TOPIC: EGG QUALITY
Q	Are there any measures of egg quality after retrieval? Can anything be gathered about egg quality during lab time, how does one tell good eggs from bad eggs? Can it be seen from cell division? What is granulation and what does it tell about the egg? Are there any other descriptive terms to describe the oocyte and its development to an embryo that has bearing on egg quality?
A	Immediately after egg retrieval it is not possible to comment on the quality of the eggs. This is due to the fact that they are surrounded by cumulus cells which masks the true nature of the egg. Therefore, it is only about 19 hours after insemination that one can comment on the quality, as the sperm have by that time removed most of the cumulus cells. After this has taken place, the embryos have to develop due to a specific timeline, that being a four cell stage on day 2 and an eight cell stage on day 3. Fast and slow embryos are generally, but not always, of a lesser quality. Fragmentation also has bearing on embryo quality and fragmentation of more than 20% almost guarantees an embryo of bad quality. Depending on the circumstances, it is therefore possible to draw certain conclusions as to the quality of the oocytes.
	TOPIC: STRESS/ANXIETY/PSYCHOGENIC MEDICATIONS
Q	What is the effect of stress/depression/anxiety on the success of IVF? Can it be detrimental? And related to this, what should people do that are using psychogenic medications such as anti-depressants and tranquilisers? Should these medications be discontinued entirely? Are any of these medications safe to use during IVF and pregnancy? Which has the worst negative impact, anxiety or the drugs to treat this anxiety?
A	The factors mentioned all have a detrimental effect on the ultimate outcome of an IVF attempt. Going through an attempt is stressful enough as it is and therefore stress/anxiety/depression only ads fuel to fire so to speak. Therefore staying on the medication to help the patient cope until the actual start of the procedure is adviseable. There are certain anti depressants/anxiolytics that are safe during the procedure, for example fluoxetine. Depending on the severity of the depression/anxiety, the effect is probably worse that the drugs to treat it. It is therefore wise to seek a professional opinion (e.g. psychiatrist/psychologist) as to whether it would be more beneficial to stay on medication or stop it all together.
	TOPIC: SMOKING & IVF
Q	How big of an influence does smoking really have on the outcome of IVF?
A	Overall, the literature strongly supports an association between cigarette smoking and infertility and therefore the outcome of IVF.Available data indicate that up to 13% of infertility may be attributable to cigarette smoking.It accelerate the loss of reproductive function and may advance menopause by up to 4 years. Gamete (oocyte)mutagenesis is one possible mechanism. Results of a meta-analysis examining the outcome of IVF cycles indicate that smokers require nearly twice the number of IVF attempts to conceive as non-smokers.
	TOPIC: EMBRYOS ESCAPING
Q	After ET, is there any way the embryos can come out from the uterus by means of moisture that gets secreted by the uterus or any other way the embryos can come out?
A	There are good studies to support the fact that embryos can not “fall out” after transfer if placed properly inside the uterine cavity under ultrasound guidance. The only possible mechanism would be if they should adhere to the mucus on the outside of the transfer catheter. This should theoretically not happen if preparation of the endocervical canal was proper in that all visible mucus be removed before the transfer takes place. Overall the answer is therefore a definite no.
	TOPIC: EBRYO FRAGMENTATION
Q	Why do embryos fragment? What are the causes and is there anything you can do to prevent them from fragmenting?
A	Embryos fragment mainly due to two reasons: 1) Poor oocyte or poor sperm quality leading to an embryo of poor quality. 2) Some embryos do not handle the stress of being in the incubator and being evaluated on a daily basis too well, and if of borderline quality therefore fragments.
	TOPIC: PROGESTERONE OIL INJECTIONS VS. PESSARIES
Q	Is there a benefit of using the progesterone oil injections as opposed to the utrongestan pessaries?
A	There is no benefit in using an injectable progesterone as opposed to the available vaginal preparations. Numerous international studies have confirmed this more than once. Furthermore, the injectables are painful and can lead to the formation of a sterile abcess. Any of the vaginal preparations on the market has therefore exactly the same efficacy as the injectable preparations.
	TOPIC: HOSTILE CERVICAL MUCUS & BICARB SODA
Q	How should bicarbonate soda be used in improving cervical mucus round the time of ovulation? When administered, how regularly, how much?
A	The bicarb douche is generally used when a post coital test is poor from the point of view that the sperm number,motility and survival is low in the presence of acidic mucus. The douche is employed in order to try and rectify the acidity by douching the whole vagina up to the level of the cervix. The douche should be performed about 3-4 hours prior to intercourse, once every 24 hours and if possible not more than twice during any particular cycle.
	TOPIC: HOSTILE CM - CAUSES
A	What causes hostile cervical mucus? Can it be affected by diet/lifestyle factors, or is it genetic? Are there ways to improve HCM?
Q	I do not think that there is a clear answer to the question as I am sure that there are many factors that we are not aware of. A documented reason however is antibodies being present in the mucus which may be detrimental to sperm function. In our experience we also feel that the presence of endometriosis in the pelvis might be a contributory factor.
	TOPIC: IVF - LONG VS. SHORT PROTOCOL
Q	What is the reasoning behind some people doing a long ivf protocol and some doing the short ivf protocol? How is this decided?
A	I do not think that there is a clear answer to the question as I am sure that there are many factors that we are not aware of. A documented reason however is antibodies being present in the mucus which may be detrimental to sperm function. In our experience we also feel that the presence of endometriosis in the pelvis might be a contributory factor.
	TOPIC: ACUTE ALCOHOL BINGING AND SMOKING
Q	Many women going through the motions of infertility treatment often resort to short spurts of alcohol binging and smoking when faced with a negative result, they often associate the menstrual period as a ‘safe zone’ to revert to the before mentioned and many a time go into a stimulated cycle without taking a break. How can this practice negatively affect: Successful ovulation The uterine environment IVF success The viability of the eggs Egg production
A	As mentioned in question 3, there is no doubt that smoking has a negative effect on all the parameters as mentioned in the question. The same can be said for binge drinking. There is a very good article on “Impact of lifestyle factors on reproductive performance” by HOMAN,DAVIES and NORMAN that can be read in the Human Reproduction of January 11, 2007.