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faq
Fertility
Clinic
What is infertility?
Infertility is the inability to achieve a successful pregnancy based on a patient’s age, physical findings, diagnostic testing, medical, sexual and reproductive history, or any combination of those factors. This includes the need for donor gametes. For patients having regular unprotected intercourse, a timeframe is added whereby an evaluation is indicated if 12 months have passed without a successful pregnancy and the female partner is less than 35 years of age. This timeframe shortens to 6 months (if > 35 years of age) and 3 months (if >40 years of age).
What causes infertility?
The most common reasons to have trouble conceiving are 1) ovulation problems (failure to release an egg each month) 2) ovarian reserve or egg quality issues (including age-related infertility) 3) sperm factors (aka male factor); and female anatomic factors such as: 4) endometriosis, 5) problems of the uterus (polyps, fibroids or scar tissue) or 6) problems of the fallopian tubes (blockage). There can also be combinations of the above. In our patient population, the single most common diagnosis is diminished ovarian reserve (DOR) caused by advanced reproductive age.
What are my chances of getting pregnant at home?
When we think of conception through appropriately timed intercourse, we characterize “chances” based on a monthly rate. We call this “fecundability” (the chance of getting pregnant in a single month). Many patients are surprised to learn that human fecundability peaks at about 20% per month in a woman’s late 20s and decreases to about 5% per month by the age of 40. The length of time trying to conceive can also be informative as statistically, after a period of 2 years, fecundability drops to about 2% per month.
How common is miscarriage?
Many patients are equally surprised to learn how common pregnancy loss (miscarriage) occurs. Think of miscarriage as the flipside of the pregnancy coin. As pregnancy rates drop with age, so do miscarriages increase with age. During the peak fertility years of the late 20s/early 30s, miscarriage unfortunately occurs in about 15-20% of all pregnancies. This rate continuously rises over time and, by 40 years of age, the chance of a naturally achieved pregnancy ending in loss is 40%. The number one cause for pregnancy loss by far is chromosomal abnormalities and the current mitigation strategy for this is preimplantation genetic testing for aneuploidy (PGT-A).
What fertility testing do I need?
We like to organize fertility testing into “tiers” with the first tier being the absolute “musts” to investigate if there is no clear initial reason (such as advanced age). Also keep in mind that, without doing a single fertility test, by biological definition, once you reach the age of 35 there will be some degree of “egg factor” when statistically compared to peak fertility at a younger age. The first tier diagnostics include investigations into 1) eggs (ovulation and reserve/quality) 2) sperm and 3) anatomic factors (uterine, tubes, endometriosis). The corresponding 1st tier tests are 1) ultrasound and bloodwork for egg factors 2) semen analysis for sperm and 3) ultrasound and endometrial biopsies for anatomic factors. Sometimes nothing is revealed and 2nd tier testing is indicated. Also, more information can reveal itself as the fertility journey evolves, and this can trigger additional testing such as investigations into the uterine microbiome, sperm DNA fragmentation or autoimmune factors.
Read more
Does fertility testing hurt?
All of the basic fertility testing can be accomplished with simple bloodwork and ultrasound.The blood work involves a routine venipuncture and the ultrasound is performed transvaginally. The majority of patients experience only pressure (no discomfort) with transvaginal ultrasound. Patients with a history of pelvic discomfort should inform their provider so an individualized approach can be planned.
How can I get the above fertility completed?
All of the above mentioned testing is done onsite at our primary office in Greenbrae, CA. Schedule an appointment.
How do you approach (fallopian) tubal evaluation?
We are excited to offer a novel ultrasound based method of tubal evaluation called HyFoSy (Hi-Foh-Sigh). This test is performed in our office and, in contrast to traditional tubal testing (known as a hysterosalpingogram or HSG), avoids any radiation.
What is IVF?
IVF (In Vitro Fertilization) is a fertility treatment where eggs are retrieved from the ovaries and fertilized with sperm in a laboratory. The resulting embryos are then transferred to the uterus to achieve pregnancy. IVF is recommended for a wide range of clinical situations including egg factors, endometriosis, low sperm count or motility, blocked fallopian tubes and ovulation disorders.
How long does IVF take?
The modern approach to IVF consists of two 1 month segments of time which can be completed back to back in 8 weeks or separated into two non-consecutive 4 week blocks of time. Each 1 month block starts with a menstrual period (natural or induced). The first month consists of 5 office visits occurring over a period of 2 weeks and culminates with the egg retrieval procedure. The second block consists of 3 office visits over a period of 3 weeks and finishes with the embryo transfer procedure Simplified: IVF typically consists of 8 office visits over 8 weeks. Read more here.
Does IVF hurt?
The best way to understand exposure to possible discomfort during IVF is to organize the process into two main areas of the patient experience: the medications and the office visits. IVF requires 2 different kinds of injectable medications. During ovarian stimulation subcutaneous injections are used and during embryo transfer intramuscular progesterone is used. Besides the physical administration of the injectable medications during the ovarian stimulation process, physical sensations can be experienced from the growth of multiple ovarian follicles simultaneously. Monitoring office visits (typically 5-6) consist of only a quick ultrasound and a venipuncture (to check hormone levels). The egg retrieval procedure is performed under intravenous sedation so no discomfort is felt during the procedure. Post procedure experience is highly variable with some patients experiencing minimal discomfort and some requiring a few additional days of rest. The embryo transfer procedure is gentle and no anesthesia is required.
Which is better: a fresh or a frozen embryo transfer?
Fresh embryo transfer is the original approach of IVF and allows for immediate transfer of an embryo after fertilization. However, it carries risks of ovarian hyperstimulation syndrome (OHSS) and potential desynchronization of the timing “match” between embryo development and uterine receptivity. Frozen embryo transfer (FET) is currently the most common form of transfer as it eliminates the risk of OHSS and avoids any embryo/uterine synchronization issues (translating to higher success rates). For patients pursuing PGT-A, a frozen transfer is always necessary to allow time for the results of the genetic testing to be completed and inform the embryo selection process.
What are the success rates of IVF?
Reproductive success requires a complex interplay of many factors including the health of the uterus and the quality of the sperm, but the single most powerful predictor (by far) is the age of the female partner (or source of the egg). Female age is the number one determinant of egg quality and egg quality is the number one determinant of the reproductive potential of an embryo. An easy way to understand the relationship between age and IVF success is to divide ages into groups. Starting with a 34 year old (or younger) female as having the best prognostic age, success with IVF drops by about 10% every 2-3 years of age and after the age of 42 drops even more significantly. To mitigate this decreased potential of embryos associated with aging, many patients will elect to undergo screening of embryos with a technology known as preimplantation genetic testing for aneuploidy (PGT-A). By using PGT-A, implantation rates can be expected to be as high as 60-65% per single embryo (with miscarriage risks decreased to only 5-10%), regardless of age.
What is embryo banking?
Embryo banking is the process of creating and storing multiple embryos through in vitro fertilization (IVF) for future use. Although multiple embryos may be generated from a single cycle of IVF, embryo banking often involves more than one cycle of ovarian stimulation (medications and egg retrieval) to maximize the chances of reaching a future reproductive goal. This strategy can be a good match for a variety of family-building plans that are impacted by age-related fertility decline including a planned delay of a first child, a “back up” plan for a second baby down the road or as a primary strategy for multiple children over many years in the future.
Can I go through IVF as a single parent?
Yes, it's possible for single individuals - male or female - to undergo IVF to conceive a child. Advances in fertility treatments and the availability of donor sperm and eggs have made this option more accessible.
If you decide to go through IVF as a single parent, we will work closely with you to guide you through the added complexities of donor selection, legal considerations and emotional support throughout your journey.
Lab
Where is our IVF lab located?
Our IVF Laboratory is located in our main office in Greenbrae, Marin County, California.
What hormone tests do I need as part of an infertility evaluation?
Helping to characterize ovarian reserve through bloodwork is the single most time-sensitive test to pursue when struggling to conceive. Most often this consists of measuring anti-müllerian hormone (AMH) but sometimes a basal follicle stimulating hormone (FSH) level can provide additional insight (ultrasound can also be informative). Besides ovarian reserve testing, endocrine (hormone) problems that can interfere with fertility include PCOS (elevated androgens), underactive (or overactive) thyroid function and inappropriately elevated prolactin (the hormone responsible for breast milk production which can be raised outside of pregnancy). These tests are traditionally ordered as indicated.
What information does a semen analysis provide?
The main parameters that are examined during a semen analysis include the volume, concentration, motility and morphology (shapes) of sperm. These numbers are then used to formulate the clinically-significant parameter called the total motile count which is the quantification of “how many moving sperm are in the ejaculate” (normally only a percentage of sperm are moving). Even more insight can be gained in measuring how many sperm are progressively motile (physically propelling forward vs swimming in place). Reference ranges for a semen analysis are based upon men from around the world who have successfully sired a child. It is important to understand that a single semen analysis does not necessarily provide the complete picture about fertility potential. Semen quality can fluctuate from day to day and the main parameters listed above do not fully represent the true potential of sperm to fulfill their required contribution to healthy embryo creation.
Can my partner do double collections for IUIs?
Yes, your partner can do double collections for intrauterine inseminations (IUIs). Double collection refers to collecting two semen samples, typically within a short time frame, to potentially increase the number of motile sperm available for the IUI procedure. Issues to consider in this strategy are fluctuations in output (the quantity of the second sample can sometimes be lower or it can sometimes be higher!), timing,logistics and patient experience (the process can be physically and emotionally demanding).
How do you process sperm for use with IUI or IVF?
We are proud to offer the Zymot device for sperm processing, a novel approach that promotes the selection of sperm with the highest capacity for healthy embryo creation.
What fertilization techniques do you use, ICSI or conventional insemination?
ICSI (intracytoplasmic sperm injection) is a laboratory procedure where a single sperm cell is chosen from the provided semen sample and injected directly into one egg cell under a microscope. Conventional insemination is a laboratory procedure where an egg is exposed to a significant quantity of sperm (~100,000) with the goal of a single sperm successfully fertilizing the egg through its own effort. Both methods most often produce equally good outcomes but for some individuals and couples there may be a method that is most optimal (most successful) for them. As in all of our operations at MFC, we individualize treatment recommendations. Factors to consider include current and past semen analysis indicators, past proven fertility, general statistical probabilities, theoretical associated risks and patient values.
What kind of embryo culture system do you use?
We are so proud of our embryo culture system which employs the latest technology and principles to create the best possible embryos for you. Our advanced incubators (called “Geri’s”) allow culture to proceed with zero exposure to the external environment for the whole duration of their development (~ 1 week). As an individual embryo has its own developmental trajectory, timelapse technology (a picture of the individual embryos is taken every 5 minutes) allows us to pick the optimal timing for interventions (such as embryo biopsy or embryo freezing). Each patient gets their own individual chamber and our beloved Geri’s also provide humidity which allows us to avoid compensatory interventions that are necessary with “dry” incubators.
In addition to helping me to become pregnant, what else can I learn from going through IVF?
Going through the laboratory phase of IVF can provide a deeper level of understanding than you can ever achieve from any pre-IVF tests. Metrics you will acquire include egg yield (do my individual follicles yield eggs at the expected 1:1 ratio?), egg maturation rate (do the eggs that are collected match the maturity stage that was predicted by ultrasound?), fertilization rates (do my eggs and sperm come together at the expected rate of 80-85% of the time?), embryo development rates (do 50% of my early stage embryos develop into advanced stage blastocysts?) and euploidy rates (does my cohort of embryos match the predicted rate of euploidy based upon my age?). Any deviations from averages may provide subtle clues that can inform use of your true reproductive potential.
Should I choose preimplantation genetic testing for aneuploidy (PGT-A) as part of my IVF lab plan?
PGT-A is a laboratory test that provides information about whole chromosomes (large pieces of DNA) in individual embryos. Abnormal chromosome copy numbers (there should be two and only two copies of each of the 23 chromosomes in a human cell) are a major contributor to impaired reproductive capability and the incidence of abnormal chromosome content is strongly related to age. The goal of PGT-A is to “screen out” embryos with chromosome problems. In practice, current clinical research supports the use of this technology (especially in patients of advanced reproductive age) however it is important to understand testing limitations. From a scientific perspective the testing methods are extremely complex and validity and reproducibility capabilities are continuously evolving. For example, our field’s current best estimates regarding false positive or false negative results is somewhere around 2-4%. Ultimately the use of PGT-A by patients is an individual choice made after careful consideration, ranking values such as cost, past reproductive experiences (going through a miscarriage), general reproductive viewpoints and long term family building goals.
What other genetic technologies do you offer besides PGT-A?
We work with an array of genetics reference labs to provide you with a platform that best fits your reproductive goals. Several labs offer parental verification, confirming the parental origins of the embryo. PGT-P tests embryos for disease risk for medical conditions that might be a part of your family history (diabetes, asthma, cancer, mental health). The latest form of genetic testing, whole genome sequencing (WGS), holds the promise of detecting de novo (new) conditions that arise spontaneously during egg, sperm or embryo development. Read more here.
What is your policy on working with abnormally fertilized eggs?
There is an increasing recognition in our field that a proportion of embryos once thought to have no potential (based on their fertilization appearance) can actually lead to a normal liveborn baby. In line with our “nothing left behind” policy, all fertilizations with initial abnormal appearance are kept in culture and watched for development along with all of the other embryos. Many times abnormal fertilizations do not result in a fully developed embryo. However, if one does make it to full development, our lab will freeze and store it along with your other embryos.
How do you ensure no mix ups in the lab?
At MFC, safety is our priority. Our clinic staff and embryologists are constantly performing redundant name checks, verifications, cross-checking paperwork, lab orders, and information in the patient’s chart. Our lab workstations only house one patient sample at a time and our moderate lab volume mitigates against errors associated with high throughput.
How long can embryos be frozen?
Embryos can be stored indefinitely once they are frozen. Current studies and practice indicate that embryos can remain viable for decades after freezing. No “expiration” point has yet to be identified.
What makes your lab different?
In our lab, our laboratory director, Dr. Uzelac, holds his High-complexity Clinical Laboratory Director (HCLD) license is onsite and able to advise whenever needed, unlike many labs where the lab director does not often work onsite and can even live out-of-state, only coming by their lab for routine check-ins. Both of our embryologists hold technical supervisor (TS) licensure, and have many years of experience in the field.
Is the lab accredited by any professional bodies?
Yes, our laboratory is accredited by the College of American Pathologists (CAP), which is the gold standard for IVF laboratories across the country. We also hold all current state and federal licenses (California Tissue Bank, CMS, CLIA) required to operate.
What certifications and experience do your embryologists have?
Our embryologists hold college degrees in scientific fields, as well as certification by the American Board of Bioanalysis and American Association of Bioanalysts as Technical Supervisors (TS). Both are considered “senior” in the field and have been working together for 10 years. This elevated background and seamless team translates into better outcomes for you.
Egg Freezing
Lab
Is there any way to tell me about the quality of my eggs?
Age is the number one determinant of egg quality. Unfortunately, at this time there is no validated test to characterize egg quality further. When eggs undergo the freezing process, we are able to observe them under the microscope but most eggs look like “shiny” circular single cells. On rare occasion, frankly poor quality eggs can be observed that look dark. The “machinery” inside an egg that makes “a good egg good” is not visible to the eye. Only when eggs are turned into embryos that are then observed to develop through stages over time do we gain insight into the original egg quality.
What other information do I get about my eggs in the laboratory?
Besides the raw number of eggs retrieved, other information that can be useful to help characterize your reproductive potential (i. e.“how fertile you are”) includes the follicle to egg yield ratio and proportion of mature eggs. Eggs go through developmental stages prior to their release from the ovary and it is only fully mature eggs that have the ability to be fertilized with sperm. Shortly after arriving in the lab from the egg retrieval procedure each egg will be assessed for what stage it is at. Normally we expect a 1:1 ratio from enlarged follicle to egg yield. Any decrease in the proportion of mature eggs can shed light on an otherwise masked fertility issue.
What is MFC’s “no egg left behind” policy?
MFC has extensive background and experience with in vitro maturation (IVM) which is a laboratory technique used to finish the egg maturation process in the lab after retrieval. We have a “no egg left behind” policy meaning we work with immature or transitional stage eggs to allow them the opportunity to convert to a mature egg and thus add to your overall pool of frozen eggs. Extra effort interventions like this set is apart from other labs where the norm is to immediately discard non-mature eggs in the name of lab efficiency.
What technology and methods do you use for freezing and thawing eggs?
At MFC we use the modern freezing technology known as “vitrification”, a rapid-freezing technique that prevents ice crystal formation by using high concentrations of cryoprotectants. It differs from the older “slow freezing” method, which has a higher risk of ice crystal formation that can damage the eggs.
Where are my eggs actually stored?
Your eggs are stored in special tanks called dewars, which are filled with liquid nitrogen (-196°C) and closely monitored.The tanks are located in our onsite, certified biorepository in our main office in Greenbrae, California. They are taken care of by our own embryologists (the same people who froze your eggs). Your eggs are always “in-house” and you don’t have to worry about them going to a secondary location for storage. In the event you should move out of the area in the future and wish to transfer your eggs to an IVF center located near you, your frozen eggs are completely transportable.
How long has the lab been performing egg freezing procedures?
We are extremely proud of our lab's track record with egg freezing. One of our senior embryologists was trained at the laboratory that had one of the first successful live births from frozen eggs in North America (2005). In Marin, we have been performing egg freezing since the technology was given a non experimental status by the ASRM (2012).
How long can eggs be stored once they are frozen?
Eggs can be stored indefinitely once they are vitrified. Current studies and practice indicate that eggs can remain viable for decades after freezing. No “expiration” point has yet to be identified.
What are the success rates of egg survival after thawing?
The survival rate of vitrified eggs after thawing is generally high, often above 90%. Successful thawing varies based on the inherent quality of the eggs and this is largely driven by your age at the time of freezing.
What happens during the thawing process in the lab?
During thawing, eggs are carefully warmed at specific rates and rehydrated by removing cryoprotectants and gradually replacing them with water. The eggs are then assessed for viability before being fertilized through intracytoplasmic sperm injection (ICSI).
How do they ensure each patient’s eggs are correctly identified and stored?
We have a system of multiple checks in place that include 2-person witnessing system, physical labels on the canes, straws, and other devices used in storage and redundant documentation. One of the key advantages of MFC is that, as a mid-size center, our staff is not overwhelmed with an overly burdensome workload and can therefore have the ability to care for you (and your eggs) as an individual.
Are my eggs safe in storage?
Along with identification safety, biorepository safety is the top priority in our lab. We have exceeded industry standards in our cryostorage operations, employing the latest technologies such as Cryosentinal Thermographic Monitoring and Boreas Weight-Based Monitoring to ensure we have done everything possible to keep your eggs safe. With the addition of temperature sensors, we have 5 tiers of redundant alarms on all of our cryostorage tanks. The lab staff conduct daily quality control checks, manual inspections and liquid nitrogen filling, ensuring each tank is well maintained.
What protocols are in place in case of power outages?
The storage system we use does not rely on any power. It is simply just liquid nitrogen submersion. So a power outage has absolutely no effect on your stored eggs. That said, our tank alarm systems do require power and these are connected to a backup generator in case of a power outage. Fortunately, because we are on the same electric grid as Marin Health Medical Center (which is located just blocks away) power outages are rare.
What protocols are in place in case of an earthquake?
Our office and biorepository is located in a single story building that meets all California building codes concerning seismic activity. Compared to storing eggs in the city of San Francisco, Marin offers a theoretical advantage due to less seismic activity (San Francisco is located directly on the San Andreas fault) and a less densely populated area (potentially allowing for quicker emergency responses and easier access in and out of the area).
Clinic
What is ovarian reserve and how do I assess it?
Ovarian reserve refers to the quantity and quality of a woman's remaining eggs at any given time. Ovarian reserve continuously decreases over time and this starts to become clinically significant (i.e. declines from peak fertility) in a woman’s late 20s and early 30s. It is important to understand that assessing ovarian reserve is nuanced. Tests to do this primarily rely on evaluating quantity; there is no validated test of egg quality. The number one determinant of egg quality is age. To gain more understanding about quantity of eggs remaining we use hormone blood testing and ultrasound. Antimullerian hormone (AMH) and follicle-stimulating hormone (FSH) can provide valuable information. Finally, medical history (e.g. endometriosis), past performance in reproductive treatment and family history can all shed light on ovarian reserve and reproductive potential.
What is egg freezing?
Egg freezing is the process of removing a group of eggs from the ovary (ones that would have naturally soon expired), placing them in liquid nitrogen and storing them there until their desired use (can be years later). Prior to removal, the ovary is stimulated with medication so that several eggs can mature at the same time (‘normally just a single egg grows in 1 month). The whole process takes about 2 weeks.
Why would I want to pursue egg freezing?
After birth, eggs in the ovary stop replicating so there is a finite supply of them. The ones that are present at any given time have continuously aged throughout life. When eggs are removed from the ovary, they cease to age. Therefore, egg freezing can preserve the option of having a baby in the future when it might not otherwise be possible because of age.
Does egg freezing affect my future fertility?
No, egg freezing preserves a single group of eggs that is in the active process of maturing and are therefore on their way to either 1) being imminently ovulated or 2) being naturally re-absorbed into the body. Egg freezing “saves” the whole group.
How many eggs should I freeze for the future?
The number of eggs you should freeze for the future use can vary depending on several factors, including your age, ovarian reserve markers and reproductive goals. We also suggest factoring in room for some “evolution of thought” (ie your reproductive goals may increase in the future). A good starting point is to consider freezing 20 eggs before the age of 35. This would statistically give you a 90% chance of having at least one liveborn baby in the future. After going through an egg freezing cycle, consideration can be made to pursue additional cycles of egg freezing, adding to the overall number of eggs that you would have in storage. Big picture strategy can be refined based upon your experience and outcome of the first cycle, age and family-building goals.
Is there an ideal time to freeze my eggs?
There is no real “right” time to freeze your eggs. It varies from person to person and what your goals are for freezing. We know that fertility begins to decline in a woman’s late 20s/early 30s so the general rule is “the younger the better” but you have to weigh the advantages of pursuing egg freezing at a younger age vs. the chances that you may not need to call upon your frozen eggs in the future. As part of this assessment, costs of treatment are also considered (some women have insurance benefits and some will be paying out of pocket).
I’m still in my 20s. Should I consider egg freezing?
Ovarian reserve decreases over a lifetime for everyone but it also decreases at a different pace for each individual. That means that some women will reach their peak fertility earlier than others which also means their general fertility will end earlier than average. Risk factors for early ovarian reserve problems include women with family histories of age-related fertility struggles and medical conditions (endometriosis, history of ovarian cysts, past ovary or reproductive surgery, cancer or other illnesses requiring chemotherapy or radiation therapy). Most women with diminished ovarian reserve (DOR), however, have no identifiable risk factors. Some women discover markers of early ovarian reserve issues through direct to consumer/at-home tests.
Is there a way to predict how many eggs I might be able to freeze in a single cycle of egg freezing?
Yes. The ovarian reserve markers, antimullerian hormone (AMH) and antral follicle count (AFC), are very useful at predicting response to ovarian stimulation. Typically, 50-60% of antral follicles will grow and yield “freezable” eggs with ovarian stimulation.
What if I don’t reach my egg number goal in a single egg freezing cycle?
Depending upon your ovarian reserve and your ultimate reproductive goals, it may not be realistic to retrieve all of the eggs you desire to freeze in a single treatment cycle (1 round of egg collection). For this reason many women will pursue an additional cycle or multiple cycles of egg freezing to bank, over time, the amount of eggs with which they feel comfortable.
Do I have to come off of my birth control?
Birth control such as the IUD does not have to be removed in order to complete egg freezing. Hormonal birth control such as “the pill” will be briefly stopped for the ovarian stimulation and can be restarted immediately after.
In the future, do I use my frozen eggs or try to conceive at home first?
There are many variables to consider in this situation including 1) your age at the time of freezing and amount of eggs frozen, 2) your current age and ovarian reserve markers and 3) your ultimate reproductive goals (i.e. how many children do you want?). Our providers would use the above information as a starting point and then counsel you on your individual circumstances. There are pros and cons to each pathway. In the end some women will elect to proceed first with an egg thaw and some will keep their eggs frozen as they begin attempts at home.
What if I don’t end up using my frozen eggs?
If you don't end up using your frozen eggs, there are several possible dispositions for your frozen eggs including donation to another individual, research or simply disposal.
How is egg freezing different from IVF?
Eggs freezing and IVF initially follow the exact same clinical procedures which consist of 1) ovarian stimulation (ultrasound monitoring and bloodwork while taking injectable medications for about 10 days) and the egg retrieval procedure (see more in section below). It is the lab procedures after the egg retrieval where the two differ. For egg freezing, the eggs are, within hours of their removal, frozen and stored in liquid nitrogen. For IVF, the eggs are fertilized to create embryos which are eventually transferred to the uterus to achieve pregnancy.
Can I do both egg freezing and IVF at the same time?
Yes, some patients may want the flexibility of having both frozen eggs and frozen embryos available for use in the future. If a sperm source is available or selected, embryos have the advantage of a statistical higher potential (better chances to turn into a baby) since they have demonstrated their ability to successfully progress through a series of developmental steps as an embryo over a period of 5-7 days prior to freezing. Frozen eggs hold the advantage of retaining their autonomy for sperm source.
Ovarian Stimulation and Egg Retrieval
Both IVF and Egg Freezing require two identical components to treatment: ovarian stimulation and egg retrieval. Information in the following section applies to both IVF and egg freezing.
Treatment Experience
What are the basic steps to ovarian stimulation/egg retrieval?
Ovarian stimulation/egg retrieval is typically a two-week process as follows:
- Hormone Stimulation: 10-14 days of hormone injections, ending with a final “trigger shot” 35-36 hours before the egg retrieval. During this time there are typically 4 office appointments for the purposes of “monitoring” (each appointment consists of an ultrasound and blood work to check in on the progress of follicle growth.
- Egg Retrieval: A 20-minute procedure performed under sedation (I.V. anesthesia only, neither intubation nor paralysis). The entire process typically requires a total of 5 office visits.
Is the process safe?
In general, ovarian stimulation/egg retrieval process is a very safe medical intervention. It is estimated that there are around 2.5 to 3 million cycles of ovarian stimulation/egg retrieval carried out around the world annually. All major risks associated with ovarian stimulation and egg retrieval have a statistical occurrence probability of less than 1%.
What is a typical monitoring visit like?
A typical monitoring appointment is a brief office visit (typically 10-15 minutes) which consists of an ultrasound (to measure the sizes of the ovarian follicles) and blood work (to measure the level of estrogen in your blood which correlates to follicle growth). At MFC, large wall mounted video screens reveal all of the ultrasound data in real time so you can ask questions and truly feel engaged in the process. Monitoring occurs in the morning (before lunch) to allow time to get the estrogen level results back and call you with further instructions regarding any changes to medications moving forward.
What is the purpose of monitoring?
Monitoring during ovarian stimulation is crucial for tracking follicle development and hormone levels to optimize the timing and effectiveness of the egg retrieval process. It helps detect under and over response and prevent complications like ovarian hyperstimulation syndrome (OHSS) by allowing for timely adjustments in medication. Additionally, regular monitoring ensures provides reassurance and support throughout the treatment.
How often will I need to visit the clinic during stimulation?
You will usually have about 4 monitoring appointments during the stimulation phase to check hormone levels and follicle growth.
Can other members of my family join me during appointments?
Yes, of course. We encourage you to bring your spouse, partner, mom, dad, friend, or whoever is a part of your support network.
Do I have to do all the injections myself?
Injections are self-administered in the evenings to allow time for the medication to work before we see you for monitoring (in the morning). Most patients will self administer the injectable medications however if this is a hardship there are alternatives. Many women will receive the help of a partner, friend, or neighbor. There are also local businesses that provide a nurse who can administer injections at your home.
How will I feel during ovarian stimulation?
During ovarian stimulation, the ovarian follicles will grow and this usually results in a sensation of pressure in the pelvic region or back. For some women this is the extent of what they will feel. Others experience localized bloating or cramping or even more generalized side effects include fatigue, mood swings, nausea or headaches. Response is HIGHLY patient specific and can vary from cycle to cycle within the same person. Regarding nightly medication self-administration, injections are given subcutaneously (meaning just under the skin surface, not deep in the muscles) and so are usually very well tolerated. Some may experience mild site reactions such as redness, bruising, or tenderness.Typically a total of 10-12 shots is needed to complete the whole cycle.
What medications are used for ovarian stimulation?
There are 3 main categories of medications for ovarian stimulation: 1) gonadotropins like FSH (follicle-stimulating hormone) and LH (luteinizing hormone) to promote follicle growth 2) GnRH agonists or antagonists to block premature ovulation and hCG (human Chorionic Gonadotropin) and/or Lupron to trigger ovulation.
How do I prepare for egg retrieval?
Egg retrieval is the most critically timed event of the whole process and so preparation starts with taking your trigger shot exactly as instructed (medication, dose and the exact time). You will be instructed to fast (no food or drink) for 8 hours prior to your scheduled procedure. Egg retrievals always occur in the early morning so align with biological events in the laboratory. Stay hydrated and maintain a healthy diet leading up to the retrieval, and finally, ensure you arrange for someone to drive you home after the procedure, as you will be under sedation.
What is the egg retrieval like?
Egg retrieval is a minor surgical procedure performed under sedation, where a needle is used to aspirate eggs from the ovarian follicles through the vaginal wall. The procedure typically takes about 20 minutes, and you will be asleep with an anesthesiologist always present. You might experience some mild cramping when waking up. After the procedure, you will rest in the recovery area before going home.
What is recovery from egg retrieval at home like?
Most women feel back to normal within a few days, although some may experience mild cramping and bloating for up to a week. The majority of women report not having a need for prescription strength pain relief medications. The menstrual period following the egg retrieval (typically within 10-12 days) can be more intense due to the multiple follicle growth and associated higher hormone levels.
Can I resume normal activities after egg retrieval?
Light activities can be resumed within a day or two, but strenuous exercise and heavy lifting should be avoided until your period resumes.
Lifestyle
How will going through ovarian stimulation and egg retrieval fit into my life?
There is no perfect time to pursue ovarian stimulation/egg retrieval but many patients will elect to pursue the process during a time of lighter work or life responsibilities. As age and aging are often factors, this is commonly weighted into the decision making as well. The process will require some time and effort on your part and so we highly encourage patients to consider this in picking a time when you can truly devote energy to the process.
How should I eat during the process?
During ovarian stimulation and egg retrieval, focus on a balanced diet rich in whole foods. Prioritize lean proteins, whole grains, fruits, and vegetables to support overall health and optimize egg quality. Stay well-hydrated by drinking plenty of water. Additionally, small, frequent meals can help manage any bloating or discomfort you may experience.
What about dietary supplements and vitamins?
It's important to discuss your current dietary supplements with your doctor before continuing them during ovarian stimulation. Some supplements, like omega-3 fatty acids, Vitamin E and herbals may increase bleeding risks during the egg retrieval procedure and therefore should be stopped when starting ovarian stimulation medication.
Do I have to give up caffeine?
Current literature supports the safe use of up to 200 mg of caffeine per day throughout all reproductive treatments and pregnancy. Examples:
One 12-ounce cup of brewed coffee: A typical 12-ounce (355 ml) cup of brewed coffee contains about 120-200 mg of caffeine, depending on the strength of the brew.
Two 8-ounce cups of black tea: An 8-ounce (240 ml) cup of black tea generally has about 40-60 mg of caffeine, so two cups would provide approximately 80-120 mg.
One 16-ounce energy drink: Many 16-ounce (480 ml) energy drinks contain around 160-200 mg of caffeine.
Is alcohol allowed?
Consuming alcohol in moderation (1-2 drinks per day) is usually acceptable until 2-3 days prior to egg retrieval, but abstaining entirely can also be a good option. While there's limited research specifically examining the effects of alcohol consumption on IVF success rates, some studies suggest that moderate alcohol intake may not significantly impact IVF outcomes, whereas heavy alcohol consumption may be associated with reduced success rates. This time can be an excellent opportunity to focus on optimizing your overall health and healthier lifestyle habits.
Can I still exercise?
Yes, moderate exercise is permissible until the ovaries start to enlarge (typically around day 6 of stimulation). After that point, we recommend only low-impact activities like hiking, walking or yoga (physical inversion should be avoided). Following your retrieval, it's best to avoid strenuous activities for 1 week.
Can I continue having sex during treatment?
Yes, sex is permissible until the ovaries begin to enlarge, typically around day 6 of stimulation. Using barrier contraception is advisable since multiple eggs may be growing and could eventually be exposed to any sperm in the reproductive tract. This period of abstinence should continue until about one week after egg retrieval to allow the ovaries to heal.
Is traveling permitted?
Traveling is permitted during ovarian stimulation just as long as you can still make it to your monitoring appointments. In cases where you will need to be out of town more than a couple days, it is sometimes possible to find a local fertility center that can perform monitoring for you. Some medications need refrigeration; you can use a cold pack and we can furnish you a note for TSA. Please remember to avoid any prolonged periods of sitting or inactivity as this can increase your risk for blood clots.
Are hot tubs, saunas and pools okay to use?
Hot tubs and saunas are not recommended throughout ovarian stimulation, primarily because eggs are in an active growth phase during and may be affected by a significantly elevated core body temperature. Pools are permissible to use throughout ovarian stimulation and then should be stopped the day prior to egg retrieval. All of these activities can be resumed 48 hours after egg retrieval.
What about acupuncture and massage?
Acupuncture is fine to continue during ovarian stimulation. Massage is also permissible but please inform your masseuse, as the ovarian areas may be more sensitive.
Fertility lexicon
aneuploidy
Human genetic material is arranged into structures called chromosomes. While most healthy individuals possess 46 chromosomes, additions or subtractions to this number can result in disease; this is known as
antimullerian hormone (AMH)
The ovary produces antimullerian hormone and its blood levels correlate with the number of eggs that are remaining in the ovary. AMH is used clinically as an assessment of ovarian
antral follicle count
Small ovarian follicles, spherical cyst-like structures that each contain an immature egg, can be directly visualized by ultrasound. The total number of these follicles, termed the antral follicle count, can
assisted reproductive technology (ART)
Assisted Reproductive Technology (ART) is any fertility procedure that involves removal of oocytes (eggs) from the body. The most common ART is in vitro fertilization (IVF). Others include ZIFT (zygote
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