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Do Chromosomally Abnormal Embryos Implant?
Fertility Treatment

Do Chromosomally Abnormal Embryos Implant?

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If you’ve done IVF with embryo genetic testing (PGT-A) you’ve probably gotten some embryos with abnormal results. Your doctor may have told you that these embryos aren’t recommended for transfer, but you may not have been given any more information than that.  A lot of blood, sweat, tears, (and meds!) went into the creation of those embryos, so it’s normal to want more information about them. We’ll walk you through what it means for an embryo to be chromosomally abnormal, and whether these embryos can lead to a pregnancy. What is implantation? Implantation is the process of an embryo getting cozy and burying itself within the uterine lining. Soon after, the pregnancy hormone, β-hCG can be detected causing a positive pregnancy test. Implantation is the very first stage of pregnancy.  Implantation is different from an embryo transfer. A transfer is the process of your doctor placing an embryo inside the uterine cavity in the hopes that implantation will happen, but unfortunately not all embryos that are transferred end up implanting into the uterus.  What are chromosomes and why are they important? Chromosomes are the packages that contain all of our genes. Genes are the instructions for the human body, so you can think of chromosomes like the instruction books, each holding thousands of genes together. Most people have 46 chromosomes in total. A healthy egg has 23 chromosomes and a healthy sperm has 23 chromosomes too. When a healthy egg and sperm come together, they create an embryo with 46 chromosomes.  If an embryo has a chromosome that is missing, this means there are thousands of genes that it is missing and thousands of important instructions for its development that it doesn’t have. If an embryo has an extra chromosome, this means it has thousands of extra genes. This means it is getting a lot of instructions in the wrong “dose” (like when you put twice as much salt in your cake recipe) which isn’t good either.  What is a chromosomally abnormal embryo? In order to know that an embryo is chromosomally abnormal, a genetic test called PGT-A needs to be done on the embryo before it is transferred. There are a few different ways that PGT-A can be done, but it usually involves removing 5-10 cells from the area of the embryo that would become the placenta. These cells are opened, the DNA is removed, and testing is performed to estimate the number of chromosomes that the embryo has.  There are a few different types of results that you can get from PGT-A including euploid (normal), aneuploid (abnormal), mosaic (intermediate), and no result (inconclusive). Some clinics refer to embryos with mosaic and inconclusive results as “abnormal” but in this article “abnormal” only refers to embryos with aneuploid results.  Aneuploid can mean that PGT-A detected an extra chromosome, missing chromosome, a whole set of chromosomes that are missing or extra, or just a piece of a chromosome that is missing or extra.  So, can chromosomally abnormal embryos implant? Yes, chromosomally abnormal (aneuploid) embryos can implant. Depending on the specific chromosome abnormality, some might be more likely to implant than others. But remember, implantation is just the first step of pregnancy. Aneuploid embryos have a lot of genetic instructions that are incorrect. If implantation occurs with an aneuploid embryo, the pregnancy usually does not keep going beyond the first trimester. This means that if an abnormal embryo implants there is a high risk of miscarriage.  Some embryos with chromosome abnormalities can lead to the birth of babies with genetic conditions due to the extra or missing chromosome. For example, an embryo with an extra copy of chromosome 21 could lead to a baby with Down Syndrome.  Finally, it is important to remember that PGT-A is not 100% accurate, and some aneuploid results are more accurate than others. If you want a detailed understanding of your abnormal embryos, you should meet with a Certified Genetic Counselor who specializes in PGT-A so they can walk you through what types of abnormal embryos you have. This will help you understand the meaning of your specific genetic results.

Fertility Treatment

IUI Explained: Enhancing Your Fertility Journey

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Did you know that IVF is not the only option for fertility treatment? While IVF is the most well known, procedures like IUI are more affordable and a less invasive option. So what is IUI? Let’s break it down.  IUI stands for intrauterine insemination and is a type of artificial insemination. IUI involves timing ovulation with an insemination of washed sperm placed directly into the uterus. This is often coupled with stimulation and ovulation medication.  The Process While IUI’s don’t have to be done using stimulation medication, they often are. This allows for the best chance of pregnancy. After your standard diagnostic testing including HSG, Day 3 labs, Ultrasound and a Semen Analysis, your physician may recommend medications like Clomid, Letrozole, hCG, and FSH. These medications stimulate your ovaries to produce more than the typical one follicle, as well as work with your body to force ovulation. These medications can be beneficial for patients that have ovulation dysfunction.  On day 2 or 3 of your period is when you will typically start these medications. Every couple days you will come into the clinic to get a scan to see how your follicles are growing. Your follicles hold eggs and as the follicle grows, the egg inside matures. Since we can’t see the eggs on ultrasound, we use the follicle size as an indication of the maturity of the egg inside. Once the follicles reach a mature size, you take a trigger shot to tell your body it’s time to release the egg!  Now it’s time to talk sperm. Since the insemination is timed, we know exactly when we need to process the sperm. The goal is to have the sperm ready and waiting for the egg when it’s released. This means that the insemination will happen before we think the egg will be released. Luckily, sperm can live in the reproductive tract for days!  After the sample is collected, it is washed in the lab. This process allows us to separate the sperm from the rest of the ejaculate. Ejaculate contains seminal fluid, round cells, immature sperm, bacteria and more. Washing the sperm is essential to concentrate the sample and remove all of those extra things that can make it harder for the sperm to swim. Washing is also needed to eliminate any cramping during the insemination.  Once the sample is ready, it is drawn up in a long catheter. That catheter is then moved through the cervix and placed in the uterus via ultrasound. Then, all the little swimmers are injected directly into the uterus in hopes that they meet the egg, fertilize and create a pregnancy.  When is IUI a good fit? Always talk to your doctor about what is best for you given your medical history, but here are some of the times IUI may be a good fit:  While IUI is a go to option, note, it doesn’t have as high success rates as other methods including INVOcell and IVF. Success rates vary by patient but most clinics see a success rate of 10-20%. 

Fertility Treatment

From Eggs to Blastocysts: Understanding IVF Attrition

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Undoubtedly, one of the biggest surprises with in vitro fertilization (IVF) is the dramatic drop or loss of eggs/embryos. Many people assume that if they have 10 eggs collected, that’s 10 embryos, which means 1 fresh transfer and 9 in the freezer. Unfortunately, that can be far from true and there are multiple steps along the way that results can take an unexpected turn. This “numbers game” is what is known as IVF attrition. There are no set rules for this game, meaning that it’s impossible for a doctor to predict what may happen with a patient. In addition, results can vary from person to person. So what are realistic expectations? As an embryologist, I can share what is generally known about IVF attrition. Attrition With Egg Retrieval In an IVF cycle, medication is used to hyper-stimulate ovaries to develop multiple follicles that hopefully contain eggs. Constant monitoring with ultrasound is done and you should get an idea of how many eggs are expected to be collected based on the size of your follicles at the ultrasound and your estrogen levels. (Read more about preparing for your egg retrieval.) Straight up, you may not get as many eggs collected as you expect: Some follicles stimulate that have nothing in them. Sometimes when the doctor goes in and looks around, some of the follicles just aren’t there anymore. Sometimes at egg collection when I assess the fluid I see large masses of cumulus cells (the support cells that surround an egg) that do not contain an egg inside. Even though there is no egg, it may lead to a growing follicle and be an expected egg. So, please note: the number of follicles seen on ultrasound does not necessarily equal the number of eggs that will be retrieved. Attrition in the IVF process happens right from the start. That said, I’ve also seen a patient devastated to end up with only 1 egg go on to have a baby from that single egg. Example: Let’s use a hypothetical scenario where there are 12 eggs retrieved. Attrition During Fertilization After the egg collection, approximately 4-6 hours later, the eggs get inseminated with sperm. This can happen with either: IVF where sperm and eggs are placed together in a petri dish. Intracytoplasmic sperm injection (ICSI) where a single sperm is injected directly into an egg. Your specialist will make the decision of which one is best for your situation. Mature Eggs Only Not all eggs that are retrieved are able to be fertilized. Eggs start off with 46 chromosomes and need to undergo a process of shedding extra chromosomes to become a mature egg. For fertilization to properly occur, a healthy egg cell should have 23 chromosomes that can pair with the 23 chromosomes from a sperm cell. If ICSI is being performed, only the mature eggs can be injected and it’s common to have some eggs that are not. So, straight up, there is a loss in numbers here. Overall, it’s expected that about 80% of eggs should be mature, but just as with every step I’m going to discuss, this can vary greatly among patients—and even one person’s subsequent cycles. Example: We will assume 10 out of 12 eggs or 80% are mature. I commonly see many patients have all mature eggs, but it’s very common to see some immature ones in there as well. Very rarely, they can all be immature! If IVF is being done, all eggs are going to get inseminated (as eggs are left in their fluffy cumulus cells) and the next morning we will see which ones are fertilized. Again, the immature ones will not fertilize. Fertilization Rates With 12 eggs collected, 10 can be injected with ICSI, or only 10 will be able to be fertilized by the sperm with IVF. Of those mature eggs that are capable of fertilizing, they are not all expected to fertilize. Approximately 70-80% is a good fertilization rate but many labs are happy with less than this as they may treat poorer prognosis patients that aren’t expected to do as well. Absolutely, I see many patients get 100% fertilization, but it’s important to know that seeing some not fertilize is completely normal. We may also see some that fertilize abnormally and need to be discarded. I’ve also seen people who had only a small fraction of their eggs fertilize get pregnant from the few embryos they had. Fertilization results can be a common point of disappointment among patients. Example: Let’s assume that 7 out of 10 eggs or 70% fertilize properly. Attrition During Embryo to Blastocyst Development Most fertilized eggs, or embryos as they now are, will divide onto a day 3 embryo; as the cells divide, the quality may start to deteriorate, cell fragment, and may divide unevenly (read more about embryo grading). For this reason, not all embryos will be suitable for transfer or freeze on day 3 if your doctor/clinic has chosen day 3 for you. While this may be disappointing, please know that it’s this process that allows us to choose the ones that are best for use and allows some genetically abnormal embryos to deselect themselves from the batch. These embryos would not have been capable of forming a healthy pregnancy. This process allows us to choose the ones that are best for use and allows some genetically abnormal embryos to deselect themselves from the batch. The Day 3 Drop A big drop in numbers usually occurs in the phase between day 3 and day 5 of embryo development. We fully expect that not all embryos will be able to form a blastocyst and this is because the egg has everything in it to drive growth to get to day 3 and then embryonic genome activation (EGA) has to occur. This means that embryo development is under the control of the maternal egg genes until day 3 and then control is taken over by the genes of the zygote which many embryos just

Fertility Treatment

Is IVF a Promise of a Baby?

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In vitro Fertilization (IVF) is considered the ‘big gun’ of infertility treatment, but does it always work? Sadly, the answer is no. According to Resolve: The National Infertility Association, women with the best chances of IVF success have per-cycle success rates of 40% or higher, while the majority of women have per-cycle success rates of just 20-35%. In other words, the odds of success just aren’t that high. This is partly related to the fact that there are multiple steps involved in an IVF cycle, and complications may occur at any point in the process. While everyone loves a success story, we are going to get real here by taking a look at some of the scenarios that can go wrong during an IVF cycle. An Intro to the In Vitro Fertilization Procedure Issues During the Stimulation Phase Issues with IVF can occur right from the stimulation phase when medications are used to mature multiple eggs (rather than a single egg that is generally produced with each menstrual cycle) and induce ovulation to allow for egg retrieval. Several different protocols are used, and each woman’s body can respond differently. Too few or too many eggs may mature. An over-response with too many eggs means it is possible the egg quality may not be ideal. A poor response to the medications can result in a low number of eggs being retrieved, meaning a slimmer chance of creating embryos that survive to transfer. It is also possible that there are no eggs to retrieve at all. If the body is overstimulated and estrogen levels become too high, ovarian hyperstimulation syndrome (OHSS) can occur, which can prevent an embryo from being transferred, creating a need for it to be frozen and transferred at a later time when estrogen levels have returned to an acceptable level. Even if a response to medication is typical, there are additional factors that can complicate the cycle. Hormone levels can be off, and estrogen can be too high, or too low, which can affect how the follicles grow or interfere with other medications, like those meant to suppress ovulation. The presence of cysts, which can sometimes be brought on by the stimulating medication itself, can further delay or derail a cycle as cysts often produce estrogen, which can interfere with the process. Occasionally the body’s natural cycle will override and breakthrough bleeding can occur, despite best efforts to delay ovulation and menstruation. Many of these situations can result in a delayed or a canceled cycle. With so many variables, stimulation is a tricky scenario to attempt to control. IVF Stimulation Protocols Issues During Fertilization If retrieval is successful and at least one mature egg is retrieved, sperm will be introduced in the hope that fertilization will occur (or intracytoplasmic sperm injection might be used). Once the sperm has fertilized the egg, the embryo is allowed to grow in a controlled lab setting until it reaches a stage where it can be transferred back to the woman’s uterus, or frozen to be transferred at a later date. The time between when the egg is fertilized and when it is transferred back, or frozen, often has a high attrition rate. This attrition combined with a low number of eggs retrieved can mean that no embryos make it to transfer. Even embryos that grow to a point where they are deemed acceptable to be transferred may still be genetically abnormal, and without expensive (and potentially damaging) testing, there is no way of knowing which embryos are the healthiest. An Intro to Intracytoplasmic Sperm Injection (ICSI) Issues During Embryo Transfer After progressing through stimulation (without having OHSS) and retrieval with at least one successful embryo, the uterine lining must still be prepared for implantation, and the embryo transferred. Again, medications are used to stimulate the uterus to grow a lining for the embryo to implant in. Sometimes the hormones used to stimulate the lining to grow don’t work, leaving the lining too thin or, on the other end of the spectrum, the lining can also become too thick. Cysts in the uterus can also form, either spontaneously or due to the use of the stimulation medications. A cyst can prevent an embryo from being transferred as it can interfere with implantation. Issues During Implantation If a suitable uterine lining is achieved and an embryo is transferred, the embryo needs to successfully implant within the lining. This is one of the most mysterious points in an IVF cycle as there is little that can be done to assist in implantation; it is simply a waiting game to see if implantation will be successful or not. A blood test will be taken at some point after the transfer (the exact time frame differs from doctor to doctor, but usually between 10 – 14 days after). If the blood test comes back positive for the hormone human chorionic gonadotropin (hCG), implantation has been successful, and pregnancy has been achieved. The level is often monitored every few days for two or three more blood draws to make sure the levels are rising appropriately. If the levels do not increase accordingly, a chemical pregnancy may have occurred, meaning the embryo implanted for a short time, but did not continue to grow. This can happen even with spontaneously conceived achieved pregnancies, but these are often missed because the pregnancy ends before the woman even realizes she was pregnant in the first place. A chemical pregnancy can be a difficult experience because there is often no specific reason to indicate why the pregnancy didn’t continue. There have been amazing advances in reproductive technologies and though there are still limits, IVF is a powerful tool that has helped many individuals and couples achieve successful pregnancies. Knowing what you are up against can be a step in the right direction to deciding if IVF is for you.

Fertility Treatment, oldposts

Preparing for Your IVF Egg Retrieval

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In vitro fertilization (IVF) can be overwhelming, but the egg retrieval, also known as egg harvesting or egg collection, doesn’t have to be. After all the preparation with the appointments, pills, shots, and ultrasounds, you’re finally getting ready to see what happens next. Here’s what you can expect from an egg retrieval procedure. What is an Egg Retrieval Procedure? The IVF cycle is basically a zuped up menstrual cycle. What exactly does that mean? In a natural menstrual cycle, hormones called gonadotropins are released from the pituitary gland and help recruit one egg to mature over about 10-14 days and then signal ovulation (egg released from the ovary into the fallopian tube where hopefully it meets sperm). The medications in an IVF cycle are simulating the natural recruitment process with the goal of recruiting more than one egg. Retrieving multiple eggs increases the likelihood of having high-quality embryos to transfer back to the uterus. Essentially, the egg retrieval is like ovulation; however, there are more eggs involved and they are retrieved out of the body before they would ovulate on their own inside the body. If a patient does not have a fresh embryo transfer, they can expect a menstrual period about 7-10 days after the egg retrieval and the ‘cycle’ is then complete. Preparation for IVF Stimulation Most IVF stimulation protocols start with some sort of medication to prepare the eggs and the most common is the birth control pill. Patients are often shocked when I tell them that the first step in IVF is taking birth control pills and they often say, “Isn’t that the opposite of what we’re trying to do here?” I then joke, “We need to re-brand them, no one would hesitate if I call them ‘IVF prep pills.’ The birth control pills are meant to prepare the eggs for recruitment. I describe it as getting them on the starting line for stimulation so that they all develop at the same rate and most of them will be mature and ready for retrieval at the same time. Other ways to prep for the stimulation phase of IVF can be: Estrace (estrogen-only pill) Lupron (a daily shot) Sometimes your provider may recommend stimulation without preparation. This can mean starting daily stimulation shots with the onset of a period and can be called a spontaneous start IVF cycle. Suppression Check and Breakthrough Ovulation Before you start the stimulation medication, you’ll have an appointment (often called a suppression check) to check that you are ready. This usually involves an ultrasound and a blood test for estradiol (an estrogen that your ovaries produce). Occasionally people breakthrough birth control pills and other preparation medications, and if so, we do not recommend starting the cycle. Breaking through birth control pills means recruiting an egg while on birth control pills and we can tell this happens if there is a large follicle on the ultrasound in combination with a higher than expected estradiol level on the blood test. It is very frustrating to be ready for your IVF cycle and have it delayed but it’s the right thing to do. If we started the stimulation shots when your body has already selected an egg to start recruiting, then that is the only one that would develop to maturity in that cycle and the whole point of IVF is to recruit more than one egg. If the ovaries are quiet and the estrogen level low, you are ready to start the stimulation phase of the IVF cycle! Stimulation Phase of IVF Let’s take the mystery out of the IVF cycle — it’s not magic recruiting eggs—it’s science. Every menstrual cycle women may ovulate one egg but many more eggs are lost (this happens every month whether or not we are having menstrual cycles). Our eggs are constantly trying to develop and then the vast majority die off (I wish we could put a pause button on this process!). Of all the eggs that we lose each month, a small group of them are recruitable (able to respond to stimulation medication, if given). In a natural cycle, the pituitary gland makes enough gonadotropins, mostly follicle-stimulating hormone (FSH), to recruit one egg and when the ovaries make enough estrogen to signal that the egg is mature the pituitary gland produces a surge of another gonadotropin, luteinizing hormone (LH) which induces ovulation of that mature egg. We are mimicking this process in IVF with the goal of recruiting more than one egg. We give gonadotropins for 10-14 days in the form of shots to recruit the eggs that are available. These shots are the same hormones a woman’s body makes each month, just in higher doses. It’s important to know that every woman is different, and every cycle is different. The same dose of medications can produce a different number of eggs in different women and even in the same woman but over different menstrual cycles. Women are followed closely throughout the cycle with ultrasounds (follicle sizes increases as eggs mature) and blood tests (estrogen levels increase as eggs mature). Ovulation Suppression The medications you take in your IVF cycle are not all stimulation. Another medication will usually be given to prevent ovulation before the egg retrieval. This medication is either leuprolide (Lupron) or an antagonist medication (Ganirelix or Cetrotide). Daily Lupron shots are started before the stimulation medications and given throughout the cycle while antagonist shots are usually only taken 4-5 days before the egg retrieval. The goal of IVF is to retrieve the eggs when the majority of them are mature and so it is a balance between stimulation and preventing ovulation. Ready Set, Trigger Shot Time! When your doctor feels that the majority of the eggs are mature and you’re ready for retrieval, you’ll do one last shot to trigger the final maturation of the eggs. This ‘trigger shot’ is mimicking the LH surge that occurs in the middle of a natural cycle once the ovaries give the signal that the egg

Fertility Treatment, oldposts

IVF Pregnancy Announcements

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We’ve had the joy of gathering unique IVF pregnancy announcement ideas—from tear-jerkingly touching to downright nerdy—and attempted to categorize them for your viewing pleasure. From intricate to easy, there is something for every skill level! If you are dreaming about what might be in the future or planning for an imminent announcement, hopefully, you can draw inspiration from some of these great ideas. IVF Onesie Pregnancy Announcements Credit: Kacey Kennedy Roth / @kck_roth Credit: Emily Aranda / @empricea Credit: Amy Lynn / @amy_lynn_l Credit: @brittanischwab on Instagram Credit: @lovk1019 on Instagram Credit: Cristina Gullo @mrs_cristina_gullo Credit: @ivfgotafarmhouse Credit: Nora O’Brien-Gleason/ @norasaurus85 on Instagram IVF Needle & Medication Pregnancy Announcements Credit: @olivuafeldman_ via @seesusierun Credit: @making_baby_mikkelsen Credit: Allana Handley / @allanahandley on Instagram Credit: Emily Aranda / @empricea Credit: Hannah / @journeytomotherhood Credit: @jessicadaniellehess on Instagram Credit: Lauren Supernaw / @lilsupergirl82 Credit: Stella Paglia lamundo / @stellapaglia Credit: Jess Veit / @mamainthemaking21.22 Credit: Jess Veit / @mamainthemaking21.22 Fun & Adorable IVF Pregnancy Announcements Credit: @jessicadaniellehess on Instagram Credit: Savannah Smith Soskin / @savannahsmithphoto Credit: Stella Paglia lamundo / @stellapaglia IVF Pregnancy Announcements With Pets Credit: Amy Dunnuck / @amydunnuck Credit: @ivf_pride IVF Pregnancy Announcement for Twins/Triplets Credit Lo / @_lo.f_ Credit: Natalia Marek Griffin / @antimony79 Have a great announcement to share? We’d love to hear from you.

Fertility Treatment, oldposts

14 Onesies that Celebrate IVF Babies

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For pregnancy announcements, birth announcements, or baby shower gifts, we’ve found 14 of the best onesie designs to help celebrate the arrival of a special IVF baby. From adorable to nerdy or funny, there is something to celebrate a child worth the wait. Buy on Amazon | $14.97 “Made with love & Science” Cozy Bear Boutique Buy on Etsy | $19.99 “Expensive AF—but with every penny…” Panda Tots Apparel Buy on Amazon | $14.95 “Little Miracle” Bump and Beyond Designs Buy on Amazon | $14.95 “The Little Embryo That Could” by Sunray Clothing Store Buy on Amazon | $22.99 “Finally ❤” by CafePress Buy on Amazon | $12.49 “Worth Every Single Shot” by Peanut Press Designs Buy on Etsy | $10.79 + “I’m So Cool I Used To Be Frozen” by KAYANDTEE Buy on Etsy | $14.62 “Made With Lots Of Love & A Little Bit of Science” by IndiElleDesigns Buy on Etsy | $18.00 “No one ever wanted anything more than I wanted you” by GingerAndBabe Buy on Etsy | $19.98 + “Science & Me Go Way Back” by PuddleKickers Buy on Etsy | $17.26 ” Mom + Dad + Science = Me” by milestonepost Buy on Etsy | $14.99 “Some Things Are Worth The Wait” by OneStopSussenshop Buy on Etsy | $15.99 “Worth It All” by HearthandArrowBtq Buy on Etsy | $15.99 “Worth the wait and wait and wait” by HearthandArrowBtq Pin me

Fertility Treatment

A 12 Step Guide on What to (Really) Expect with IVF

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Look, you can read about the step-by-step process of IVF in a number of places (like here: An Intro to the IVF Process) and hopefully, you’ve been well-equipped by your clinic. But it’s likely that you are getting the high-level, glossy version; the tidy technical steps that—while daunting, seem straight forward(ish). But if you ask anyone who has undergone the process they’ll tell you that the advertised steps are really only part of the story. There is a lot more grit and emotional upheaval involved in the process than any handout could ever possibly highlight. Here, in plain language, are the real 12 steps in an IVF procedure. 1. Referral for IVF Eek! IVF feels like your best chance for a baby. Perhaps only chance? Feel elated and relieved that it is finally here, whilst simultaneously panicking. What if your ‘safety net’ option also fails? Feel all the feels. Tell only a handful of people and then feel lonely. Be told ‘how exciting!’ by kind family and friends who are trying to be supportive but are unaware of the stats. They assume IVF always works and don’t know that: a) You are about to walk a tightrope wire of your hopes and dreams. b) You have poor balance, especially when pumped full of hormones. And then, as is so familiar with infertility, you wait. And wait. And wait….. 2. Initial Appointment Anticipate a life-changing appointment (it isn’t) because IVF begins today (it doesn’t) and the waiting is over (it isn’t). DO celebrate the fact that you are one step further along. Enter the clinic and pass the gauntlet of smiling baby photos. Deliberate with your partner about whether this provides hope or is in poor taste. Decide its poor taste whilst also making a mental note to send in your own baby photo should the treatment be successful. Meet with the nurses. Have your identity checked more thoroughly than at passport control and sign forms. Lots of forms. For everything. Meet with the consultant. Decide that taking notes is too geeky and that you will definitely remember what was said at the appointment. Definitely. Instantly forget every word on exiting the room and curse yourself for not taking notes. Clutch at an unintelligible drawing from the consultant about how your womb works (or doesn’t in your case) and ponder its meaning which was once clear but now escapes you. Consider, then dismiss, having it framed and put up at home as IVF ‘interpretative’ art. 3. Implications of Appointment/Drugs Appointment Meet again with the nurses. Have a needle waved in your face that would be appropriate for tranquilizing an elephant and almost faint. Find out that it is not the one used for the injection. Pretend that you knew that by giving a little ‘in-joke’ giggle whilst internally heaving a huge sigh of relief. Be shown how to mix the drugs, grab the fat and inject. Be asked by the nurse to do a dry run on yourself. An observed and critiqued recce. What now? Yes, now. Take the needle. Tell yourself ‘you can do this.’ Give big, reassuring smiles, like you are finding it the most natural thing in the world. Receive encouraging nods from your partner and the nurse. You are not reassured. One doesn’t have to do it ever and the other does it daily. Make a joke about not having any spare fat on your stomach only to have multiple areas pointed out by your partner (thanks, love). 4. Drug Collection Empty the fridge of all perishable goods to make way for its new calling in life as a drug storage facility. Collect drugs from the clinic. Drive home with extreme caution, like you work for a nuclear authority transporting an atomic bomb. Spread all the drugs out on the kitchen table. Take a photo and send it to your partner with some amusing remark about ‘being a drug lord.’ Read the descriptions of each box. Be informed that your drugs are to be stored at room temperature. Turn it over in your hands. Realize you have no idea what it does and replace it carefully on the table. Sit back and look at the next month or two and thousands of dollars spread out in front of you. Have a little panic, potentially a quick weep, then crack on with the rest of your day (which includes going food shopping to restock the fridge). 5. Progress Scans Pose in front of the mirror to see if your belly looks bloated. Try a different angle and another. Stick out your belly. Decide that is cheating. Panic that the lack of bloating means that it isn’t working. Throw a hissy fit. No fertility treatments work for you ever. Why expect IVF to be different, hey? Slump into the scan room like a deflated balloon expecting the worst. Be told to your surprise that follicles are developing and have lots of numbers thrown about (size of each follicle). Rub your tummy proudly. You knew it was all going to plan. Float out of the scan room on cloud nine. Promise yourself never to panic again about bloating. Forget this at the next progress scan and repeat the above steps. 6. Trigger Shot Do NOT mess it up. Don’t be a plonker. Don’t pull the back off the syringe. Don’t spill it on the floor. Don’t bodge up the timing. It needs to be exact. EXACT. How exact? Like to the minute? Mix it early. Sit staring at it and worry that it is curdling. Get your partner to watch you like a hawk and check that you don’t do anything stupid. Partner stares at you, while you stare at the needle. And you both wait, for your exact time slot. Trigger done! Phew. The final injection. 36-hour count down commences. 7. Egg Collection Feel sorry for your partner, as having a compulsory orgasm under clinical conditions must be tricky. Then remember that you are having an operation after

Fertility Treatment

Embryo Freezing and Thawing: What You Need to Know

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As part of the in vitro fertilization (IVF) process, you may have embryos cryopreserved through freezing for later use. Here is what you should know about the freezing and thawing of embryos. How are embryos frozen? Embryos were traditionally frozen using a ‘slow-freezing’ method where the temperature is gradually reduced using a specially designed machine. However, the survival rates of frozen embryos have skyrocketed since the development of a new freezing technique called vitrification. Vitrifying embryos means that they are frozen at such a rapid rate that there is no time for ice crystals to form inside the cells, which is the main cause of damage, often leading to embryo death. Vitrification Instead, the water inside the cells freezes at -20,000°C per minute into a glass-like state. Because no ice is formed, technically vitrification isn’t freezing; it is referred to as ‘cooling.’ This super-fast rate of cooling is achieved by holding the embryo in extremely small volumes of liquid and plunging it into liquid nitrogen which keeps the embryo perfectly preserved at -196°C. Cryoprotectants Before embryos can be frozen, they need to be gradually dehydrated to remove the water in and around the cells. They are moved individually through different liquids which vary in their concentration of cryoprotectant (solutions that replace the water and protect the cells). Although cryoprotectants protect the embryos from ice damage, they can also be toxic. This means that the embryos can only be in contact with the media for very specific amounts of time to ensure the cells are sufficiently preserved, without excessive exposure which can do more harm than good. The water in the cells is gradually drawn out and the cryoprotectant is slowly transferred in. It is standard protocol for labs to artificially collapse blastocyst before freezing. It is routine for many labs to collapse a blastocyst using a laser because it contains a central cavity filled with water that needs to be removed before freezing. Read: 6 Days in the IVF Lab How are embryos thawed? When the embryo is ready to be used for transfer it can be thawed out. Although because the embryo has been vitrified into its glass-like state and there is no ice involved, technically the embryo isn’t thawed; it is ‘warmed.’ The process of warming embryos is essentially the reverse of cooling them. They need to be gradually rehydrated by moving them through solutions designed to draw out the toxic cryoprotectants and replace the water in the cells. Embryo Warming Survival Rates Embryos are actually very resilient and they handle the freeze-thaw process very well. If you have more than one embryo cryopreserved, they will be thawed in order of their quality with the highest grade embryos being chosen first. (Read more about embryo and blastocyst grading.) The survival rate should be around 95% if the embryo is handled correctly. However, immediately after the embryo has been warmed it is often collapsed and looks squashed so it is difficult to tell whether it is still viable. Many clinics leave the embryo in an incubator for a few hours or even overnight after warming so it can re-expand and be assessed fully to get a better idea of its potential before transfer. Other clinics may thaw the embryo immediately before transfer because they believe that the embryo should be given the opportunity to re-expand inside the uterus which might be a more favorable environment for it to recover in. Can you refreeze a thawed embryo? It is possible to refreeze an embryo after it has been thawed. For example, this might be done if the parents want the frozen embryo to be genetically tested. In this case, it will be thawed and biopsied then refrozen while we wait for the results. Read: From Eggs to Blastocysts: Understanding IVF Attrition What can go wrong with embryo freezing? The most common problem is that the embryo doesn’t survive the freezing/thawing process. This may be due to: Technician Error Technician error can occur when the embryo is exposed to toxic cryoprotectants for longer than it should be. Issues with Freezing Process The embryo may not be frozen correctly which causes damaging ice to form inside the cells. Storage Embryo degeneration (failure to survive) could also be due to damage caused by many accidental mini freeze-thaw cycles during storage. This can happen if lots of embryos are stored in the same place; all the embryos have to be taken out of the freezer (dewar) to find a specific patient and it causes the temperature of all of those embryos to increase ever so slightly. Although the change in temperature is only brief, the embryo is frozen in such a tiny volume of liquid that it can have a substantial effect on the embryo’s survival. Membrane Permeability Permeability of the egg or embryo's plasma membrane to water and cryoprotectants, the tolerance of the cell to osmotic swelling, and membrane shrinkage are all factors that affect how well cells survive the freezing and thawing process. If the plasma membrane of the cells does not function well to let water or cryoprotectants flow through then ice crystals can form inside the cells and lyse (break) the cells open. Also, the cryoprotectants are chemically toxic and need to be removed from the cells through the membrane. Lastly, the freeze and thawing process can cause osmotic swelling and volume changes of the cell that may not be tolerated well. Genetic makeup Alternatively, the embryo may not survive simply due to its genetic makeup. The embryo may be low grade and perhaps should not have been frozen in the first place. However, even high-grade embryos can degenerate after freezing for no known reason and through nobody’s fault. This is one of the most frustrating aspects of working under biology’s control. Partial Survival Sometimes, the embryo can just partially survive. This means that some of the cells look healthy and some less so since each cell's membrane functions independently. An embryo is often considered suitable for transfer if

Fertility Treatment, oldposts

Best Fertility Lubricants

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This article contains affiliate links. Personal lubricants are liquids or gels that help with vaginal dryness or pain during sex by reducing friction. This article covers what you need to know about using lubrication when trying to conceive (TTC). Lubricants and Trying to Conceive When it comes to baby-making, it’s no surprise that timed intercourse can be stressful. In couples trying to conceive, vaginal dryness is found to occur at a rate as much as twice as that of the general population. Sometimes getting your body to “perform” is too much pressure. For people with endometriosis, dyspareunia, or infertility-related distress, or those taking the fertility-enhancing drug Clomid, lubrication during intercourse might be necessary. The bottom line: if lubricant can make sex more comfortable for you, there is no good reason to go without it. Can lubricant affect fertility? For pregnancy to occur, sperm needs to propel themselves through the cervix to meet an egg. Sperm motility, or its ability to move straight ahead quickly, is required for this to happen. Some over-the-counter lubricants such as KY Jelly, Replens, and Astroglide have been found to impair how sperm move or even are toxic to sperm in lab testing. If sperm have impaired movement (or are dead), they likely aren’t contributing to a pregnancy; but there’s more to the story. Do you need a “sperm-friendly” lube? While standard lubricants have been shown to slow or even kill sperm in a lab setting, studies in 2012 and 2018 found that lubricant use didn’t seem to reduce the chance of conceiving. These results may be because sperm are exposed to lubrication in the lab for longer durations than is likely to occur in real life. Both studies have limitations (for example, the 2012 study groups fertility-friendly lube and regular lubes in the same category). Both also say that more research is needed to confirm the finding, so It’s possible that “lube didn’t make a difference” might not be the full picture. So is sperm-friendly lube a must when trying to conceive? Without a diagnosis of male-factor infertility, the data doesn’t suggest that it is critical, but it also lacks consensus. (We found doctors recommending no lube, any lube, and only sperm-friendly lube.) What we do know is that there are lubrications that don’t harm sperm in a lab setting. What does fertility lubricant do? Fertility-friendly lubrication is a particular category of lubricants (called PEB lubricants) required by the FDA to undergo testing to prove they won’t impact fertilization or harm eggs, sperm, or embryos. Essentially, a fertility-friendly lube has proven not to harm conception. Does fertility lubricant help you get pregnant? No, not really. Theoretically, a sperm-friendly lubricant works by not make it more challenging to get pregnant because it doesn’t damage sperm. Fertile-quality cervical mucus that has an egg-while-like consistency is the real pregnancy helper. Does using lube prevent pregnancy? No! Commercial lube isn’t birth control! It can’t prevent pregnancy. See more on spermicides and contraceptive gels. What You Should Know About Lube The chemical ingredients in lube are called excipients. The combination of these excipients creates a lube’s sensations—slippery, tingly, moist, etc. These desired characteristics can come at the cost of a chemical makeup that can damage tissue and cells. There are two measurements to know with water-based lubricants (which all fertility-friendly lubes are): pH and osmolality. Lube pH pH is a measurement of a solution’s acidity or alkalinity on a scale from 0 to 14. Less than 7.0 is acidic, or greater than 7.0 is alkaline. In the middle, 7.0 is neutral, just like water. The pH of the healthy vagina is moderately acidic, with a range of pH 3.8–4.5 to help protect against bacterial growth. Acidity, however, can also kill alkaline-loving sperm that prefers the 7.2–8.2 pH of optimal semen. This acidity is why fertile cervical mucus is essential to natural conception. It is more alkaline with a pH of around 7.0, helping to provide sperm safe passage. We know that pH matters because sperm can live up to 5 days in fertile mucus and die within hours in more acidic non-fertile mucus. So what does this mean for fertility lubes? A fertility lube’s pH should not seriously alter vaginal pH or be toxic to sperm (so you don’t want a low pH). There is no specific pH that the FDA requires a fertility lubricant to be, but any PEB-certified lubricant has a pH that has been proven not to harm sperm, eggs, or embryos. Many fertility-friendly lubes are neutral pH of around 7.0 to match optimal semen and fertile fluids. Lube Osmolality Think of osmolality as the ability to pull water from tissue and cells. A lubricant with high osmolality can draw moisture out of cells which can dehydrate and irritate vaginal tissue and harm sperm. The ideal state is isosmotic/isotonic, meaning the lube and the cells have the same hydration levels, and no water is exchanged. So what does this mean for fertility lubes? Commercial lubricants often have high osmolalities (2000-6000 mOsm/kg). The World Health Organization (WHO) recommends that lubrication not exceed 300 mOsm/kg but set 1200 mOsm/kg as an upper limit because of the lack of lower osmolality products. For a fertility-friendly lube, isotonicity requires a product to have a comparable concentration of the water molecules to vaginal secretions (260-290 mOsm/kg ), semen (289 to 351 mOsm/kg ), or fertile cervical mucus (250 to 422 mOsm/kg.) There is no specified osmolality for a PEB lubricant to meet, but a PEB-certified lubricant is considered to be within a safe range. Based on the products available, the acceptable range is likely around 260 mOsm/kg to 400 mOsm/kg. Glycerine Glycerine (glycol) is an ingredient used to attract and retain moisture found in some fertility lubes. Glycerine has a bad name in lubes because higher levels can significantly increase osmolality, which can dehydrate tissue and cause inflammation. With PEB fertility lubes, osmolality cannot be high (max of 400 mOsm/kg compared to the 2000-6000 mOsm/kg of some lubes). While only low

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FertilitySmarts was founded by Kelly Park several years ago with the intention of providing educational resources for individuals facing fertility challenges. In 2023, IVF Store, LLC acquired the platform, aiming to perpetuate Kelly’s mission while enhancing its content through contributions from esteemed fertility clinicians and experts globally. Presently, FertilitySmarts stands as a premier online information hub, featuring articles authored by recognized specialists in the realm, elucidating the scientific intricacies of fertility issues.

 

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