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

The differences between an IVF and an ICSI

Articles and websites are known to use the two names (IVF and ICSI) interchangeably, without explanation, or definition. How are people supposed to know what these treatments are and how they’re different? Wait, are they different? Let’s start from the beginning.

In Vitro Fertilization (IVF)

You may already know a little about IVF because it’s probably the most popular form of assisted reproductive technology (ART) out there. It’s also the most expensive. One IVF cycle can cost anywhere from $8,000 to $30,000 depending on factors like age, health, or if you plan on using donor sperm or eggs. However, if IVF turns out to be the right choice for you, it may very well be worth the hefty price tag.

Many people who seek out IVF treatment do so because they have issues with fertility. These could include endometriosis, polycystic ovary syndrome (PCOS), problems with sperm function, and unexplained infertility. For people over 35, IVF may also offer a better chance of conceiving than traditional intercourse, ICI, or IUI. It’s always a good idea to speak to your healthcare provider when you are thinking about moving forward with any ART or other fertility treatments.

How IVF works

The IVF process can take up to two weeks, and there are several different ways to prepare the body for treatment based on individual health. These preparations include taking hormone-encouraging drugs to boost ovulation and improve chances of producing a high number of mature eggs. There are also medications to help prepare the uterine lining for fertilized embryos. Specialists work closely with patients to help develop a game plan.

When a healthcare provider gives the green light, mature eggs will be carefully retrieved from the ovaries. These eggs (or donor eggs) are taken to a lab where they will then be put in a petri dish with fresh sperm (collected shortly before the procedure), or sperm that has been thawed and prepared beforehand. These close living quarters will allow sperm to mingle with eggs in a way that is isn’t really possible during traditional intercourse. Aside from the setting of the petri dish, the fertilization process is much the same as during intercourse. In the end, one sperm should match up with one egg. Then it’s a bit of a waiting game. If the procedure is successful, after a period of two to six days, the fertilized embryo or embryos will finally be transferred to the uterus, where, hopefully, implantation will be successful and result in pregnancy! With IVF and ICSI, it’s sometimes possible to find out if it worked by taking a pregnancy test as soon as two weeks after implantation.

Intracytoplasmic sperm injection (ICSI)

This treatment is also used when people are having trouble getting pregnant, or by people using donor eggs or sperm. The name “intracytoplasmic sperm injection” makes ICSI sound like a very complicated treatment, but when you break it down, the concept is pretty straightforward. In truth, the term is just a really formal way of saying that during the ICSI process, sperm will be directly injected into an egg to fertilize it. But, what exactly does that mean, and how is it possible?

How ICSI works

ICSI is a form of IVF treatment, often referred to as “IVF with ICSI,” so both processes take place in a IVF lab. As for preparation, traditional IVF and ICSI are very similar, if not identical in some cases. The real difference between the two happens after the sperm and eggs have already been taken to the lab. Unlike traditional IVF, ICSI samples are not mixed together in a petri dish and left to match up on their own. Through the ICSI process, you are able to make the connection for them. A single egg is delicately held in a specialized pipette, while a very small and hollow needle carefully selects a single sperm and immobilizes it by picking it up. Once both parties are secured, the needle is slowly brought through the shell of the egg (zona) before reaching its goal at the center of the egg (cytoplasm). The needle then places the sperm within the cytoplasm. After injecting the sperm, the process is complete, and the needle is removed. Eggs are checked after a day or so to see if the process of “normal fertilization” has begun. Just like traditional IVF, the successfully fertilized eggs are then implanted in the uterine lining once they are mature enough.

Other things to consider

In the end, there really isn’t a “qualifying factor” that can say for sure whether you should use traditional IVF or ICSI treatment (though ICSI may be more effective in cases of severely low sperm count and unexplained male infertility). The process of egg retrieval and insertion of embryos into the uterus are the same between both options. Both are mostly painless, and have mild side effects. In fact, because ICSI has become more popular over the last decade with a 70% to 85% fertilization rate, many clinics have begun to use the two procedures interchangeably, and some have even begun using ICSI for every treatment!

We all know that it’s sometimes difficult to get a straight answer from the internet. We’ve covered the basics, but nothing can replace your healthcare provider’s knowledge and advice. Asking them detailed questions may be the first step in beginning your IVF journey!

Read more

• Sperm donation 101
• Egg donation: thinking it through

Sources

• Mayo Clinic Staff. “In Vitro Fertilization (IVF)”. Mayo Clinic. Mayo Clinic. March 22, 2018. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716
• “Intracytoplasmic Sperm Injection- ICSI and IVF. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/icsi.htm
• “Egg Donation Cost at the Advanced Fertility Center of Chicago”. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/eggdonationcost.htm

There are many factors that might have you considering alternative insemination, and using a sperm donor to help you in start (or expand) your family.

If you’re thinking about sperm donation, here’s what you should know

Your primary care provider (PCP) will be able to give you a fertility evaluation, and this will help you decide whether using donor sperm, or other reproductive assistance, is right for you. During this appointment, you’ll be asked to provide information about your lifestyle, but don’t worry, this isn’t a test. You won’t “fail” the exam if you admit to being a couch potato every once in a while, and it’s important to be honest if you want a care plan that’s specific to your family’s health and needs.

Choosing sperm

After meeting with your PCP, your mind may shift to figuring out the type of sperm you’d like to use. “Known” sperm (the sperm of someone you know) and anonymous sperm are the two options you’ll find. Both can be the right choice, but each has different emotional and legal considerations that go with them, so take your time with this decision.

Remember, all donations (anonymous or not) are screened for sexually transmitted diseases, as well as any evidence of genetic disorders. In the case of anonymous donation, the sperm is usually frozen and kept for 6 months after it is deposited, before it is then re-tested and given to patients.

In addition to deciding whose sperm to use, there is also the matter of what form of sperm you’re going to use. As with insemination procedures, there are few different options that are available:

• ICI-ready sperm: Semen in this category is used for intracervical insemination. This process is probably the closest to the movie and TV representations of sperm donation. These specimens are not “prepared” or altered before they are frozen (but of course they go through the same thorough screening process). Often, this sperm is injected into a patient at a clinic or doctor’s office, but this type of sperm can also be used for private home insemination. ICI is the least invasive form of alternative insemination, and has success rates of anywhere from 10% to 18% (tracking your cycle can help give you the best odds).
• IUI-prepared sperm: These samples are prepared for intrauterine insemination. The seminal fluid is removed or, “washed” from the donor’s semen to isolate sperm, and all dead swimmers are removed before the sample is frozen. This option is more expensive  than ICI sperm because of the process the semen goes through, and because by eliminating seminal fluid and dead sperm, there is a better chance of fertilization.The IUI procedure is also a little more invasive than ICI because the sperm is directly inserted into the uterus rather than the cervix. This process is always performed in office, and has a success rate of 18% to 30%.
• IVF-prepared sperm: This is the cheapest form of prepared sperm, but it isn’t offered by every sperm bank. These samples have a lower sperm count than ICI or IUI prepared sperm. This is because it is believed that less sperm is needed to conceive through IVF, and that saves you some money. But despite saving a couple of bucks on sperm, IVF is one of the most expensive options for alternative insemination. This process involves taking already fertilized embryos and inserting them into a uterus. And again, this increases the success rates to 13% to 41%.

The varying success rates within methods are due to a lot of situational factors including medication, health, age, and lifestyle.

Because the cost of donor insemination can range from $300 to $4,000 depending on what sperm is used, and an average cost of $12,000 per IVF cycle, be sure to ask your provider how many vials of sperm you’ll need!

Preparation

Sometimes people are prescribed medication to help prepare the body by encouraging fertilization. Every case is different, but many medications prescribed in these situations are follicle stimulating hormone (FSH) treatments. FSH is a naturally occurring hormone in your body that helps mature an egg living in the ovaries, while also causing a follicle to grow around that egg as it continues to mature before ovulation. The medications prescribed by healthcare providers encourage this process in the same way.

The day of

Traditionally ICI, IUI, and IVF are all outpatient procedures. IVF can be a little different because the process may involve two outpatient procedures. In those cases, there is a standard egg retrieval and a seperate embryo transfer performed after the eggs have been fertilized. Though all of these procedures may be a little different, a benefit of all three options is that once the insemination process is over, you’ll be able to resume your day as normal.

After insemination

After these outpatient procedures, you’ve made it! And despite popular belief, there’s no need to lay on your back with your legs in the air. You may be asked to lay down or relax for a while, but your legs won’t be airborne, and this downtime could help you process your excitement or calm your nerves. After insemination, you may experience some mild cramping or bloating. This is normal, and shouldn’t be too intense. Then, you may be able to take a pregnancy test as soon as two weeks after insemination! On the other hand, some healthcare providers may suggest waiting a longer period of time. Waiting a little longer will be hard, but if you can do it, you’ll get a more accurate reading on whether or not the insemination was successful.

The bottom line

Alternative insemination is a procedure without many physical risks, and is a great option for people looking to expand their families. Because there are varying success rates to each procedure, your PCP can offer a great deal of guidance and support when making this decision. Be sure to keep all of your personal needs in mind, and take everything at your own pace.

Sources

• Office Andrology. Illustrated Edition. Battaglia, David E. and Patton, Phillip E.. Human Press. 2010. Web. https://books.google.com/books?id=WMazHT_VXrcC&printsec=frontcover&dq=Office+Andrology&hl=en&sa=X&ved=0ahUKEwjh9tXSqJfcAhVDn-AKHZDTCcYQ6AEIJzAA#v=onepage&q=Office%20Andrology&f=false
• “Single Cycle IVF Cost Details – Advanced Fertility Center of Chicago.” Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/ivfprice.htm
• Mayo Clinic Staff. “Female Infertility”. Mayo Clinic. Mayo Clinic. March 8, 2018. https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313
• Seattle Sperm Bank Staff. “Demystifying IUI, ICI, IVI, and IVF”. Seattle Sperm Bank. Seattle Sperm Bank. 2015. https://www.seattlespermbank.com/demystifying-iui-ici-ivi-and-ivf/
• Seattle Sperm Bank Staff. “How to Inseminate at Home Using Donor Sperm.” Seattle Sperm Bank. Seattle Sperm Bank. 2015. https://www.seattlespermbank.com/how-to-inseminate-at-home-using-donor-sperm/
• Pacific Fertility Center Staff. “Donor Sperm.” Pacific Fertility Center. Pacific Fertility Center. 2018. https://www.pacificfertilitycenter.com/treatment-care/donor-sperm
• “In Vitro Insemination: IVF”. American Pregnancy Association. American Pregnancy Association. 2018. http://americanpregnancy.org/infertility/in-vitro-fertilization/
• “Artificial Insemination (Intrauterine Insemination, IUI)”. University of Wisconsin Hospitals and Clinics. University of Wisconsin Hospital and Clinics. 2018. https://www.uwhealth.org/infertility/intrauterine-insemination-iui/26136

Considerations to make if you choose sperm donation more than once

When parents go down the path of sperm donation twice or more, there are a few important decisions to make. The most prominent one sometimes being whether to use the same sperm donor, or to choose a different one.

If you use the same donor twice

By using the same donor, you’ll ensure that your children are related to one another whether they’re carried by the same parent or not, which can feel important for some families. However, this is something you might need to know a little bit sooner than you might expect.

If you go to the sperm bank knowing you want one child, it’s possible that you’ll also need to decide at that time if you’d like a potential future sibling to be related to that child through sperm. Sperm banks can run out of sperm from popular donors, so there might not be any samples from your donor left if you decide in a few years later that you’d like another child.

If you already know you’d like to have multiple children using a specific donor, stocking up on sperm could be a good idea. You will be spending more money, but it will guarantee that the same sperm is available should you want to use it later on.

If you use different donors

Your children will always be siblings, no matter whether they’re genetically related or not. Using different donors for your children won’t make you any less of a family. If you’ve already had a child using donor sperm and you aren’t able to obtain a donation from that same person, you can start looking for another donor.

As you’re looking for another donor, you might want to consider the attributes of the original donor. What were their physical characteristics? If your donor had brown hair and you’d like your children to have similar appearances, you might choose another donor with brown hair. But it’s worth keeping in mind that even if you do use the same sperm, there’s no guarantee that your children will look alike, so try not to stress about this too much.

If you’re not sure

You don’t necessarily need to decide right now. Some sperm banks have a sibling inventory where they place donor sperm after a family has reported a birth using sperm from that donor. This can increase the chances that if you were to go back in a couple of years there would still be sperm available from that donor. If you choose to buy this sperm in advance to ensure it will be available for a potential future child, there will likely be a storage cost involved, plus the cost of the sperm itself.

For couples who plan on using sperm donated by a friend, you might want to talk with your donor about the possibility of more children in the future. If you think you might like to use sperm from the same donor again, do check in advance to make sure he’d be open to donating again, and make sure you don’t lose his number.

Jennifer Heinen, MS, RDN, LDN Founder, Nourish for Life

As couples begin their journey toward pregnancy, they may consider making changes to their lifestyle. Many are aware that a nutritious diet, exercise, stress reduction, and improving sleep habits are keys to preparing the body for reproduction. However, after 6 months to a year of trying without becoming pregnant, it’s time to start looking at what each partner can do to improve their chances of conceiving. As information directed at women and fertility is abundant and readily-available, we are going to focus instead on what male partners can do on their own.

If you’re looking to boost male fertility, consider these diet changes

According to research, male factor infertility is the cause of infertility about 40% of the time, and yet less than 15% of people in this category seek independent medical advice for infertility. Considering that it takes both partners to make a baby, male lifestyle and diet also play a role in TTC. The good news is that men can take some control over their reproductive health by making simple changes to daily habits.

Maintaining a healthy weight is one way to improve fertility for men. Obesity and being overweight are acknowledged risk factors that can impact male fertility, as they can lead to lower testosterone levels and reduced semen quality. According to one study, the chances of infertility increase by 10% for every 20 pounds a man is overweight. Following a healthy eating plan and getting regular exercise to help manage weight can be a first step towards improving a couple’s chances of getting pregnant.

But not all men struggling with infertility are overweight. Even those at a healthy weight can practice unhealthy behaviors. For instance, smoking, drug use, and excessive alcohol intake can negatively affect chances of conception. Men at a normal BMI that do not eat a well-balanced diet may not reap the benefits that good nutrition could have on their fertility.

Add more produce to the mix

So what is a fertility-friendly meal plan for men? Begin by eating more fresh produce. This can easily be done by getting at least one serving at each meal and snack, or filling half the plate with fruits or vegetables. Focus on the most colorful veggies, which are packed with antioxidants like Vitamin E, Vitamin C, and beta carotene. Also, enjoy fatty fish, like salmon, sardines, and mackerel on a regular basis. They are high in DHA, a fatty acid that is found in sperm. Other healthy foods to focus on are chicken, low-fat dairy, and whole grains.

Reduce consumption of processed meats

Some research suggests that certain foods have a negative effect on fertility in men. These include processed meats (like hot dogs, deli meats, bacon, and canned meats), sweets, fatty foods (especially trans-fats and saturated fats), and other highly processed foods. Replacing these with healthier options may increase sperm motility and quality.

Although the research around male fertility and diet is limited, following a healthy eating pattern and managing weight is a solid recommendation – not only to benefit conception, but the overall health for the father-to-be. Men play an important role in baby-making, so discuss ways you can help make changes and support each other in your journey towards starting a family.

Reviewed by the Ovia Health Clinical Team

Read more

• Finding a fertility specialist
• What you need to know about fertility and perimenopause

Sources

• Myriam C. Afeiche, et al. “Meat intake and reproductive parameters in young men.” Epidemiology. 2014 Oct. 1. 25(3): 323-330. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180710/.
• Phil Berardelli. “Sugar and Sperm Don’t Mix.” Science. American Association for the Advancement of Science, May 3 2007. Retrieved September 19 2017. http://www.sciencemag.org/news/2007/05/sugar-and-sperm-dont-mix.
• Giahi L, et al. “Nutritional modifications in male infertility: a systematic review covering 2 decades.” Nutr Rev. 2016 Feb;74(2):118-30. https://www.ncbi.nlm.nih.gov/pubmed/26705308.
• Katib, A. “Mechanisms linking obesity to make infertility.” Cent European J Urol. 2015; 68(1): 79–85. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pubmed/25914843.
• Sallmén M, et al. “Reduced fertility among overweight and obese men.” Epidemiology. 2006; 17: 520–523. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pubmed/16837825.
• Nancy Shute. “Fatty Foods Bad for Sperm.” NPR. NPR, March 14 2012. Retrieved September 19 2017. http://www.npr.org/sections/health-shots/2012/03/13/148540108/fatty-foods-bad-for-sperm.
• “Infertility FAQs.” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, March 30 2017. Retrieved June 7 2017. https://www.cdc.gov/reproductivehealth/infertility/index.htm.
• “Less processed meat, more fish and exercise may boost sperm count, quality.” Harvard School of Public Health. The President and Fellows of Harvard College. Retrieved September 19 2017. https://www.hsph.harvard.edu/news/hsph-in-the-news/less-processed-meat-more-fish-and-exercise-may-boost-sperm-count-quality/.
• De Jonge CJ, Gellatly SA, Vazquez-Levin MH, Barratt CLR, Rautakallio-Hokkanen S. Male Attitudes towards Infertility: Results from a Global Questionnaire. World J Mens Health. 2023 Jan;41(1):204-214. doi: 10.5534/wjmh.220099. Epub 2022 Aug 16. PMID: 36047077; PMCID: PMC9826912.

More about missed miscarriages

Missed miscarriages are uncommon, occurring in about one-percent of all pregnancies, but when they happen, they can be devastating.

Why do missed miscarriages happen?

The majority of missed miscarriages occur in the first 12 weeks of pregnancy. This type of pregnancy loss often happens as a result of chromosomal abnormalities with the embryo, for example if the embryo has too many or too few chromosomes. Abnormalities like these make it impossible for the body to continue the pregnancy. In other cases, a missed miscarriage occurs for unknown reasons.

What are the symptoms?

Women who experience a missed miscarriage usually don’t have typical miscarriage symptoms like bleeding or pain. In most cases, the miscarriage goes undetected until a woman’s next appointment. Some women still experience pregnancy symptoms, which can happen if the placenta continues releasing the hormones that cause pregnancy symptoms. Unfortunately, the presence of pregnancy symptoms can make a missed miscarriage diagnosis that much more surprising.

How is a missed miscarriage diagnosed?

Most women discover that they have miscarried at their regular check-up, when the provider notices an underdeveloped embryo or a lack of fetal heartbeat in the ultrasound. To make sure there isn’t a heartbeat, the provider will send the woman to a radiologist for confirmation. The provider will also probably take a blood test to measure hCG levels (the hormone that is produced during pregnancy). If these are low and there’s no heartbeat to be found in the ultrasound, the provider will diagnose a missed miscarriage.

How is a missed miscarriage treated?

With a missed miscarriage, the body still has to expel pregnancy tissue, so after a diagnosis the next step is determining a way to remove this tissue. A provider might recommend any of the following for treatment.

• Wait and let the tissue expel naturally: Women may choose this option if they want to let the pregnancy end on its own, or if they don’t yet want to take medical or surgical action. This is usually not an option after eight or nine weeks, however.
• Medical treatment: Women can take a drug called misoprostol that helps the body expel the tissue. This might be preferable for women who are very early in their pregnancy, or for women who prefer treatment that is less invasive than a D&C.
• Surgical treatment: A provider might recommend a dilation and curettage (D&C) if a missed miscarriage occurs after eight or nine weeks. For this procedure, the woman is put under anesthesia, her cervix is dilated, and the provider uses a thin instrument to remove the pregnancy tissue from the uterus.

What comes after treatment?

Women who have been treated for a missed miscarriage should wait one menstrual cycle before trying again to conceive. It’s entirely likely, though, that women who experience a missed miscarriage will want some time to grieve before trying again. Miscarriages can be devastating, and this kind of miscarriage is made more painful by the fact that it often comes as a complete surprise, and sometimes happens for an unknown reason.

It takes some women a long time to recover from the loss, although the healing process is different for everyone. What is the same for every woman in this situation is that due to the traumatic nature of a missed miscarriage, as well as the hormone changes that take place during and after a miscarriage and make a woman vulnerable to postpartum depression, it’s important for women to find a way to process their feelings or reach out to someone who can support them while they grieve.

Sources

• Linda W. Prine, Honor Macnaughton. “Office Management of Early Pregnancy Loss.” Am Fam Physician. 84(1):75-82. Web. Jul 2011.
• “Miscarriages.” KidsHealth. Nemours Foundation, Jun 2015. Web.

Although the terms “infertile” and “sterile” often get thrown about like they’re the same thing, there’s actually a big difference between the two. So what is that difference exactly?

Infertility and sterility differences to consider

A person is considered clinically infertile if they have been unable to conceive with unprotected, well-timed sex for 12 months or more (6 months for those 35 and older). Infertility is extremely common, and once the reason for the infertility is diagnosed and treated, most formerly infertile couples do in fact conceive successfully. Men and women alike can be the source of infertility with a variety of different causes. Some common ones include:

Sterility is totally different. A person who is clinically sterile is unable to conceive, whether through medical or surgical intervention, or through assisted reproductive technologies. Sterility is most commonly a result of a medical condition or surgical procedure, like a vasectomy, hysterectomy, or ectopic pregnancy that results in the removal of a fallopian tube. Chromosomal disorders like Klinefelter’s syndrome could also result in sterility.

The bottom line

Here are the TTC acronyms you should know about

AF:

Aunt Flow. Your period.

Thanks for the invite, but my Aunt Flow’s in town. I’m gonna go home and treat her to some wine and reruns.

BBT:

Basal Body Temperature. BBT may spike right before ovulation, so many women track it to help them pinpoint their ovulation.

The very first thing I did this morning was grab my thermometer and take my BBT.

BCP:

Birth Control Pills.

In almost no time after I stopped taking BCP, I was pregnant.

BD:

Baby Dance. Sexual intercourse, usually done on the most fertile days of your cycle. (Can also mean baby dust, which is a phrase you use to wish someone good luck.)

My ovulation test is positive, which makes me want to dance – the BD, that is!

BFN/BFP:

Big Fat Negative/Big Fat Positive (on your pregnancy test).

Every time I buy a pregnancy test, I think about how it could be the one to show the BFP.

BOB:

Baby on the Brain!

I’m having a hard time shopping with BOB. All I can think about is tiny socks and pacifiers, which makes it impossible to keep track of my grocery list.

CD:

Cycle Day. A specific day in your menstrual cycle (or fertility treatment cycle). To track it, start by counting from the first day of your last menstrual cycle.

It varies each cycle, but normally I ovulate on CD 13, or 13 days after the first day of my period.

CM or CF:

Cervical Mucus or Cervical Fluid. Changes in cervical fluid indicate that a woman is at different stages of her cycle.

At the most fertile point of each cycle, my CM is clear and super stretchy.

CP:

Chemical pregnancy. A very early miscarriage.

My doctor recommended that I put off trying again until one cycle after my last CP.

DD:

Darling daughter. A daughter you already have.

DH, DD, and I go on vacation next week.

DH:

Dear husband.

I’m 42 and DH is 43.

DPO:

Days Past Ovulation, or Cycle Date Post Ovulation.

By 7DPO of the TWW, I’m already wondering if every little cramp is a sign of pregnancy.

DS:

Darling son.

It’s a challenge to care for DD and DS while also TTC.

ENDO:

Endometriosis. A chronic disease in which tissue that is supposed to grow in the uterus grows outside of it. Millions of women experience this condition and it can affect fertility.

After getting diagnosed with ENDO, I was able to find a huge and supportive online community of other women who had the same condition.

EWCM:

Egg White Cervical Mucus. When your cervical mucus looks like egg whites, it may mean that you’re at your most fertile point.

Nothing is as exciting as seeing EWCM when TTC!

FMU:

First Morning Urine. Most pregnancy tests require that women take them the very first time they pee in the morning. In the morning, urine typically has the highest concentration of Human Chorionic Gonadotropin, or hCG, an early pregnancy hormone.

I tested with FMU and got a faint BFP.

FP:

Follicular Phase. The phase of the menstrual cycle when follicles mature in the ovary. This phase begins on day 1 of your period, and ends with ovulation.

I’m so excited to try and get pregnant, I just want my FP to be over!

hCG:

Human Chorionic Gonadotropin. A hormone produced during early pregnancy that helps the baby grow.

I had a positive test, which means there was enough hCG in my urine to detect a pregnancy.

HPT:

Home Pregnancy Test. A pregnancy test that you can take at home. This morning my HPT showed a BFP – but I’m going to my doctor’s to take a blood test to confirm.

IUI:

Intrauterine Insemination. A specific kind of fertility treatment where sperm is placed directly into a woman’s uterus during ovulation.

After 2 years of TTC, we’ve decided to try IUI.

IVF:

In Vitro Fertilization. A procedure in which an egg is fertilized in a lab and then implanted.

We went through several rounds of IVF before getting a BFP.

LMP:

Last Menstrual Period. The first day of your last period.

I started my LMP on June 6th.

LPD:

Luteal Phase Defect. If the corpus luteum didn’t form properly, a luteal phase defect may occur, causing a short luteal phase. This can make it hard for a woman to get pregnant.

I’ve been really accurate with my charting, because I suspect I might have LPD and I want to have a lot of information to show my provider.

LSC:

Low Sperm Count. Commonly the cause of male infertility.

A semen analysis showed that my partner has an LSC.

M/C:

Miscarriage.

I got my first BFP a year ago, which ended in a really upsetting MC.

MF:

Male Factor Infertility.

To help with the MF issues, we found an infertility counselor who was covered by our insurance.

NTNP:

Not trying for pregnancy, not preventing pregnancy.

I just stopped taking BCP, so I guess that we’re NTNP.

O or OV:

Ovulation.

I O’ed on CD15 and BD on days 13 and 15.

OPK or OPT:

Ovulation Predictor Kit or Ovulation Predictor Test. These tests tell you when your body has a surge of luteinizing hormone (LH), which indicates the onset of ovulation.

I just got a positive OPK, which means BD as soon as possible!

PCO, PCOS, or PCOD:

Polycystic Ovaries, Polycystic Ovary Syndrome, or Polycystic Ovary Syndrome Disease. A condition in which a woman’s levels of estrogen and progesterone are unbalanced. Women with PCOS develop cysts on their ovaries, and the condition can cause infertility.

My doctor thinks I have PCOS, so I’m waiting to hear back about my blood work.

POAS:

Pee On Stick. Taking a pregnancy test (peeing on a stick), usually at home.

I’m 7DPO and it’s so hard to wait to POAS!

RE:

Reproductive Endocrinologist. A type of fertility specialist.

I’m meeting with an RE tomorrow to go over my fertility test results.

SA:

Semen Analysis. This is a test that providers can use to determine the quality and quantity of a man’s sperm.

The results of his SA show he has low sperm count, low motility, and poor morphology.

SO:

 Significant other.

My SO and I have decided that next month we’ll start TTC.

TWW or 2WW: Two Week Wait. The time period between when you ovulate and can take a pregnancy test.

 just started my TWW and I need to find some ways to distract myself!

TTC:

Trying to Conceive.

I haven’t decided who I want to tell that we’re TTC.

U/S:

Ultrasound.

Our first U/S is scheduled for the end of the month.

Potential causes of infertility

There are many different possible causes of infertility in both men and women, so it’s recommended that couples who are struggling to conceive visit a fertility specialist to identify and treat the particular condition of infertility. Many fertility problems can be fixed, and couples go on to have healthy, successful pregnancies.

Women

Women can suffer from a range of different infertility conditions with various causes, including hormonal and anatomical issues.

• Polycystic Ovarian Syndrome (PCOS) – PCOS develops from a hormonal imbalance that usually results in the growth of small, benign cysts on the outer edge of the ovaries. Women with PCOS tend to have irregular and absent periods and ovulations, making getting pregnant more difficult. The disorder can have wide-ranging effects, from weight gain, acne, and increased risk of diabetes, to thinned hair on the head and excess hair growth on the face and body. People with PCOS can benefit from tracking their cycles to best predict their ovulation, but if this is ineffective by itself, a fertility specialist may recommend an ovulation-inducing medication like Clomid, possibly in conjunction with Metformin. Surgical options like ovarian drilling, which induces ovulation by making tiny holes in the ovaries, also have significant success rates and minor recoveries. There is no test to diagnose PCOS, so doctors will often only diagnose PCOS if all other explanations have been ruled out.
• Endometriosis – Caused by a buildup of uterine tissue in the pelvic area outside of the uterus, endometriosis can result in fallopian tube blockages, scarring, cysts, and other damage. These blockages bar eggs that the ovaries release from making their way through the tubes, preventing fertilization. Endometriosis can also be quite painful, especially during your period. Women who have endometriosis may want to consult a fertility specialist about surgical options, both to better understand the extent of the extent of the possible tissue damage and to remove it. Laparoscopic surgery can remove the obstructive tissue and help clear the way for eggs to move through the fallopian tube. In vitro fertilization (IVF), in which the egg is fertilized in a laboratory before being transferred to the womb, is another option for women battling endometriosis.
• Hormonal problems – Oftentimes, women who have irregular cycles will have trouble getting pregnant, due to irregular, infrequent, or absent ovulations. Short luteal phases may also contribute to the problem, in which menstruation begins before a fertilized egg would have time to implant in the uterine lining. Hormone supplements are a good option for women with hormonal disorders, in order to regulate the condition and induce ovulation.

Men

• Poor sperm quality: Whether due to age, lifestyle factors, or bad luck, some men’s sperm have trouble making their way to, or fertilizing, an egg waiting in the fallopian tube. Some men may have a low sperm count, while others could have poor sperm motility. Couples can still get pregnant if a man has poor sperm quality, but the likelihood is reduced. A fertility specialist may be able to recommend a course of action for the best chance of conception.
• Varicocele: Varicoceles are enlarged veins in the scrotum that raise the temperature of the testes, hindering sperm production. Because varicoceles can reduce sperm count or harm the quality of sperm produced, they make conception difficult. If the varicocele is severe enough, a fertility specialist might recommend surgery to cut the veins contributing to the varicocele. Surgery is relatively minor, and men recovery fully within about a week.
• Blockages: Some men may have blockages in the vas deferens or epididymis, which can prevent healthy sperm from reaching and fertilizing the egg. A fertility specialist might recommend a surgical procedure to remove the obstruction. Men with blockages also generally have otherwise healthy sperm, meaning in vitro fertilization with one’s own sperm is entirely possible.

Read more

• Infertility treatments
• Other options

Sources

• Mayo Clinic Staff. “Infertility Causes.” Mayo Clinic. Mayo Clinic, 7/2/2014. Web.
• “What Causes Female Infertility?” Stanford University. Stanford University, n.d. Web.