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/. 

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/ 

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.

What artificial insemination is and the types to consider

It’s essentially when sperm is introduced into a female’s uterus or cervix with the hope of getting pregnant without sexual intercourse. You might think of it as a little bit of assistance with getting pregnant. Just how are these methods different?

IUI

IUI stands for intrauterine insemination. This insemination method injects the sperm directly into the uterus. Because this insemination method will place sperm closer to the egg that other insemination methods, IUI is believed to have a slightly higher success rate than other methods. Many people who undergo IUI (and the following two forms of insemination, ICI and IVI) do it while also taking fertility drugs to increase egg production and, as a result, increase the chances of getting pregnant. If you’ve heard about IUI leading to a higher chance of multiples, it’s likely because of accompanying fertility treatments, not the procedure itself.

ICI

ICI isn’t a tasty frozen treat you can get at your local movie theatre – it stands for intracervical insemination. Intracervical insemination happens when sperm is injected into the cervix, which is the tissue that connects the vagina and the uterus. Unlike IUI, you can perform ICI with unwashed sperm. There is a recommendation that IUI and ICI be performed by a healthcare provider, but some couples have found success performing these methods of artificial insemination at home.

IVI

IVI means intravaginal insemination, which is when sperm is injected into the vagina. Of the three methods of artificial insemination, this one places the sperm farthest from the egg and therefore has the lowest success rate. However, it’s the cheapest method and doesn’t necessarily require assistance from a healthcare provider. If you’d like to try intravaginal insemination at home, it can be done with a clean syringe or a cervical cap.

IVF

You’ve probably heard of IVF, which stands for in-vitro fertilization, but this procedure isn’t actually a method of artificial insemination. IVF is sometimes confused with the above methods and believed to be a kind of artificial insemination, but it’s actually another type of assisted reproductive technology. For IVF, semen and an egg are combined to form an embryo, and that embryo is then implanted into the uterus.

So which method is best?

Each method of artificial insemination has its own set of benefits. The cheapest method of artificial insemination is IVI, and if you’re looking to inseminate at home, you might want to consider this method. But the most effective method might be IUI. And IVF is an effective form of assisted reproductive technology, but it’s expensive, and, like all of these methods, it isn’t guaranteed to work. Really, if you need a little bit of help getting pregnant and are considering one of these methods, it’s advisable to speak with your healthcare provider or a fertility specialist so that they can help you decide which method will be best for you.

Gina Nebesar, Co-Founder of Ovia Health

I was so excited to speak with my two dear friends Becca and Jean Ann recently. Just this year they started on the crazy journey that is parenthood with their beautiful baby girl, Roz. They’re total badasses at home and at work, they’re incredible people, and now they have this gorgeous family. Their TTC journey took them a little while, and IVF helped them get pregnant, and I’m really grateful they could share their story – including incredible advice about choosing and buying sperm, real talk about IVF shots, and really candid conversation about adjusting to life as new moms.

IVF success stories: Two moms talk about growing their family… and how

I want to start by saying congrats! I know you just celebrated your 5 year anniversary, a big milestone. And an even bigger milestone is the birth of your baby girl! I’d love if you could start by telling us a little about your beautiful family.

Becca: We did just celebrate our five-year wedding anniversary, and in April we had our baby girl Roz. She’s almost 5 months old. And it’s been great so far!

I just left town for the first time, and left her alone this weekend with Jean Ann, her other mom. And in that 48 hours she learned how to roll over, without me there! And now she sleeps on her stomach, so I came home to a totally different baby. But I feel like she’s changing every single day, so it’s really awesome.

I love hearing about how people make the decision to start a family. Could you tell us a little bit about your journey to becoming parents?

Jean Ann: Because we’re two women, one question that I asked a lot is how we decided who will carry. And when your partner basically says, “One thing I’ve always wanted to do in my life is be pregnant and give birth, like, totally unprompted,” you’re like, “Cool, that seemed too easy.” Becca had always wanted to do that, and I’m still sort of on the fence – it doesn’t seem like something I have to do. So Becca had decided that she was excited about that a few years ago, and eventually I got more excited about it.

The first thing we had to do was choose a sperm donor. That was probably one of the biggest decisions we’ve ever made. Because you have to decide if you want an anonymous donor or someone you know. And we actually had a good friend who offered. And we took it pretty seriously, but ultimately decided it was important for us to have our own separate family unit. So then we looked at a lot of the websites for sperm. It’s basically like a KAYAK for sperm, and you can sort for different things.

Becca: It’s almost like online dating!

Jean Ann: We wanted someone that hopefully shared a lot of my characteristics. So were able to find someone who was half-Asian, he was getting a graduate degree in chemistry. We could even listen to a 45-minute interview with him where he talked about his favorite books, and he just seemed very thoughtful, quiet, serious, and nice.

Becca: We spent a lot of time looking for sperm – really thinking about these profiles and listening and narrowing it down. I remember we had all these pieces of paper on the kitchen table – we had written down the different donor numbers and which ones we liked – and then we narrowed it down.

And we actually had kind of had a long journey. It was about two and a half years from buying sperm until having Roz. Buying the sperm was step one. I remember, they were having an end-of-year sale, so we had to get it in before the end of 2015!

Were they really? Like, they were really having a sale?

Jean Ann: Yeah, it’s expensive. It’s something that there’s a lot of in the world, but it’s not cheap!

Becca: Well, it wasn’t quite a sale, but they were like, “We’ll throw in an Amazon gift card if you buy today!”

Jean Ann: “And three years of free storage!” But, yeah, we’ve actually spent several thousands of dollars on sperm, if you can believe it.

So, obviously, you found a great deal, but how did you get started with that process?

Becca: Really, we just Googled.

Jean Ann: There’s three or four big sperm cryo websites.

Becca: The one we went with is called California Cryo, one of the largest ones. For us, they felt right— it was a good website experience, and their customer service has been great. We did look at the big ones, some other small ones, and some local ones.

Jean Ann: But I think, for us, wanting a donor who was half-Asian like me was important, and that actually narrowed it down a lot. It went from like 550 to like, eight.

Becca: So then we could spend our time kind of really thinking through those people.

Jean Ann: You can definitely get a situation where there’s a run on the sperm. So we had this total disaster about a year later, where we had used up half the vials that we’d bought, and we were getting really low, and we went online, and they had sold out! And the donor had stopped donating! So we recommend you check what’s in stock a lot.

Becca: Yes, check frequently! And if you can afford it, buy more than you think you need.

Jean Ann: Buy a lot!

Becca: Because you can store it, and you can sell it back if you don’t need it.

Jean Ann: Nothing is worse than the feeling of having decided on someone to be your sperm donor and being very excited about them, and being halfway through the journey, and then realizing that if you want to have more than just one kid that you’re going to run out of sperm.

Becca: You’re going to run out and you may have to use different sperm.

Any other advice about that process for others that are just starting out with sperm donation?

Jean Ann: Just check your sperm stock frequently. And if you’re really excited and settled on someone, I would buy more than you need or just be willing to have a weekly reminder to check that it’s not running out.

Becca: I think the other thing is I would pony up for the extra access to information. Because I think, for us, the interviews with the sperm donors, that was the most impactful. You can only tell so much from a baby picture and some  generic likes and dislikes – which is the basic info you get – but I actually think you can get a pretty good feel for a person from something like an audio interview. It’s like a typical website where it’s like, “Pay to unlock this feature!” but it’s worth it to pay for that premium membership.

So, in December 2015, once you made that decision about your donor, how did things progress from there?

Becca: So that winter when we were back home from the holidays, we started trying to get pregnant, and we were doing IUI.

Jean Ann: You basically have two options, you can do IUI or IVF with donated sperm. IUI is basically artificial insemination.

Becca: Turkey baster!

Jean Ann: The turkey baster method, but at a facility. So we started with IUI.

Becca: I actually got very lucky with the first IUI try in February 2016. I was tracking my ovulation – I was using the Ovia app – and I was peeing on sticks and all of that, and when my ovulation test said I was ovulating we went in for the IUI, we did IUI, and I got pregnant that very first time. And it was amazing! We were so excited! First try!

And then in the spring at about 12 weeks I had a miscarriage. So I got almost through my first trimester, and I had a miscarriage. That sucked, that was a setback and sad, and that was really hard.

So the summer of 2016 was kind of recovering from that, and then it takes a while to get back on track, especially when you have a miscarriage when you’re that far along there’s a lot that your body has a lot to process and then re-regulate. And then we didn’t have a chance to try again until September of that year. So we got back on the horse and started trying again. And we were gonna continue to do IUI at that same facility because it had worked that first time.

And I started tracking my ovulation and going back in monthly, but something was wonky with my cycles. I would think I was ovulating, but I would go in and I wasn’t ovulating. I think one or two times we did get an ovulation, and we tried, but I didn’t get pregnant.

Jean Ann: And that’s when we started running out of sperm. And we realized that there wasn’t more. So that’s when we panicked, realized we couldn’t get anymore, and so we decided to move to IVF. But neither of our insurances, we thought, really covered IVF.  We were both on my insurance, and it wasn’t explicit. It was basically like, “Your IVF is covered, if it’s for a medical reason.”

Becca: “Medically necessary.”

Jean Ann: Yeah, “medically necessary,” that’s the phrase that’s used – and so I went down this whole rabbit hole to figure out if that means coverage if you’re gay. It took forever. But basically, no, being gay was not a “medically neccessary” reason, so it wouldn’t be covered. So I fumed about this for a while.

And then I ended up talking to our company’s head of HR kind of randomly about something else, and I just kind of mentioned this to her and didn’t expect it to go anywhere—I just figured this would sort of take some kind of lawsuit situation to change it— but she was like, “Oh, really? I didn’t know that!” Then two days later somebody that worked for her called and they were like, “Oh, we added it for same-sex couples to our insurance, so it’s covered now!” So I guess some advice would be to know that in terms of your health insurance, you may be able to change the coverage for something like this, depending on your company.

I constantly tell women to ask for those benefits, because they might end up with that exact same story. I was in a meeting recently with a health plan and an employer where we we pointed out in the language of the plan how it was alienating to same-sex couples. And the woman didn’t even realize it and was like, “I’ve gotta change it!” She had just never read the fine print before, but then took action to change it as well. I’m so glad that you asked about it, and I wish more people would!

Becca: Yeah, it was pretty awesome. So, we started IVF in the summer of 2017, and there’s a whole series of tests and all sorts of painful things they need to do to make sure you’re ready for it. And that takes months— you have to wait a few cycles, you have to get on the right timing. So I remember this being such a frustrating time in our lives. It felt like everything was going slowly and like everyday I had to be at the doctor doing some other painful thing. It was a rough period. It is funny now looking back on it, because it all feels like such a blur in retrospect, but at the time it felt really pronounced and painful.

Jean Ann: As someone that has now done IVF three times myself – and Becca has done it once – it’s not as bad as people think it is. It sucks giving yourself the shots, but it’s fast. It’s like a two week period of shots.

Becca: At this point we’ve both done it, because as the journey continues, we ended up having a baby and decided that we wanted to at least give ourselves the option to having another baby in the future with Jean Ann’s eggs.

Can you share more about that experience and what it’s like? Again, I’m sorry to hear about this part of the journey. I just can’t imagine having the 12 week miscarriage, that’s just awful, and the fear of the sperm running out, and then going through the pain of IVF. And I know you say it’s not that bad, but I think maybe you’re just tougher than many – that sounds really hard to me!

Becca: Honestly after being pregnant for nine months, you can barely remember the IVF, it’s like a blip. But I think that the shots – for us at least – I think the shots look scarier than they end up being.

Jean Ann: I feel like the first and second time you’re really just like, am I really going to stab myself in the leg with this needle?

Becca: The thought of it is tough. The first time is the hardest, because you’re just staring at this needle and you’re like looking at your leg, and you’re just like, so I’m really just going to push this in, huh? But it’s a needle, and it’s made to go in. I actually think over the two week period of shots, it gets progressively more painful toward the end. So the last few days are the worst. I think at that point you’re feeling a little bit bloated, you’re not allowed to go to the gym, you’re giving yourself shots every single night. For some reason those last few nights hurt the worst. At that point you’ve shot yourself everywhere on your legs, everywhere on your stomach, and you’re looking for a new spot. So those last few nights, you just want it to be over.

Jean Ann: And then you have the trigger shot, and everybody makes a big deal of the trigger shot. Somebody else gives you that one, and it has to be at an exact time – like, 1:45 in the morning, 10:30 p.m. – so when you go in to have your eggs be retrieved, it’s exactly 36 hours after the trigger shot.

Becca: And then for the egg retrieval process you do go under.

Jean Ann: Under some very temporary anesthesia. You’re all the way under, but it’s very short. And then you’re done!

Becca: And then there’s some anxiety as you wait to hear your egg count. For us we were doing embryos, so right when they retrieved the eggs they fertilized them with our frozen donor sperm. So after that you’re kind of waiting on eggshells – no pun intended – to hear how many of your embryos made it to day 3 or day 5, or just what the status of them is. And we’ve been on both sides of the spectrum. For me, I was really fortunate, I had a pretty high egg count, and with just one retrieval I got enough embryos that we felt comfortable and were able to freeze them. For Jean Ann, on her first and second try she didn’t get that many, and so she’s had to go through the egg retrieval process three times now.

Jean Ann: I will just add that for anybody that’s getting close to age 35, 35, you can get a blood test that will give you your AMH number. It basically tells you how many eggs, roughly, you have left. It’s a very good indicator or whether IVF is going to be a breeze and you’ll just have to do that once, or if your egg yield is going to be low and you’re going to have to do it multiple times like me. It is also a good predictor of if you will have to do IVF at all because the same number is also a good indicator of whether or not you will naturally be able to get pregnant. It’s a very easy first step.

Did you know about this AMH (or Anti-Mullerian Hormone) test before starting the IVF process, or did you learn about that after?

Jean Ann: Actually, someone at work told me about it. Because I was like, “I don’t think I want kids for a few years,” and this very matter of fact 40 year old man was like, “How old are you?” And I said, “35.” And he was like, “Just go get your AMH number. My wife had a low AMH number and it took us 5 years of trying and then we ended up adopting.” I was like, oh, my gosh!

And then I got the test, my AMH number was bad, and, indeed, it took me multiple times to do IVF. So I feel like this AMH blood test is pretty much free information.

A lot of healthcare providers might say no to that sort of testing, but I always suggest that people go to their provider and just insist on it. So, through this process, who was supporting you along the way? Obviously, you had each other. Was there anyone else in your life who was particularly helpful during this time?

Becca: Each other, for sure. I’m not a big oversharer, but it’s been really helpful for me to share, because what I’ve found is that as soon as I start talking about it, everyone has either a similar story themselves, or their friend does, or their sister does. So when I had my miscarriage, it was really helpful for me to tell people about it – even at work – and then people would share these success stories, and that made me feel better. And it was similar when going through IVF. I would talk about it with my friends, and they all had someone they knew who had been through it. At the time, I was really the first of my very good friends who was having a lot of trouble getting pregnant, and I felt a little bit alone, so their IVF success stories were helpful for me.

Jean Ann: But since then, now we know several people who’ve been through this.

Becca: We know people who’ve had miscarriages, been through IVF, and now I’ve been able to help them because we have this success story. So, for me, I would tell anyone who’d listen! And that helped me a lot.

Jean Ann: Then you had a pretty good pregnancy.

Becca: Yeah, and the IVF really worked well for us. We did an egg transfer, and I got pregnant on that first one, and then I had a pretty good pregnancy.

Jean Ann: And you have to give yourself these progesterone shots for the first 12 weeks.

Becca: No one talks about this!

Jean Ann: No one talks about this, but these are actually really terrible shots. And every night for the first 12 weeks that you’re pregnant—

Becca: You give yourself a progesterone shot in the butt.

Jean Ann: That was probably the worst part.

Becca: I think some doctors will allow you to do a suppository instead. So I went, like, running in after three nights of shots and was like, “Give me the suppository!” And they were like, “No, we highly recommend the shots.” They wouldn’t do it. So you’re giving yourself shots for 12 weeks. So much worse that the two weeks of IVF shots! It’s so much longer! So you’re basically so sore in the butt for the entire first trimester. But once we got through that, things were okay.

Jean Ann: Smooth sailing.

Becca: Yeah. I had a lot of heartburn, and that was my main symptom really.

Jean Ann: Then because you were a geriatric pregnancy, they told us that they wouldn’t let you go past one week over your due date. So we got an induction date for almost a week past your due date.

Becca: Yeah, 5 days past my due date they scheduled us for an induction. We went in, I got induced, and like these things do, it took forever to get a room, it took forever for the induction to start.

But then, like, once it started, it really started.I had pretty strong contractions for a long time, for like 15 hours. But I really wasn’t dilating. So, it was kind of sad, I kept having these big contractions and the doctor would go away and then come back a couple hours later to check my cervix and every time I was like, “Oh, I think I’m making progress!” and then she would check and be like, “Nope, still 3 cm. You’ve barely made it to 4 cm.” So I just wasn’t dilating. And then at some point, in about hour 16 or 17 of labor, I got a fever, and they said we’ve got to do a C-section. So we went in on a Thursday night, that Friday night at 11:30 p.m. she was born via C-section. And she was great!

Jean Ann: There’s so much pressure to not have a C-section and to be able to breastfeed right away and all this stuff, and, like, if you walk out with a healthy baby, that’s the goal, that is 100% success. I feel like people shouldn’t put that much pressure on how they want everything to turn out.

I know. There’s so much pressure for birth to be this perfect experience, just as planned. And I remember, too, even with me, I had a C-section, just feeling guilt, feeling like a failure, and realizing that, like, my baby’s awesome, and I really don’t care about how I got her! Do you remember what the first couple of days after Roz was born were like?

Becca: It’s funny, it’s such a blur. And I remember at the time saying to myself, I’m totally lucid and I’m recovering fine and I’m gonna remember all of this. And now I realize I don’t remember much of what those days were like!

I remember stumbling out of bed in the middle of the night and either feeding or pumping, and I remember napping a lot. Because I was recovering from a C-section, I needed a lot of help both during the days and the nights. So luckily I had Jean Ann to help, we had family, we got some help for me during the day when she went back to work. We were fortunate to be able to do that because I couldn’t lift the baby, but it’s all such a blur.

I do remember her being so cute. Like everything she did was so cute. I would feed her, and she’d fall asleep on me right after, and it was the cutest thing I’d ever seen! This weekend, actually, I saw a picture of Roz from her first few weeks. And I remember at the time looking at her and thinking, My newborn is so cute! She doesn’t look like a weird scrunched up newborn like every other one! She’s a perfect baby! And, like, five months later I realize that she definitely looked weird! But you just don’t see it at the time.

You do have an exceptionally cute baby! So what is it like now versus what it was like then?

Becca: I just feel like we’re getting more into what our life will look like for the next few years. Those first few weeks in my maternity leave I just kept thinking about how it was a temporary time – and it was wonderful, and I really enjoyed it – but now we’re trying to figure out what our real life looks like. Like how we manage the jobs and the baby, how we manage finding time for ourselves, how we manage time for the extended family who wants to visit. So, it’s different – I’m much more lucid, I’ve recovered from the C-section, all of that kind of blurriness is gone – but I’m in this, like, this half-place where I feel like, we don’t quite have enough time for everything. And I don’t know if this is just what the new normal is, or if we’re still figuring it out. So that’s kind of the phase we’re in now.

I feel like our journey has taken a lot of different turns. And where we are now – we’re so so happy and so lucky that we have this wonderful healthy baby – but it took a while. And it took a lot of different types of interventions, and along the way there were times when it felt like it wasn’t going to happen, but now she’s here, and she’s perfect, and it makes the last two and a half years feel like a blur, like just a blip. So it was all worth it.

Jean Ann: But at the time, it was tough. It can be very tough.

Becca: Yeah, and I guess some advice we would give is to try to release some of the expectations that you have and some of the perfection that you’re striving for, because you really just don’t know how things will turn out. Like, you might not always be able to hit that exact timing for getting pregnant that you want. Or we thought we wanted a boy, but we obviously love our baby girl! It turns out it doesn’t matter. So just to try to release some of that, to the extent that you can, because the journey is hard enough.

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

What you should know about the law around surrogacy

How U.S. surrogacy laws vary. Know the differences and what your state allows.

States with laws favoring surrogacy

The law favors surrogacy in California, Connecticut, Delaware, Maine, New Hampshire, Nevada, Oregon, and Rhode Island. This means surrogacy is permitted in these states. In these states, it’s possible to draw up pre-birth orders about the legal parents of the child, though some won’t become effective until birth. And in most of these states, both intended parents can be named the legal parents whether they’re genetically related to the child or not. Some of these states don’t guarantee this right, but it’s often granted anyway.

States that allow surrogacy

It’s allowed in Alabama, Arkansas, Colorado, Florida, Georgia, Hawaii, Illinois, Kansas, Kentucky, Massachusetts, Maryland, Minnesota, Missouri, North Carolina, North Dakota, New Mexico, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Vermont, Wisconsin, and West Virginia. This means surrogacy is permitted in these states, but there are some legal issues surrounding the practice. Some states will only grant parentage orders after the birth of the child. In some states, there are additional legal procedures required after the birth. Also, both parents might not be recognized as the legal parents if they’re not both genetically related to the child.

States with potential issues with surrogacy

Potential issues with surrogacy law may occur in Alaska, Arizona, Iowa, Idaho, Indiana, Louisiana, Mississippi, Montana, Nebraska, Oklahoma, Tennessee, Virginia, and Wyoming. This means surrogacy is practiced in these states, but there are potential legal issues, such as surrogacy contracts being prohibited by law and therefore unenforceable. The intended parents might not be recognized as the legal parents if they are not both genetically related to the child.

States with laws prohibiting surrogacy

Surrogacy law prohibits surrogacy in the following states, District of Columbia, Michigan, New Jersey, New York, and Washington. This means some of these states will allow altruistic surrogacy, but they will not recognize surrogacy contracts or grant pre-birth parentage parentage orders. Both intended parents may not be recognized as the legal parents, even if they are both genetically related. Surrogacy contracts for compensation in these states may be subject to criminal penalties.

Surrogacy law in other countries

The following countries have laws allowing some forms of surrogacy: Australia, Canada, Denmark, Greece, India, Mexico, Nepal, Russia, Thailand, the United Kingdom, and the United States. This isn’t a complete list of countries where you could have a surrogate pregnancy, as some countries don’t have laws regarding surrogacy but will allow it.

And there are many countries in which surrogacy is legal, but there aren’t policies in place to support it. Many countries will only allow altruistic surrogacy – surrogacy where the surrogate mother doesn’t receive payment for carrying the pregnancy. Some countries where surrogacy is legal will still recognize the surrogate mother as the legal mother, and others have legislation in the works to modify the surrogacy laws in one way or another.

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.