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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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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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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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Fertility treatments such as in-vitro fertilization and egg donation (egg donor IVF or donor egg IVF) allow many individuals and couples to start or expand their family size regardless of their fertility and health status. A 2016 Center for Disease Control and Prevention survey revealed that donor eggs were used in 24,300 Assisted Reproduction Technology (ART) cycles.

Although the success rate of donor egg IVF procedures varies, the average success rate of live births utilizing this procedure is 49-50%. Your odds of succeeding in using donor eggs are higher when you follow specific steps and consult a fertility specialist. Our team has compiled a few guidelines to help you with the donor egg IVF procedure.

This article will teach you more about egg donor IVF, the process of how donor eggs and IVF work, and the procedure’s benefits and success rates.

What is Egg Donation?

Egg donation is the process in which a donor (female) contributes her eggs to a recipient for conception purposes. At RGI, our egg donors undergo thorough physical and psychological screenings. These screening tests help to ascertain the egg donor’s health status and suitability for the egg donation journey before matching with recipients.

After an egg donor passes the critical screening steps to confirm their eligibility, she will undergo the process to retrieve eggs. First, the donor will take medication to stimulate the ovaries to produce multiple eggs. Egg donors then undergo an egg retrieval to obtain the eggs available for use by another individual or couple.

Eventually, the eggs are fertilized in the lab through in vitro fertilization. In vitro fertilization is the process in which the eggs are exposed to sperm resulting in the development of an embryo in a culture medium in the laboratory. This embryo will then be placed in the recipient’s uterus to result in pregnancy.

Who Benefits From Egg Donation/Donor Egg?

The egg donation process is suitable for individuals and couples who want to start a family but cannot for various reasons.

The egg donation process is recommended in the following clinical cases:

• older females with infertility
• single males who have a gestational carrier (surrogate)
• gay male couples
• those with a high risk of transmitting a genetic disease
• females with low ovarian reserves and primary ovarian insufficiency
• females with damaged ovaries due to cancer treatment
• unexplained recurrent IVF failure

Apart from these indications, the fertility doctor will evaluate your unique health needs to determine if you will benefit from egg donation.

What Is the Process of Egg Donation?

Pre-donation Screening

Fertility doctors use specific guidelines stipulated by the law to screen egg donors in a fertility clinic. U.S. Food and Drug Administration (FDA) guidelines recommend the following screening procedures for egg donors:

The egg donation process occurs in phases and has both medical and legal procedures to protect the donor and recipient. Here are the typical steps of the egg donation process.

• formal application
• in-person or phone interview
• clinical and psychological history to discover the donor’s medical and family history
• physical examination
• blood tests such as HIV, etc, for infectious disease screening
• drug tests
• ultrasound scan to examine the female reproductive organs
• genetic testing to screen for inherited disease

These screening procedures help to confirm the eligibility and health status of the prospective egg donor.

Legal Procedure

The law regulates the egg donation process and helps to protect both parties involved. Generally, the donor and recipient may opt for legal counsel before the egg donation process. Sometimes, a lawyer helps mediate the legal procedures, such as verifying and witnessing contract signing. For instance, some egg donation clinics require all donors to sign a contract. This contract will typically state that the donors do not have any legal rights or responsibilities to a child resulting from the process.

The Treatment Phase

The fertility specialist will use specific fertility drugs to prepare the egg donor. While on these medications, fertility experts monitor the donor closely, stimulating her ovaries to make several eggs in a single cycle. Once the ovaries appear ready, a medication to induce the maturity of the eggs is administered at a precise time relative to the egg retrieval procedure. During this phase, egg donors remain abstinent from sexual intercourse to eliminate pregnancy risk for the egg donor.

Egg Retrieval

On the retrieval day, the donor will receive anesthesia medications, often through the IV. Then the doctor will use ultrasound guidance to insert a needle through the vagina and into the ovary to extract the eggs from the matured follicles. Extracted eggs are cryopreserved until they are used by a recipient for in vitro fertilization.

How Do Donor Eggs and IVF Work?

The in vitro fertilization process takes place after eggs are retrieved from the donor. The sperm donor or intended parent will provide the semen specimen, which will be used to fertilize the mature eggs.

Fertilization can occur in two ways;

• Conventional insemination: Healthy matured eggs are exposed to sperm cells in the culture medium to allow fertilization.
• Intracytoplasmic sperm injection (ICSI). In ICSI, a sperm cell is injected directly into each mature egg. ICSI is ideal for clinical cases of low sperm count or repeated history of failed IVF.

After successful fertilization, the embryo grows in the culture medium in the lab. The fertility expert transfers the embryo into the intended parent or gestational carrier’s uterus for implantation.

How Much Do Donor Eggs and IVF Cost?

The cost of egg donation varies depending on the source of the donor eggs. Couples can get egg donors from the following sources:

• Egg donor agencies: These are specialized commercial egg donation agencies that recruit, screen, and match healthy egg donors with interested couples.
• Infertility clinics: Some have a bank of frozen eggs harvested from past clients.
• Specific individuals: A couple can choose a close relative or friend as their egg donor.

The cost of the invitro fertilization process differs for each fertility clinic. The average cost of egg donation will range between $10,000- $15,000. This could be more if it is a fresh egg donation process versus frozen donor eggs, which are typically less expensive.

According to the American Society of Reproductive Medicine, the average cost for one in vitro fertilization (IVF) cycle is more than $12,000. This cost is in addition to the cost of an egg donor.

What Are the Success Rates of Donor Egg + IVF?

The success rate of egg donation and in vitro fertilization differs from clinic to clinic. The recent Center for Disease Control fertility report states that close to 50% of donor eggs and in vitro fertilization result in a live birth.

The success rate of egg donation and IVF also depends on the following:

• egg donor’s age
• extraction process
• quality of sperm,
• recipient’s health status

Hence, it is important to consult a fertility expert with a proven track record of successful egg donation and IVF.

Do You Need Help With Egg Donation and IVF?

Egg donation and IVF help couples to start or expand their family size regardless of their health or fertility status. Egg donation and IVF are safe and suitable for LBGTQ+ couples and heterosexual couples struggling with fertility. The egg donation process involves multiple steps and requires expert guidance from an experienced team of fertility experts.

At Reproductive Gynecology and Infertility, we have years of experience helping build families through IVF and donor eggs. Our state-of-the-art IVF technology solution has helped partners achieve their dreams of having a beautiful family.

We have a team of industry-leading fertility physicians and assisted reproductive technology professionals to assist you. Schedule an appointment with us to get started on your family-building journey.

Going through fertility treatment, you may wonder about the best path to self-care during IVF, especially as embryo transfer day approaches. You may be worried about what effect your actions can have on the process, and you want to make sure you do everything in your power to ensure success. The good news is that caring for yourself before and after your embryo transfer procedure isn’t complicated.

Here are ten simple tips for taking care of yourself during this exciting time.

1. Eat a Healthy Diet and Stay Hydrated

If you already eat wholesome meals, keep it up. Now is the time to cut down on sweets, reduce alcohol, and add more fruits, vegetables, and lean protein. There’s no “embryo transfer diet” to follow, but eating as if you’re already pregnant is a good idea. Drinking fluids is also crucial since proper hydration is essential to optimal cell functioning. You want your body to be in optimal condition.

2. Take a Prenatal Vitamin (and Make Sure You Get Enough Folic Acid)

Now is a good time to start taking a prenatal vitamin — following your doctor’s instructions. If you’re taking an over-the-counter prenatal rather than a prescription brand, ensure that it includes DHA omega 3, vitamin D, calcium, and folic acid. While most prenatal vitamins contain adequate amounts of folic acid, your doctor may recommend an additional supplement. Folic acid helps prevent neural tube defects in your baby and may also reduce the risk of heart defects.

3. Avoid Chemical Exposure from Everyday Sources

Modern life is full of products containing endocrine-disrupting chemicals or EDCs. These chemicals may interfere with your hormones, and some can cross the placenta and build up in your unborn baby’s bloodstream, causing developmental issues. Become a label reader and avoid products that contain the following:

• Bisphenol A (BPA, common in plastics)
• Phthalates
• Parabens (common in cleaning and personal care products such as shampoo)
• Triclosan (found in anti-bacterial products).

Avoid EDCs both before and after embryo transfer or, better yet, cut them out of your life entirely.

4. Take it Easy on Transfer Day and Immediately After

While there’s certainly no need for bed rest (the embryo isn’t going to fall out, after all), relaxing and pampering yourself on embryo transfer day and for a couple of days after is a good idea. This is as much for psychological and emotional reasons as for physical ones; post-transfer days can be an emotional rollercoaster, and rest, relaxation, and pampering can go a long way toward reducing stress.

5. Relax — but Not in the Hot Tub

While pampering yourself in the days after an embryo transfer can be good for your mental and physical health, avoid the sauna or jacuzzi, and pass on a long soak in a hot bath for a few days. Some research suggests that activities that elevate your core temperature might interfere with implantation. Just to be safe, stick to showers or warm baths rather than turning up the heat.

6. Keep Taking Your Medications

Unless your doctor advises you differently, continue taking your prescribed medication. Progesterone is vital as it helps the embryo implant and ensures it stays implanted. Don’t stop any medicines unless your doctor recommends a break.

7. Abstain from Sex Until Your Doctor Okays It

If your doctor has suggested that you refrain from sexual intercourse for a short time after the embryo is transferred, you may wonder why. The answer? Sex can cause uterine contractions. This can affect the embryo’s ability to implant and, in a worst-case scenario, could theoretically lead to a miscarriage. Most experts agree that abstaining from sex for 10 to 14 days is sufficient.

8. Pay Attention to Your Body

You know your body best, so pay close attention to what it’s telling you. If anything feels wrong or “off,” inform your doctor immediately. There’s probably nothing to be concerned about, but a quick consultation can relieve your mind.

If you’ve been taking fertility drugs, keep your eye out for the following symptoms:

• Sudden weight gain
• Abdominal pain
• Bloating
• Nausea
• Vomiting
• Diarrhea

These can be symptoms of ovarian hyperstimulation syndrome or OHSS, and it’s important to let your doctor know immediately.

9. Don’t Rush Out and Buy a Pregnancy Test

Taking a pregnancy test too early isn’t a good idea, no matter how tempting it may be. Pregnancy tests measure the amount of pregnancy hormone in your urine, and it takes some time for this hormone to build up to measurable levels. You might get a false-negative or even a false-positive result if you take a test too soon. So, settle in with a stack of good books, binge-watch Netflix, or find another way to pass the time until your scheduled pregnancy test with your fertility doctor.

10. Use Stress-Reduction Tools to Make the Wait Easier

Finally, do what you can to de-stress while you’re waiting. This is a good time to sign up for meditation, a beginner’s yoga class, or embark on a stress-reduction course.

The Takeaway

The time before and after your embryo transfer can be a template for how you plan to advance during your pregnancy. Forming good habits now and learning to care for yourself with compassion can create a firm foundation to build on in the future. If you’re just starting your fertility journey, if you have questions, or if you simply want to learn more, we can help.

Contact Reproductive Gynecology and Infertility today and speak to one of our fertility experts.

By The Time You’re 30, Here’s What You Should Know About Your Fertility

Many individuals are having their first child later in life than in previous generations. Therefore, it’s important for people to understand the timeline of their fertility.

In the U.S, the average age that a woman has her first child is 26, up a full five years from the average age of 21 in 1972. A growing percentage of women are choosing to wait to have children until their 30s. This is influenced by factors including demanding careers, longer times spent in college or graduate school, or getting married at a later age.

By the time you’re 30 or 35, what do you need to know about your ability to conceive and have a healthy pregnancy?

Below we’ll look at how hormones, egg count and quality, and other factors involved in reproduction change once you’re in your 30s. We’ll also cover fertility treatments most often recommended for those over the age of 35 and cover the basics of freezing your eggs.

Fertility In Your 30’s

If you recall learning about reproduction in high school biology class, you may remember that women are born with all of their eggs. Unlike men who continuously make sperm throughout their lives, women don’t make any new eggs over time. Therefore, the quantity and quality of a person’s eggs start to diminish the older they get, starting from a young age.

According to the American College of Obstetricians and Gynecologists, “Peak reproductive years are between the late teens and late 20s. By age 30, fertility (the ability to get pregnant) starts to decline. This decline becomes more rapid once you reach your mid-30s.”

By the age of 45, the average person’s ability to get pregnant naturally has substantially decreased, to the extent that they’re very unlikely to get pregnant without any intervention.

“Ovarian reserve” refers to the number of healthy, normal eggs that a woman has left inside her two ovaries. This number decreases with age. Having “diminished ovarian reserve” becomes more likely in a person’s 30s, indicating that reproductive potential is lower based on the number and quality of eggs left.

Not only does the quantity of eggs decrease over time, but egg quality also diminishes as a person gets older; remaining eggs in older women are more likely to have abnormal chromosomes compared to eggs in those that are younger.

Changing hormones and pre-existing conditions are two other fertility factors to consider during your 30s. Women in their mid to late 30s have a higher risk of having disorders that can affect a healthy pregnancy, such as uterine fibroids, ovarian cysts, endometriosis, and pelvic inflammatory disease.

Levels of estrogen, the key hormone that controls a menstrual cycle, start to decrease in your mid-30s, resulting in less regular ovulation and irregular periods. Estrogen does not control the menstrual cycle. I would say something like the incidence of ovulation dysfunction increases as we age, resulting in fewer ovulatory cycles per year and irregular periods. Some women enter perimenopause (the stage prior to menopause) as soon as their late 30s, which can make conception less likely.

Finally, although it’s usually only temporary, past birth control use can also impact fertility, especially birth control forms such as injectables/shots. It can sometimes take up to 18 months for ovulation to resume once stopping birth control injections, which is something to take into account if you currently use birth control and wish to get pregnant in the near future.

Success Rates of Getting Pregnant

The average 30-year-old woman without any preexisting reproductive conditions has about a 20% chance of getting pregnant each month. In comparison, someone in their 20s has an even greater chance, about 25% per month.

By the time a woman reaches 40, the success rate of getting pregnant naturally drops to about 5% per month, meaning about one or two out of 10 would be able to get pregnant each month when actively trying to conceive.

Once an individual reaches their mid-30s, the older they get, the higher the risk of having a miscarriage or having a baby with fetal abnormalities. It’s estimated that about 15% of pregnancies in those under 35 result in miscarriage, but this number increases up to 25% to 50% if the person is between 39 and 44 years old.

Other factors to consider are the increased likelihood of chromosomal abnormalities, including Down syndrome, the most common chromosome problem that occurs among women who have children in their 40s. Down syndrome affects about 1 in 85 fetuses if the mom is 40 or about 1 in 35 if the mom is 45.

There are also increased maternal risks involved in having a baby at a later age, including preeclampsia (high blood pressure during pregnancy that can lead to organ injury). Older people pursuing pregnancy also have a higher chance of having twins/multiple pregnancies since the ovaries are more likely to release more than one egg per month.

Fertility Treatments Available

Tracking Your Cycle

If you’re in your 30s and trying to conceive, first start by tracking your menstrual cycles to get an understanding of how regular your periods are and when you’re most likely ovulating.

You can use any number of fertility apps on your phone to help you track your cycles, plus ovulation strips to help you pinpoint which days are best for having sex (a strip will turn positive 24 to 36 hours before ovulation, indicating to have sex at that time).

Additionally, you can monitor changes in your cervical mucus and basal body temperature to determine if and when you ovulated, which is helpful for predicting the following month’s cycle.

Visiting A Reproductive Endocrinologist (REI)

If you haven’t conceived on your own after trying for 6 to 12 months, it’s best to visit a healthcare provider for help with an infertility evaluation.

How long should you wait before seeking professional help?

Once you’re in your mid-30s, it’s recommended that you meet with a Reproductive Endocrinologist (REI) sooner rather than later. The recommended point is after about 6 months of trying on your own. REI fertility specialists can help pinpoint any fertility issues that may make conception more challenging.

REIs perform extensive exams and tests to uncover the full picture of a patient’s reproductive health, including a pelvic ultrasound (which can spot issues such as endometriosis or ovarian cysts), tubal evaluation, ovarian reserve testing, hormonal panel tests, and semen analysis for a partner.

Based on test results, your REI can help you decide which treatment options are most likely to be successful. Treatment for infertility, including if it’s related to advanced age, always depends on the individual case, as there are many potential pathways to having a successful pregnancy.

Potential fertility treatments that may be used to help you get pregnant in your 30s or 40s include IUI (most often for women under 35), IVF, or use of donor eggs, donor sperm, or possibly a gestational carrier (surrogate) if necessary.

Assisted reproductive technologies, including in vitro fertilization (IVF), can help with a variety of infertility causes that come into play in your late 30s or 40s, such as damaged or absent fallopian tubes, genetic abnormalities of embryos, low ovarian count, or a partner with low sperm quantity or quality.

Your REI can also perform prenatal and diagnostic screening tests, both before you become pregnant and once you’re pregnant, to assess the risk of birth defects or genetic disorders, including those that are more common in later-age pregnancies.

Keep in mind that no matter how you plan to become pregnant, and no matter the age, it’s important to take care of your body holistically — by maintaining a healthy weight, eating a nutrient-dense diet, quitting smoking, exercising enough, and managing stress.

Freezing Your Eggs

Egg freezing (fertility preservation) may be a good option for women in their 30s if they want to build their families later in life.

Also called oocyte cryopreservation, egg freezing essentially pauses the progression of chromosomal abnormalities that eggs experience past a certain age. This option allows women to preserve higher-quality eggs that are more likely to be chromosomally normal so that they can get pregnant at a later age through IVF.

Egg freezing can result in a lower risk of miscarriage and a lower risk of Down’s syndrome. One drawback is that it can be expensive and somewhat invasive, considering it involves many of the same medications and steps as IVF; however more employers and insurance companies are beginning to cover some costs of egg freezing.

If egg freezing seems like it may be a good fit for you, speak with your OB-GYN or an REI to discuss your future family building plans and next steps that will help you prepare as best as possible.

About 1 in 8 couples in the United States experiences infertility. This number might seem high, but considering how many things need to go perfectly suitable to conceive, it’s not surprising.

There are many reasons why an individual or couple might have a hard time becoming pregnant, including factors related to ovarian health and egg quality, sperm quality (concentration, motility, shape), uterine health, and more.

For those having trouble conceiving, there are various options to seek or utilize that can help you get pregnant, some of which you can even begin to pursue on your own, like making changes to your diet and lifestyle to optimize your body for pregnancy. You can also work with your current OB/GYN or Primary Care Physician (PCP) to start with preliminary testing, such as basic ovarian reserve testing and a referral for a semen analysis.

For many looking into fertility treatments, two options become top choices to consider pursuing: intrauterine insemination (or IUI) and in vitro fertilization (or IVF).

For people struggling to conceive, an initial evaluation with a fertility specialist can help identify the root cause of infertility and factors that may be creating challenges. Reproductive Endocrinologists have extensive training and experience in evaluating problems that can interfere with conception — such as egg, sperm, uterine, or implantation issues — and are therefore best able to guide patients in choosing which treatments are best for them.

IUIs should be performed by a medical professional trained to do them. In most cases, IUIs are used in conjunction with medicated (oral pills) treatment cycles. IVF is a more involved treatment and should only be managed by an experienced reproductive endocrinologist (REI).

Below we’ll look at what IUI and IVF entail, the pros and cons of both treatments, and knowing which one is the right option for you.

What Is IUI?

IUI stands for intrauterine insemination. It involves having sperm injected into the uterus around the time of ovulation. This is done to bypass any potential cervical issues and decrease the sperm’s travel time to the egg and increase the likelihood of fertilization happening.

For whom is IUI a good option? It’s typically one of the first fertility treatments recommended for patients who have not gotten pregnant on their own within about six months to one year of trying depending on age. It’s a great option for those dealing with hormonal and fertility issues such as:

• Anovulation (lack of ovulation without help from medication)
• PCOS
• Cervical mucus problems
• Sperm quality issues
• It can also help same-sex couples using donor sperm, single mothers using donor sperm, and sometimes couples with unexplained infertility.

You might also hear IUI referred to as artificial insemination. IUI involves the sperm first being “washed” to increase its potency, then being delivered directly to the uterus.

“Washing” sperm means that a sperm sample is first collected, and then the sperm are separated to sort healthy, motile (swimming) sperm from the less healthy sperm and seminal fluid. Only the best quality sperm is used during an IUI; this way, there’s the greatest chance of the sperm being able to reach and penetrate the egg.

It’s essential that the individual is ovulating or just about to ovulate when IUI is performed because this is the only time that a person can get pregnant. Ovulation is when a mature egg is released from an ovary to begin its journey down the fallopian tubes, at which point it can be fertilized.

Before an IUI is performed, a doctor monitors the individual to track the timing of their cycle and ensure they are ovulating. Monitoring can be done using an ultrasound, which looks at egg follicles within ovaries, and sometimes with bloodwork.

Here are the basic steps involved in an IUI cycle:

• The IUI cycle begins on the first day of a person’s period and the egg(s) mature inside the ovaries for about the next two weeks leading to ovulation.
• Some people will take medications to encourage ovulation during this period. For example, medications (such as oral meds like Clomid or Letrozole or injectable hormone medications called gonadotropins) can be used to stimulate more eggs to mature and be released.
• In most cases, the IUI will take place on the day of ovulation or sometimes the day prior. This is determined using monitoring. A “trigger shot” might also be used to time ovulation since this medication induces ovulation within about 36 hours.
• A sperm sample from either a partner or a donor will be provided to the doctor’s office, then washed.
• The doctor/practitioner will insert the washed sperm sample into the uterus using a thin catheter. This is primarily painless and only takes a couple of minutes.
• After the IUI, the person will lay down and relax for about 10 minutes, and then they are free to leave the doctor’s office and go about their day. Hopefully, at this point, fertilization takes place.

What are the advantages of IUI?

Below are some of the main advantages of IUI:

• Less invasive and less expensive compared to IVF. A typical IUI cycle can cost about $1000 (depending on your insurance), while IVF can cost $20,000 per cycle.

• IUI Deposits the best quality sperm possible close to where the egg is waiting, which increases the chances of becoming pregnant in comparison to conceiving through intercourse.
• Uses monitoring to ensure that insemination happens at the time of ovulation.
• IUI cycles can either use medications or not, depending on the specific situation. Those who have difficulties ovulating, such as those with irregular periods or PCOS, can use medications to help release more mature eggs.
• Not using ovulation medication can help lower the cost. This is a good approach for those who ovulate regularly or who are using donor sperm.

Who performs IUIs?

IUIs cannot be performed at home without proper processing and washing of seminal fluid; however, some people may try intravaginal or intracervical inseminations at home, with significantly less success. Most often, people choose to see a medical professional for the procedure. OB/GYNs can perform IUI, which means patients may be able to work with their previous provider if they prefer (only reproductive endocrinologists can perform IVF, however).

That being said, patients often choose to work with a fertility specialist or an REI for an IUI because an REI can perform thorough tests prior to an IUI in order to gain more advanced knowledge of a patient’s fertility status and obstacles.

Specialists typically have cutting-edge technology and equipment and are capable of uncovering a great deal of information about the quality of one’s sperm, eggs, anatomy, menstrual patterns, and so on, which can help increase success with IUI.

How successful is IUI?

IUI is said to have “modest results” in terms of success, meaning it isn’t guaranteed to work and isn’t necessarily more successful than two healthy people having intercourse.

In best-case scenarios, it’s successful about 7% to 20% of the time per IUI cycle, depending on the woman’s age. If a couple tries IUI several times and does not have severe damage to fallopian tubes and has decent quality sperm, they may have a 50% chance of getting pregnant with up to six rounds of IUI.

Overall, success rates depend on the couple’s age, the timing of the procedure, and the health of the eggs and sperm. Individuals younger than 35 tend to have more success with IUI than those over 35 to 40 years old.

Are there any side effects of IUI?

IUI typically doesn’t hurt, although it may feel a bit uncomfortable. Some people experience mild cramping during the procedure. Afterward, it’s okay for the person to resume normal activities, as they’re unlikely to feel any significant side effects.

Side effects can be more noticeable if medications are being taken. For example, ovulation medications can sometimes cause temporary bloating, cramping, water retention, and breast pain.

There’s also a higher likelihood of having multiples (twins or triplets) if using gonadotropin medications with IUI since these drugs can cause multiple eggs to be released and potentially fertilized.

What Is IVF?

IVF stands for in vitro fertilization. It’s a fertility treatment that fertilizes eggs with sperm in a lab (“in vitro” refers to a process performed in a laboratory culture dish instead of inside the body).

IVF is one type of artificial reproductive technology (or ART). IVF aims to stimulate the ovaries to mature as many healthy eggs as possible in a given cycle in order to create embryos. In the majority of cases patients pursuing IVF choose to utilize genetic testing, which entails a few cells being removed from the embryos for testing prior to freezing. Through genetic testing, your REI physician will be able to dramatically increase the likelihood that the embryo being transferred into the uterus is genetically healthy and increase the liklihood of getting pregnant. There are many reasons individuals or couples choose to pursue IVF when growing their family, including various causes of infertility, wanting to utilize genetic testing on embryos, or moving on from other fertility treatments that have been unsuccessful.

The entire IVF process can usually occur within three months. Medications are first used to help eggs inside the ovaries mature, then as many eggs as possible are removed from the body with help from an egg retrieval procedure. The mature eggs are then mixed with a sperm sample in a lab (called insemination), hopefully facilitating fertilization and embryo formation. In frozen embryo cycles, embryos are then frozen to allow for the woman’s body to return to normal after stimulation within a few weeks. The final step is the frozen embryo transfer which occurs after the uterus is primed with estrogen and progesterone for approximately three weeks. In this minor painless procedure, an embryo is released inside the uterus with the aid of ultrasound guidance.

To summarize the steps above, a cycle of IVF includes several steps:

• Ovarian stimulation using injectable medications.
• Egg retrieval from the ovaries.
• Fertilization of retrieved eggs using a semen sample within a laboratory.​​
• Optional but recommended preimplantation genetic testing of embryos prior to freezing them.
• Uterine lining preparation.
• Transfer of the fertilized embryo back into the uterus using a thin tube through the cervix under ultrasound guidance
• Then hopefully, pregnancy occurs!

There are several additional treatment options available with IVF, including using intracytoplasmic sperm injection (or ICSI), Preimplantation Genetic Testing (PGT), or using donor eggs, donor sperm, or a gestational carrier (surrogate). Including any of these options into your treatment plan will all depend on the couple’s specific needs.

Who is IVF best suited for? Depending on the factors contributing to infertility, IVF may be the best choice and recommended as the primary treatment plan due to its significantly higher success rates than IUI. However, less aggressive initial attempts with IUI cycles would also be appropriate in many situations due to its less invasive and costly nature. In general, IVF would be a good first choice for those with the following conditions:

• Damaged, blocked, or absent fallopian tubes (the procedure bypasses the fallopian tubes, where ovulation typically takes place).
• Poor sperm quality (it can be successful even with very little healthy sperm, as explained more below).
• Prolonged unexplained fertility.
• Problems with ovulation that are not being solved with other treatments.
• Severe endometriosis
• A genetic disorder that can be passed down to offspring.

IVF With ICSI:

ICSI is a procedure only available during IVF and cannot be performed with an IUI. It involves having a single healthy sperm be injected into a mature, retrieved egg. Research shows ICSI typically fertilizes between 50% to 80% of eggs. ICSI is often recommended as a good option when undergoing IVF treatment if:

• The partner produces too few sperm to do IUI or traditional IVF (in which 50,000 sperm are used to inseminate a retrieved egg).
• Sperm aren’t motile, or sperm have trouble attaching to or penetrating the thick outer layer of the egg.
• There’s a blockage in the reproductive tract that is preventing sperm from exiting.
• Traditional IVF fertilization has not worked for unknown reasons.
• Eggs that were previously frozen are being used.

What are the advantages of IVF?

Below are some of the main advantages of IVF:

• Considered the most potent fertility treatment, it can help couples get pregnant when other options cannot.
• It can help address reproductive issues related to both egg and sperm providers, including egg and sperm health and problems with the cervix and fallopian tubes.
• It can help treat age-related infertility and prolonged unexplained infertility, which often lead to unsuccessful treatment with  IUI.
• It offers the option of using ICSI, which IUI does not.
• It offers the option of using genetic testing, which IUI does not. This reduces concerns regarding certain genetic disorders since embryos can be tested before being implanted to identify genetic disorders or chromosomal abnormalities.
• It offers the option of storing embryos to be used and transferred at another time.

Preimplantation Genetic Testing:

One of the significant advantages of IVF is that it allows for genetic testing of embryos, including for inherited familial diseases, which IUI and other fertility options do not.

Called Preimplantation Genetic Testing (or PGT), this type of testing is performed to identify if embryos have a specific genetic or chromosomal condition. This way, those embryos are not transferred to the uterus, and the defect is not passed onto the offspring. The goal is to ensure that healthy embryos are transferred to the uterus in order to sustain a pregnancy and result in a healthy baby.

PGT also helps address the fact that one of the most common reasons embryos do not transfer and result in pregnancies is because of abnormal embryo genetic factors.

PGT may be recommended for couples or patients with a history of single-gene disorders, such as cystic fibrosis or sickle cell anemia, or sex-linked disorders, such as Duchenne muscular dystrophy and Fragile X syndrome.

How successful is IVF?

IVF now accounts for up to 4.5% of all live births in the United States and Europe.

The chances of getting pregnant with help from IVF ultimately depend on a number of factors, including age and overall health status, the underlying reason for infertility, and how many healthy embryos were created.

Like with IUI, IVF is most successful when the person providing eggs is younger than 35 to 40 years old and generally healthy. Overall, women between 30 and 40 have about a 40% to 50% chance of IVF working depending on several factors, and however, with the advent of PGT testing, a genetically normal embryo would have an approximately 70% chance of resulting in a healthy pregnancy in a high-quality fertility clinic.

Are there any side effects?

IVF involves using medications that can cause side effects, such as bloating, nausea, water retention, headaches, and mood swings. These are temporary and usually last about one week or so.

The egg retrieval procedure is performed under anesthesia and takes approximately 15-20 minutes. After the process, there may be some mild discomfort, including cramping, swollen ovaries, light bleeding, and tenderness. Following IVF, patients should avoid anything too strenuous, or that involves twisting of the ovaries.

Depending on the medications used in the IVF stimulation, there may also exist a minimal risk of ovarian hyperstimulation, which is a condition that can cause the ovaries to become temporarily swollen and painful, and in very rare circumstances, requires fluid to be removed from the abdomen.

IUI Vs. IVF: Which Is Right For You?

There’s a lot to consider when deciding between IUI and IVF, including the cost, invasiveness, time commitment, use of medications, potential side effects, and success rates.

An IVF cycle is more involved, invasive, and expensive than an IUI cycle; however, it can also be significantly more successful when IUI and medications are not.

If you’re dealing with infertility, your provider will help guide you through the process.

Your fertility provider will run tests to determine things like your egg and sperm quality and then be able to advise you on options that are most likely to be successful. Because every infertility situation is unique and complex, it’s best to listen to your provider’s recommendations regarding your treatment plan.

Is it worth trying IUI before IVF?

You and your doctor together can review your current health status and the specific conditions you’re facing to determine if IUI should be performed first or if it is in your best interest to move directly to IVF as your first-line treatment choice.

In many cases, if appropriate, your physician may recommend trying up to three cycles (sometimes up to six) of medicated IUI before moving onto IVF, assuming there are no significant obstacles that can interfere with IUI being successful. Sometimes certain insurance companies will require this before paying for IVF.

Some doctors may suggest that women in their 40s only try IUI once or twice before going to IVF, or even that they go straight to IVF to not waste time.

How do you know if you should do IUI first or go straight to IVF?

According to fertility experts, here is when to consider IUI before moving on to IVF:

• Try IUI first if your infertility is mainly related to ovulation issues. This includes individuals with PCOS or other forms of anovulation, plus cervical mucus problems.
• If the partner providing sperm has moderate sperm health issues but is still producing healthy amounts of sperm, try IUI first.
• Same-sex couples and single parents trying to conceive with donor sperm can also try IUI first.
• If the egg provider is under 35 or between 35 and 40 with no significant known fertility issues, IUI is typically done before IVF.

IVF may be a better option if 3-6 IUI cycles have been unsuccessful, or if the individual providing eggs or carrying the pregnancy is in their 40s, there is very little good quality sperm, or if there are known problems with uterine or fallopian tube function.

Family planning is another crucial element to consider when deciding where to start. If more than one child is desired, and advanced female age is one of the issues, IVF may be the best option in order to provide ample opportunity for fertility preservation through embryo creation. This future planning can allow individuals and couples to build the family of their dreams instead of enduring a long fertility journey that results in a significant decrease in the chance of additional successful cycles and future children.

Don’t forget to discuss these issues with your trusted REI so they can guide you appropriately.

April is National Infertility Awareness Month, and the fertility specialists at Reproductive Gynecology & Infertility (RGI) wanted to share what happens when we get to meet the babies we help create.

Thrilled. Happy. Joyful.

These are just some of the words that come to mind when a baby conceived through in vitro fertilization (IVF) comes back to RGI for a visit. While we’ve known this little person since it was an impossibly tiny embryo, our eyes soften as we marvel at their tiny fingers and toes. It’s a special moment filled with heartfelt congratulations and well wishes. It’s also a very welcome reminder of why we do what we do.

“It brings me so much joy to reconnect with patients after they give birth. The RGI IVF process itself is highly personalized and gives me the opportunity to really get to know people, learn intimate details about their fertility struggles and help grow the family of their dreams. Meeting the baby is incredibly rewarding. I love to watch couples transform from disheartened to joyful—and so in love with their new little boy or girl.”

Is IVF right for me?

Unfortunately, infertility is very common, occurring in approximately 1 in 8 couples. The fertility specialists at Reproductive Gynecology & Infertility understand the emotional and physical toll fertility issues can take on people—and relationships. If you’ve been trying to conceive for 12 consecutive months, you might want to consider treatments like IVF. IVF is a safe and effective process of fertilization in which an egg is combined with a sperm outside of the body.

How much does IVF cost?

If you and your partner meet all of the IVF qualifications, each fresh embryo cycle can cost approximately $25,000. We understand a financial burden can make an already stressful situation worse. That’s why we created the IVF 100% Success Guaranteed Plan; we wanted to eliminate the stress of success. RGI is the first and only practice in Northeast and Central Ohio to offer a plan that shares the financial risk with IVF patients.

Our IVF 100% Success Guaranteed Plan means that we guarantee you’ll take home a baby or we’ll refund every penny.

“Scientific evidence confirms that stress and fertility go hand in hand. We want to help manage the emotional stress as well as the fertility of our patients. With the IVF 100% Success Guaranteed Plan, we can help ease the financial burden so our patients can focus on their mental and physical wellness during their fertility journey.”

How can I afford IVF?

There are many insurance plans that can help lower your costs—and financial risk. However, we are proud have an exclusive partnership with Samantha’s Gift of Hope, a quarterly monetary award intended for those who are already a part of RGI’s IVF 100% Success Guaranteed Plan in the Northeast Ohio office locations.

If you’d like to learn more about RGI, our IVF 100% Success Guaranteed Plan or applying for a Samantha’s Gift of Hope grant, please call 866-537-2461. We can’t wait to help grow your happily ever after… and marvel at your new baby girl or boy. There is hope, and we can help.