An Interview With Jake Frankel
IVF has a good success rate, but it’s not always guaranteed to work on the first attempt. It’s important to be prepared for both possible outcomes. Various factors can affect the success of IVF, including age, health status, lifestyle, embryo abnormalities, egg quality, male factors, uterine receptivity, and implantation issues related to a thin uterine lining.
In vitro fertilization (IVF) has become a widely used assisted reproductive technology, helping many individuals and couples achieve their dreams of parenthood. However, despite its prevalence, there are still many misconceptions and questions surrounding IVF. Through this series, we aim to provide comprehensive and insightful information about IVF, covering topics such as the procedure itself, success rates, emotional and financial considerations, ethical concerns, and advances in the field. As part of this series, we had the pleasure of interviewing Lora Shahine, MD, FACOG.
Lora Shahine, MD, FACOG, is a reproductive endocrinologist at Pacific NW Fertility in Seattle, author, and host of the Baby or Bust Fertility Podcast. She is Stanford University trained and double board certified in reproductive endocrinology and infertility as well as obstetrics and gynecology. Her areas of expertise include infertility, IVF, reproductive medicine, and recurrent pregnancy loss. In her practice of over 20 years, Dr. Shahine has worked with countless people facing infertility and going through the IVF process.
Thank you so much for joining us in this interview series. Before we begin, our readers would love to “get to know you” a bit better. Can you tell us a little about yourself?
I love educating. Whether it’s teaching the next generation of gynecologists at the University of Washington and Swedish Hospital OBGYN residency programs in Seattle or through my medical educational content, I love helping people learn more about their reproductive health. Through my blog, books, Baby or Bust Fertility podcast, and content on social media platforms like Youtube, Instagram, and Tiktok I reach over a million people a month who want to learn what they didn’t in middle school health class. My passion for teaching stems from a combination of helping my patients for over 20 years and my personal experience with infertility and IVF. As a fertility doctor feeling vulnerable and confused through my own fertility path — I realized how much I wanted to help other people learn, understand, and feel less alone on their family building journey.
Ok, thank you for that. Let’s now jump to the primary focus of our interview, about IVF. Let’s start with a basic definition so that all of us are on the same page. Can you please tell us what IVF is?
In Vitro Fertilization, or IVF, is a proven medical treatment for infertility that has been used for more than 40 years. It has helped millions of people achieve their dream of having children. The first baby born to IVF was in 1978, and since then, millions more have been born. In the U.S. alone, the use of IVF has more than doubled over the past decade and now accounts for 2.5% of births annually.
The IVF process involves injecting hormones to stimulate the ovaries to recruit and mature multiple eggs. After about 2 weeks of monitoring and taking medication, the eggs are then retrieved and fertilized with the sperm outside the body in the lab, hence the term “In Vitro”. The fertilized egg, or embryo, is then placed back inside the women’s uterus. Pregnancy occurs when an embryo attaches to the lining of the uterus, known as implantation.
One of the amazing impacts of IVF is its use for diverse family-building needs. IVF can be used by heterosexual and same-sex couples, single parents by choice, or people who need to preserve their fertility because of other conditions like cancer treatment, endometriosis and desire to delay having children for any reason.
IVF is a remarkable scientific achievement, and it’s exciting that innovation in the field continues. New and improved technologies, such as vitrification freezing technique, intracytoplasmic sperm injection, and preimplantation genetic screening of embryos, have been developed to improve treatment options and success rates.
All of the medication, appointments, and treatment options can get overwhelming and confusing. If you choose to undergo IVF, it may be helpful to know that Fertility Coaches are available at no cost on FertilityOutreach. They can provide additional support alongside your doctor’s care, offering a safe space to discuss sensitive issues, coping strategies and guidance on navigating the insurance process.
What are some common misconceptions about IVF that you have encountered, and how do you address them?
There are several misconceptions that need to be dispelled so I am so pleased you asked that question.
Myth: IVF is for older women.
Reality: While women over 35 tend to be less fertile and may have greater difficulty getting pregnant, women of all ages may struggle with conceiving for several different reasons, whether it be reproductive health issues, endometriosis, PCOS, tubal disease or other conditions. IVF is a good option for all women who are struggling to get pregnant or those who need to preserve their eggs due to medical conditions like endometriosis or those undergoing cancer treatments.
Myth: IVF is a guaranteed way to become pregnant.
Reality: While IVF may help, and the success rate is higher now than ever, there are no guarantees. Some people take several cycles to become pregnant. Not all fertilized eggs are viable and can be successfully implanted and result in live birth.
Myth: IVF can cause birth defects.
Reality: IVF outcomes have been monitored closely since the first IVF baby born in 1978 to ensure outcomes are safe and research is reassuring that treatment with IVF will not increase risk of birth defects.
Myth: IVF causes multiple births.
Reality: The goal of IVF is one healthy baby at a time and the risk of multiple births increases with the number of embryos transferred. With the advances in technology and success rates more and more cycles transfer one embryo at a time. A single embryo transfer will decrease the risks of multiple gestation pregnancy like preterm delivery and all the complications that result from it.
Myth: IVF can cause cancer because of ovarian stimulation.
Reality: Studies show no increase in cancer from IVF. It is a proven and safe medical treatment that has been around for over 45 years.
Can you discuss some of the emotional challenges individuals and couples may face throughout the IVF process, and what strategies you recommend for coping?
That’s a crucial question because it’s important for people to understand what they’re getting into. This knowledge helps them assess whether their decision and timing are right and if they are emotionally prepared for the challenges of the IVF journey.
For instance, they need to ask themselves the following questions:
- Do I have the financial means to cover the costs of IVF including the medication, clinic fees, testing expenses and other related costs?
- Do I have the support system to help me through this journey, and the help or care for my baby once it is born?
- Am I mentally and physically prepared for the possibility that I may have to go through multiple cycles of IVF before I am successful?
- Am I in a healthy state for pregnancy?
- Do I have access to an IVF clinic with excellent care and personalized approach?
Hormonal changes can also cause mood fluctuations, and patients need to be mentally prepared and have the right support. The first treatment cycle can be especially stressful, and patients may feel confused, bewildered or anxious. Having the right partner and/or people around you that can help support you during this challenging time is critically important.
IVF can also be expensive. Not having the financial means could result in added stress and anxiety which could impact a positive pregnancy experience.
If the IVF cycle fails, the emotional aftermath can be devastating and the individual and couple may feel grief, sadness, anger, frustration and a sense of failure. It’s important that individuals and couples are aware of this potential before embarking on IVF to ensure they are mentally prepared.
Two great resources for fertility support are Fertility Outload and Resolve.org.
How do you approach the topic of ethics in IVF, particularly regarding issues such as embryo selection and genetic screening?
Let me start by saying that before my patients embark on IVF or other medical treatments, I make sure they are well educated so they can make an informed decision. There are many sites that can help them, including FertilityOutLoud.com and my own site where I have educational videos, podcasts and resources and the patient page at the ASRM website.
As for ethics, I think it is important to know that your doctor can educate you but the decisions you make are your own. Ethics are personal and based on an individual beliefs, values and attitudes. Thus, before a person or couple embarks on the IVF process, they need to determine if they are comfortable with IVF and all the components involved. By understanding the process, they can make an informed decision on whether to move forward based on their ethics and values.
Important topics to discuss and think through before starting the IVF cycle are:
- Genetic screening of the parents to see if they carry similar mutations for genetic diseases the children could inherit like cystic fibrosis and spinal muscular atrophy. If it’s known that both parents carry these mutations — it can be found in embryo with a technology called preimplantation genetic screening.
- How many eggs to fertilize to create embryos. If patients worry about having more embryos frozen than they want to use — they have the option to create fewer embryos and freeze some eggs.
- Genetic screening of embryos for chromosomal abnormalities in the embryos — this is different from carrier screening — each time and egg and sperm fertilize there is a chance of balanced chromosomes with a high chance of live birth or an imbalance of chromosomes that increases risk of negative pregnancy test or miscarriage. Not every patient does this preimplantation genetic screening for chromosome balance, but it should be discussed.
- Embryo disposition for the future — patients should discuss options with their doctor for what to do with embryos remaining after their family is complete before they start the IVF cycle
What recent advancements or innovations in IVF technology have you found most promising or exciting, and how do you see them impacting the field in the future?
To name a few, I am excited about some of the new advancements emerging in genetic testing for rare diseases and genetic abnormalities, mitochondria replacement therapy to help prevent or treat diseases earlier and technology improvements in egg quality and egg preservation methods. I’m also inspired by the attention being paid to lifestyle optimization to improve reproductive health. IVF can only do so much, and patients should be inspired and empowered to optimize nutrition, exercise, sleep, and stress management to improve fertility.
Ok super. Here is the main question of our interview. Based on your experience and research, can you please share “5 Things Everyone Should Know About IVF?” If you can, please share a story or an example for each one.
1. Before embarking on IVF, go through a checklist of things that should enable you to pursue IVF without anxiety. You need to ask yourself:
- Am I ready to have a family?
- Do I have the right lifestyle to commit to parenthood?
- Do I have support both for my IVF journey as well as when I have a child?
- Am I financially stable and able to pay for IVF and its extended costs (visits to clinics, treatments, etc.)?
- Am I healthy and ready to become pregnant?
- Am I prepared mentally should the first IVF cycle not be successful?
2.The IVF process has a few steps that a person goes through that are good to know in advance. For women undergoing IVF, the steps involve:
- Consulting with a Reproductive Endocrinologist to learn about all options including IVF
- If so, hormone injections are administered to stimulate the ovaries to recruit and mature eggs
- The best quality egg(s) are retrieved and combined with the sperm in the laboratory
- The fertilized egg(s), or embryo(s), is placed back into the woman’s uterus
- Pregnancy occurs when the embryo(s) implants into the lining of the uterus
- If the IVF process is intended for egg preservation, once the eggs are retrieved, they are frozen and stored in liquid nitrogen tanks in a highly controlled embryology lab.
3. Make space for your IVF cycle — mental space and actual time set aside. There are appointments, phone call, learning modules and recovery that take time. You may feel symptoms like bloating, discomfort, headaches, some mood fluctuations, nausea or feeling ‘off’ and not your normal self. These will pass but it is important to know that you may experience these symptoms at the beginning. Be prepared but know that these symptoms are temporary.
4. IVF has a good success rate, but it’s not always guaranteed to work on the first attempt. It’s important to be prepared for both possible outcomes. Various factors can affect the success of IVF, including age, health status, lifestyle, embryo abnormalities, egg quality, male factors, uterine receptivity, and implantation issues related to a thin uterine lining. This site shares real stories of IVF journeys, including both successful and challenging experiences. For more real-life IVF stories, visit: https://www.fertilityoutloud.com/content-hub/category/fertility-journeys/ivf/
5. IVF is a proven scientific innovation that has allowed millions of people to have children since the birth of the first IVF baby in 1978. It has helped many realize their dreams of having their children, including same-sex couples and single parents by choice. In the U.S. alone, the use of IVF has more than doubled over the past decade and now accounts for 2.5% of births annually.
In your experience, what are some of the key factors that contribute to IVF success, both medically and psychologically, and how can someone optimize these factors?
Key factors that contribute to IVF success include:
- Eating well and having a nutritional diet
- Being reasonably fit
- Being in a good emotional state and practicing stress management techniques
- Living a healthy lifestyle
- Having a good support system
- An IVF team and clinic you trust with good success rates
All of these factors are not hard to achieve, but they do require a strong effort on the individual’s part to ensure they are in a healthy state before embarking on their IVF journey. HCPs and Reproductive Endocrinologists can assist you in finding good diets, exercises, resources and guidance that can optimize these factors. I share a playlist on my YouTube channel with my patients all about lifestyle optimization for fertility with evidence and tips on the importance of nutrition, sleep, exercise, and stress management for success.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Educate everyone who wants to learn about their own reproductive health! We are taught to fear getting pregnant before we’re ready in middle school health class but when we are ready and it’s not happening, we are shocked by what we don’t know. I’m reaching as many people as I can through my YouTube channel, Instagram, and Tiktok and I’m especially proud of my podcast Baby or Bust. The goal of this podcast is to educate those who are facing infertility and/or those who wish to go through the IVF process. In this podcast, I interview experts, share stories from infertility warriors, and educate on all things fertility. My goal is to expand this more so that access to information is available. To listen to my latest episodes, you can go to https://drlorashahine.com/podcast.
How can our readers further follow you online?
The best site to follow me at and see my background, educational materials, video segments, and links to my podcast, YouTube channel, and other social media platforms is at: https://drlorashahine.com/.
And if your readers wish to find further IVF educational materials, they can also go to FertilityOutLoud.com.
Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!
Dr Lora Shahine Of Pacific NW Fertility: 5 Things Everyone Should Know About IVF was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.