Frequently Asked Fertility
In Vitro Fertilization (IVF)
If you are under 35 and have been trying to conceive for over a year with no results, you should consult a infertility doctor. If you are between 35-39, you should try for 6 months and if you are 40 and above, you can reach out anytime you are ready. Of course, if you have risk factors for infertility, such as irregular menstrual cycles, blocked fallopian tubes, known sperm issues, or endometriosis to name a few, you can reach out to a fertility specialist anytime.
Sperm is retrieved for IVF in the same way that it is retrieved for Intrauterine Insemination (IUI) or sperm freezing. Your partner or donor will collect a sample into a sterile cup at home or in a designated, private area in the clinic and the laboratory staff will then carefully preserve it until it is ready for use.
Yes! IVF success rates can be 5 times higher than IUI! In vitro fertilization is definitely more involved than other fertility treatments, but IVF pregnancies have a better success rate than other methods of conceiving.
Most insurance plans do not cover infertility treatments; however, a small but significant percentage will cover at least some part of the process. It all depends on your insurance company. Some plans cover the IVF procedure, but won’t cover the cost of injections that you must take prior to the procedure. Some plans will cover a certain number of attempts or specific elements of the overall process. It is best to check with your insurance company; try to get as in-depth as possible with them so you have all the information you need.
Yes, twins can happen with IVF. When we do genetic testing on the embryo, we recommend only putting in one embryo at a time. This will increase the chance of a single healthy pregnancy. Some patients, however, do not want to do genetic testing on the embryos, and in this case we can transfer two embryos to increase the chances that one will take, but sometimes a mother may get lucky and both embryos will attach and start growing into healthy babies.
Before undergoing IVF treatment, there are several changes you can make to help get you ready for this new chapter! Proper nutrition, normal weight, good sleep, healthy stress management, and a moderate amount of exercise can ensure your body is ready for this important time in your life!
A single IVF cycle can take 2-4 weeks to complete. It takes 10-14 days to grow mature eggs and remove them from the body. The eggs are fertilized in the laboratory with the sperm and we grow the embryos for 5 days. On day 5, we do an embryo transfer. The actual embryo transfer procedure is very quick. Usually, a patient will be in and out of the office within an hour and 9 days later, it is time for a pregnancy test. If you decide to test the chromosomes of the embryo, instead of transferring them into the uterus on day 5, we freeze them and then do an embryo transfer the next menstrual cycle.
There are very low risks associated with IVF. Of course, it is critical that you find a good doctor that listens to your specific needs and takes into account all of your health concerns and conditions. But if you are careful and make sure you have a good physician who puts your health first, the process is not considered to be dangerous.
IVF pregnancy is only high risk if you have other medical conditions that would cause any other pregnancy you would have to be high risk. If you are healthy and don’t have any medical conditions other than infertility, there should be very low risks for an IVF pregnancy akin to what any other pregnant woman would face.
There can be some discomfort and side effects from the fertility drugs you take. You might have nausea, bloating, and cramping due to the multiple eggs growing in your ovaries. For the egg retrieval, you are asleep under anesthesia so you won’t feel anything. And the embryo transfer itself is almost always painless.
There may be some side effects from the medications used to prepare your body for egg retrieval, but these are usually mild and typically disappear after the eggs are removed from your body. Some of these side effects can include irritability, breast tenderness, upset stomach, cramping, bloating, or a feeling of fullness and pressure due to the ovaries being enlarged from this preparatory medication.
Sometimes 10-20 eggs can be collected during a single cycle, many of which will be viable to freeze and survive deep freezing. This number has been going up as freezing technology has developed. The biggest factor that puts eggs at risk is that they can form ice crystals when frozen, compromising the viability of an egg. Thankfully, methods have been developed that freeze eggs quickly and prevent ice crystals from forming, giving you the highest chance of as many eggs as possible surviving the freezing process.
Freezing your eggs, especially during a young age, has not been shown to have any negative impacts on fertility. When you have a high egg reserve, extracting and freezing your eggs will not reduce the amount that you will release in your lifetime or cause egg loss earlier in your life. Because you are naturally losing around 1,000 eggs a month, storing a portion of them that would otherwise die off anyway will not significantly affect your natural cycle.
Yes! Collecting eggs is a relatively non-invasive process and should not leave any lasting effects that would impede a natural pregnancy. Many women get pregnant the traditional way after freezing their eggs. Some even freeze their eggs with the full intention of getting pregnant naturally but want to ensure that they have a backup plan in case they do run into any issues.
Sometimes a frozen embryo transfer will fail due to the condition of the patient or the uterus. Mostly though, failure will occur due to certain chromosomal or genetic abnormalities in the embryo. Although these can be tested for prior to implantation, sometimes patients don’t want to test their embryos. When an embryo has an abnormality, the embryo becomes too weak to develop and grow. This can occur whether or not a woman becomes pregnant naturally or through IVF.
You want to have about 10 eggs stored for each pregnancy attempt. This will give you the highest chances of a healthy embryo and successful implantation.
The procedure to remove your eggs is done under anesthesia and usually women only experience mild discomfort during and after. Imagine a period that is a bit more intense than usual, bloating, cramping, a feeling of sensitivity or swollenness usually occurs. The procedure itself is quick, allowing you to be in and out within 1-2 hours. Cases vary a bit, and everyone is different, so doctors make sure to closely monitor your health in the weeks leading up to the procedure to make sure you have the best care possible.
After eggs are collected, they will be analyzed under a microscope to evaluate their maturity. Only the mature eggs are selected for deep freezing, increasing the chances of viability and successful development when they are used again. Once the healthiest eggs have been selected, they undergo rapid freezing to make sure no ice crystals form and they stay as perfect as possible. They are then kept securely in a deep freeze until they are needed. Eggs can be stored for years, and theoretically indefinitely. So far, as technology has advanced, eggs have been lasting longer and longer during the freezing process, increasing success rates from viable, healthy frozen eggs. Once you are ready to use your frozen eggs, they will be thawed and the best ones will be used for implantation, hopefully giving you a successful pregnancy!
Once the procedure is over and your eggs are retrieved, you can usually continue going about your business the next day, but you may still feel some discomfort. For the majority of women, there are no more side effects after one week and they are able to get back to their normal lives and routines without a second thought!
Whether or not it is worth it to freeze your eggs is completely up to you. We recommend consulting your doctor to determine if the procedure seems like the right fit. Depending on your future plans, health conditions, or current lifestyle, you may or may not decide that this is the right choice. Many women are choosing to freeze their eggs to give themselves peace of mind and autonomy over starting their family when they feel it is right. They want to have a biological child, but don’t want to live in fear of having to cut their careers short, or that a health condition may prevent them from conceiving. Some want to give themselves the best chance for conceiving when they do decide to build a family, just in case something goes wrong. It’s a deeply personal decision, but one that you can make by getting as much education as you can and ensuring you have the best care and resources at your disposal to guide you. At Reproductive Health and Wellness Center, we will walk you through each step of the process and help you decide if this seems like the right route for you to take. We care about your individual needs, and want to make sure your personal journey in building your family is exactly what you want it to be.
Intrauterine Insemination (IUI)
Success rates for insemination depend on the patient and their reason for infertility. IUI success can be:
As low as 0% for women who have blockages in their tubes. If the tubes are blocked then sperm and egg cannot meet. Blockages can be caused by a previous infection or by conditions such as endometriosis.
As high as 20-25% if the sperm count is good and the reason you are in need of IUI is due to irregular ovulation.
This gentle, low-cost treatment can be a good starting point for some causes of infertility, for women under the age of 35 who have been trying to get pregnant for over a year, for women over age 35 who have been trying for 6 months or more, for women with endometriosis or ovulation problems, and for women dealing with fertility issues where the sperm just needs an extra boost.
Whether it’s male factor infertility at play, affecting the quality, quantity or mobility of the sperm, or a female factor that makes it hard for the sperm to pass the cervix, IUI can help. IUI is also perfect for lesbian couples or women using donor sperm.
IUI is like a boost to the natural fertility process, increasing the number of sperm that reach the fallopian tubes and thereby increasing the chance of fertilization and pregnancy.
The IUI is timed around ovulation so sperm is there and ready when the egg is released. First, an ejaculate is collected typically through masturbation. Then the semen is washed so the sperm is separated from the ejaculate. The sperm is then counted and placed in a very small tube, or catheter. After inserting a speculum into the vagina, the catheter is inserted through the cervix and into the uterus where the sperm is deposited close to the fallopian tubes. The whole process is relatively quick and usually painless. In fact, after the insemination, you will rest for a few minutes and then you can go about your normal day.
Unlike IVF, you cannot choose gender with IUI. With insemination, the sperm is deposited at the top of the uterus, an embryo is formed, and it will develop into a male or a female. There are a number of “recommendations” online that tell you how to increase your chances of a boy or a girl but none of them have been reproducible with scientific research.
The only testing we currently have to determine gender prior to pregnancy is IVF (in-vitro fertilization). With IVF, eggs are removed from the body and fertilized with sperm in the laboratory to form embryos. The embryo grows in the lab and when it reaches the day 5 stage, a few cells can be removed and analyzed for their chromosomes. This is called pre-implantation genetic testing and it will tell you if the embryo is male or female.
No birth defects have been linked to the IUI fertilization process. If birth defects occur, they would happen at the same rate/risk level that a natural pregnancy would have.
IUI is a relatively painless and easy procedure! After inserting a speculum into the vagina, a very small tube or catheter is gently inserted through the cervix and into the uterus where the sperm is deposited close to the fallopian tubes. The procedure occurs in an exam room and it takes just a few minutes to complete. No anesthesia is needed. After the insemination, you will rest for a few minutes and then you can go about your normal day.
Before undergoing IUI treatment, there are several changes you can make to help get you ready for this new chapter! Eating a healthy diet, achieving a normal body weight, getting good sleep, developing healthy stress management skills, and undergoing a moderate amount of exercise can ensure your body is ready for this important time in your life!
The best way to increase your chances with insemination is to live a healthy lifestyle. Smoking, excessive drinking, and an unhealthy diet can have negative effects so switch to a healthier diet, cut back on drinking, and definitely quit smoking. Most importantly, try to reduce your stress levels. Stress will negatively impact fertility so put together a plan for self-care that is realistic and specific for you.
So much has to happen in order to have a successful pregnancy. The egg that is released has to be good, the sperm still has to fertilize the egg, the chromosomes of the egg and sperm have to meet and divide correctly, the fallopian tubes have to help the sperm and egg meet and then help the growing embryo move back into the uterus, and the uterus itself has to be healthy and ready for implantation. And so on.
Remember all that IUI does is put the sperm closer to the fallopian tubes and to the egg but it doesn’t help with all of these other things that have to occur.
Follicles are the small cysts in the ovaries where the eggs live and grow. One follicle should equal one egg. For some patients undergoing insemination, we only want one follicle to grow. This would usually be the goal for women who have irregular ovulation, women who do not ovulate at all, or for women using donor sperm. For other women, we would recommend using hormones before the IUI to stimulate the ovaries to grow a few follicles. By growing more follicles and ovulating more eggs, we can increase the chances of success with insemination. This would usually be a goal for women who have unexplained infertility, endometriosis, low egg counts, or issues with the sperm quality.
The good news is that you only have to wait two weeks after the insemination to know if it worked. You will be able to take a urine pregnancy test at home or you can come back into the office for either a serum pregnancy test (blood test) or a urine pregnancy test.
Every infertility case is unique and so is every fertility plan. We start with a thorough and complete diagnosis of both partners, and we examine the whole person. We then develop a plan together that fits your individual needs and goals. Reproductive Health and Wellness Center is also proud to offer the most comprehensive infertility care in Southern California. We have specialists in acupuncture, nutrition, and counseling to ensure the very best chance of fertility success. We share a common goal with our patients and we mean it when we say we will do everything we can to help you have a successful pregnancy.
The cost of fertility treatment can really vary depending on the type of treatment. One way to achieve a pregnancy is through IUI, or Intrauterine insemination. This is when sperm is placed at the top of the uterus timed around ovulation. This option is typically less than $1000 per attempt. Another option is IVF, or In Vitro Fertilization. IVF is when eggs are removed from the body and mixed with sperm in the laboratory to make embryos which are then placed back inside the uterus. IVF costs can range from $10000-20000. In either scenario, you will need sperm which can be from a known donor or purchased from a sperm bank for typically less than $1000.
Reciprocal IVF is when eggs are removed from one woman, mixed with sperm to make embryos, and then the embryos are placed into her partners’ uterus. This is similar in cost to traditional IVF and costs can range from $15000-20000.
Reciprocal IVF commonly takes two months. The first month would be for stimulating the ovaries, removing the eggs, and growing the embryos in the laboratory. The second month would be for getting the uterus ready and transferring the embryos back inside.
There are all sorts of ways a woman can accomplish this feat. At the end of the day, sperm needs to be inside the vagina around the time you are ovulating (releasing an egg). If you are planning to use sperm from a sperm bank (the best way to proceed in our recommendation,) the bank may require a permission slip signed by your doctor. Once that is signed, they will release the sperm directly to you so you can try at home.
Of course! Gay men will first need to find eggs which can come from an anonymous donor or from a friend or family member. The donor will undergo an IVF cycle where the eggs are removed from their body. The eggs are then mixed with sperm from the intended parents. Only one sperm is used per egg and the sperm can be from either male partner.
Gay men will also need someone to carry the pregnancy, or what we call a gestational carrier. The carrier can be someone found through an agency or can be a friend or family member.
Yes! You can choose whether you want the sperm to come from a sperm bank or from a known donor. Obviously you know what the known donor looks like but if you choose to use a sperm bank, they will give you access to their catalogues. The catalogues include pictures of the donor as well as their background, education, family history, medical history, etc.
This is known as Reciprocal IVF. It is when eggs are removed from one woman, mixed with sperm to make embryos, and then the embryos are placed into her partners’ uterus.
We would highly recommend using a sperm bank. We work with sperm banks all across the country and once you identify and buy the sperm, the bank will ship it to the fertility clinic for your use. Sperm banks are anonymous and the sperm has been quarantined and is free from any sexually transmitted infections. Another option is to use a known sperm donor. In that case, the donor will need to get infectious disease testing done and because there can be legal issues around paternity, you should consult an attorney prior to getting pregnant.
There are a few ways to get a donor. Some patients choose to use a known donor, typically a friend or family member who is willing to give you their eggs. Others prefer an anonymous donor. With an anonymous donor, the eggs can come from an egg bank where they are already frozen and available to purchase. They also can come from a donor through an agency. The donor will need to go through an IVF cycle to have their eggs removed. In either case, egg bank or agency, you will know a lot about your donor, including their background, education, family history, medical history, etc. Of course you will also see their picture so you know what they look like.
Intracytoplasmic Sperm Injection (ICSI)
IVF stands for In-Vitro Fertilization. IVF is a fertility treatment where eggs are removed from the body and mixed with sperm in the laboratory to make embryos. With natural fertilization, the egg is retrieved and placed in a culture dish with tens of thousands of sperm. Fertilization occurs when one of the sperm naturally penetrates the egg. Another method for fertilizing the egg is called ICSI. ICSI stands for Intracytoplasmic Sperm Injection. ICSI is when a tiny needle is used to inject a single, healthy, high-quality sperm directly into the egg.
There are a number of reasons to choose ICSI over natural fertilization. The most common reasons are issues with the quantity or quality of sperm, unexplained infertility, or poor fertilization in a previous IVF cycle. In general, ICSI is the primary method used for fertilization because it maximizes the number of embryos that can be created and gives patients the best chance of a successful outcome.
Our embryologists have years of experience performing ICSI. Because of that experience, usually less than 5% of eggs would be damaged as a result of the needle insertion.
ICSI is a procedure that happens in the laboratory after the eggs are retrieved. There is no pain with this.
After ICSI, the embryos are allowed to grow in the lab for 5 days. Once they reach the day 5 stage, which is called a blastocyst, the embryos are ready to be transferred into the uterus. Some patients prefer to test the chromosomes of the embryos to make sure they are healthy and normal before doing a transfer. In that case, the embryos are frozen while we wait for the genetic results to come back. Once we have the results and are able to identify normal embryos, we will start a frozen embryo transfer cycle. During a frozen embryo cycle, we get your uterus ready for implantation and at the exact right time, we transfer one embryo into the uterus.
With ICSI, the overall risk of having a baby with a chromosomal abnormality is 0.8 percent, or eight per 1000. This is higher than if you conceived on your own and at present, we do not know the reason for this increased risk. The risk of having a chromosomal abnormality like Down’s syndrome is not increased with ICSI but increases with maternal age. There is no evidence of increased risks of developmental delays with ICSI.
ICSI itself does not cause twins. In general, there is an increase in twins with IVF because 1) more than one embryo is being put back inside the uterus and 2) there is higher likelihood of a single embryo splitting. It is not entirely clear why there is an increase in embryo splitting but is likely due to the manipulation of the embryo in the laboratory.
While the sperm determines whether the embryo will be male or female, the ICSI procedure does not. There is currently no accurate way to determine whether the sperm that is selected for ICSI will become a male or female.
However, we can tell the gender of an embryo with Pre-implantation Genetic Testing, or PGT. PGT is when a few cells are removed from a day 5 embryo and the chromosomes are analyzed. This will tell us if the embryo is a male or a female and whether the embryo has the normal number of chromosomes.
ICSI is recommended in cases of male factor infertility with an abnormal semen analysis, patients with unexplained infertility, and patients with a history of poor fertilization with IVF previously. It is also used for patients after vasectomy repair and when trying to fertilize frozen eggs.
Most patients choose to undergo the ICSI procedure in order to maximize their success even when the procedure is not clearly indicated because it can increase the number of embryos created and give patients the best chance of a successful outcome.
The semen sample is first washed to remove the ejaculate. The sperm is then prepared using multiple techniques which work to separate the best sperm from the rest. The embryologist will then examine the sperm under the microscope and will choose the best sperm to inject directly into the egg.
Donors Egg IVF
IVF success rate are determined by a number of factors, but the age of the woman is the single most important one when she is planning to use her own eggs. Success rates decline as women age which is largely due to egg quality. Because donor eggs usually come from women who are young, in their early 20’s, they typically have a lot of high quality, healthy eggs. Success rates with donor egg can be as high as 70% per cycle.
There are a number of reasons why women may not be able to use their own eggs and might need to use donor eggs. IVF with donor eggs is a wonderful treatment for women who are older and/or have a decrease in ovarian reserve and function. Decreased ovarian reserve is another way of saying decreased number of eggs. While that decrease can occur at any age, it is more common in women in their late 30’s and 40’s. For women unable to conceive using their own eggs, donor egg treatment offers the highest pregnancy and delivery rates of any fertility treatment and still allows the woman to carry a child.
When you use donor egg, the genetic material of your baby will 50% from the egg and 50% from the sperm. Many parents choose a donor that is similar in appearance and ethnicity to the intended mother. That way the baby will more closely resemble the birth mom. I can’t tell you the number of successful donor parents who tell me how strangers come up to them and tell them their baby is a spitting image of mom!
DNA is what makes up all of our genetic material. A person’s DNA is made up 50% from the egg and 50% from the sperm.
According to the U.S. Centers for Disease Control and Prevention, 12% of all IVF cycles in the United States involve eggs retrieved from a donor. With donor egg banks, that number will continue to rise.
The first step with using donor eggs is to choose the right donor. Some people have friends or family that they would like to use and others prefer to have an anonymous donor. While you won’t meet the donor, you will see their picture and learn all about their history and background. Once the donor is identified, then the IVF process can start. Eggs are removed and mixed with sperm and embryos are formed. At that point, we start preparing the uterus for an embryo transfer.
As women age, their chances of success with IVF using their own eggs decreases. This is because of egg quality. Older women have decreased ovarian reserve and function. Although that decrease can occur at any age, it is more common in women in their late 30’s and 40’s. For the women who are unable to conceive using their own eggs, donor egg is the best treatment.
The first step in egg donor IVF is to identify the donor. From there, the process of removing the eggs and growing embryos in the laboratory is approximately 3-6 weeks. From there, we work to get the uterus ready to receive the embryos. That can also take approximately 3 weeks. After embryo transfer, you will know if you are pregnant in only 9 days. In general, it takes approximately 3 months from the time we start with the donor to the time of pregnancy test.
A semen analysis is the only way to know about the sperm in the ejaculate. The sperm and the majority of the fluid itself actually come from different body parts so you can have normal volumes of ejaculate/fluid and still have no sperm at all. A semen analysis measures three major factors of sperm health:
1) the number of sperm,
2) the shape of the sperm, and
3) the movement of the sperm
A traditional surrogacy is when the woman is carrying a pregnancy that used her own egg with someone else’s sperm. This type of surrogacy is legally complicated and is very rarely used.
More common are gestational carriers. During an IVF (In Vitro Fertilization) cycle, eggs are removed from a woman’s body and mixed with sperm in the laboratory to make embryos. The embryos are grown for several days until they are mature and healthy enough to be transferred back into a different woman’s uterus.
To get the uterus ready to receive an embryo, the fertility specialist will prescribe hormones to the surrogate to help thicken the lining of the uterus and to make it receptive to implantation.
In traditional surrogacy, the egg belongs to the surrogate. Because a baby comes 50% from the egg and 50% from the sperm, the baby will carry some of the same genes as the surrogate and can look like her too.
In gestational surrogacy, the egg comes from a different woman entirely and shares no genes with the baby.
Some reasons why patients might choose to use a surrogate include single men or gay couples who want to have a family, women who do not have a uterus, women who have medical issues and cannot safely carry, or women who have had multiple pregnancy losses.
You can’t put an egg directly into another woman; however, a fertility doctor can put an embryo inside another woman. An embryo is formed by fertilizing a single egg with a single sperm. That egg can be yours!
Single men and gay male couples are perfect candidates for using a surrogate or gestational carrier. Sperm from the man is mixed with eggs from an egg donor, embryos are formed, and embryos are placed into a woman’s uterus where it will grow into a baby.
Traditional surrogacy is now much less common than gestational surrogacy because traditional surrogacy is complicated legally and emotionally. Remember that a traditional surrogate is carrying a pregnancy with her own egg. That by definition makes the surrogate the biological mother and that can mean she has legal parental rights.
Surrogacy success rates vary with many different factors. The most important factor is the age of the egg donor. Younger women have more eggs and healthier eggs and that leads to higher chances of success. Another important factor is the health of the surrogate. We work with only the best agencies to make sure you are matched with a surrogate that has a healthy lifestyle, a normal and healthy uterus, and a reassuring medical history.