Clinic many patients come for treatment from other localities or from other countries. Communication and some monitoring can be done remotely or through collaborations. No procedure requires staying overnight in Bucharest. If you live in another country, consider a period of at least 2 weeks, provided that the treatment plan is organized in advance.







Can freezing affect embryos?

Some embryos may not tolerate the freezing and thawing process. If after thawing most of the cells recover, the embryo can resume its evolution.

The survival rate depends on the stage and quality of the embryos, the cryopreservation method, but last but not least and the experience of specialists.

In the Gynera Clinic, over 95% of blastocysts resume their evolution after cryopreservation by vitrification. Implantation rates of frozen blastocysts are also exceptional; over 50% of them are implanted and cause clinical tasks.







Do children born with IVF have an increased risk of birth defects?

The risk of developing a congenital anomaly in the general population is about 2-3% of births and can be affected by age, lifestyle or certain conditions that occur during pregnancy.

IVF does not significantly increase these risks, but does not eliminate them, as they are dependent on various factors, sometimes occurring after implantation.

In the case of severe genetic male pathology, the IVF / ICSI procedure may increase the risk of transmitting genetic abnormalities to the fetus.






How is infertility diagnosed?

The specialist evaluates the risk factors and conditions that can cause infertility and recommends specific tests. For women, these include hormonal tests, ovulation monitoring, hysterosalpingography. For men, the first test is the spermogram.


How many artificial inseminations (AIs) should I try before switching to in vitro fertilization (IVF)?

After 3-4 cycles of treatment followed by artificial insemination, the chance of getting pregnant by AI no longer increases significantly. At this stage, the transition to IVF is considered.




When is In Vitro Fertilization Required?

In situations where the woman has obstructed or absent fallopian tubes or in severe male infertility, IVF is the only option. IVF is a solution in case of endometriosis or infertility of unexplained cause, if other treatments have not been successful.






Will I get through menopause sooner if I do a lot of ovarian stimulation?

In a natural cycle, several dozen follicles (formations containing oocytes in different stages) are recruited and lost in the ovary. One follicle grows and ovulates, the others will degenerate, a process called follicular atresia. Stimulating medication does not increase the number of follicles that are lost in a month, but matures those already recruited. Ovarian stimulation does not consume the eggs faster, but, on the contrary, saves eggs that would have been lost in that cycle, allows them to grow and be used.






Are the procedures painful?

Oocyte sampling is the only minimally invasive procedure, as it involves puncturing the ovaries. It can be performed without anesthesia, with local anesthesia or with intravenous sedatives or anesthetics for a short time. The other procedures are not painful.








When is genetic testing of embryos done in the laboratory before implantation?

Genetic analysis of embryos in the laboratory is possible, but not routine, due to limitations and risks: it is invasive (requiring the extraction of cells from the embryo) and can generate false or inconclusive results. It is recommended in particular situations, with high genetic risk.









Is the chance of getting pregnant higher in case of blastocyst transfer?

Embryos that evolve in the laboratory for 5-6 days can reach the blastocyst stage, the stage in which the embryo implants. Most embryos formed in the laboratory (and naturally) do not reach this stage, they stop evolving after 3-4 days. If an embryo exceeds this critical stage and reaches the blastocyst stage, it will have a higher chance of implantation.









How are embryos frozen?

Before freezing an embryo, it is dehydrated, so as not to form ice during freezing. As the water is removed, it is replaced with a cryoprotective medium; subsequently, the embryo is placed in a small container called a sequin and cooled rapidly (a process called vitrification). Frozen embryos are stored at -1960 Celsius in liquid nitrogen.












How are embryos thawed?

The thawing of embryos is done in reverse to the freezing procedure. Embryos removed from liquid nitrogen, from -1960 C, are heated. The protective medium is progressively removed and replaced with water, until complete rehydration. Subsequently, the embryos are evaluated and incubated under special conditions.













How is infertility treated?

There are two types of treatment: treating the cause when possible or using an assisted reproduction technique. Assisted reproduction does not address a specific cause, but improves the chances of success by controlling some stages involved in reproduction.



If I do two inseminations in the same cycle, will the chances of success increase?

Most studies show that insemination performed at the right time is sufficient.




Can hormone treatment have long-term risks?

Women who do not have children generally have an increased risk of genital cancers compared to the general population, even if they do not have hormonal treatments. Long-term studies do not show an increase in this risk if you perform hormonal stimuli





Is it dangerous if many follicles develop as a result of ovarian stimulation for IVF?

If over 15-20 follicles develop as a result of ovarian stimulation, the chances of success increase, but complications can occur – ovarian hyperstimulation syndrome. There are ways to avoid or reduce the risks if appropriate measures are taken during treatment.






How to determine if the eggs are of poor quality?

The most important factor that determines the quality of the eggs is AGE. Even if in the laboratory the oocytes look the same, the older they are, the less embryos they will generate. Even in young people there may be problems with oocyte quality, from birth or after inflammation, endometriosis or certain treatments. There is no specific test, but the poor quality is seen in the unfavorable evolution of embryos in the laboratory or after implantation.








How can we be sure that sperm, oocytes or embryos are not confused in the laboratory?

In the Gynera Clinic such an error cannot happen, because in our work protocols are provided rigorous safety measures and verification by three concomitant methods.

In addition to checking the unique number of patients assigned by the electronic database, patients are asked to verbally confirm their own and partner’s name. In addition, the unique MatcherTM system in Romania scans, records and verifies all barcodes on patients’ cards and labels of organic products. For frozen samples, a color-based identification system is also used, making it easier to identify samples in cell and embryo banks.







Can I travel during assisted reproduction procedures?

Lifestyle should not change radically during treatment. Travel by car, train or plane is allowed at all stages, after a discussion with the doctor, in case certain additional measures are needed.








How long can embryos be frozen?

There is no known maximum period in which frozen embryos can be stored. Human embryos have been successfully frozen until 12–15 years of age. It is generally recommended to limit the storage period and the use of embryos after a maximum of 5 years.










Is IVF pregnancy different from natural pregnancy?

The probability of having a multiple pregnancy is higher if more than one embryo is transferred to the uterus. The transfer of a single embryo is recommended to reduce the increased risk of complications associated with twin pregnancies.

And in the case of single fetal pregnancy, there was a slight reduction in fetal weight at birth. This effect does not occur in the case of frozen embryo transfers.

The risks of miscarriage, ectopic pregnancy or fetal abnormalities also exist in the case of pregnancies after IVF, as well as in the case of pregnancies that occur spontaneously. The IVF procedure does not exclude, but neither does it significantly increase the risks.