The surrogacy process is this long because it involves various stages and requires input from multiple professionals. The process also depends on a number of factors that fall outside of one’s control, such as a successful embryo transfer and pregnancy. In the grand scheme of things, it’s worth the wait – as each day gets you closer to hopefully welcoming your little one.

For many intended parents researching their surrogacy journey, creating a realistic timeline in advance is really helpful. Seeing the entire process broken down into smaller, achievable steps helps you focus on each stage and know when to expect the next. With that said, let’s get into the entire surrogacy process and the stages you should expect along the way, with approximate timelines for each:

Research Surrogacy 

The decision to build your family through surrogacy is a big one. And, as with all big decisions, research goes a long way. The time you need to weigh your family building options and to address any complicated feelings you (or your partner) may be dealing with is completely personal. When you’re sure that surrogacy is the right path for you, it’s time to decide whether to enlist the help of a surrogacy agency or go ahead on your own. Here are a few articles that can help you start to think this through:

• How do surrogacy agencies help intended parents?
• How do I choose a surrogacy agency that’s right for me?
• How can I finance surrogacy?

Consultation and Application: 1-3 Months

If you decide to work with a surrogacy agency for your journey, the first step is to choose the right one for you. Here’s one place GoStork can really help you save time: we’ve researched and vetted top surrogacy agencies across the US, so you don’t have to. Rather than managing accounts with multiple agencies, you can view (and easily compare side-by-side) many different options on our platform, including all of the important information about their services offered, ratings and reviews, number of babies born, team profiles and much more. We’re also the only place where you’ll see costs published upfront, saving you the time it takes to call agencies or attend initial consultations to get them. All of this combined reduces what used to take many weeks of research into as little as a few hours.

Once decided on your top choice (or choices), you can instantly message the agency or schedule a phone consultation, where you can discuss the surrogacy process and your wishes in more detail, get to know the staff, and start building a relationship with them. It’s important that you develop a good rapport – knowing you can trust the agency, and that its staff will help you manage any difficult situations that may arise. A service agreement is signed once you’re sure the agency is right for you. 

If needed, at this stage you will also match with an egg donor and create your embryo(s). 

Matching with a Surrogate or Carrier: 3-6 Months

The agency will ask you to complete an intended parent profile, which they will present to potential gestational carriers. (As a note of clarification: a gestational carrier is a woman who carries a pregnancy for someone else but has no biological link to the fetus. When the carrier also provides the egg, she is called a surrogate. Most surrogacy arrangements today are gestational surrogacies). The agency helps to find the most ideal carrier that meets the intended parents’ requirements and then presents the match to both parties. If everyone is happy with the match, the agency facilitates a meeting (which happens over a video conference in current times or if you don’t live close to each other) where you get to learn more about each other. If everyone’s excited about taking things further, the journey can officially begin! 

The length of this stage greatly depends on the criteria you have for your gestational carrier. If you’d prefer that she is a specific age, or from a specific location, for instance, this can lengthen the process. Some intended parents reach an agreement at the very first video call – others meet with more than one gestational carrier before finding a match.

Here’s another helpful article where you can learn more about the Essential Qualifications to be a Gestational Carrier.

Medical Screening and Contracts: 1-2 Months

A number of milestones mark the next few weeks, all of which have a big impact on the overall surrogacy process. 

The gestational carrier undergoes medical and psychological screening to ensure that all is well for her to carry a child and in general to successfully complete the surrogacy process. 

During this time, you will also work with your surrogacy attorney to draw up the surrogacy contract – while the gestational carrier simultaneously works with her own lawyer. Once all points are made clear and agreed upon, both parties sign the contract – another milestone successfully reached!

Embryo Transfer: 1-1.5 Months

Once the legal agreement has been finalized, the IVF clinic provides the gestational carrier with her protocol and the required medication for her Frozen Embryo Transfer. She is also advised on the monitoring required ahead of the embryo transfer. 

If you already have embryos available, this stage will take an estimated 4-6 weeks. For the embryo transfer itself, many parents choose to join their carrier and experience this important moment together – if they can’t be there in person, a video call is often organized. 

While we all hope for success at first try, in reality there are instances where the transfer is not successful. In that case, you will have to wait another 6-8 weeks before a second transfer attempt. 

Following the transfer, your gestational carrier visits the local clinic for beta tests until a heartbeat is confirmed.

Pregnancy: 9-10 Months

Congratulations! Next up is the longest stage of the surrogacy journey, but also an amazing one. A full term pregnancy takes 40 weeks, but a couple of weeks would have already passed at the point the pregnancy is confirmed. Your gestational carrier will keep you updated as the pregnancy progresses. At this stage, she’s cared for by her own OBGYN. Depending on the legal framework in your gestational carrier’s state, your attorney may be able to start the pre-birth order process around the 16th to 20th week mark. We’ll go into more detail on this in a later section.

If you’re considering breastfeeding (or if you’re reading here first that it’s even possible to breastfeed if you don’t carry the baby), you can speak to your doctor early on in the pregnancy about inducing lactation. In this article, Candace Wohl, infertility advocate, co-writer of Our Misconception blog, and mom to two daughters born via a gestational carrier, writes about her experience of deciding and then preparing to breastfeed.

As the pregnancy progresses, it’s time to create a birth plan, book any travel as required, and prepare the hospital bag including everything you need (carseat, etc) to take the baby home. A note on car seats: all states require parents to have a car seat before leaving the hospital – some hospitals offer car seat safety classes and can also check your seat for correct installation. For international parents, the surrogacy agency can help you source a car seat and any other baby gear you may need before you travel back to your home country. You should also take the time to research, interview and choose a pediatrician. Most hospitals ask for the name of the pediatrician as soon as your gestational carrier is admitted to deliver the baby. 

Birth and the Postpartum: 1.5-3 Months

When the doctor gives the all-clear, you can head home. International parents, however, will have to stay in the state the baby was born in for a few more weeks until all paperwork is complete and the baby has a passport. 

Establishing Parental Rights

The Uniform Parentage Act provides a legal framework for establishing parent-child relationships. Under this act, the woman who gives birth to the child is presumed to be the child’s mother, both biologically and legally. Because of this, the gestational carrier (and if applicable, her husband) have to formally establish that they are not the child’s parents. 

Once your baby is born the carrier and her partner sign and relinquish any rights they may have. Your attorney submits this documentation to the court, together with other paperwork to prove the baby’s parentage.

As noted earlier, in some states, the process of establishing parental rights can start before your little one’s birth. At around the 16th and 20th week of pregnancy, your attorney starts the pre-birth order process which establishes the baby’s legal parentage.

If one of the intended parents is not genetically related to the baby, they may need to complete an adoption, or (a more straightforward) stepparent or second-parent adoption. In cases where neither intended parent is related to the baby, a full adoption or embryo adoption is required.

In Conclusion

We’ve gone over all the main elements of the surrogacy journey so you should now have a better idea of what to expect. That said, this is a general outline: surrogacy is a very human and highly personal experience, with variables that can affect the overall length of the process. Focusing on each step as it comes and remaining flexible throughout will help you stress a bit less and be at peace with the fact that there may be some unexpected situations along the way. 

As you start your search for a gestational carrier, we hope you’ll take advantage of our free platform where you can find, compare, and connect with top surrogacy agencies across the US, already researched and vetted for you with profiles including all of the important criteria (years in business, number of babies born, costs, ratings and reviews, team profiles, and much more) you need to make an informed decision. Find your ideal surrogacy agency, here.

Originally published by GoStork.com. Re-published with permission.

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The egg donation process – a quick overview

Through egg donation, a donor chosen by the intended parents provides her eggs to be transferred via IVF. Fertility clinics follow a rigorous screening process when it comes to clearing egg donors. Prior to starting the egg donation process, the egg donor undergoes a thorough medical screening to ensure that she is fit to receive the stimulation medication required (more on this below). Her egg reserve is assessed, and her medical history and family and genetic history evaluated. Blood tests are done to check for undiagnosed medical conditions or infectious diseases.

Once the egg donor is cleared by the clinic, she is prescribed hormone medications to stimulate ovulation and the production of multiple eggs. If it’s a fresh cycle, the intended mother will be prescribed estrogen and progesterone to build up the uterine lining and prepare it for implantation.

The next step is the egg retrieval and fertilization with sperm from the intended father or a sperm donor. The best embryo is transferred to the uterus using a thin catheter, a procedure known as a fresh embryo transfer (FET). The intended mother continues her medication (progesterone). If the transfer is successful, once a heartbeat is confirmed, the pregnancy progresses from there, hopefully making it successfully to term.

While there are various reasons why the use of an egg donor may be recommended, the first step is to understand if egg donation is right for you. 

Is egg donation right for you?

Deciding to grow your family via egg donation is not easy, however it may be an ideal solution if conceiving naturally isn’t possible. The first step is to consult a reproductive endocrinologist (RE) or your fertility clinic to go over your options. Egg donation may be recommended in the following scenarios:

1. Advanced age: fertility naturally diminishes with age as changes start occurring in the ovaries
2. Diminished Ovarian Reserve (DOR): when the ovaries no longer produce quality eggs in adequate numbers. This generally occurs with ageing and menopause, but genetic abnormalities, medical treatments or injury may also lead to an earlier DOR 
3. Primary Ovarian Insufficiency(POI): women naturally experience reduced fertility around 40 years old but for those with POI, this starts earlier – in some cases even as early as the teenage years
4. Absence of the ovaries: due to surgery or a congenital malformation
5. Poor oocyte quality: an oocyte is an immature egg cell. During ovulation, the oocyte matures and becomes an egg. The number of oocytes decreases with age, as does their quality 
6. Poor embryo quality: this could be due to a genetic abnormality in the egg or sperm of the male or female partner, or a genetic abnormality in the embryo
7. Prevention of genetic diseases: if the intended parent is aware of a condition that could be inherited by the baby
8. Previous IVF failure: when IVF was attempted using one’s own eggs
9. Men: who are single or in a same sex relationship need the help of donor eggs to conceive

If a medical issue is keeping you from growing your family, the news that you will need an egg donor can be difficult to take. It’s important that, if necessary, you seek support to come to terms with the news and to discuss the way forward. It’s also completely understandable that you may feel wary of using an egg donor for some time, but chances are the desire to have a baby will help you overcome your reservations and concerns. 

So, give yourself the time you need. Remember that, donor eggs or not, you will still 1,000,000% be your child’s parent. And then once you and your partner feel ready, it’s time to start searching for the ideal egg donor, one that matches all of your preferences.

Factors to consider when selecting an egg donor.

Choosing your specific egg donor is one of the most personal and important decisions you’ll make. Many intended parents choose to seek the services of an egg donor agency – however, choosing which agency to work with is a big decision in itself and many intended parents go to multiple agencies before they find their perfect donor. To make the process easier, GoStork provides the largest free online database of over 10,000 egg donors from various egg donor agencies all in one place, allows you to compare egg donors side-by-side, then connect directly with the agencies of your favorites.

Egg donor profiles you review include the donor’s physical attributes, education level, medical history, as well as family history, among other elements such as ethnicity and religion. Undeniably, you are presented with a large amount of information, but in this case, the more information the better! To get started, you’ll want to decide what characteristics matter personally to you. Here is a list of criteria you’ll have to consider:

• Age – Donor must be between the ages of 21 and 30 but if you prefer one on either the younger or older end of that spectrum, that’s a valid decision
• BMI – Donors must have a healthy Body Mass Index (BMI) between 18-27, but as far as the donor’s specific weight – that may be a consideration that’s important to you.
• Medical History – Personal health history (ideally, a non-smoker, non-drug user and non-alcohol dependent, has no STDs, and is not undergoing treatment for depression or anxiety – these elements are pre-vetted and indicated for you to consider), family health history (ie. you would be looking for egg donor profiles with no family history of genetic disorders, and no significant family history of cancer).
• Reproductive history –  If applicable, you’ll see information about ‘proven fertility’ in egg donor profiles, ie. a previous successful pregnancy shows that the donor has the potential to provide healthy eggs. You may also learn that the donor has donated eggs prior that resulted in a successful pregnancy.
• Appearance – You’ll see the donor’s photos, (ideally current as well as from childhood) and – when available – videos, natural hair color, eye color, height, and, as already mentioned, you’ll see her weight. Many intended parents are interested in donors with similar physical features to themselves, while others are interested in dissimilar features. Again, these are personal decisions and any preference is valid.
• Personal Background – This can range across heritage, religion, characteristics, education, career, and even criminal record. This is obviously a wide range of criteria – so just to explore one example; a donor with a graduate degree or high test scores may be someone you’re ideally looking for – so you could, as a starting point, filter your options through the lens of your desired standard of education. Also, many intended parents look for egg donors with a similar heritage or religious background as themselves.
• Compensation: Fee can range from $2,500 to $30,000 – and even upwards. Donors may charge more when they have proven fertility or a higher level of education, among other factors.
• Location – An egg donor close to your IVF clinic can help save you money in covering her travel costs. That said, this may not be your most important criterion – in which case it’s totally up to you to prioritize other factors over where the donor lives.

Choosing Between Frozen or Fresh Donor Eggs

Both fresh donor eggs and frozen donor eggs have specific pros and cons which you should consider:

Advantages of using fresh donor eggs

1. Better odds of live birth– IVF with fresh donor eggs has been widely researched and found effective. A national study published in the journal Obstetrics and Gynecology found that the use of fresh donor eggs in IVF has a small advantage in birth outcomes. According to the study’s lead author, Jennifer L. Eaton, M.D., “the odds of a good birth outcome were less with frozen than with fresh, but it was a small difference.” Data from the Centers for Disease Control and Prevention (CDC) also shows that, overall, 55.3% of embryo transfers from fresh donor eggs resulted in a live birth vs. 46.7% for embryo transfers from frozen donor eggs.
2. Larger number of eggs – A fresh egg donation cycle will give intended parents anywhere from ten to twenty eggs. This is ideal if you plan on having more than one child: a fresh donation cycle will likely provide you with a good number of embryos to pursue more than one pregnancy. 
3. No need for ICSI – with frozen eggs, an extra procedure known as intracytoplasmic sperm injection (ICSI) becomes a must (which also adds to the overall cost). The freezing and thawing process makes the shell surrounding the egg hard for the sperm to penetrate on its own. ICSI bypasses this as a single sperm is injected directly into the egg. 

Caveats with fresh donor eggs

1. Longer timeline – using fresh donor eggs is a longer process: it takes time to match a donor to the recipient and then to synchronize schedules and cycles.
2. Greater cost – fresh donor egg IVF is typically more expensive than the frozen alternative: as noted by what to expect, at an average of $25,000, fresh donor eggs amount to around twice the cost of frozen eggs.
3. Potential for cancellation – donation cycles can on occasion get cancelled due to poor medication response or issues, or because of an insufficient amount of eggs obtained. Medical issues more specifically may include uterine cysts or bleeding, which can have a negative impact on implantation, preventing the cycle’s success. 

Ultimately, when it comes to choosing between fresh or frozen eggs, it all comes down to your personal situation. There is no easy answer as to which is best. Success rates can depend on each individual’s specific case, as well as the expertise of the clinic you’re working with. A doctor and the clinic can help you assess your options based on your medical history and specific circumstances.

We hope that this helped provide the information you need. And remember – the right decision is whatever feels right for you. All the best on your journey!

This article was originally published on GoStork.com and re-published with permission.

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IVF and ICSI have many similarities. However, the differences between them are very important to note as you make a decision about your treatment path.

What is conventional Insemination (IVF)?

In this technique, a woman’s eggs are surrounded by sperm in a petri-dish and ultimately one sperm fertilizes the egg. Conventional insemination (IVF) largely recreates the “best sperm wins” dynamic of natural conception. 

Fertilization by insemination relies on the normal healthy functions of the sperm as well as for the egg’s outer layer to be optimal. An egg’s outer layer may be thick or hard to penetrate due to egg quality or maternal age related issues.

And let’s face it, if both the sperm and egg were optimal, you may not need the assistance of IVF to conceive in the first place. 

A few other downsides to conventional insemination are:

• 10 – 15% of cases, patients experience total fertilization failure (TFF), when none of their eggs fertilize.
• Performing PGT after conventional IVF is not recommended
• Embryologist will not know how many eggs were mature at the time of retrieval, or what their quality was.

These are all things that are important to know to help diagnose your case and help plan for the next steps in your journey.

What is ICSI?

In this technique an embryologist selects a single sperm from a man’s semen sample and injects it directly into the egg. ICSI is used in 90% of IVF cases that involve male factor infertility and 60% of cases that don’t.

Apart from the way the sperm is introduced to the egg, there are not too many other differences. The egg retrieval and the monitoring of the embryo remain the same. The transfer of the embryo does as well. 

Another variation of ICSI is called “PICSI” which stands for physiological ICSI, and uses a specialized dish coated in a substance called hyaluronan.  Healthy sperm are attracted to that enzyme and stick to it, they are later used to inject the egg with.

The success rates for ICSI (50-80%) are higher than IVF without ICSI (50%). Live birth and birth defect rates have been reported to be quite similar between the methods, but ICSI is especially important for couples who want to have their embryos genetically tested.

The downsides to ICSI is:

• This microsurgery costs an additional $1,500 – $3,000. I
• t can only be performed on “mature eggs” (ruling out ~20% of eggs retrieved).
• 5 – 15% of eggs are damaged in the process.
• Success rates vary by embryologist.
• Pregnancy rates are slightly higher for IVF without ICSI (27% vs. 24%). 

Why would I need ICSI?

ICSI helps to overcome fertility problems, such as Male Factor issues where fertilization previously seemed impossible, to now be achieved if…

• The male partner produces too few sperm to do artificial insemination (intrauterine insemination [IUI]) or IVF.
• The sperm may not move in a normal fashion.
• The sperm may have trouble attaching to the egg.
• A blockage in the male reproductive tract that keeps sperm from getting out.

ICSI allows embryologists to look at the eggs and know the quality and maturation right after the egg retrieval, and determine if egg quality issues are present. ICSI helps…

• Eggs that did not fertilize by traditional IVF, regardless of the condition of the sperm.
• History of eggs in previous cycles having low fertilization rates using traditional IVF.
• If in vitro matured eggs are being used.
• If previously frozen eggs are being used.

What if your IVF Lab does ICSI, But you want to try conventional IVF? 

It’s in your best interest to do what your clinic does 99% of the time. Clinics have switched to ICSI for very very good reasons. It increases their patients’ success rates and decreases chances of contaminating DNA from sperm during PGT. The embryologist will be able to examine and inject the nicest looking sperm.  

Veering from the established standard of care for a lab (any lab) introduces another possibility to the mix; one of them is making an error. 

With all of this said, speak to your clinic about their success rates for women or couples with similar age and diagnosis. This will help you get a better understanding at what is best for you.

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A normal embryo (that is euploid) has 23 pairs of chromosomes and has a better chance at leading to a successful live-birth than an aneuploid embryo. 

Aneuploid embryos have missing or extra chromosomes and will typically fail to implant, result in a miscarriage, or lead to the birth of a child with a chromosomal disease. ⁠

And then there are mosaic embryos, which consist of both euploid and aneuploid cells. PGT has only been able to recognize mosaicism in embryos within the past three years, so there is still a lot of research ongoing about their potential. About 10-15% of all embryos are mosaic.⁠

Up to three types of preimplantation genetic testing can be performed on embryos during the IVF process.

• PGT-A which screens for an abnormal number of chromosomes.
• PGT-M is the test for individual or monogenic diseases.
• PGT-SR tests for abnormal chromosomal structural rearrangements, like translocation or inversion

How is PGT performed?

PGT begins with a biopsy of an embryo in the blastocyst stage of development. The biopsy removes 3 to 10 cells from the outer layers of cells that will become the placenta.

The biopsy does not remove any cells from the inner cell mass, which develops into the fetus. After these cells are removed, the blastocyst is frozen and stored in the lab. The biopsied cells are sent for laboratory testing and results are typically returned in a week to 10 days.

A study by Cimadomo et al. (2018) showed that inconclusive results occur about 1.5-5% of the time. This happens because the cell sample is not loaded properly and the tube is actually empty, or that the sample was degraded. ⁠

Inconclusive or no result embryos have a good chance of being “normal”. A large study (Demko et al., 2016) found for women <35 there is about a 60% chance of a blastocyst being euploid (normal) to 30% by age 41. The chance of getting NO euploid (normal) embryos was about 10% for <35 and about 50% by 43.⁠

Do you need PGT?

PGT-A, CCS, or PGS is a diagnostic tool to tell your fertility doctor which embryos are likely to be chromosomally normal and therefore, which to transfer.⁠

As women age, the chance of a chromosomally normal embryo declines. On average, under age 30, roughly half of the embryos will be normal. Over age 40, 1/3 to 1/2 of all women will not find a viable embryo after PGT-A.⁠

Euploid (normal) embryos are most likely to lead to living birth and should be transferred first. Embryos that are mosaic can still lead to living birth, but depending upon the type, do so less often, and carry some risk. Embryos that are aneuploid almost never lead to live birth and if they do, carry a major risk the child will be unhealthy.⁠

PGT typically costs $5,000, but can help to avoid:⁠

• FailedFET (each costs $3,000 to the patient)⁠
• Miscarriages ⁠
• Multiple gestation births from transferring back more than one embryo. 

The current data do not support the universal use of PGT-A for all patients undergoing IVF. Depending on where you live in the world PGT may not be offered as a regular service by your clinic. For example, some countries require that a known genetic issue exist in order for PGT to be carried out. 

If you are someone who produces very few blasts, your clinic may not want to take the risk of PGT or the freezing and thawing process damaging the embryo. They therefore may opt to do a fresh transfer instead. 

As always, discuss your options and concerns based on your specific diagnosis with your practitioner.

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Whether the freeze-all embryo strategy does increase IVF success rates is still up for debate. Over 11 clinical trials and 5000 eligible subjects later, eFET was found to be associated with a higher live birth rate only in hyper-responders. 

There was no outcome difference between fresh and frozen in normal responders, nor in the cumulative live birth rate of the two overall groups. 

But, here is where it gets complicated. The CDC described the increase in the number of elective FET cycles between 2007 and 2016 as ‘dramatic’, rising steeply from almost zero to more than 60,000 cycles per year. In its summary of US activity for 2016 the CDC seems unequivocal – at least, based on its observational registry data – that rates of pregnancy and live birth are higher after frozen transfers than after fresh. 

Yet the (published, peer-reviewed, or randomized clinical trial) so far has not shown a large difference. It seems to be a case where the clinical trials have not caught up with clinical practice, and because there is clear evidence that for hyper responders outcomes are better, many clinics are now relying on a Freeze all Embryos over a Fresh Transfer strategy to reduce this poor outcome. 

Who should consider a “Freeze-all” Embryo Strategy?

According to RBMO, Depending on the clinical setting, IVF deferred frozen embryo transfer could provide significant advantages over fresh embryo transfer for the following reasons: 

If you’re at Risk for OHSS: 

The first obvious candidate based on the above data are women who are at risk for OHSS (ovarian hyperstimulation syndrome). Mild OHSS happens in up to a third of all IVF cycles while more moderate to severe OHSS happens only 3 percent to 8 percent of the time.

OHSS is often seen in women with PCOS or high responders. Women with over 25 eggs retrieved are more likely to suffer from severe OHSS.

If you have known endometrial anomalies:

Thin endometrium, polyps, associated metrorrhagia, submucosal leiomyomas and endometritis, or elevated progesterone levels on the last day of stimulation, a freeze-all should be considered as surgery or a long lupron protocol may be required before transfer.

If you are using PGT:

If you have known genetic issues or are looking to rule them out and increase your implantation success with PGT, you will be required to freeze all embryos as you wait for the test results.  

Endometrial receptivity:

Ovarian stimulation with IVF and intracytoplasmic sperm injection (ICSI) cycles may have a negative effect on endometrial receptivity due to higher estrogen and progesterone levels. If you receptivity is in question, an ERA test may be recommended before you transfer your embryos, and therefore a freeze-all strategy would be implemented.

If you have a day 6 or 7 Blastocyst:

A recent meta-analysis, the transfer of day-5 blastocysts was associated with significantly higher pregnancy rates compared with the transfer of day-6 blastocysts as the intrinsic embryo implantation potential in day-6 blastocysts is impaired (Bourdon et al., 2020a), an asynchrony between the endometrium and day-6 blastocysts is also a possibility, reported significantly lower live birth rates in fresh day-6 compared with fresh day5 blastocyst transfers, whereas this difference was not found with frozen embryo transfer 

If you’ve had a failed Fresh Transfer:

Freeze-all strategy increases the chances of a live birth in women with repeated IVF/ ICSI failures. Women with at least one failed fresh blastocyst transfer have a significantly greater probability of a live birth with the ‘freeze-all’ and subsequent thawed approach than with another fresh cycle 

If you are at high risk of a thromboembolic event:

Fresh transfers are associated with an increased risk of thromboembolic diseases (pulmonary embolism and venous thrombosis), with a doubling of risks during pregnancies than those who conceive naturally or with a FET. That’s because a fresh embryo transfer is preceded by an elevated level of oestradiol and consequently a hypercoagulation state. Therefore, a freeze-all strategy could be the best option to limit the thromboembolic risks induced by ART treatments in women who are at high risk of a thromboembolic event.

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You’ve been so INVOLVED up to this point. Administering shots and going to your checkups made you feel “in control” (even if that is an illusion). But then you arrive at the clinic for retrieval, and it’s all out of your hands. 

It’s even out of your physician’s hands. Your eggs are about to pass through a tiny window, into the hands of an embryologist you have never met. 

You are usually asked to arrive at your clinic two hours ahead of your retrieval. You will be asked to fast for at least 12 hours. Once you get checked in and changed into a not-so-fancy robe, you’ll be asked to empty your bladder before being wheeled into the operating room.

What happens in prep for Egg Retrieval? 

The Embryologist will do a “time out” through the tiny window that leads to the sterile lab. They will confirm your name, date of birth and IVF cycle plan with the physician. Then you will start to go under, as the anesthesiologist puts you “to sleep”. 

After you are comfortably asleep, the nurses, medical assistants and physician will drape all of your exposed skin with soft sterile towels. The vagina is washed and prepped for the ultrasound guided transvaginal oocyte retrieval. The physician positions the gooseneck light, and the OR lights are turned down low for the retrieval to begin!

What happens during Egg Retrieval?

In short, the Embryologist goes hunting for eggs. They look for eggs in every shape and size and depend on eggs being surrounded by a nice “cloud” of fluffy, nurturing cumulus cells. 

In general, your last scan tells your physician and embryologists how many eggs to expect. They make that determination based on the number of follicles over 14 mm. They are also seeing if the “small” follicles did or did not hold a mature egg.

As the tubes of follicular fluid are handed through the window, they are taken into a dark, warm, and humid environment. They then pour the fluid into a petri dish and start examining it closely under a microscope. As an Embryologist finds eggs, they count to your clinical team; One, Two, Three, and so on. 

Mostly, the number of eggs expected are retrieved and sometimes, you get a huge surprise and get more eggs than expected! Occasionally, there are retrievals that yield no eggs. There are several reasons that can occur; something went wrong with the stimulation protocol. Maybe only one egg was expected, but it can’t be found. Perhaps the patient didn’t time the trigger correctly or the surgery started late and the patient ovulated, or the trigger didn’t “absorb” properly. Maybe it’s a rare case of empty follicle syndrome. Whatever the cause, “no egg” retrievals are devastating.

At the same time as your retrieval is happening, the sperm for your egg insemination is being processed. Maybe it is being thawed, or in the case of fresh samples, it is being separated from the semen of the ejaculate and being prepared so the best most “motile” sperm will be available for later use.

What happens in the lab post Egg Retrieval?

After the eggs are collected they are washed, and sometimes they rest in the cumulus cells in an incubator hoping for any last – or slow maturation to happen, before they are processed further. 

In conventional IVF the eggs stay in the cumulus until they are combined with sperm cells. But if ICSI will be performed, then they are “striped” of the cumulus cells, graded, and their quality assessed. 

On average, about 80% of the eggs that are retrieved will be mature enough to fertilize. To assess egg maturity and quality, an embryologist dissolves the cumulus cells from around the eggs with an enzyme. Then gently swish each egg cell up and down in a tiny pipette, about the width of a sharp pencil lead. In the end they only want to see one single, clean cell- THE EGG!

Then only the mature and healthy eggs are then separated for fertilization. Mature eggs are referred to as “MII” ie. “meiosis two” ready oocytes. Besides seeing nice mature MII oocytes, the lab may see slightly immature eggs, called MI (Meiosis I) or very immature eggs called “GV” (ie geminal vessicle). Unfortunately, sometimes we see eggs that have fractured zonas, or are severely compromised due to vacuoles, dented cyctoplasm, or other abnormalities. 

Whether you and your physician opt for ICSI or conventional IVF, or if your lab only offers ICSI, your eggs will be combined with your partner or donor sperm within a few hours of the egg retrieval. This is referred to as “insemination” and it is not the same as fertilization. 

To learn more about insemination and your choices of ICSI or IVF, click here.

The post What Happens During An IVF Egg Retrieval? appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

In a normal and healthy menstrual cycle, the ovaries make the egg that is ovulated (released) each month. Because of the hormonal imbalance, the egg may not develop or ovulate during ovulation as it should, causing irregular or missed cycles. 

Bottom line, if you don’t ovulate a healthy egg, or at all, it means you can’t get pregnant. 

Most women won’t know they have PCOS until they begin and fail at trying to conceive.

Some of the symptoms of PCOS include:

• Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods all together.
• Development of cysts (small fluid-filled sacs) in the ovaries.
• Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS.
• Acne on the face, chest, and upper back
• Thinning hair or hair loss on the scalp; male-pattern baldness
• Weight gain or difficulty losing weight
• Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
• Skin tags, which are small excess flaps of skin in the armpits or neck area

What causes PCOS?

The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role with the most common two being a high level of androgens or insulin.

Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.

Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. Many women with PCOS have insulin resistance,  which over time can lead to type 2 diabetes.

How is PCOS diagnosed?

There is no single test to diagnose PCOS. PCOS is diagnosed by a mix of tests and exams that may include: 

• Ultrasound to look for a high AFC, enlarged or swollen ovaries, and multiple cysts.
• Blood tests for your hormonal panel, androgens levels, AMH (higher than normal AMH can indicate PCOS), and diabetes.
• Physical exam will look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).

What are my treatment options for PCOS if I’d like to get pregnant? 

After ruling out other causes of infertility in you and your partner, the most commonly prescribed treatment is medication such as Clomid or Letrozole to help you ovulate. Fertility medication is often used in conjunction with Metformin, to reduce insulin levels.

IVF may be an option if medicated cycles do not work. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk of having twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus), as those diagnosed with PCOS are more likely to produce multiple eggs with medicated cycles.

The great news for those with PCOS who do choose to undergo IVF treatment, is that you are likely to have more eggs retrieved than average. The question will always be the quality of your eggs, which lifestyle and diet changes can help. 

The post PCOS 101: Diagnosis, Infertility & Treatment Options appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

If a normal monthly follicle keeps growing, it’s known as a functional cyst. There are two types of functional cysts…

What Is A Simple Ovarian Cyst?

A simple cyst is basically a big follicle that didn’t realise it was time to stop growing and got bigger becoming a simple cyst. They usually disappear on their own in a few months or with down regulation drugs if you’re doing fertility treatments.

Your Fertility treatment cycle may get delayed due to a simple cysts. That’s because it can produce excess estrogen which won’t allow your protocol to have control over your cycle. 

What Is A Corpus Luteum Cyst?

The corpus luteum is the ‘shell’ of the egg that gets left behind and pumps out progesterone. It normally dissolves away if you don’t get pregnant in that cycle. If it doesn’t, it can fill with fluid and form a cyst. 

They can bleed into themselves which can be painful and is described as a ‘haemorrhagic corpus luteum cyst’. his is not the same thing as an endometrioma (see below) and does not mean you have endometriosis.

Your fertility treatment cycle may get delayed due to a Corpus Luteum Cysts because the progesterone it produces can delay your menstrual cycle from starting, or not allow for your protocol to have control over your cycle.

What are some other types of common benign (non-cancerous) ovarian cysts?

• Dermoid cysts, Also called teratomas, these can contain tissue, such as hair, skin or teeth, because they form from embryonic cells. They are rarely cancerous.
  
• Cystadenomas develop on the surface of an ovary and might be filled with a watery or a mucous material.
  
• Endometriomas, aka chocolate cysts can develop as a result of endometriosis. Some of the tissue can attach to your ovary and form a growth of old blood.
  
• Polycystic ovaries, is when you have over 12 small follicles – tiny developing eggs – on a single ovary. The cysts are caused by a hormonal imbalance, where the egg may not develop or ovulate as it should, causing irregular or missed cycles.

Dermoid cysts and cystadenomas can become large, causing the ovary to move out of position. This increases the chance of painful twisting of your ovary, called ovarian torsion. Ovarian torsion may also result in decreasing or stopping blood flow to the ovary.

What Are My Treatment Options For Ovarian Cysts?

Not all cysts need removing and most functional cysts will go away on their own. Your doctor will explain depending on the type, size and  your symptoms.

Treatment options may include down regulation drugs such as birth control pills or lupron, draining of a fluid filled cyst, or in severe cases, laparoscopic surgery. 

The post What Are Ovarian Cysts And How Do They Impact Your IVF Cycle? appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

Sperm quality refers to the sperm’s ability to fertilise an egg. This ability is determined by two interconnected factors: sperm motility and sperm morphology. The health of the DNA carried by the sperm is also extremely important.

The sperm analysis test explained:

When performing a sperm analysis we look at the following key parameters to determine the quality of the sperm: 

1. Volume: 1.5ml to 4.5ml
2. Count: minimum 15million/ml 
3. Concentration: minimum 39 million/ml
4. Motility: ideally 40-50% (minimum 32%)
5. Morphology: minimum 4% normal

What is Sperm motility?

Sperm motility refers to the ability of the sperm to “swim” to an egg. Progressive motility is the best type of movement noted during a semen analysis and means that the sperm are moving forward in straight lines, as opposed to in small tight circles or along highly erratic paths.

The lower limit for sperm motility is 40% of both progressive + non-progressive aka “twitching” sperm.

What is Sperm morphology?

Sperm morphology refers to the way the sperm looks – it’s appearance. A morphologically normal sperm should have:

• A long tail: made of protein fibers that contract to propel the sperm through the seminal fluid. Up until very recently it was thought that sperm moved forward due to the lashing movement of their tail. Last year a breakthrough study revealed that the tail of a sperm actually only flagellates on one side, causing a rotating “corkscrew” pattern, so sperm  actually “spin” towards the egg!  
• A mid-piece: which contains mitochondria (energy producing organelles) to power the sperm’s movement.
• A nicely shaped head: made of a fatty acid membrane which stores the nucleus (which contains the sperm’s genetic information (DNA)) & cytoplasm: a thick solution that fills cells and is made of water, salts & protein. At the tip of the head is the “acrosome”: a structure bound to the sperm membrane in its own fatty acid layer, which contains digesting enzymes that enable the sperm to break down the zona pellucida (outer glycoprotein layer) in order to enter the egg for fertilisation. 

The lower limit for normal sperm morphology is 4% according to WHO statistics, though some clinics use 2% as their barometer – if your clinic does use the latter and dismisses these results as problematic, seek the second opinion of a urologist specializing in fertility. 

What should my Total sperm count be?

The total number of sperm is considered the total number of sperm in a particular quantity of semen, the fluid that carries sperm out of the penis. 

A high sperm count isn’t helpful to fertility if most of the sperm have abnormal morphology or can’t swim properly. Similarly sperm with textbook morphology may carry abnormal DNA.

The lower limit for total sperm count is 39million per ejaculation.

What is Sperm Concentration?

Sperm concentration refers to the total number of sperm per milliliter (ml) of ejaculate.

The lower limit for sperm concentration is 15 million per ml.

Sperm count and sperm quality (morphology and motility) can be tested with a semen analysis. A routine semen analysis however cannot assess the genetic health of sperm. 

What is Sperm DNA Fragmentation?

The sperm DNA carries all the instructions for the development of the embryo. Any damage to this DNA may interfere with the sperm’s ability to fertilise an egg correctly or develop into a healthy developing embryo. Genetic integrity is thought to be one of the most important factors for male fertility. Our DNA is contained in structures called chromosomes. Our cells usually contain 46 chromosomes but sex cells or gametes, i.e., the sperm and egg, contain just 23. When the egg and sperm combine, they produce an embryo with 46 chromosomes in each cell. 

Sperm DNA fragmentation happens when there is a change in the strands of DNA contained within the nucleus of the sperm. This could be a deletion, a break or a separation in the DNA strands and can occur at any point during the sperm’s life: whilst its being made in the testis (during spermatogenesis), during its time stored in the epididymis before ejaculation or even after ejaculation. 

A specialist test is required to assess the level of DNA fragmentation within a sperm sample. The following tests can be offered:

• sperm chromatin structure assay (SCSA) – the most commonly used test (industry standard)
• sperm chromatin dispersion test (SCD)
• transferase-mediated terminal uridine nick-end labelling (TUNEL)
• Comet Assay test

Risk factors for sperm DNA fragmentation: 

• Paternal age
• Smoking
• Illness or infection (e.g., covid-19)
• Cancer treatment (e.g., chemotherapy)
• Chemical, radiation or toxin exposure

The post Male Factor Infertility: Sperm Analysis Test Explained! appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

Why is my Egg Fertilization Rate Low? 

And more importantly, is there anything that can be done about it?

Understanding the exact cause of TFF is extremely difficult. Some of the most common causes are:

Poor Egg Quality:

Once injected, an egg needs to go through certain processes in order to become ‘activated’. ‘Oocyte activation’ renders the egg capable of becoming fertilised. Failure of oocyte activation is one of the most common reasons for failed fertilisation after ICSI, accounting for over 50% of TFF cases.

Egg Maturation Issues:

An egg can degenerate following ICSI if it is post-mature or if the egg matured immediately prior to injection. Eggs falling to achieve good maturation may be due to hormonal stimulation methods which did not suit you.

Sperm Issues:

Failed fertilisation due to sperm factors has been linked to sperm morphology, sperm nuclear morphology, acrosomal factor and sperm chromatin status. Issues with sperm head decondensation can lead to the sperm’s DNA remaining ‘locked’ inside the sperm head and not being released into the egg. This inevitably leads to failed or abnormal fertilisation.

Technical Issues:

A rare cause of TFF after ICSI can indicate poor technical skill of the embryologist – as it is possible for an egg to be damaged by the injection process.

How can my egg fertilization rate be improved?

The life cycle of an egg is long, complicated & prone to errors. By improving your lifestyle & nutrition and supplementing with the correct antioxidants, egg health may be improved. 

The human egg starts its final developmental cycle about 90 days before ovulation, so it’s important for these adjustments to take place during as much of these 90 days as possible.

A change in treatment protocol and/or stimulation medication may also improve your results.

In cases with persistent failed fertilization (after different meds and protocols were used), using assisted oocyte activation (AOA) is currently the only available method to improve fertilization rates. 

Activation can be induced with the use of electrical, mechanical, or chemical stimuli that elevate intracellular concentrations of calcium ions (driving force behind activation). However, these methods work by flooding an egg’s ooplasm (the inside of the egg) with calcium ions that don’t follow the physiological cascade. 

This practice raises concerns, as these chemicals may affect embryo viability and future offspring due to their potential cytotoxic, mutagenic and teratogenic effects.

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