Infertility can be a lonely journey — from trying to understand the latest fertility science, to finding the right provider, to coming up with the most effective way to respond to the constant question of “When are you going to have a baby?” — it’s a lot. 

If you’re going through this now, we hope these testimonials help you know that you’re not alone. 

What do you wish other people knew about infertility? 

“Infertility is a medical condition. This condition is not only about trying to conceive, it affects our mental health as well. It can also affect our friendships and daily living. Infertility can consume a large portion of your life trying to reach the end goal of having a baby. Those dealing with infertility will more than likely need a little bit more grace, love, and understanding while on their journey.”  – April Christina

“Infertility is such a challenge to navigate and you can feel so alone. One thing people should know is that someone experiencing infertility may not want to talk about it. It’s best not to ask questions unless the person indicates they are open to talking about their experience. It’s a rollercoaster…some days are good, some are heartbreaking, and today may not be a good day.” – Caroline

What kind of support do you wish you had while dealing with infertility?

“I think that there needs to be more openness around infertility. When you are going through it, you can feel so alone and ashamed, like there is something wrong with you as a woman. Once you start talking about it and you know that you are not alone, there is a comfort that comes. If more people talk about it, the stigma will disappear and so will the feelings of loneliness.” – Tobi

“When we were trying to conceive and got the diagnosis of male factor infertility, I struggled with being angry and blaming my husband for what he couldn’t control — which in turn caused a lot of guilt for me. I think he probably dealt with similar feelings of guilt and shame but we never talked about it together, or to a professional. We both would probably have benefited from individual and couples therapy to work through those complicated feelings without hurting each other.” – Leslie G. 

“Our best supporters are the ones who listen and ask how we are feeling. When family/friends ask “are you trying XYZ” or “my friend went through it and everything worked out” it is not helpful. No one has poor intentions, but it puts even more pressure on us and it hurts when others assume we’re not doing the best we can. I want to see conversations about infertility be more common and not taboo, and the best way to start that is to lend your ear in a safe, judgment free space for anyone wanting to share their struggles.” – Jackie Straz 

Do you have any advice for those struggling with infertility? 

“One thing that I say all the time is “your pace, your race.” It’s hard when you see other people pregnant and you’re waiting for your time to come. There will be a day and time that is tailor-fit for your journey. I realized when I understood where I was on my journey, it made this road a bit easier. Continue to stay your course.” – April Christina

If you’d like to share your story, message us on Instagram @oviahealth

While medicine may have expanded fertility options, it can feel like there are so many more decisions to make about when to start a family or how to preserve fertility. If you’re wondering: should I freeze my eggs? you’ve come to the right place. Make sense of egg freezing and why it might be an option to consider.

What Is egg freezing?

Known in official medical circles as mature oocyte cryopreservation (OC), egg freezing is the process by which a doctor takes eggs (oocytes) from your ovaries. These eggs can then be frozen and stored until you decide you’re ready to use them. At that point they are thawed, mixed with sperm in a laboratory, and re-inserted into your uterus (womb) through your cervix, hopefully leading to pregnancy.

Who’s freezing their eggs in the U.S.?

Nationally, the number of egg freezing cycles increases every year. The Center for Disease Control (CDC) reports there were more than 22,000 egg freezing cycles in 2019, up from around 18,000 in 2018 and 14,500 in 2017.

• It’s becoming more common for people under the age of 35 years to preserve their fertility through egg freezing.
• White patients freeze their eggs more than people of color, although more minority groups are freezing their eggs, especially Asian women.
• University-educated or professional people are more likely to pursue elective egg freezing.

Why might you want to freeze your eggs?

People choose to press pause on becoming a parent or growing their family for many reasons. Elective egg freezing is now safer, more affordable, and more common. Some of the reasons people give for choosing electively to freeze their eggs include:

• Not being in a relationship with a partner they want to parent with 
• Wanting to be financially stable before starting a family
• Working in a demanding career where being pregnant could come at a professional cost
• Having access to employer-subsidized egg freezing benefits

Other people may turn to egg freezing because they have a medical condition that threatens their future fertility. One out of five women in one study reported choosing egg freezing because of underlying health conditions. Women and their health care providers may consider egg freezing if they:

• Have a condition impacting fertility such as sickle cell anemia, autoimmune diseases such as lupus, or premature ovarian failure
• Have a cancer diagnosis or other illness and need to receive chemotherapy or radiation that could harm their ovaries

Egg freezing also helps LGBTQ+ people keep their parenting options open. Gender-affirming surgery or medical treatments can limit fertility so some transgender men choose egg freezing before beginning their transition.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. The more eggs you can harvest and freeze, the better your chances for pregnancy down the road. As you get older, it gets harder to harvest enough high-quality eggs. Here’s what the science tells us:

• Egg quality peaks between 16 and 28 years old
• Women in their mid-reproductive years (29 to 37 years old) produce enough high-quality eggs to make egg freezing cost effective
• People who freeze their eggs before age 34 have the highest overall live birth rates.
• One 2015 study found that the biggest difference in live birth rates between people who did and didn’t freeze their eggs was at age 37. At younger ages, the differences in live birth rates in people who did and did not freeze their eggs were smaller.
• There is little benefit (no comparative increase in the number of live births) for women ages 25-30 to freeze their eggs

From a straight biological perspective, the younger you are when you freeze your eggs, the better your chances for good egg quality and number harvested.

Egg freezing and deciding what’s right for you

Decisions about fertility and parenting are individual and personal — egg freezing is no different. It can be helpful to think of egg freezing as an insurance plan rather than a guarantee for a baby. It is a way to increase your chances of being able to be a parent, without being limited by your biological clock or life circumstances. That said, it can be very expensive and so is not a good option for everyone.

Reviewed by the Ovia Health Clinical Team

Read more:

• Egg freezing step by step
• Egg freezing FAQ

Sources 

• Katler QS, Shandley LM, Hipp HS, Kawwass JF. National egg-freezing trends: cycle and patient characteristics with a focus on race/ethnicity. Fertil Steril. 2021 Aug;116(2):528-537. doi: 10.1016/j.fertnstert.2021.02.032. Epub 2021 Mar 30. PMID: 33795141.
• Inhorn MC, Birenbaum-Carmeli D, Birger J, Westphal LM, Doyle J, Gleicher N, Meirow D, Dirnfeld M, Seidman D, Kahane A, Patrizio P. Elective egg freezing and its underlying socio-demography: a binational analysis with global implications. Reprod Biol Endocrinol. 2018 Jul 23;16(1):70. doi: 10.1186/s12958-018-0389-z. PMID: 30037349; PMCID: PMC6056999.
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 

• “Assisted Reproductive Technology (ART) National Data.” Centers for Disease Control and Prevention (CDC). CDC. 2019. https://nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&ClinicId=31&ShowNational=0. 
• Kylie Baldwin, Lorraine Culley, Nicky Hudson & Helene Mitchell (2019) Running out of time: exploring women’s motivations for social egg freezing, Journal of Psychosomatic Obstetrics & Gynecology, 40:2, 166-173, DOI: 10.1080/0167482X.2018.1460352
• Amato, Paula. “Fertility Options for Transgender Persons.” UCSF Transgender Care. University of California, San Francisco. June 17, 2016. https://transcare.ucsf.edu/guidelines/fertility. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 
• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002

Step 1: Choosing your fertility clinic or doctor

The American Society for Reproductive Medicine (ASRM) suggests scheduling a consultation with prospective fertility clinics to ask about their egg freezing methods, success rates, costs, storage, and policies for disposing of unused eggs. Most importantly, you should choose a doctor you feel comfortable with and trust. 

Step 2: Your baseline fertility evaluation

Once you choose your doctor, you will have several appointments and evaluations. These include appointments for:

1. Consultation with your fertility doctor (aka reproductive endocrinologist)
2. Transvaginal ultrasound to count the number of eggs (follicles) on your ovaries. (If this baseline testing is encouraging, you might decide to opt out of egg freezing completely or to delay egg harvesting.) 
3. Blood test examining your fertility hormones
4. Follow-up appointment several weeks later to review lab test results and your ovarian stimulation protocol

Ovarian stimulation protocol is the name for the sequence of medications you will give yourself over the next 3 to 4 weeks to stimulate your ovaries to produce multiple mature eggs.

Step 3: Ovarian stimulation

In a normal monthly cycle, your ovaries form multiple fluid-filled sacs called follicles, but only one mature egg, which your ovaries release when you ovulate.

Ovarian stimulation medications mimic your natural menstrual hormones (estrogen and progesterone), but fool your ovaries into growing multiple mature eggs simultaneously.

Most of the medications used for ovarian stimulation must be injected with a needle. You or your partner or family member can do this. You will have another appointment with a nurse to review the medicines, how to mix them and inject them, and to review the timeline and plan for your egg retrieval process.

Where you are in your cycle, timing, and the results of your fertility evaluation determine the best protocol for you. Here is a typical ovarian stimulation protocol and commonly-used medications:

1. A short course (1-2 weeks) of birth control pills, estrogen, Lupron, or Aygestin (a form of progesterone) before starting injections. 
2. Self-administered hormonal injections medications for the next 9-12 days. The injections will most likely be some combination of follitropin alfa or beta (Follistim AQ, Gonal-f) or menotropins (Menopur) to stimulate your ovaries.
3. Hormonal injections on days 9-12 to prevent your ovaries from releasing an egg too soon. Medications could include leuprolide acetate (Lupron) or cetrorelix (Cetrotide).
4. A trigger shot 36-37 hours before your scheduled retrieval procedure time to complete the “ripening” of your eggs. These injections are usually Lupron (leuprolide acetate) or hCG (human chorionic gonadotropin), sold as Ovidrel or Novarel. 

The purpose of the first 1-2 weeks of medications is to help align your follicles so they all start maturing simultaneously.

During days 9-12 of the fertility injections, you can expect to have 5-7 monitoring appointments with blood tests and vaginal ultrasounds to evaluate your response to the medications. These appointments typically take about 30 minutes.

Step 4: Egg harvesting

Your doctor will schedule your egg harvesting or egg retrieval appointment once ultrasounds and bloodwork show that you have enough mature eggs. Egg retrieval is usually 9-12 days after starting the fertility injections in a typical cycle.

The actual harvesting procedure only takes about 15 minutes and is not painful. You will be given anesthesia and pain medication to keep you comfortable and very briefly asleep (conscious sedation). Next, your doctor will use ultrasound to safely direct a special suction needle through your vagina to remove mature eggs from your ovaries.

Clinics usually monitor you for one to two hours after the procedure before sending you home to rest. Plan on taking the rest of the day off from work and avoid heavy lifting or intense exercise for the next week to protect your ovaries.

Step 5: Flash freezing your eggs

After harvesting, your eggs are quickly frozen in a process called vitrification. Vitrification prevents harmful ice crystals from forming and results in higher egg freezing success rates. Eggs will be stored at subzero temperatures until you are ready to use them.

Once you’re awake, your care team should tell you how many eggs they retrieved. It will probably take 24 hours to know how many mature eggs were frozen.

When the time is right, your eggs can be thawed, and hopefully fertilized with sperm in a lab, and implanted in you or a gestational carrier’s uterus through in vitro fertilization (IVF).

Step 6: Live your life and plan your future fertility

The decision to freeze your eggs is as complicated as all the steps in the egg freezing process. Egg freezing can offer you more options, but it does not guarantee you a future baby. If you have more questions about the egg freezing process, head over to our FAQ. 

Reviewed by the Ovia Health Clinical Team

Read more

• Should I freeze my eggs
• Egg freezing FAQ

Sources

• “Transvaginal Ultrasound: Medlineplus Medical Encyclopedia.” MedlinePlus. U.S. National Library of Medicine. April 1, 2022. https://medlineplus.gov/ency/article/003779.htm. 
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556.

When should I freeze my eggs?

According to the American Society of Reproductive Medicine (ASRM), elective egg freezing is most successful for women younger than 38 years. Elective egg freezing is when you voluntarily choose to freeze your eggs as a type of insurance plan against natural aging — not because you have a medical condition such as cancer that might harm the eggs in your ovaries (called oocytes).

With age, the likelihood of problems with the chromosomes inside your eggs increases. Chromosomes are the building blocks of your DNA or genetic information. Egg freezing allows you to use “younger” eggs when you want to get pregnant. With age, there are:

• Higher rates of infertility
• Fewer eggs can be harvested
• Lower IVF success rates
• Increased rates of miscarriage
• Higher rates of congenital disabilities
• Higher-risk pregnancies for people who are pregnant when they are older than 35 increase

People who freeze their eggs before age 34 have the highest overall live birth rates. So, while egg freezing does help you slow down your biological clock, you can not push pause forever. Data from fertility centers indicate that most women 38 and younger can expect to harvest 10-20 eggs per cycle. The more eggs your doctor can collect, the higher your chances of a successful live birth. So, the ideal window for egg freezing is somewhere between 34-38 years old.

How much does egg freezing cost?

You can expect to pay $30,000-$40,000 to freeze your eggs. The average cost per cycle of just the medical procedure (harvesting) ranges between $10,000-$20,000. It will cost $500-$600 per year to store your eggs.

Costs will increase or decrease depending upon how many cycles you need to do to freeze the recommended number of eggs (usually around 10). The average person must go through about two cycles to reach this number. The older you are, the more likely you will need multiple cycles, and your medication costs may increase. 

Some commercial health insurance plans will cover the cost of some of the prescription medications used to stimulate your ovaries. However, without any insurance coverage, drug costs can run $2,000-$5,000 per cycle.

Where you live in the country can impact how much egg freezing will cost you, and costs vary even city by city within the same state. If you live far from medical centers, lost wages due to medical appointments and transportation costs can add up quickly.

Employer-financed egg freezing or fertility benefits changed many people’s financial calculus for egg freezing. As of 2020, about one out of every five (20 percent) US companies offered coverage for egg freezing. Apple and Facebook pay their employees up to $20,000 for egg freezing.

Egg freezing costs do not include the cost of thawing and implantation via in vitro fertilization (IVF), which as of 2019, ranged from $10,000-$15,000 per IVF cycle, according to the Society for Assisted Reproductive Technology (SART). Some people will also need to factor in the potential purchase of donor sperm (around $1,000), other assisted reproductive technologies (like assisted hatching or ICSI treatment), or embryo freezing ($200-$800 annual storage fee).

How long does the egg freezing process take?

One egg freezing cycle takes approximately 3-4 weeks. This includes:

• 1-2 weeks of birth control pills or other medication to temporarily turn off your natural hormones
• 9-10 days of hormone injections to stimulate your ovaries and ripen multiple eggs.

During the ten or so days of hormone injections, you will have to make frequent visits (usually at least five appointments in ten days) to your fertility clinic or doctor for vaginal ultrasounds to monitor your eggs and find the right time for harvesting.

The actual egg retrieval procedure takes only about 15-30 minutes, however, you will need to spend several hours after your retrieval at your clinic for observation before you can head home. People report that they usually can return to work and other normal activities within 1-2 days.

It takes most people 2-3 cycles to harvest the recommended 10-20 eggs for freezing. So, depending on your baseline fertility, age, and response to the ovulation stimulation medications, you can count on your egg freezing endeavor taking somewhere between 9-12 weeks, best case scenario.

Is egg freezing safe?

The actual procedure to harvest your eggs is a very low-risk surgical procedure. Egg harvesting carries about the same amount of risk as undergoing IVF. Surgical procedures like egg harvesting and IVF have small risks such as:

• Problems with the anesthesia (the medicines used to put you to sleep for the procedure)
• Injury from the needle passing through your vaginal wall to remove the eggs from your ovary
• Infection after the surgery

The main risks associated with egg freezing come from the regimen of fertility medications you take before egg harvesting (the ovarian stimulation protocol). These medications send your ovaries into overdrive, stimulating multiple eggs to develop simultaneously.

Fertility medications can cause something called ovarian hyperstimulation syndrome (OHSS). If the medicines over-stimulate your ovaries, they can swell, become painful, and cause fluid to build up in your belly, making you nauseous and bloated. One out of three women has symptoms of mild OHSS during controlled ovarian stimulation, but very few women go on to develop severe OHSS, which requires hospitalization.

Egg freezing also carries the emotional risk of undergoing a complicated and uncertain medical procedure. Many fertility medications can cause mood changes. The stress of navigating complex medication injections, multiple doctors’ appointments, and the unpredictability of the results can take a mental toll.

Navigating fertility or infertility can have psychological, financial, and socio-cultural consequences and it’s essential that you look out for your mental wellbeing. 

How many eggs should I store?

This calculation is based upon the biological reality that not every egg makes an embryo, not every embryo makes a pregnancy, and not every pregnancy makes a baby. Eggs are lost at each stage, from thawing, to fertilization, to development into an embryo, to transferring the embryo into a womb. And so, the chance that a single frozen egg will lead to a live birth is about 2 to 12 percent, according to the American Society for Reproductive Medicine. 

So what is the magic number? Fertility experts and clinics worldwide seem to land on the number ten. Research shows you may expect to retrieve about 14 mature eggs on average if you’re 36 and under, about ten if you’re 37-39, about nine if you’re 40-42, and about seven if you are 43 or older.

How long can eggs stay frozen?

Babies have been born from eggs frozen for as long as 14 years. Most people store eggs for five to 10 years. In vitrification, scientists remove the fluid from your eggs and replace it with a chemical version of antifreeze that increases successful fertilization, implantation, and live birth rates.E mbryos do tend to thaw better than unfertilized eggs. If there is a partner in the picture or already a plan to use donor sperm, it’s worth considering freezing embryos. It’s possible to do a mix of both embryos and unfertilized eggs.

The bigger time limits on egg freezing are age and the cost of storage. As people become older (in their 40s and 50s), IVF success rates decline, and they are at higher risk for miscarriage and other pregnancy complications. The chance of becoming pregnant after implantation is roughly 30 to 60 percent, depending on how old you are when you freeze your eggs. Some people opt for a surrogate, which carries a separate set of considerations and costs. 

Your egg freezing decision

The decision to freeze your eggs can seem almost as big as deciding whether you want to become a parent. Egg freezing is one option that can buy you some time as you consider parenthood. However, it’s not for everyone. If you’re in the process of making this decision, speak with your provider for guidance and to your community for support. 

Reviewed by the Ovia Health Clinical Team

Read more

• Should I freeze my eggs
• Egg freezing step by step

Sources

• Mesen, Tolga B et al. “Optimal timing for elective egg freezing.” Fertility and sterility vol. 103,6 (2015): 1551-6.e1-4. doi:10.1016/j.fertnstert.2015.03.002. 
• Cil AP, Bang H, Oktay K. Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis. Fertil Steril. 2013 Aug;100(2):492-9.e3. doi: 10.1016/j.fertnstert.2013.04.023. Epub 2013 May 24. PMID: 23706339; PMCID: PMC3888550.
• “Cost of Egg Freezing.” USC Fertility. University of California, San Francisco. January 27, 2019. https://uscfertility.org/egg-freezing/cost/. 
• Carnegie, Megan. “More Companies Offer Fertility Benefits. It’s Only the Beginning.” Wired. Conde Nast. December 1, 2021. https://www.wired.com/story/fertility-benefits-work/. 
• “Frequently Asked Questions.” SART. Society for Assisted Reproductive Technology, https://www.sart.org/patients/frequently-asked-questions/. 
• “Ovarian Hyperstimulation Syndrome (OHSS).” Reproductive Facts. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/ovarian-hyperstimulation-syndrome-ohss/. 
• Kumar, Pratap et al. “Ovarian hyperstimulation syndrome.” Journal of human reproductive sciences vol. 4,2 (2011): 70-5. doi:10.4103/0974-1208.86080. 
• Hasanpoor-Azghdy, Seyede Batool et al. “The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study.” Iranian journal of reproductive medicine vol. 12,2 (2014): 131-8.
• Vaughan DA, Leung A, Resetkova N, Ruthazer R, Penzias AS, Sakkas D, Alper MM. How many oocytes are optimal to achieve multiple live births with one stimulation cycle? The one-and-done approach. Fertil Steril. 2017 Feb;107(2):397-404.e3. doi: 10.1016/j.fertnstert.2016.10.037. Epub 2016 Dec 1. PMID: 27916206.
• R.H. Goldman, C. Racowsky, L.V. Farland, S. Munné, L. Ribustello, J.H. Fox, Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients, Human Reproduction, Volume 32, Issue 4, April 2017, Pages 853–859, https://doi.org/10.1093/humrep/dex008
• Mayo Clinic Staff. “Egg Freezing.” Mayo Clinic. Mayo Foundation for Medical Education and Research. April 23, 2021. https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556. 
• “Can I Freeze My Eggs to Use Later If I’m Not Sick?” ReproductiveFacts.org. American Society for Reproductive Medicine. 2014. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/can-i-freeze-my-eggs-to-use-later-if-im-not-sick/. 

A failed embryo transfer

Although it’s easy to wonder what you did wrong, a failed embryo transfer is not your fault. Most people need more than one embryo transfer to bring home a baby. The good news is, your odds of success are fairly high within six cycles. About 86% of those 35 and under get pregnant within six IVF cycles and about 42% of those over the age of 40. “Most clinics will also offer PGS/PGD genetic testing, that is generally more meaningful than grading embryos visually in a lab. Higher grade embryos have a statistically higher chance of leading to viable pregnancies,” for example some research shows a 95% success rate with three normal genetically tested embryos. PGS stands for Preimplantation Genetic Screening and can be used to screen for genetic abnormalities, while PGD (or Preimplantation Genetic Diagnosis) is used when one or both parents have family histories of certain issues to search for those specific genetic abnormalities. 

Egg quality is the biggest predictor of success. Highly graded, genetically screened normal embryos are the most likely to implant. But even genetically screened normal embryos with good grades can fail to result in pregnancy. There aren’t always clear answers when it comes to why some embryos implant and others don’t. 

When you’re ready, you can try again. If you have frozen embryos, you don’t have to do another retrieval, unless you prefer to bank more embryos. If you decide to do another retrieval, your doctor may change your medication protocol to see if that changes the quantity and quality of the eggs and embryos. 

Additional testing

If you’ve had multiple failed embryo transfers, your doctor may want to perform additional tests like a hysteroscopy, which uses a scope to look inside the uterus and rule out any potential uterine issues, like polyps. Uterine masses, like polyps and fibroids, and inflammation, can make it difficult for an embryo to implant, so diagnosing these issues ahead of time is key. Your doctor may also adjust your transfer protocol to see if that leads to a better outcome. For example, they may add more progesterone or have you take a different form of progesterone. 

A mental health note

Staying busy and preparing for your next transfer can be a helpful distraction, but it’s also important that you take time to process your grief. Find people you can open up to about how you’re feeling, whether that’s a partner, friend, or mental health professional. It may also help to talk to someone who gets what you’re going through. Some fertility clinics offer support groups for their patients. If your clinic doesn’t have a support group, you can ask them to create one, or see if Resolve: The National Infertility Association offers a local or virtual support group. 

Reviewed by the Ovia Health Clinical Team

Sources

• Karayalçın, Rana, et al. “Office hysteroscopy improves pregnancy rates following IVF.” September 2012. https://pubmed.ncbi.nlm.nih.gov/22818094/ 
• Malizia, Beth A., Michele R. Hacker, and Alan S. Penzias. “Cumulative live-birth rates after in vitro fertilization.” January 2009. https://www.nejm.org/doi/full/10.1056/nejmoa0803072 
• Scott, Richard. “Normal Embryo Success Rate Based on IVF: RMA Research Study” ​​https://rmanetwork.com/blog/women-with-three-normal-embryos-have-95-chance-of-pregnancy-rma-research-shows/ 

The next steps 

If you’ve gone through fertility treatments like IUI or timed intercourse before, you’re likely familiar with the beginning steps of an IVF cycle. IVF cycles start with a monitoring appointment. During these appointments your fertility specialist will perform a transvaginal ultrasound to count your ovarian follicles, tiny fluid-filled sacs in the ovary that contain one egg each. Repeat ultrasounds throughout the cycle will monitor the growth of these follicles, giving you an estimate of how many eggs you might retrieve. You will also have blood drawn to make sure your hormone levels correspond with the growing follicles. The closer you get to the day of your egg retrieval, the more frequent monitoring appointments become. 

IVF medications

During a typical menstrual cycle, multiple eggs grow but only one egg reaches the point of ovulation. IVF uses medication to develop all of the eggs because the goal is to collect as many eggs as possible in one round. Most of the medications you’ll use during IVF are injections. Some injections are subcutaneous, or under the skin, while others are intramuscular, and go into the muscle. With practice, it’s easy to do the under the skin injections in your lower abdomen by yourself. The intramuscular ones are a bit harder to do and may require help from a partner, friend, or nurse. Most people find the injections get easier the more they do them. Your clinic nurse will have plenty of tips to make things easier if you’re having challenges.

Stimulation medications

The medications you take, and their dosages, change throughout the cycle. The first medications are stimulation medications, or “stim meds” as they’re more commonly known. These injections help multiple follicles grow. Research suggests that 9-11 days of stim meds produces the best outcomes. However, your cycle may be longer or shorter depending on how your body responds. As your follicles grow, you may feel some bloating, soreness, and heaviness in your lower abdomen. Some bloating and discomfort is normal, but if it becomes excessive and painful to the touch, let your doctor or nurse know right away. 

Once your follicles grow large enough, it’s time to trigger ovulation. Some trigger shots, like stim meds, are done under the skin while others need to go into the muscle. Follicles ranging from 12–19 mm on the day of the trigger shot are most likely to be mature and fertilize. You must take your trigger shot at the exact time provided by your fertility clinic, typically 36 hours before your scheduled egg retrieval. Your clinic will also monitor estrogen levels at this critical point in time.

Egg retrieval 

Egg retrievals usually occur under light sedation, so you will be asleep for the procedure. Most retrievals are performed vaginally, the doctor uses a probe similar to the wand used for transvaginal ultrasounds, except this wand has a place to slide a hollow needle through. The needle goes through the wall of the vagina and into the follicle to retrieve the egg. Your fertility specialist will let you know how many eggs they retrieved when you wake up from the procedure. You may have some cramping and bleeding following the procedure, but these symptoms usually go away within a day or so. It is also common to feel very fatigued, so planning a day or two of recovery is ideal when possible.

Embryos 

After the egg retrieval, your fertility clinic’s embryologist will use your partner’s sperm, or donor sperm, to fertilize your eggs. From there, the newly formed embryos grow either three or five days before being transferred to your uterus and/or frozen. The number of embryos that make it to day three or five will be less than the number of eggs retrieved. Typically, 80% of the eggs retrieved are mature and 80% fertilize, but only 30-50% of embryos make it to day five. While this is often disappointing, it’s totally normal! At this stage most embryos will undergo testing for quality and genetics. This is an optional, but often highly recommended step, based on your personal history.

Embryo Transfer

One of the biggest moments on your journey to conceive is the day of embryo transfer. Unlike the egg retrieval, you will be awake for the embryo transfer. Most clinics will let your partner join you. Some clinics even have on-site acupuncture, and all clinics will recommend a plan for your care the day after transfer — sometimes recommending rest or bedrest. If you’re working, coordinating time off can cause some added stress. 

The 10 day wait

While the shots, blood draws, and procedures, may seem like the hardest part, having to wait 10 days to two weeks to take a pregnancy test tends to be the most trying. While most people don’t get pregnant on the first try, which can be very challenging, your odds increase with subsequent cycles.

Reviewed by the Ovia Health Clinical Team

Sources

• Abbara, Ali, et al. “Follicle size on day of trigger most likely to yield a mature oocyte.” Frontiers in endocrinology 9:193. April 2018. https://www.frontiersin.org/articles/10.3389/fendo.2018.00193/full 
• Murdock, Cynthia. “IVF Attrition Rate: Why Don’t All Eggs Create Embryos?” Reproductive Medicine Associates. April 2020. https://www.rmact.com/fertility-blog/ivf-attrition-rate 
• Sarkar, P., et al. “Duration of gonadotropin stimulation is predictive of IVF outcome.” Fertility and Sterility 108.3:e231. October 2017. https://www.fertstert.org/article/S0015-0282(17)31218-9/pdf 
• Smith, Andrew DAC, et al. “Live-birth rate associated with repeat in vitro fertilization treatment cycles.” JAMA. 314.24. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934614/ 

Dear Ovia, My husband and I have been trying for a third kid for the last year and a half. He wants to stop trying and says it’s taking away from us appreciating the beautiful babies we do have. But I’ve always dreamed of a big family and I don’t feel ready to give that up. 

First of all, secondary infertility isn’t something we talk about enough — and I hope this answer helps you know for certain that you’re not alone! 

So many families hesitate to talk about fertility struggles. And when you’re already parents you may feel the social pressure to just be grateful for the kiddos you have (which I am sure you are!). I’m here to tell you that feeling like there is an empty seat at your family’s table is a valid feeling whether you have 0, 1, 2, 3 or 9 children. The tough part is that you’re both having valid feelings — and they’re not the same. There may be middle ground in taking a break from TTC for a period of time or continuing to try for “X” number of months before starting a break. 

At the end of the day, it sounds like expanding your family is something that would make you both happy if it could happen with the wave of a wand. So, try to focus your conversations with him around the challenges of the journey (the process of TTC), rather than the destination (the decision to have another baby).

In any case, you need an ongoing and open dialogue, but it can be hard to find a good and private time to talk (especially when you have other children in the house). It’s common for people to either avoid tough subjects or to bring them up at times that are not conducive to conversation (like when you’re getting into bed). 

If you’re avoiding the conversation or one of you is bringing it up at less-than-ideal times, it’s essential that you create a space where you can both actively listen to each other. Try scheduling some time to talk, that way you can both come to the conversation prepared to share and listen. 

Having a disagreement hanging over your heads makes the whole situation more stressful.

Some tips:

• Avoid talking about it before bed when everyone is tired and sex is on the table. 
• Sometimes a drive is helpful because you have a little bit of emotional distance, can break endless eye contact, and sex is (usually) off the table. 
• Agreeing on how to move forward may take more than one discussion, but it should be simple to make a plan for more chats. Breathe, you’ve got this. 
• Fertility journeys start, pause, and end for a variety of reasons, and it often takes a toll. It’s always okay to look for more support from family, friends, or professionals. 

More from this series

• Dear Ovia, My partner isn’t sure if he wants kids
• Male fertility testing

What you can control

Timing of intercourse or introducing sperm

Making a baby is all about timing and, thankfully, you have control over how often and when you have sex or introduce sperm. Checking your cervical fluid and tracking your basal body temperature can help you know when you are ovulating to maximize your chances of success. For couples TTC through intercourse, the highest rates of pregnancy happen for those who have sex every day or every other day during the fertile window, which is the day of ovulation plus the 5 days beforehand. 

Your health

Having a healthy body is important overall, and it’s no different for baby making. This goes for your partner too. Having healthy habits such as eating nutritious food and integrating movement into your day can help prime your body for when you finally do get that positive test. Cutting down on alcohol and caffeine, avoiding smoking, and taking a folic acid supplement can help in your efforts to get pregnant.

Your mindset

It’s common to feel sad or frustrated when you’ve been TTC for a while with no results. Even if it’s taking a little longer than expected, with practice you can aspects of how you think about the situation. Staying relaxed and having a positive attitude can help make the process a little easier. And if you just rolled your eyes, we hear you. There are some specific things you can do to improve your mindset like talking to a therapist and setting boundaries around work. Even spending time outside has been shown to increase happiness.

Things you can’t control

How long it will take

Although it would be nice to have a crystal ball and know exactly when conception will happen, unfortunately there’s just no way to know for sure. Studies show that most couples (about 84%) will get pregnant within their first year of trying. This is reassuring, but of course, every person is different. Some may get pregnant on their first try while others may take 6 months or more.

Your fertility

Having a condition that affects fertility is not your fault. About 12% of women ages 15- 44  have difficulty getting pregnant or carrying a pregnancy to term. And even though it’s common, struggling to conceive can feel extremely isolating. It’s essential that you have a support system and/or a professional to speak with. 

When your friends get pregnant before you

When you’ve been TTC with no luck, hearing of a friend’s pregnancy can be bittersweet. Of course, you’re happy for your friend, but you may also feel a sense of sadness. Acknowledging your feelings, focusing on self-care, and remaining optimistically realistic can all be helpful in moving forward.

Reviewed by the Ovia Health Clinical Team

Sources

Mayo Clinic Staff. “How to get pregnant.” Mayo Clinic. Mayo Clinic. October 5, 2019. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/how-to-get-pregnant/art-20047611.

“Trying to get pregnant.” National Health Service. NHS. December 2, 2020. https://www.nhs.uk/pregnancy/trying-for-a-baby/trying-to-get-pregnant/.

“How long does it usually take to get pregnant?” National Health Service. NHS. September 4, 2018. https://www.nhs.uk/pregnancy/trying-for-a-baby/how-long-it-takes-to-get-pregnant/.

Here, we’ll break down the basics of male fertility and what to do if you and your male partner are having trouble getting pregnant.

What typically happens when sperm meets egg

A healthy male produces tiny reproductive cells called sperm, which are made in the testicles. When he ejaculates, the sperm mixes with fluid from the prostate, forming semen. During vaginal intercourse, ejaculation carries the semen into the vagina where it travels through the cervix and into the uterus and fallopian tubes. During ovulation, an egg is released from the woman’s ovary and, if fertilized by the sperm, a ball of cells (called the oocyte) is formed. Fertilization occurs in the fallopian tube and the embryo then implants inside the uterus. If the egg is not fertilized, it disintegrates and sheds during the next menstrual period.

When to see a doctor

It’s generally recommended to see a doctor for a fertility evaluation if you and your partner have been trying to conceive for at least a year with regular, unprotected sex with no success. Depending on your and your partner’s medical history, your doctor may decide to check one or both of you for a fertility workup. You may want to seek care sooner if the female partner is over 35 years old or if the male partner has certain medical conditions such as:

• Past surgery on the groin, testicle, scrotum, or penis
• A history of testicular or prostate problems
• Problems with erection or ejaculation, low sex drive, or other issues with sexual function
• Pain, lumps, or swelling in the testicular region

What to expect when seeking care

For men having trouble with infertility, a doctor may order tests to  measure the amount and quality of the sperm. This is called a sperm analysis. Your partner will provide a semen specimen at the doctor’s office and the doctor will look at the sperm under a microscope. There are 3 factors doctors look for in a sperm analysis. 

• Sperm count: This shows the amount of sperm produced in an ejaculation. A healthy number is 20 to 150 million sperm per milliliter of semen.
• Sperm motility: This test shows how well sperm are moving. At least 60% of sperm should have normal forward motion. Sperm that move erratically or not at all can affect the ability to conceive.
• Sperm morphology (size and structure): Normal sperm have an oval head with a long tail. Damage to any part of the sperm can affect fertility by decreasing the ability to reach and penetrate an egg. Many conditions affecting the shape of sperm are genetic.

Remember that infertility is no one’s fault. It can be difficult and frustrating to experience any kind of fertility troubles on your journey to getting pregnant. Communicating and empathizing with your partner can help make the journey to parenthood a little easier.

Reviewed by the Ovia Health Clinical Team

Sources

“How common is infertility?” National Institutes of Health. National Institutes of Health. February 8, 2018. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common

Mayo Clinic Staff. “Male infertility.” Mayo Clinic. Mayo Clinic. August 13, 2021. https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773

“What is male infertility?” Urology Care Foundation. American Urological Association. n.d. https://www.urologyhealth.org/urology-a-z/m/male-infertility

Cedars-Sinai Staff. “Optimizing male fertility.” Cedars-Sinai. Cedars-Sinai Medical Center. May 31, 2017. https://www.cedars-sinai.org/blog/optimizing-male-fertility.html

Bradley D. Anawalt & Stephanie T. Page. “Patient education: Treatment of male infertility (beyond the basics).” UpToDate. UpToDate. November 11, 2020. https://www.uptodate.com/contents/treatment-of-male-infertility-beyond-the-basics

There are lots of reasons people choose adoption. Some people have concerns about passing down inherited health problems; some have medical reasons that prevent them from becoming pregnant; some simply don’t want to carry a child. And all want to provide a loving home for a little one who is already in this world.

Regardless of the journey that landed you on adoption as the choice for expanding your family, it is a tremendous gift and responsibility. You are giving a home and, what’s more, a future, to a baby or child that may not otherwise have had one. Let’s talk about the adoption process.

The adoption process

The first step to pursuing adoption is to understand the landscape. Some people think adoption may be quicker or more cost effective than seeking fertility care including IVF, but in fact the adoption process can take a very long time. The average time it takes to place a child in an adoptive home is anywhere from six to eighteen months. The legal process of adopting the child and securing full protections for your family can take another several months to a year on top of that.

Similarly, the average cost of an adoption in the U.S. is somewhere in the $50,000 to $60,000 range. Of course, the time and cost will depend on a number of factors, including where you are looking to adopt from – whether within the U.S. or elsewhere – and the other criteria you are considering. If you are LGBTQ+ or a single parent, be mindful of religious foster or adoption agencies that could turn you away.

Set expectations

It’s important to understand that foster care is distinct from adoption. Some think that you can become a foster parent as the path of least resistance to adopting the child you are fostering. But it doesn’t always, or even often, work out that way. For one, any number of unforeseen circumstances can arise when you’re fostering, including the return of the child’s biological parents or legal next of kin. If you find yourself in a situation where you are able to adopt a child you are fostering, that process can take anywhere from months to a year or more. 

The actual adoption process can include things like meeting with and being interviewed by adoption agencies, including home visits from an accredited social worker. You may have to give references to people who can attest to your character, share your financial documents, and undergo a background check. 

Provide extra TLC

Once you have gone through the adoption process and welcomed a baby or child into your family, it’s important to meet them where they are. Understanding that our children come through us, not from us is a helpful mindset. Babies, and particularly older children who have been through the foster care system or who have otherwise had traumatic experiences, may require special care. 

You may need to invest in extra medical and mental health care for your child. You may also need to acknowledge that your child comes from a different cultural background with different norms. Making space for your adopted child to express themselves and be fully themselves is an important accommodation. That can include anything from getting books that reflect their background to learning how to incorporate people, languages, or customs into your family’s life that will help them connect with their place or culture of origin.

Adoption is a beautiful option for growing your family. No step on the path to becoming or being a parent is easy, and adoption is no exception. But, as they say, nothing good in life comes easy.