• Peer support groups (such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), etc.)
• Therapy and Psychiatry
• Inpatient detox/residential drug or alcohol treatment
• Medication-assisted treatments
• And more

You can visit the online SAMHSA treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The lists below are not all-encompassing, but they should help you get started with your goals. 

Substance Use Resources

Alcohol Resources

Opioid Resources

Smoking/Tobacco Resources

Mental Health Providers

To Learn More About Substance Use and Health 

Next Steps

Reducing or eliminating substances is not always easy! It can certainly be a challenge, but with the proper support, you can be on your way towards achieving your goals.   

The first step is connecting with a resource that is right for you. You can also speak with your primary care provider to discuss any concerns you may have. Your insurance company should be able to provide you with guidance on inpatient and outpatient treatment when needed.  

There is hope.  Reach out and allow yourself to receive support because you deserve to be healthy and happy! 

Reviewed by the Ovia Health Clinical Team

When the pregnant person’s life is in danger

Some preexisting health conditions as well as some pregnancy complications can put your pregnancy health and safety at risk. Expert provider can help manage many of these conditions to allow a pregnancy to progress long enough that the baby is viable (able to survive outside of the womb). But some health conditions and pregnancy complications cannot be managed safely long enough to reach this point. Continuing the pregnancy in these cases would mean certain or high likelihood of death, loss of uterus, or other long-term medical complications — like stroke and other permanent disabilities for the parent. 

Recent federal legislation aims to secure abortion rights in all cases when a parent’s life is in danger, but it is in dispute in several states. Even a delay in care in these situations can have devastating short and long-term health impacts. 

Before we explain the conditions and complications you should be aware of, there are some steps you can take before you become pregnant to support your health. 

Understand the laws in your state

Abortion access varies depending on your state — and in many places your pregnancy trimester, your provider, and your age. In some states, if you’re a minor, you’ll need one or both of your parents’ consent. You can find a state by state breakdown here.

Schedule a preconception visit with your provider 

A pre-pregnancy checkup helps your healthcare provider make sure that your body is ready for pregnancy and often includes some health screenings. During this appointment, you can ask your provider any questions you have about your general and fertility health. 

Consider pre-pregnancy carrier screening

You may discuss this at your pre-pregnancy appointment. A carrier screen is a genetic test that can help you understand your risk of having a baby with a genetic disorder. And you can request it before you’re pregnant. Carrier screening is one of many tools to help you go into starting or growing your family with more information about your risks and options. 

Let’s review conditions and complications that can happen during pregnancy. If you experience one of these, then your state abortion laws could impact your care.

Ectopic pregnancy 

Ectopic pregnancies are early pregnancies that implant and grow in the wrong part of the body — outside of the uterus. The most common location of an ectopic pregnancy is in a fallopian tube, but can happen anywhere within the abdomen, including on the liver or bowel. 

Ectopic pregnancies can never result in a healthy pregnancy and lead to severe internal bleeding and death if left to grow. The only medical treatment available is abortion. The earlier these pregnancies are identified by ultrasound, and treated, the safer it is. If you live in a highly restrictive state, it’s important to know how your provider treats this type of situation. Will you have early ultrasounds? Will you have to travel if you need an abortion? Is there a local hospital that has experience navigating the legal difficulties of this situation? 

Severe hypertensive disorders 

Severe hypertensive disorders of pregnancy most commonly occur later in pregnancy. But, when they happen before viability (around 24 weeks), they are incredibly dangerous for parents. If the pregnancy is not ended, it can result in seizure, stroke, bleeding, and death. The only “cure” for these disorders is immediate delivery. There is no known long-term management option to safely allow the pregnancy to reach viability. Especially for parents with any history or high risk of hypertensive disorders, it’s important to discuss an emergency plan with your provider and any possible preventative steps.

Sepsis and bleeding 

Sepsis and bleeding are two other life threatening complications that can happen in early pregnancy where your body starts to miscarry or labor before about 24 weeks. In these situations, a pregnant person can experience their water breaking or heavy bleeding while their baby is still alive. The treatment for these conditions is delivery.

In states that don’t recognize the life of the parent as a valid reason for abortion, this can end in the death of the parent and the fetus. Even delaying care can increase the risk of serious infection (sepsis), need for blood transfusions and surgery, and death. Again, discussing your options with your provider early in pregnancy can help you feel at ease or make a necessary emergency plan.

When the fetus is at-risk or will not survive after birth

Finding out your baby has a complication or severe illness is one of the most devastating pieces of news to receive as a parent. Modern medicine has made enormous strides to treat certain conditions during pregnancy and work miracles for some people. However, there are chromosomal and genetic conditions that make it more likely for a fetus to die during the pregnancy or immediately after birth. There are also complex fetal differences that may survive birth, but not all parents feel they have the capacity to manage medically, emotionally, financially, or physically. Many people choose to end a pregnancy in these circumstances to reduce suffering for everyone and potential medical complications for the pregnant parent. 

The impact of abortion bans and restrictions

The abortion bans in many states do not have exceptions for these situations. These laws can be confusing and cause delays in care of the pregnant person. Knowing your state’s guidelines, and where you can travel to safely get the care you need is essential. In some states, specialized OBGYNs, called MFMs (Maternal Fetal Medicine specialists), will help identify and explain what is happening with your fetus, but they may be limited in discussing options. They may be able to refer you for a virtual appointment with an MFM out of state to have a more open discussion inclusive of more care options. Early genetic testing and counseling can leave more options open in states that only restrict abortion after a certain gestational age. 

If you find yourself in need of support or information after a devastating diagnosis here are some resources to explore: 

• Empty Arms
• Rare Disease information
• Neonatal donation
• Medical Ethics and Decision Making

Reviewed by the Ovia Health Clinical Team

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

Dear Ovia, My partner of a few years isn’t sure if he wants to have kids and I know that I do. I thought he would change his mind on this as we got older, but he hasn’t…

I’ve had so much personal experience with this topic, this disagreement between partners happens so often! You’re not alone and it is SO tough. Every relationship involves compromise, but that level of compromise is up to you both. 

A big question: has your partner always maintained he’d like to be child free? Sometimes this feeling stems from childhood experiences, or his love for the life he has with you. Do these people change? Sometimes! But you can’t bank on it. The soul searching you have to do right now is your own. Can you live without being a parent? Will your relationship suffer because this need won’t be met? 

Many couples even take some time apart to ponder this exact question. If you take time apart, I would not frame the time you need as an ultimatum for him, but look at it as time spent evaluating your choices to be child free or seek parenthood another way. 

Parenthood is complex and life changing (I know there are some unicorn children out there, but most upend life as we know it). Having a partner who is all-in is amazing. There are so many people who are in your shoes waiting for that time to happen, but it generally can’t be rushed. 

More from this series

• Male fertility testing
• Dreams of a big family

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/. 

Dear Ovia, How do I tell my hubby that he’s the one who needs to get tested now?

This is such an important issue, and a surprising challenge for many people with a male partner. It’s been ingrained in our culture for so long that infertility is very likely a woman’s “fault.” And many people are genuinely shocked to learn that about half of all known cases of infertility have what’s called a male factor. Infertility is no one’s fault, and identifying medical issues that impact your struggle to conceive shouldn’t carry stigma, but I live in the real world with you, so I know that stigma is alive and well.

My advice is to be as dry as you can about it. If this is a first attempt, go basic, “Hey, doctors say the next step is a sperm analysis, they gave me the info for a provider for you.” Even though there are big emotions involved, this is a medical and clinical step. Keeping the conversation simple and medical can help. 

That said, you know your hubby best. Would it work best to make the appointment and tell him when it is? Or maybe to have your doctor explain that it’s the next step if he’s said he doesn’t think he needs to go get tested? Or to reassure him this is what everyone does at this stage? 

Again, we live in a culture that often connects fertility and feelings of pride. If he’s having trouble believing he may need medical help to conceive, there’s probably some grieving and acceptance that has to happen. 

More from this series

• Dear Ovia, My partner isn’t sure if he wants kids
• Dreams of a big family

A failed embryo transfer

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

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

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

Additional testing

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

A mental health note

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

Reviewed by the Ovia Health Clinical Team

Sources

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

hCG level testing

About 10 days after your transfer, your doctor will have you come in for a blood test to check your human chorionic gonadotropin (or hCG) levels. hCG levels rise when an embryo implants in the uterus and a blood test can typically detect the hormone before at-home urine pregnancy tests. hCG levels below 5 mIU/mL are considered negative for pregnancy. Anything between 6-24 mIU/mL is a gray area, which could indicate a biochemical pregnancy, a type of early pregnancy loss. 

Research suggests that pregnancies with hCG levels that reach at least 100 mIU/mL within 10 days of a five-day transfer or 12 days following a three-day transfer are the ones most likely to result in a successful pregnancy. Although high hCG levels are typically a more promising sign, rising hCG levels are more important than the initial number. Your fertility clinic will want to check your hCG levels every few days, and then weekly, to make sure the levels continue to double every 48 hours.

The ultrasound

You will have your first ultrasound when you are five weeks pregnant to confirm that there is a gestational sac — a fluid-filled body containing the embryo. Then, when you’re six weeks pregnant, you’ll return for another ultrasound, this time where you’ll be able to hear the baby’s heartbeat. Later, toward the end of your second trimester, you’ll have a full anatomy scan, taking a detailed look at baby from head to toe. 

Graduating from the fertility clinic

Fertility clinics typically monitor IVF pregnancies up until weeks eight to ten of pregnancy. During this time, you will be prescribed progesterone suppositories or injections. Studies show that progesterone increases the pregnancy rate following IVF and helps decrease the risk of miscarriage. Once you graduate from your fertility clinic, you will see your obstetrician At a traditional schedule with several weeks between appointments. Though this can be nerve-racking, especially considering how closely your fertility clinic monitors you, it’s the normal schedule of appointments. If you have a high-risk pregnancy due to a health condition or a history of pregnancy loss, you may have more frequent appointments. 

It can be hard to feel calm after getting pregnant using IVF, even after you reach your second and third trimesters. Your road to parenthood might not look like what you expected, and that’s OK. You worked hard for this pregnancy, so you deserve to enjoy it. If the fear of pregnancy loss feels all-encompassing, try opening up about these complicated feelings to a friend, trusted loved one, or mental health professional. It’s important to take time to celebrate each milestone, no matter how small. The IVF process takes away some of the big firsts, like the randomness of a positive at-home pregnancy test, or, for some, being surprised by the sex of the baby, but that doesn’t mean you can’t make your own unique memories. 

Reviewed by the Ovia Health Clinical Team

Sources

• American Society for Reproductive Medicine. “Progesterone Supplementation During In Vitro Fertilization (IVF) Cycles.” https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/progesterone-supplementation-during-in-vitro-fertilization-ivf-cycles/.
• Coomarasamy, Arri, Adam J. Devall, Jan J. Brosens, Siobhan Quenby, Mary D. Stephenson, Sony Sierra, Ole B. Christiansen et al. “Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence.” August 2020 https://pubmed.ncbi.nlm.nih.gov/32008730/.
• King, N., L. A. Bernardi, J. Tolentino, J. Zhang, A. Lawson, and R. B. Barnes. “Serum HCG values are as predictive of live birth after single embryo transfer as early pregnancy ultrasound.” November 2017. https://www.fertstert.org/article/S0015-0282(17)31536-4/pdf.

To help guide you along your IVF journey, we answered some of the most commonly asked questions about IVF. 

How many eggs will I get? 

During your fertility testing, and at the start of your IVF cycle, you will have an ultrasound to measure the number of antral follicles (tiny fluid-filled sacs within the ovary that contain one egg each) you have. This count gives you a rough estimate of how many eggs you may retrieve during your cycle. 

The injectable medications you use during IVF will help grow these follicles. Follicles must be at least 12mm for an egg to be retrieved, but doctors typically like to see follicles a lot larger. Research shows follicles between 17-19 mm are the most likely to have a mature egg inside. 

It’s normal to not get a lot of eggs from your first round. In fact, most people, especially those over the age of 35, need more than one egg retrieval to bring a baby home.  

What happens if an egg isn’t mature? 

Eggs need to be mature in order to be fertilized. Sometimes, embryology labs can mature eggs that aren’t quite ready yet in the lab, but this isn’t always the case. 

My doctor mentioned ICSI, what is that? 

IVF is often used as a catchall to describe egg fertilization done in a lab, but if your partner has male factor infertility, your doctor may offer ICSI, intracytoplasmic sperm injection. The ICSI process looks nearly identical to IVF for you and your partner. You still need an egg retrieval and your partner still needs to provide a sample. The difference between the two happens in the lab. With ICSI, the embryologist picks a sperm to inject directly into an egg, manually fertilizing the egg. Some clinics offer ICSI as an add-on, even without male factor infertility, but research shows it only benefits fertilization rates for couples with male factor infertility. 

How many eggs become embryos? 

Unfortunately, not all eggs become embryos. While this is disappointing, it’s totally normal. A day after your egg retrieval, you will get a fertilization report. Typically, 80% of the eggs retrieved fertilize. The next report typically comes on day three. Most embryos that fertilize make it to day three. In the past, most embryos transfers occurred on day three, but today most labs have the ability to grow embryos to day five. Most clinics prefer to transfer embryos on day five, especially if you have a lot of day three embryos to choose from. Only 30-50% of embryos make it to day five. Although it may feel disappointing to see your embryo count drop significantly, the embryos that make it to this point are the ones more likely to succeed. 

How many embryos can I transfer? 

Twin, triplet, and higher-order pregnancies are high-risk pregnancies. To minimize the risk of complications, doctors typically prefer to transfer one or two embryos. If you are older or have had failed transfers, your doctor may be open to transferring two or more embryos depending on your medical history. 

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?” April 2020.  https://www.rmact.com/fertility-blog/ivf-attrition-rate
• Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. “Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion“ July 2020. https://www.fertstert.org/article/S0015-0282(20)30523-9/fulltext 
• Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. “Guidance on the limits to the number of embryos to transfer: a committee opinion.” July 2021. https://www.fertstert.org/article/S0015-0282(21)00563-X/fulltext