Fertility Blog

Infertility is a common struggle for many people who want to build a family. Worldwide, about 1 in 6 people deal with infertility. Luckily, there are many ways to treat infertility, including a medication called letrozole. But how, exactly, does letrozole work?

How Does Letrozole Work?

Some people experience infertility because of ovulation problems. Letrozole boosts fertility by promoting ovulation. It does so by suppressing estrogen production in the body, which ultimately leads to increased follicle-stimulating hormone (FSH) levels. This stimulates follicle growth and egg development, increasing the chances of ovulation.

When is Letrozole Needed in Fertility Treatment?

Ovulation problems stem from different causes, such as Polycystic ovarian syndrome (PCOS). Therefore, letrozole may be recommended for those with PCOS, unexplained infertility, or low egg count.

Letrozole is also commonly used as part of an intrauterine insemination (IUI) During IUI, sperm is inseminated into the uterus around the time of ovulation. Letrozole is often used during  IUI to stimulate ovulation and thus increase the chances of becoming pregnant.

Success Rates and Evidence of Letrozole

Success rates vary from person to person, depending on the root cause of infertility and your unique situation. Evidence suggests that letrozole is more effective than other medications in people with PCOS, and studies show that letrozole appears to help treat infertility stemming from endometriosis or unexplained causes.

Other Fertility Medication Options

Clomiphene is another medication that's commonly used to promote ovulation. According to research, letrozole is more effective than clomiphene for PCOS patients. Letrozole may also cause fewer side effects than clomiphene. Some people may not respond to clomiphene, making letrozole a good alternative.

Gonadotropins are hormonal medications given by injection and sometimes used during an IUI or IVF cycle. Gonadotropins include FSH and luteinizing hormone (LH), two hormones that stimulate follicle production and egg release in the ovaries. Sometimes, gonadotropins may be used alongside letrozole during fertility treatments.

Letrozole is an oral medication, which can make it easier to take than an injection. Some research suggests letrozole may also come with a lower risk of multiples than other medications.

Risks and Side Effects of Letrozole

Like any medication, there are potential risks and side effects when taking letrozole.

While taking letrozole, you may experience:

• trouble sleeping

• hot flashes or night sweats

• breast tenderness

• fatigue

• dizziness

• stomach upset

• spotting

• headaches

Don't hesitate to call your doctor if you have side effects that are severe, persistent, or concerning while taking letrozole.

Getting Started with Letrozole for Fertility

It's worth being evaluated by a caring fertility specialist before pursuing any fertility treatment. They can assess you to determine what might be causing your infertility and then decide on an appropriate treatment plan, which may include an oral medication like letrozole. A fertility specialist can advise whether IUI or IVF may be right for you and discuss your treatment options.

Helping You Every Step of the Way On Your Fertility Journey

Reproductive Gynecology & Infertility is committed to compassionate, personalized fertility care. We offer various advanced fertility care options to provide each person with the highest quality care possible. If you are having trouble conceiving or have questions about letrozole or other fertility treatments, contact us today to schedule a consultation.

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Navigating the IVF Process with Comfort and Reassurance

In vitro fertilization (IVF) is a fertility treatment that fertilizes eggs with sperm in a lab. Couples may choose to have IVF if they have been unsuccessful in getting pregnant on their own or if they are a same-sex couple. While you might worry about how this process will affect you and if it will be painful, our team is here to guide you through each step. 

Infertility is more common than you might think. About one in six couples globally experience infertility each year. IVF is one of the options couples may choose to conceive.

The IVF Process and What to Expect During Each Stage

IVF is a complicated process that involves extracting an egg from a woman's ovaries and combining it with sperm in a laboratory. These are the steps that you will want to prepare for during IVF:

Ovarian Stimulation

The first phase of IVF is ovarian stimulation. During this process, you will give yourself an injectable medication that contains a follicle-stimulating hormone (FSH), a luteinizing hormone (LH), or a combination of FSH and LH. Synthetic hormones encourage the ovaries to produce multiple eggs, which are gathered during the egg retrieval process.

Ovarian stimulation can cause bloating as your ovaries grow follicles from the stimulating medication. Some women experience a weight gain of five to six pounds during this phase, which can be lost after egg retrieval. Women may experience heightened emotions due to the injection of hormones during ovarian stimulation.

Egg Retrieval

Once you have stimulated your ovaries, the next step is to retrieve your eggs. This procedure requires sedation to ensure you experience no discomfort while the eggs are retrieved.

After your eggs are retrieved, you may experience cramps, pressure, or a sensation of fullness. These are all normal symptoms. You should notify your provider if you experience excessive pain, are unable to eat or drink, or have any fevers after the egg retrieval process. 

Sperm Collection

Sperm collection is when your partner provides a semen sample. The retrieval is coordinated with the timing of egg retrieval. Some couples may choose to use donor sperm. 

Collecting sperm involves your partner, or donor, ejaculating into a sample cup using masturbation. However, if a fertility specialist has identified that your partner does not contain sperm in his ejaculate, he may need to have his sperm retrieved directly from the testis or epididymis with a needle. The fertility specialist will coordinate a simple sperm retrieval to be collected some time before the egg retrieval. 

Fertilization 

Fertilization of the eggs and sperm retrieved occurs in the lab. The eggs retrieved are screened for quality once they've matured. Either a single sperm is injected directly into an egg, or a small drop of concentrated sperm is mixed with each egg. Some couples may choose to freeze eggs before fertilization to use in the future.

Embryo Transfer

After fertilization occurs, embryos will develop in five to six days. When the embryos have developed, a fertility specialist will transfer one embryo to the uterus.

The embryo transfer is usually painless, but some women may feel discomfort. This is typically less discomfort than having a pelvic exam. Sedatives are generally not needed due to the minimal discomfort.

Tips for Managing Discomfort During IVF Stages

While the side effects of IVF are minimal, women undergoing IVF can take measures during each step to maximize their comfort. Certain over-the-counter (OTC) medications are considered safe for use during IVF. Discuss this with your fertility specialist, as some medicines may interfere with fertility drugs or cause hormonal imbalances. You should avoid the following medications while undergoing IVF:

•      Non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen)

•      Antidepressants and anti-anxiety medications

•      Steroids

•      Anti-seizure medications

•      Thyroid medications

•      Chemotherapy drugs

•      Skin products that contain estrogen and progesterone

Managing Injections During Ovarian Stimulation

If you fear needles, you can take measures to overcome this when giving yourself hormone injections for ovarian stimulation. When you inject, you can use breathing techniques and keep yourself hydrated to avoid fainting. You may also want to consider talking with your fertility specialist to determine if a local pain patch would be appropriate when giving yourself the injections.

For hormone injections, there are ways to reduce discomfort. Before giving yourself the injection, allow it to come to room temperature. Ensure you use a new needle with each injection and never reuse a needle. After you've given yourself the injection, apply a cold compress or ice to the site. If the injections are causing discomfort, talk with your fertility specialist about trying OTC acetaminophen. Rotate your injection sites. 

Pain Management After Egg Retrieval

When your eggs are retrieved, your provider will use anesthesia to minimize discomfort and pain. It is common to experience mild cramping and abdominal pain after the procedure. You can use OTC pain relievers that your fertility specialist approves to ease this pain. You can soak in a warm bath, place a warm compress over your abdomen, use deep breathing or other relaxation techniques, and ensure you get enough fluids. If you have severe pain or fevers, or cannot eat or drink after the procedure, notify your provider immediately. 

Embryo Implantation Expectations

Many women experience no pain during embryo implantation, while others experience mild cramping. If you experience mild cramping, you can try warm compresses to the abdomen, OTC medication approved by your fertility specialist, take a warm shower or bath, or practice relaxation techniques.

You can take action to improve the likelihood of a successful IVF cycle. These actions can help manage any discomforts associated with the IVF process, which include: 

•      Eat a healthy diet and stay hydrated

•      Take a prenatal vitamin with folic acid

•      Avoid chemical exposure from everyday sources

•      Take time to relax on transfer day and immediately after

•      Don’t use a hot tub

•      Keep taking your medications

•      Abstain from intercourse until approved by your doctor

•      Pay attention to what your body is telling you

•      Use stress-reduction techniques to make the wait easier

Remember not to rush taking a pregnancy test. Pregnancy tests measure the levels of pregnancy hormones in your urine. These hormones take time to build up to show on a pregnancy test. Taking a test too early could result in false results and disappointment.

Lean on your Support Team for a Comforting IVF Experience

We understand that fertility treatment can be an emotional process, making it crucial to maintain your mental health during treatment. Don't hesitate to connect with your fertility specialist or support team with questions or concerns regarding your IVF experience. 

You can take measures to keep your mental health balanced by doing the following:

•      Consider infertility counseling

•      Participate in relaxation techniques like guided imagery or yoga

•      Practice restorative breathing

•      Make sure you get plenty of sleep 

•      Take a warm shower or bath to relax

Focus on the Goal: Building Your Family

While undergoing IVF treatments may be stressful or cause discomfort, you can manage these to ensure a successful IVF cycle. IVF can help you build your family. Talk with one of our specialists today to discuss if IVF is right for you.

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Globally, infertility affects approximately 1 in 6 people, according to a 2023 World Health Organization fertility report. The Centers for Disease Control and Prevention (CDC),  reports that 16% of females in the United States experience infertility. 

Though male-factor causes of infertility account for 20-30% of infertility cases, medical experts predict that the male-factor infertility rate may worsen due to increased exposure to environmental toxins. Therefore, it is essential to raise awareness of the prevalence of infertility.

Infertility occurs when couples or individuals are unable to achieve conception after one year of trying if less than age 35 and six months if 35 years or greater. Infertility typically delays or prevents couples from starting or growing their family. However, with the rapid advances in assisted reproductive technologies such as in vitro fertilization (IVF), couples now have an alternative solution. 

This article discusses the rise of infertility, common causes, treatment options, and alternative solutions.

Infertility Statistics

The most current WHO infertility report states that 17.5% of the adult population in the world is infertile. This figure represents approximately 1.36 billion people worldwide. This is in comparison to  a 2004 WHO report which estimated that 60-80 million couples globally struggle with infertility. Personal, lifestyle, and environmental factors play a role in the swift increase in infertility.

Potential Causes and Risk Factors of Infertility

There are various causes and risk factors of infertility in men and women. Your awareness of some of these risk factors may cause you to adopt healthy lifestyle factors and understand if you should seek infertility evaluation early. Here are the common risk factors.

Age and fertility

Everyone  regardless of gender is more fertile when they are young. As an individual's age advances, fertility gradually reduces, which is more dramatic in females. With more couples waiting to build a family later in life, infertility has risen, and fertility treatment is often necessary. 

Race and ethnicity

Your race and ethnicity could also affect your fertility rate. A  report from the CDC noted that Black women are less likely to seek infertility care, take longer to seek care, and have lower success rates with fertility treatment.  Also, a 2021 women's health study found that infertility was more common among female minority groups than non-Hispanic whites.

Lifestyle factors

Unhealthy habits such as tobacco use are associated with infertility, early menopause, and poor pregnancy outcomes. Alcohol should be stopped at pregnancy due to the detrimental effects of fetal development. Marijuana exposure is also associated with infertility. Marijuana use in men is associated with lower sperm counts. Hence, individuals who use these substances are at risk of infertility.

Medical conditions

Medical conditions or treatment procedures that can affect the male and female reproductive tract can also increase the risk of infertility. Examples include untreated pelvic or genital infections, thyroid disease, uterine surgeries or abdominal surgeries, etc.

Infertility in females

The following are common causes of female infertility:

• Ovulation Disorders: In females with ovulation disorders like PCOS, the ovaries do not release an egg for fertilization. This affects a female’s ability to get pregnant.
• Fallopian Tube Blockage: Fertilization occurs in the fallopian tubes, and damage to the tubes hinders the process. ‍
• Uterine Disorders such as adhesions, polyps, and fibroids impair the implantation necessary for conception. ‍
• Prior history of pelvic inflammatory infections (caused commonly by chlamydia) can cause scarring of the fallopian tubes, which can block the female reproductive tract. ‍
• Genetic causes involving chromosomal disorders such as Turner's syndrome. ‍
• Endometriosis: This is a medical disorder in which the cells lining the uterus, called the endometrium, are found outside the uterine cavity. Endometriosis can lower egg reserve, block fallopian tubes, and impair the sperm from finding the released egg.

Male Infertility

Causes of male infertility include:

• Genetic Causes such as chromosomal disorders like Klinefelter syndrome.
• Hormonal disorders affecting the pituitary gland
• Undescended Testis
• Blockage in Sperm Transport Tubules due to physical trauma, prior pelvic surgeries, and infections
• Prior sexually transmitted diseases can cause blockage in sperm transport tubules.  ‍
• Medications such as chemotherapy drugs or steroids like testosterone may affect sperm production and increase the risk of male infertility.  ‍
• Exposure to Environmental Toxins such as heavy metals and industrial chemicals.

It is crucial to seek help from a fertility expert for a thorough clinical evaluation and screening and schedule an appointment early if there are any risk factors for infertility. However, in some cases, the exact cause of infertility in males and females may be unknown.

Available Treatments for Infertility

If you or your partner have risk factors for infertility, consult an experienced fertility doctor for expert clinical care. The fertility specialist will typically combine findings from the clinical and laboratory evaluation to confirm the diagnosis of infertility.

The treatment option depends on the cause of infertility. Here are some treatment methods for infertility.

Medications

Women are commonly prescribed gonadotropins, clomiphene citrate or letrozole to induce ovulation. Men can also be prescribed similar medications in the treatment of male factor infertility.  

Surgery

Surgery is typically the most suitable treatment method for infertility due to structural abnormalities in the female or male reproductive tract. Surgery can help females who have fibroids, uterine polyps, blocked fallopian tubes, or uterine scarring.  

Similarly, in males, surgery may be recommended in certain cases of varicocele, undescended testis, or blockages within the male reproductive tract. 

Assisted Reproductive Technology 

Assisted reproduction technology (ART) is a broad term that covers fertility-based treatments in which the fertility doctor handles eggs or sperm to aid conception. In-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the two common types of ART.

With ART, the doctor retrieves eggs from the ovaries during an outpatient procedure and then uses IVF techniques to fertilize the egg in a specialized culture medium in the laboratory. During Intracytoplasmic sperm injection (ICSI), the embryologist injects a single sperm directly into each egg.

After successful fertilization via IVF or ICSI, the fertilized egg develops into an embryo until it reaches the blastocyst stage (usually over a period of five days) until it is either  transferred into the uterus or biopsied for genetic screening.

The success rate of ART differs for each person depending on age, but the average rate for young females is up to 54%.

The Emotional Impact of Infertility and Coping Strategies

Couples experiencing infertility may face emotional distress, such as stress, social stigma, anxiety, and depression. These emotions can be worsened by the family pressure and societal expectations. 

In a study published in Fertility and Sterility reported that women diagnosed with infertility had twice the prevalence of depressive symptoms as women without infertility. s. Research has supported the availability of mental health professions for all individuals seeking infertility evaluation and treatment.    

Couples or individuals can use the following coping strategies to handle the emotional distress from infertility:

• Seek help from a mental health professional: Counseling and psychotherapy sessions from a qualified mental health professional can help resolve negative feelings or moods about infertility.
• Social support: Join support groups filled with individuals with similar interests.
• Engage in relaxation techniques such as meditation and yoga.
• Openly communicate how you feel with your partner or loved one.

Alternative Paths to Parenthood

Couples or individuals may choose other pathways to build their family such as adoption or surrogacy.

Legal Adoption

The process of adoption can be complicated and overwhelming. For individuals who cannot carry a pregnancy or who do not want to pursue fertility treatment, adoption may be the ideal way to expand your family. Gestational Surrogacy

Gestational surrogacy is the process of using a gestational carrier and assisted reproduction techniques to help a couple or an individual to create a family when they cannot do so themselves. 

The gestational carrier is not the biological parent, but her role is to carry pregnancy from an embryo(s) created using the intended parents' or donated sperm and egg.

Gestational surrogacy allows couples or individuals to become parents who are unable to carry a pregnancy themselves. However, the gestational surrogacy process involves many steps and requires a series of legal procedures and ma special contract between the intended parent(s) and the carrier.

Are You Looking for Solutions to Infertility?

Couples or individuals going through infertility face many challenges and emotional distress. However, regardless of the cause of infertility, there is a solution and support for you.

It is essential to consult an experienced fertility expert to evaluate you and recommend a solution that fits your unique health needs. Fertility treatments such as medications, surgery, and assisted reproductive techniques are tailored to each patient who is seen at Reproductive Gynecology & Infertility.

Our team of fertility experts at Reproductive Gynecology & Infertility are board-certified fertility specialists with experience and a proven record of helping couples and individuals with alternative family-building options.

We offer a personalized treatment plan that is specific to your peculiar needs. To get professional help from one of our experts, contact us today.

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Egg freezing is a process in which a woman’s eggs are harvested from her ovaries and frozen (in a process called oocyte vitrification), and stored in a liquid nitrogen chamber until the woman would like to achieve a pregnancy. A woman’s ability to conceive declines with age but egg freezing is an effective method for preserving or extending her reproductive potential.

The process takes about 9-11 days of ovarian stimulation with fertility medications followed by the egg retrieval procedure 2 days later. Patients can go on with their routine schedules over this 11-13 day process and only need to take the day of retrieval off of work.

Should you freeze your eggs?

There are many reasons why women delay childbearing. Women opt to freeze their eggs for several reasons:

• They may not have found their life partner
• To delay starting a family
• To preserve their fertility before beginning cancer surgery, chemotherapy or radiation.
• To avoid the creation and freezing of extra embryos after an IVF cycle.

Life circumstances may also influence your decision to freeze your eggs. For some women, knowing they have preserved eggs brings them peace of mind in a time of life that may not be the ideal time to become pregnant. Many women with demanding careers or the inflexibility of academic calendars may wish to delay family building. Here are a few guidelines to help you determine whether you are an appropriate candidate for egg freezing:

• You are in your 20s to mid-30s. (Women over the age of 37 may consider egg freezing on a case-by-case basis).
• You would like to start a family, but aren’t quite ready and would like to preserve your ability to have children later.

Women may also choose to freeze their eggs if they have a medical condition (malignancy) that could potentially harm their fertility. Here are some reasons in which egg freezing would be a viable option for preserving a woman’s ability to have a baby:

• You are newly diagnosed with a cancer, which may threaten your fertility.
• Your planned medical treatments involve chemicals that have been linked to infertility.
• You’ve been diagnosed with early ovarian insufficiency.

When should you freeze your eggs?

When it comes to your egg supply, age is a factor, since the quality and quantity of eggs rapidly deteriorate after age 35. Egg freezing allows you to preserve the optimal years of your fertility when you’re ready to conceive later in life.

As a woman, you are born with all the eggs you will ever have. With time, your eggs decrease in both numbers and cellular integrity. This decline is in large part why women in their 40s have only about a five percent chance of becoming pregnant each month. So, to answer the question, 'at what age should I freeze my eggs?' the simple answer is: Freeze your eggs in your prime reproductive years of your 20s and early 30s. This allows you to take advantage of premium egg quality and quantity.

If you know you want to start a family someday, but the time isn’t ideal for you right now, contact Reproductive Gynecology & Infertility to explore your options. In addition to providing expert IVF treatments and other solutions for infertility in Columbus, we also offer egg freezing in Columbus, Youngstown, Akron and Canton, Ohio. We will present the facts about egg freezing—how it works, the limitations and the likelihood of a successful outcome.

What You Need To Know About Egg Freezing

In 2018, the New York Times reported more than 20,000 American women elected to freeze their eggs. This number has risen sharply since 2009, when there were only 475 women freezing their eggs. The process of egg freezing involves stimulating the ovaries with hormones to produce multiple eggs. Once the eggs are mature, they are retrieved from the ovaries, taken to the lab and cooled to sub-zero temperatures. Frozen eggs can be stored for over 10 years, until you’re ready to start a family.

What's the process of egg freezing?

If you’re considering cryopreservation, or egg freezing, here are a few things you need to know:

• The timing – Generally, fertility begins to decline in your late 20s or early 30s and falls more rapidly after the age of 35. Consider freezing your eggs sooner rather than later, to ensure you are giving your future self the best chance at having a baby.
• The process – Egg freezing typically involves 8-11 days of hormone injections to stimulate your ovaries, 5-7 doctor appointments, blood draws and transvaginal ultrasound exams.
• The medications – The specialized hormone medications will not be available at your local pharmacy. Instead, your reproductive endocrinologist will recommend a pharmacy that specializes in medications for egg freezing and other fertility treatments.
• The procedure – Once your eggs are mature, you will be placed under mild anesthesia so your physician can retrieve them during a brief 10-15 minute surgical procedure. Using ultrasound guidance, a needle is inserted through the vaginal wall into each ovary. The needle is attached to a catheter that’s connected to a test tube.
• The egg freezing – Once the eggs are successfully retrieved, your physician will hand them over to a skilled embryologist who, using a fast-freezing method called vitrification, will transform the eggs into a glass-like frozen state and store them in a liquid nitrogen storage chamber until they’re needed.

What's the egg freezing timeline?

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The he basic steps and how it works.

• Consultation (~1 hour): Discuss patient's medical history and ask questions.
• Testing (~30 minutes): Undergo ultrasound and lab tests.
• Reviewing Results (~30 minutes): Treatment team goes over the results with you.
• Medication and Monitoring (10-12 days): Receive fertility shots and regular monitoring.
• Egg Retrieval (~1 hour): Anesthesia is administered, and eggs are retrieved for freezing.
• Recovery (4-5 days): Take time to recover from any discomfort or bloating.
• After retrieving the eggs, patients can consult their physician regarding additional egg-freezing cycles. Once the eggs are frozen, patients have the freedom to plan their family according to their own timeline and can return for an IVF cycle when they are ready.

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Start Your Family When You’re Ready With Egg Freezing In Columbus

We are proud to say that Reproductive Gynecology & Infertility has achieved successes where others have not. From egg freezing to IVF and more, we provide individual infertility solutions with the utmost compassion, convenience and commitment.

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If you are interested in egg freezing in Ohio, contact the fertility specialists at Reproductive Gynecology & Infertility. We are ready to help you build your family. Call 866-537-2461 to schedule your appointment today.

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The 'two-week wait' is the time between fertility treatment (IVF or IUI) and either a positive pregnancy test or your period. During this period, you’ll probably feel various emotions, from hope to fear. You may wonder if conception took place and what to do next. It can be a stressful time, but you can take steps to make the wait easier.

During the two-week wait, life can be an emotional rollercoaster. You may find yourself swaying between anticipation and joy, fear, sadness, anger, hope, frustration, or even guilt from one moment to the next. It can be exhausting and mentally draining, and you might find it hard to concentrate on anything else. But focusing on other things is exactly what you should do.

How to Cope with the Two-week Wait: The Dos

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While there’s no magic formula for getting through the two-week wait, being kind to yourself is essential. While you’re waiting, do the following:

• ‍Practice self-care. Get enough rest, eat well, drink water, and avoid alcohol and caffeine. Treat yourself to something relaxing, like a massage, a bath, or a hobby.‍
• Seek support. Reach out to your partner, family, friends, or a support group. Talk to your doctor or a counselor if you have any worries or questions.‍
• Stay busy. Keep yourself occupied with positive activities. Here are some ideas to pass the time:
  - Work on a project (Try these craft ideas)
  - Read a book
  - Go to the theatre and watch a new movie or stay in and watch a classic
  - Play a game
  - Go for a walk
  - Plan something fun after the two-week wait, like a trip you’ve been wanting to go on or a dinner with friends at the new spot in town you’ve wanted to try.‍

• Write down your feelings. Write a journal entry, a letter, or a list of hopes and fears. Expressing your thoughts and emotions on paper can help you release stress and gain perspective.‍
• Maintain healthy habits. Exercise moderately, eat nutritious foods, avoid certain medications, and quit smoking.

Communicate with your doctor and partner. Contact your doctor for guidance if you have any doubts or questions about the treatment or the wait. Keep your partner informed and involved in the process.

Behaviors to Avoid During the Two-Week Wait

Being patient for two weeks is hard, and you may be tempted to overthink things or over-test for pregnancy. These behaviors will make the wait more agonizing, so avoid them if possible: 

• Taking too many pregnancy tests. They’re often wrong 12 days after ovulation or ten days after embryo transfer, and testing too soon can stress or disappoint you with false results.
• Obsessively worrying. Worrying too much can increase stress levels and affect your immune system and hormone balance. Focus on the positive aspects of the treatment and the potential outcomes instead of the negative ones.
• Symptom searching. Many symptoms can be caused by other factors besides pregnancy. Also, some people may not experience symptoms until later in their pregnancy. Symptom searching can increase your anxiety and disappointment if you don't feel anything or your symptoms change.‍
• Drinking and smoking. In the two-week wait, prioritize caution. Steer clear of drinking, smoking, or engaging in any risky activities that could harm a developing pregnancy. If you already exercise regularly, it's okay to continue but hold off on starting any intense new workout routines for now.

Getting Through the Two-Week Wait with Patience and Joy

The best thing you can do during the two-week wait is to let your body do its work. Don’t hurry the process or expect quick results. Trust that your treatment team has done their best to help you and that nature will do its part. Be patient and kind with yourself, find joy in the small things, and celebrate every step you take.

When most think of problems with fertility, they tend to attribute the cause to the female partner. However, male infertility is responsible, directly or indirectly, for 60% of fertility-related issues in reproductive-age couples. Even considering this statistic, male infertility is still often under-evaluated or dismissed. Evaluating the male partner for infertility improves the precision of infertility diagnoses and the results of subsequent treatment and management.       

Do men need to get their semen analyzed? Evaluating male fertility is a key piece in determining the best treatment path for acouple struggling to get pregnant. One of the important fertility tests for infertile couples is a semen analysis test. Also referred to as a sperm count test, a semen analysis encompasses more information than just a sperm count.   

What Causes Male Infertility?

The main indicator of male infertility is the inability to impregnate a partner. There may be no other obvious symptom or sign. If you and your partner have not conceived a child after a year of regular, unprotected intercourse, it's time to visit a reproductive specialist who could identify underlying problems, such as hormonal imbalances, dilated veins around the testicles, or possible inherited disorders. Certain conditions or events may be associated with male infertility.

• History of genital infections or inflammation of the prostate
• Early or late onset puberty
• Hernia repair
• Injury to or torsion (twisting) of the testicles
• Genitals exposed to high temperatures
• Undescended testicles

Certain prescription medications may also place a male at risk. Discuss any new medications with a pharmacist.  

How Is a Semen Analysis Done?

The steps involved in a Semen Analysis include:

• Collection of Semen: The patient provides a semen sample by masturbating into a sterile container. The sample should be collected after 2-7 days of sexual abstinence.
• Preparation of the Sample: The semen sample is allowed to liquefy for about 30 minutes at room temperature. The liquefied sample is then mixed to ensure that the sperm are evenly distributed.
• Evaluation of Quantity: The quantity of semen is measured by using a calibrated pipette. The volume of the semen is usually between 1.5 and 5 milliliters.
• Evaluation of Quality: The quality of the sperm is evaluated by examining the sample under a microscope. The sperm are assessed for their motility, morphology, and concentration.
• Motility Assessment: The motility of the sperm is evaluated by measuring the percentage of sperm that are moving and the quality of their movement.
• Morphology Assessment: The morphology of the sperm is evaluated by examining the shape and size of the sperm. Abnormalities in the shape of the sperm can affect fertility.
• Concentration Assessment: The concentration of the sperm is evaluated by counting the number of sperm in a specific volume of semen. A low sperm count can affect fertility.
• Other Tests: In some cases, additional tests may be performed, such as testing for the presence of white blood cells in the semen or testing for infections.

A semen analysis may need to be repeated to ensure accuracy and to monitor changes in sperm parameters over time. If there are any abnormalities in the initial semen analysis, a repeat test may be necessary.

• Information Learned Through Semen Analysis

Analysis of a semen sample involves more than just counting the number of sperm present. In fact, a semen sample normally contains less than 5% sperm. It includes mucus and other fluids that make up the healthy environment for the survival of the sperm within the male's ejaculate. A sperm analysis test usually provides the following information.

Sperm Concentration

The number of sperm found in one milliliter of semen is the sperm concentration number. There should usually be approximately 15,000,000 sperm/milliliter in a healthy sample. A low sperm concentration number may show an overall low sperm count and may indicate an unusually high ejaculate volume.   

Sperm Motility

Motility is the percentage of sperm in a sample that moves. If the sperm are incapable of swimming up the female reproductive tract to meet the egg, fertilization will not take place. A healthy semen sample should include about 40  of the sperm capable of moving. A scale of zero to four measures movement rate, which should be a three or higher if showing proper movement quality.       

Viability or Vitality

Semen analysis reveals the percentage of live sperm in the sample. This is sperm viability or vitality. If sperm motility is low, it is especially important to determine viability. There should be at least 50% of the sperm cells which are viable, but if more than half are immotile, it may require further testing to determine viability.

Morphology

Morphology speaks to the shape of sperm cells. The three portions of the sperm — the head, the midsection, and the tail — are measured, and the proportions between each are recorded. For the sperm to swim effectively and fertilize, at least 4% of sperm need to have a normal shape.      

Liquefaction

Ejaculated semen is normally thick and gelatinous, which helps it adhere to the female cervix. It should liquefy in about 20 minutes to enable sperm to swim effectively. If there is a delay in the liquefaction, more testing is generally indicated. SSemen pH

This analysis measures how alkaline or acidic the semen is. A balanced solution is ideal, with seminal vesicle fluid being more alkaline and prostate fluids being more acidic. If the semen is too acidic, it may kill the sperm or impair fertilization. The pH of the semen sample should be between 7.2 to 7.8. Low semen pH usually goes hand-in-hand with other abnormal measurements, such as a low sperm count or a low volume of semen.    

Diagnosing Male Infertility Through Semen Analysis

Any male with one or more health issues that lower the chances of his partner becoming pregnant may need evaluation for infertility. While there are many causes for infertility in men that can be hard to diagnose, most often, the problem is with sperm delivery or sperm production. 

Diagnosis begins with a physical exam and a full history. An exam usually includes blood work and semen analysis, along with a visual and tactile exam of the male sex organs. The results of baseline blood work will determine the need for more tests.

Semen analysis is most often done at least twice. Abnormal sperm numbers or compromised motility may necessitate further sampling. Semen analysis does not test for sperm function but is the cornerstone of baseline laboratory evaluation for male infertility. Analysis of the semen may provide useful data from which a fertility prognosis or a diagnosis of infertility can be determined.

Low sperm numbers or even no sperm production doesn't indicate irreversible or permanent infertility. It may only illustrate a problem with the growth or delivery of sperm. More testing may further define the problem and suggest possible treatments.

Plan Your Semen Analysis Today 

Sometimes all that's needed are lifestyle changes to improve sperm health, viability and increase sperm count. A few examples include:

• Get plenty of exercise and sleep
• Maintain a healthy weight

• If you smoke, stop
• Enjoy alcohol in moderation
• Support a diet rich in antioxidants with vitamin D and calcium supplements

Avoid underestimating the possibility of male infertility. A correct diagnosis is imperative when determining the best path to building your family. A detailed, precise medical history, physical examination, semen analysis, and other lab work are key to nailing down a diagnosis. 

If twelve consecutive months of trying to conceive have been unsuccessful, it's time to see an endocrinologist specializing in reproduction. The doctors at Reproductive Gynecology & Infertility can diagnose and treat male infertility. Give them a call today!

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We get tons of questions regarding the costs of fertility treatments. At RGI, costs for an IVF cycle vary as each personalized treatment plan is created for our patients’ unique journeys. However, to give our patients a better understanding of what they might expect, we’ve created this general guide for IVF treatment cost ranges. 

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IVF costs vary, averaging from $12,000 and $30,000 for a single IVF cycle. When comparing cost information from different fertility practices, it's crucial to understand what is included in their pricing as this can vary widely and leave patients to incur unsuspected costs.

Here's a breakdown of the average fees.

IVF Cycle Costs Before the Procedure:

• IVF Cycle fee: $12,000 to $14,000
• Can vary across different providers but typically includes monitoring appointments, bloodwork, egg retrieval, embryo development, embryo transfer, Intracytoplasmic Sperm Injection, and follow-up care.
• Assessing fertility: $250 to $500
• Semen analysis: $200 to $250
• IVF Cycle Medications (injection): $3,000 to $6,000

Embryo Creation and Fresh Embryo Transfer Costs:

• Retrieving eggs: Most include this cost in the IVF cycle fee.
• Anesthesia services: Most include up to $725 in the IVF cycle fee.
• Donor sperm: $300 to $1,600
• Intracytoplasmic Sperm Injection (ICSI): Often, this is included in the IVF cycle fee (up to $2,000).

Frozen Embryo Transfer Costs:

• Embryo cryopreservation: $1,000 to $2,000
• Embryo storage: $350 to $600 yearly
• Genetic testing: $1,800 to $6,000
• Frozen embryo transfer (FET): Typically, the embryo transfer is included in the IVF cycle fee (up to $6,400).
• FET medication: $300 to $1,500

Gestational Carrier or Surrogate Costs:

• When using a Gestational Carrier, patients can expect to pay medical fees and legal fees. A typical Gestational Carrier (surrogacy)  journey can range in cost from $60,000 to $150,000.
• Costs to look out for:    
• Gestational Carrier Compensation
• Agency fees are typically assessed (if applicable)
• Any additional medical costs and legal fees

Currenthly, there are nineteen states that require employer-provided insurance to cover fertility benefits, but this varies from state to state.
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If you're ready to start your journey to parenthood, connect with our team today.

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Some couples may experience challenges conceiving or giving birth despite previous successful pregnancies. These obstacles typically hinder partners from reaching their family size easily and early. Secondary infertility is the inability to conceive or to deliver a baby where there has been previous successful delivery of at least one child after trying for 12 months before age 35 years and after six months after age 35 years.

Secondary infertility affects at least 11% of couples in the United States. Male and or female causative factors are responsible for secondary infertility. Medical conditions or diseases that impair ovulation and fertilization or damage the male or female reproductive tracts can cause secondary infertility.

In this article, you will learn more about the male and female causes of secondary infertility and the available treatment options.

Causes of Secondary Infertility in Females

Medical disorders and diseases that affect the female reproductive system and hormones are causes of secondary infertility in females. Here are common causes of female secondary infertility.

Ovulation Disorders

Ovulation disorders include anovulation, which is the inability of the ovaries to release a matured egg during the menstrual cycle. Females with anovulation may not get pregnant because fertilization cannot occur without a matured egg. Oligo-ovulation is ovulation at irregular intervals, often unpredictable, resulting in irregular menses.

Ovulatory disorders account for approximately 25% of female infertility cases. Polycystic ovarian syndrome (PCOS) is the most common ovulation disorder and causes 80% of anovulation infertility. PCOS inhibits the normal cyclical hormone regulatory processes that control ovulation, affecting a female’s ability to get pregnant.

Fallopian Tube Blockage

The sperm fertilizes the egg in the ampulla region of the fallopian tubes. Hence, damage or blockage of the tube hinders the sperm from reaching the egg for fertilization. Infections of the fallopian tubes trigger inflammatory reactions that can damage and block the fallopian tube, especially in chronic pelvic inflammatory diseases. Another risk factor for tubal infertility is a history of pelvic surgery, potentially leading to scar tissue.

Uterine Disorders

Chronic infections and procedures such as dilation and curettage predispose the uterine wall to form scars and adhesions that impair the implantation of the fertilized egg. Also, uterine fibroids, especially the submucous types, may impair implantation and lead to secondary infertility.

Genital Tract Infections

The Centers for Disease Control (CDC) reports that approximately 1 out of 8 women with a history of pelvic inflammatory diseases experience difficulties getting pregnant. Chronic or poorly treated Chlamydia or Gonococcal infections of the genital tract are major causes of female secondary infertility.

Endometriosis

Endometriosis is a medical disorder in which the cells lining the uterus, called the endometrium, are found outside the uterine cavity. These external endometrial cells may trigger inflammation that affects the reproductive process in the uterus and fallopian tubes necessary for fertilization and successful implantation.

Causes of Secondary Infertility in Males

Male factors account for approximately 20-30% of infertility cases. Here are common male factor causes of secondary infertility.

Hormonal Disruption

Some medical conditions may alter the blood level of testosterone, the reproductive hormone responsible for sperm production. Also, brain injury or trauma could damage the pituitary gland or hypothalamus in the brain, which may affect the release of regulatory hormones that control testosterone production.

Genital Tract Infections

Chronic genital infections, such as sexually transmitted diseases, cause inflammatory changes that form scars blocking the sperm transport tubules in the male reproductive tract. This blockage halts the transport of sperm from the testis to the vas deferens for storage.

Damage to Sperm Transport Tubules

After sperm production in the testicles, special transport tubules move matured sperm cells to the vas deferens (the tube that connects the testicle to the penis). However, these transport tubules are at risk of damage in males with previous testicular trauma or pelvic surgeries.

Medical Disorders

Some medical disorders interrupt the blood supply to the testis, affecting the quality and quantity of sperm cells the testes produce. Examples of medical conditions that could affect the testicular blood supply include :

•      epididymitis

•      hydrocele

•      testicular torsion

•      varicocele

•      orchitis

Medications

Medications, such as chemotherapy drugs or steroids, affect sperm production and increase the risk of male secondary infertility.

Exposure to Toxic Environmental chemicals

Prolonged exposure to toxic environmental chemicals and radiation damages the testes and affects sperm formation. Examples include some pesticides and heavy metals like lead.

Lifestyle and Unhealthy Habits

An unhealthy lifestyle typically affects the formation and quality of sperm produced in the testes. Hence, males who engage in unhealthy habits such as alcohol and tobacco intake are more prone to secondary infertility than those who avoid these habits.

When to Seek Treatment for Secondary Infertility

If you suspect you or your partner may have secondary infertility, consult a fertility doctor for evaluation.

During your visit to the fertility clinic, the doctor will take your clinical history, conduct a clinical examination, and order tests for diagnostic purposes.

For females, the doctor will take the following clinical history:

•      duration of infertility

•      your last menstrual period

•      menstrual cycle length and frequency

•      past pregnancies and their outcomes

•      history of medical disorders, including STDs and past pelvic surgeries

•      intake of medications such as birth control pills, etc

•      sexual history

Subsequently, your doctor may conduct a pelvic examination and ultrasound to evaluate your reproductive organs.

While for males, your doctor may take the following clinical history:

•      testicular trauma

•      history of infections such as orchitis or mumps

•      use of medications or previous testicular surgeries

•      exposure to toxic chemicals

•      use of tobacco, alcohol, and illicit drugs

Thereafter, your doctor may perform a pelvic exam to examine your male reproductive organs.

Tests for Secondary Infertility

Your doctor will typically order some tests to identify the underlying cause of secondary infertility and to select the most appropriate therapeutic intervention.

For females, here are some of the common fertility tests:

•      hormone profile test

•      pelvic ultrasound

•      specialized X-ray called Hysterosalpingography to outline the uterus and to check for blocked fallopian tubes

For males, semen analysis is the primary fertility test your doctor will order to assess the following:

•      sperm count

•      sperm volume

•      sperm viability

•      sperm morphology to assess any defects in shape

•      chemical properties such as pH, etc

Also, your doctor may request other tests based on the clinical history and examination findings. For example, your doctor may request a scrotal ultrasound scan if the examination reveals a varicocele. Also, serum testosterone level is crucial for suspected cases of hormone imbalance as the cause of secondary infertility.

Treatment and Fertility Options for Secondary Infertility

There are various treatment modalities for secondary infertility, and your fertility doctor has the medical expertise to decide the most suitable intervention. Generally, identifying the underlying cause and administering the specific treatment may help resolve secondary infertility. Here are the major treatment options for secondary infertility.

Medications

Your doctor will use fertility drugs to optimize the sexual hormones and other specific medications depending on the cause. In females, fertility experts use drugs to induce the ovulation of 1 or more eggs.

Clomiphene citrate is common medication doctors use in fertility clinics. It inhibits the negative feedback effect of serum estrogen in the hypothalamus and pituitary gland. This inhibition enables the pituitary gland to continue secreting gonadotropin hormones that aid the ovulation process and eventually release 1 or more matured eggs.

For males, doctors can prescribe hormone replacement medications in cases of low testosterone blood levels.

Also, your doctor may prescribe antibiotics in clinical cases of chronic genital tract infections.

Surgery

Surgical procedures may be the most suitable therapy for specific causes of secondary infertility in males and females. For instance, in females with uterine fibroids or severe endometriosis, surgery may be an effective remedy for these medical disorders.

In some clinical cases, your doctor may perform a minimally invasive surgical procedure using laparoscopic techniques— surgeries are done using a laparoscope which is a special tube with an attached camera.

For males with varicocele, a doctor may recommend surgical intervention to repair the dilated testicular veins.

Assisted Reproductive Technology

Assisted reproduction technology (ART) is a fertility-based treatment that involves the manipulation of eggs or embryos to aid conception. The two most common types of ART are in-vitro fertilization and intracytoplasmic sperm injection (ICSI).

After stimulation of the ovaries with injectable medications, ART involves obtaining eggs from the ovaries through a small outpatient procedure. 

In vitro fertilization involves the exposure of each egg to several sperm in the laboratory, eventually resulting in a fertilized egg, now called an embryo. Intracytoplasmic sperm injection (ICSI) is an alternative method of aiding fertilization, involving the injection of a single sperm directly into each egg in the laboratory resulting in an embryo. After the creation of the embryo through either IVF or ICSI, the embryo grows in the laboratory, and then eventually, the embryo may be transferred to the uterus to achieve pregnancy.

Do you Need Help with Secondary Infertility?

Secondary infertility in males and females is due to various causative factors. Hence, it is essential to seek help from qualified fertility experts to help you identify the specific cause and proffer the appropriate solution.

Our team of experts at Reproductive Gynecology & Infertility are qualified fertility specialists with a track record of helping couples with infertility cases. To expand and reach your family size early, seek help from Reproductive Gynecology & Infertility today.

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Infertility treatment in modern medicine allows so many individuals and couples to realize their dreams of parenthood. Like most medical fields, fertility treatment has its own language, often complicated or highly technical. Acronyms are also a favorite in today's infertility medical lingo. To help decipher the terminology of 21st-century infertility medicine, we've compiled an "old school" favorite: A glossary of common terms and acronyms.

Glossary of Infertility Terms and Acronyms

We've listed the items here in alphabetical order. Acronyms appear in their commonly used form, followed by the full term the set of letters represents.

Agglutination

Describes an event in which sperm clump together, making it difficult for them to swim easily. Sperm agglutination is a possible indication of immunological infertility, which makes it an important factor to consider in forming an infertility diagnosis.

AI (Artificial Insemination)

A procedure that deposits sperm near the cervix in the vagina or directly into the uterus using a catheter.

Amenorrhea

The complete absence of menstrual periods.

Anovulation

A complete absence of ovulation.

ART (Assisted Reproductive Technologies)

ARTs are various procedures used to combat infertility in which conception occurs without sexual intercourse.

ART Cycle

A process that includes an ART procedure, stimulation of the ovaries, or frozen embryos that are thawed for transfer into a woman. This process starts when a woman begins fertility medications or monitors her ovaries for follicle production.

BBT (Basal Body Temperature)

A temperature reading taken every day that can be used to chart ovulation.

Beta HCG Test

This blood test detects very early pregnancies and can help evaluate embryonic development.

Cryopreservation

This freezing process preserves embryos, sperm, and other tissues at very low temperatures. When embryos are not utilized in an ART cycle, they can be cryopreserved for potential use in the future.

DEIVF (Donor Egg In Vitro Fertilization)

An in vitro fertilization procedure in which the egg used is procured from a donor.

Donor Egg

Also known as egg donation, this term describes the donation of an egg from one woman to another. The goal is to become pregnant by in vitro fertilization (IVF).

Donor Embryo

Describes an embryo donated by a couple who previously had ART treatment that resulted in the creation of extra embryos. When donated, all parental rights of the donor couple are relinquished.

Embryologists

Professionals who specialize in advanced laboratory techniques to prepare and provide the conditions necessary for the fertilization of eggs. These specialists facilitate the development, growth, maturation, and preservation of embryos.

Fertility Specialist

A physician who specializes in treating fertility problems. These physicians receive certification in a subspecialty for OB-GYNs from the American Board of Obstetrics after obtaining extra training in reproductive endocrinology and infertility.

Gestation

This term refers to the period of development the fetus undergoes in the uterus from conception to birth, usually 40 weeks' duration.

Gestational Surrogate / Gestational Carrier / Gestational Surrogacy

Arrangement in which a woman agrees to carry a pregnancy on behalf of another individual or couple (the intended parents). In Gestational Surrogacy, embryos are created using the egg of the intended parent (or an egg donor) and the sperm of an intended parent (or a sperm donor). Gestational Carriers (surrogates) do not have any biological relation to the resulting baby.

HCG (Human Chorionic Gonadotropin)

A hormone produced in early pregnancy that's released from the placenta after implantation. It can be employed via injection to trigger ovulation after certain types of fertility treatments. In men, it can stimulate testosterone production.

‍ICSI (Intracytoplasmic Sperm Injection)

This procedure retrieved eggs and sperm from both partners. In a laboratory, a single sperm is injected directly into the egg, and the fertilized egg is then implanted into the woman's uterus.

Idiopathic Infertility

A term applied when the cause of infertility remains unexplained.

Implantation

This occurs when a fertilized egg embeds itself in the uterus lining.

Infertility

Inability to conceive following a year of unprotected intercourse, or six months in women over age 35.

IUI (Intrauterine Insemination)

Less frequently, it can stand for intra-uterine injection or intra-uterine infection. Intra-uterine insemination is a procedure for treating infertility. The sperm is washed, then concentrated before being placed directly in the uterus when the ovary releases one or more eggs.

IVF (In Vitro Fertilization)

A complex procedure for treating infertility in which mature eggs are retrieved from ovaries and fertilized by sperm in a lab.

Microinsemination

In this laboratory procedure, sperm is injected next to an egg cell surface in a laboratory dish. This is done to increase the chances of fertilization.

PGT (Preimplantation Genetic Testing)

A screening technique used to evaluate the chromosomal makeup of an IVF embryo and whether the embryo contains genetic abnormalities.

Postcoital Test

In this standard fertility test, a sample of cervical mucus is taken from the woman after intercourse to determine the number and behavior of sperm. Cervical mucus is an accurate reflection of the ovarian cycle, the PC test is an invaluable indicator of the endocrine preparation of the female reproductive system.         

Reproductive Endocrinologist

Highly trained Obstetrician-Gynecologist with advanced education, research, and skills in reproductive endocrinology and infertility. 

Secondary Infertility

Infertility lasting six months or more in a couple who previously had a successful pregnancy and birth.

Sperm Bank

A facility that specializes in the collection and freezing of sperm, preserving it to be used later by a couple or donated for use in assisting others with infertility.

Sperm Count

The number of active sperm in an ejaculate sample. Normally, the sperm count ranges from 15 million sperm to more than 200 million sperm.

Sperm Motility

The percentage of sperm in an ejaculate that moves forward.

Surrogacy

Traditional Surrogacy

Traditional surrogacy is sometimes called "straight surrogacy," "partial surrogacy," or "genetic surrogacy." It involves a legal agreement between the intended parents and the surrogate. In this scenario, the surrogate is the biological mother of the baby. The surrogate's own eggs are fertilized using a sperm donor or the intended father. Intended mothers do not have a genetic link to the baby in traditional surrogacy. IHR does not work with traditional surrogates, only gestational surrogates. 

Gestational Surrogacy

A gestational surrogate carries and delivers a baby for another person or couple. Gestational surrogate pregnancies are achieved through IVF. In this procedure, an embryo is created in a lab using the egg and sperm from the intended parents, or donor eggs and sperm may be used. The embryo is then transferred to the uterus of the gestational surrogate. Because the gestational carrier carrying the pregnancy doesn't provide an egg, there is no genetic connection between the child and the surrogate.       

TTC (Trying to Conceive)

Considered slang, this acronym is generally used as a form of shorthand in notes, in online communities, and on social media. Often seen as a hashtag: #TTC.

Ultrasound

A testing procedure that uses high-frequency sound waves to view the ovaries, uterus, and the developing fetus.

Vaginal Ultrasound

This procedure is performed through a probe inserted into the vagina. It allows the viewing of the follicles, fetus, and other soft tissues by using sound waves. Imaging the structures in the pelvis with ultrasound can identify abnormalities and help diagnose conditions.

Make the Call

Are you ready to explore the possibilities for growing your family? Request a consultation with the specialists at Reproductive Gynecology & Fertility, your premiere source for comprehensive, advanced, experienced fertility care. 

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If you are currently planning to start in vitro fertilization (IVF), you may feel overwhelmed by the decisions you have to make. Your physician and you (and perhaps a partner) will discuss IVF protocols, the fertilization method, and what to do with any surplus embryos. Another important decision you’ll need to make is whether to do preimplantation genetic testing (PGT). 

PGT is a procedure that spot screens for abnormalities in embryos to help identify the best embryo to transfer and hopefully decrease the risk of an unsuccessful transfer. In addition, it can be used to screen for genetic diseases in patients who are at risk of transmitting a genetic disease (like BRCA, a breast cancer gene) to a child. 

PGT includes three genetic screening tests for embryos. They are usually referred to by their acronyms. Here’s what you need to know about PGT to decide if it’s the right choice for your fertility journey.

What Is PGT?

PGT is an umbrella term covering three main subsets of genetic testing. They include preimplantation genetic testing for aneuploidy (PGT-A), preimplantation genetic testing for monogenetic/single-gene diseases (PGT-M), and preimplantation genetic testing for structural chromosomal rearrangements (PGT-SR). PGT-A is the most common genetic test for those going through fertility treatments like IVF.

By understanding what each of these tests does, you can speak to your fertility specialist and see if they might be right for you.

PGT-A

PGT-A screens for chromosome abnormalities in embryos. It counts the 46 chromosomes in an embryo and detects whether there is an extra or missing chromosome – this is clinically referred to as aneuploidy. This can reduce the risk of implanting an embryo with a genetic condition such as Down syndrome (where there is an extra chromosome), and it can help predict which embryos will implant most successfully during IVF, resulting in pregnancy.

PGT-M

Formerly known as preimplantation genetic diagnosis (PGD), PGT-M (monogenic/single gene defect) is a screening tool used for couples who may be at an increased risk of having a child with a specific single gene disorder. Those who may benefit from PGT-M include couples who are carriers of the same autosomal recessive condition, such as Cystic fibrosis. 

When patients (and their partners) know this information before IVF, they are encouraged to undergo screening for recessive conditions. For these conditions, if an embryo inherits one mutated gene copy from each parent, the child would be affected by the disease. PGT-M can detect mutations from parents with inherited genetic diseases, such as Huntington’s disease, or a genetic cancer risk like the BRCA gene.

PGT-SR

PGT-SR is performed when a patient (or their partner) is known to have a chromosomal rearrangement – pieces of chromosomes are missing, duplicated, or rearranged. Individuals with chromosomal rearrangements may experience recurrent pregnancy loss or have a child affected by a chromosomal rearrangement. Many times these patients are healthy and would otherwise not show any signs or symptoms. 

Patients with recurrent pregnancy loss (two or more clinical pregnancy losses) should have a karyotype to screen for a chromosomal rearrangement prior to starting IVF. By detecting the chromosomal rearrangement in an embryo, PGT-SR can reduce the risk of having a child affected by a chromosomal abnormality and the risk of another pregnancy loss. 

By working closely with a fertility specialist who understands your fertility process and health history, they’ll be able to confidently recommend whether a specialized test like PGT-SR can help in addition to a more commonly used screening tool like PGT-A.

The Pros and Cons of PGT-A

Here are some factors to remember as you discuss PGT-A with your partner and fertility specialist.

Pro: Optimal Embryo Selection

One of the main goals of PGT-A is to ensure that your IVF is successful. By screening the embryos before implantation, the doctor is able to identify the embryos with a higher chance of a successful pregnancy. Since pregnancy rates are higher with embryos that have undergone PGT-A, only one embryo is transferred. Single embryo transfer is preferred since pregnancy complications increase in pregnant patients with more than one fetus.

Pro: Sex Selection

PGT-A screens all 46 chromosomes, which means information on embryo sex is also available. Some patients prefer not to know the sex of the embryos. Others may be interested for the purpose of family balancing or for rare situations in which a genetic disease is inherited based on embryo sex.

Pro: Reduce Stressful Decisions

The most common cause of pregnancy loss is a chromosomal abnormality in the developing fetus. Some chromosomal abnormalities can increase the risk of stillbirth, shorten lifespan, or cause significant medical problems. By screening embryos for chromosomal abnormalities, some of these tragic situations can be avoided. By screening embryos with PGT-A, hopefully, the risk of miscarriage will decrease, and the number of embryo transfer cycles needed to become pregnant will also decrease.

Con: Extra Cost

IVF is expensive, and additional testing like PGT-A can add cost. Your insurance also may not cover PGT-A with your fertility treatment. However, it’s worth noting that with PGT-A, you may not need multiple embryo transfer cycles to conceive, helping to negate that cost. Together with your fertility specialist, you can discuss the expense of both IVF and PGT-A to your options and how much extra testing may cost.

Con: Embryo Damage

All genetic screening tests require embryologists to remove cells (usually five-seven) from the trophectoderm – which are the cells that become the placenta. This testing is usually performed on a day five embryo (blastocyst) when the embryo is less likely to be impacted by removing a small number of cells. Cells from the inner cell mass are not disturbed as these cells will develop into the fetus. In labs that are routinely performing PGT-A, the risk of damage to the embryo is very low because of the expertise and experience of the embryologists. Your fertility specialist will help you decide if this testing is the best choice for you and will also discuss the genetic screening options that are available after you conceive. 

Con: False Results

Just like with any type of testing, there is a chance that a PGT-A test can deliver a false negative or positive, meaning that healthy embryos may go unused when they could have been transferred, or an embryo with a chromosomal abnormality is transferred based on test results. 

This test is also not a diagnostic test but a screening test. This is because the biopsied cells come from the cells that become the placenta and not the cells that become the fetus. This is not unique to embryo testing as early genetic screening in pregnancy – such as noninvasive pregnancy testing (NIPT), which is offered at 10-12 weeks is also screening the DNA from the placenta. The earliest testing that can be done on the DNA of the fetus is at 15 weeks of pregnancy via an amniocentesis. 

In addition, sometimes embryos contain 2 different cell lines – these are called mosaic embryos. Mosaic embryos can implant and result in a live birth but do so at a lower rate than chromosomally-normal embryos. Mosaic embryo results require individualized counseling between the physician and patient before making the decision to transfer. 

Talk to your fertility specialist about the risk of a false PGT-A result so that you can factor this into your decision-making process.

Is PGT-A the Right Choice for Me?

Many personal factors come into play when deciding to do PGT-A testing on your embryos. This includes:

• Age: Women who are older who are undergoing IVF to create embryos have an increased risk of chromosomal abnormalities in those embryos. Therefore, women 35 years or older may want to use PGT-A to select the embryo that has the highest chance of pregnancy.
• Health history: If you’ve had a history of recurrent miscarriages, unsuccessful embryo transfer cycles, or have had abnormal genetic testing results in the past, PGT-A may offer you peace of mind before an IVF transfer.
• The number of embryos: It is important to note that not every fertilized egg will develop into a blastocyst (day five embryo). There is a risk that no embryos develop to day five or that no embryos are chromosomally normal. Thus, some patients who proceed with PGT-A may not have a viable embryo to transfer.
• Time: After the embryos are biopsied on day five, the embryos are cryopreserved until embryo transfer. The results from the genetic testing of the embryo may take as long as two weeks. Therefore, patients who test the embryo will usually transfer the embryo the next month. Studies have also shown that for some patients, a frozen embryo transfer has a higher live birth rate than a fresh transfer.

This is just a glimpse of the considerations when thinking about PGT-A testing. To make the best-informed decision, consult with a fertility specialist regarding your situation. They will be able to go over your health history and fertility journey and answer any questions you may have to help you confidently reach your decision.

At RGI, we offer an IVF 100% Success Guarantee Plan to qualifying patients because we’re confident in our experience and technology to help you get the family of your dreams. For some patients, an important part of that will include PGT-A testing. Schedule a consultation with a fertility specialist today and learn more about your fertility and the available treatment options.