My Fertility Store
Q&A
Search
Subscribe
FertilitySmarts - logo color

Fertility Treatment

Fertility Treatment

What you need to know about Ovarian Hyperstimulation Syndrome (OHSS)

/

Complications from fertility treatments are rare; nevertheless, some people do experience side effects. Anyone undergoing ovarian stimulation either for in vitro fertilization (IVF), egg freezing, or egg donation, is at risk of developing ovarian hyperstimulation syndrome (OHSS), a rare but potentially serious side effect of fertility treatments. Because of this, It’s to your advantage to be informed and on the lookout for symptoms to bring to your doctor’s attention What is OHSS? OHSS is caused by the presence of multiple ovarian cysts in the ovaries that can occur after a robust response to IVF injections. OHSS is characterized by high levels of vascular endothelial growth factor (VEGF) that gets released after taking the final injection of hCG during IVF. The sustained, high levels of VEGF, along with estrogen and progesterone, lead to the dilation of blood vessels in the body causing fluid to shift out of the bloodstream and into the abdominal cavity, or in more severe cases, the lung cavity. Even though a woman with OHSS drinks plenty of fluids, she can become severely dehydrated. As a result, the blood becomes thickened leaving her at risk for blood clots in the legs and lungs. Related: Dealing with IVF Injections When You’re Scared of Needles Preparing for Your Egg Retrieval From Eggs to Blastocysts: Understanding IVF Attrition What are the Symptoms of OHSS? The symptoms of OHSS may be mild, moderate, or severe and can be classified as: Early-onset. Less than 10 days from retrieval. Late-onset. More than 10 days after retrieval, which is usually associated with early pregnancy. The accumulation of fluid in the abdominal cavity can be very uncomfortable and cause bloating, and sometimes breathlessness. In severe cases, the fluid enters the lungs and causes respiratory distress. This is why it’s very important to inform your doctor if you have any of the following symptoms: Mild OHSS Mild abdominal distention and discomfort Mild nausea/vomiting Vomiting Diarrhea Enlarged ovaries on ultrasounds Moderate OHSS All of the signs of mild OHSS plus: Ultrasound evidence of ascites (abnormal build-up of fluid in the abdomen.) Severe OHSS All of the signs of mild and moderate OHSS plus: Severe abdominal pain Persistent nausea and vomiting Decreased urinary frequency Dark urine Shortness of breath Tight and enlarged abdomen Dizziness Mild or moderate OHSS usually resolves within a few days unless pregnancy occurs, which may delay recovery. OHSS & Pregnancy Because the symptoms of OHSS are exacerbated by pregnancy, sometimes a “freeze all” cycle is the safest option during an IVF cycle. In this case, all the embryos are frozen and a transfer is delayed until full recovery. Who is at risk? Some women are more at risk than others of developing this complication. Women with polycystic ovary syndrome (PCOS) are most at risk because they have many tiny follicles present that can respond to the stimulation medicine. Other women at risk are those who have: A high number of antral follicles (greater than 24) High anti-mullerian hormone (AMH) levels (higher than 3.4 ng/mL) High peak estradiol levels during stimulation (higher than 3,500 pg/mL) A high number of eggs retrieved (more than 25) An individual’s risk should be assessed by a doctor ahead of starting an IVF cycle to adjust the starting dose of stimulation medication accordingly. Additionally, the doctor will do regular ultrasound scans of the ovaries during the stimulation phase and monitor the circulating estrogen levels as they rise. If the blood estrogen level is rising too high or too quickly, the doctor can reduce the dose of FSH medication or “coast” the treatment by stopping the FSH injections for a few days. This will give the ovaries a break from being over-stimulated and help to reduce the chance of OHSS. How common is OHSS? Symptoms of mild OHSS, such as bloating are a common side effect of ovarian stimulation for IVF. The symptoms are easily managed with over-the-counter pain relievers, dietary changes, and increased fluid intake. Severe OHSS affects around 1 to 5% of cycles and is managed with medical help. At-Home Treatment of Mild OHSS Treatment usually involves keeping you comfortable until symptoms subside, which can take approximately 1 to 2 weeks or longer if you are pregnant. Your doctor may also recommend: Take over-the-counter pain relievers such as Tylenol. Reduce activities — no heavy lifting and straining or strenuous exercise. Maintain light activity as total bed rest could increase the risk of certain complications like blood clots. Elevate your feet when resting. This helps your body get rid of the extra fluid. Avoid sex until you are cleared by your doctor. Abstain from alcohol and caffeinated beverages. Drink plenty of fluids. Drinks with electrolytes, such as Gatorade or Smart Water, are a good choice. Record your weight twice daily and the number of times you urinate. Contact your doctor if you note a 5-pound weight gain in 24 hours or a reduction in the frequency of urination by approximately 50%. Be aware of bodily changes, and call the doctor with any nausea, pelvic pain, or increasing symptoms. Clinical Treatment of OHSS For more severe cases, the following may be required: Cancellation of embryo transfer until a later date Prescription anti-nausea medication Drain excess fluid from the abdomen with a needle puncture, similar to an egg retrieval Administer intravenous fluids How can OHSS be prevented? Prevention is better than cure, and your doctor should monitor the stimulation phase of the IVF cycle carefully. Ultrasounds and blood tests measure the ovaries’ response to the stimulation drugs. The dose will be lowered if the estrogen levels become too high or you may take a break from injections for a day or two. It is better to start with a lower dose and add extra FSH during ovarian stimulation than start too high and be at risk for complications. If the ovarian response is extremely high the doctor might choose to cancel the cycle altogether and start again with a lower dose next time. Read: IVF Stimulation Protocols Once a high ovarian response

Fertility Treatment, Third Party Donation

What Egg Donors Should Know About Egg Donation Contracts

/

Deciding to become an egg donor can take you into uncharted personal territories, emotionally, medically, and legally. If you signed up to be a donor through an egg bank, you will not need to wait until being matched before starting the process. But if you’re becoming a donor through a clinic or agency that does not freeze and bank your eggs, once you have been matched with a recipient, it is time to get the ball rolling. And that means signing legal contracts before you start taking any medications. Knowing what to look for when reading and signing legal contracts is important in order to make sure you understand the conditions and terms of your contracts and that you are comfortable with those conditions. Make sure you read the contract thoroughly and understand each item, and ask questions if there is something you do not understand. Before you sign on the dotted line, here are some things you should know about egg donation contracts. Will I have my own attorney? Most egg donation programs work with attorneys to draw up legal contracts. Some use the same attorney for both the donor and the recipient(s). However, using the same attorney as the intended parents could be seen as a “conflict of interest.” How do you know the attorney that is supposed to be representing your interests will not prioritize the paying clients over you? You Can Request Your Own Attorney You can request to hire your own attorney and, in some cases, the clinic or agency will cover the costs of your legal representation. A more likely scenario is that you will be provided with legal representation from a different attorney than the one assigned to the intended parents, but still one of the clinic’s choosing. If you still have concerns about having an attorney who only represents you and your interests, talk to your donor coordinator and try to negotiate your own choice of attorney without having to cover the costs yourself. You should feel comfortable that you have an attorney who is representing your interests. Read: Navigating the Decision to Become an Egg Donor Read: Becoming an Egg Donor: The Recruitment and Screening Process Read: Becoming an Egg Donor: Agencies, Clinics, Egg Banks & Private Arrangements Can I negotiate my egg donation contract? Most women going through the egg donation process—especially for the first time—think that they are required to accept whatever terms are laid out in their contracts. Many are afraid that if they do not accept the contract terms, or if they try to negotiate, they will be rejected from the program. This is not the case—nor should it be. While some egg donation programs have non-negotiable contracts, most realize that you may want to make some changes, and are entitled to do so. If you are told that your contract is non-negotiable, and you are not comfortable with the terms of the contract, it’s in your best interest to find a clinic or agency where you can negotiate the terms that are right for you. First and foremost, this is your body and for now, these are your eggs. What you negotiate now can affect you immediately and also years down the road. So yes, you can—and should—negotiate your contract to make sure your interests are covered and that you are prepared for all possible circumstances, as much as possible. If a recruiter tells you your contract is non-negotiable, see this as a red flag and go elsewhere. There are plenty of clinics, agencies, and egg banks to choose from. Make sure you discuss the terms with the attorney representing you and that your interests are protected. Below are some things to consider when negotiating your contract. How many cycles am I signing up for? Some clinics, agencies, or egg banks will build multiple egg donation cycles into a contract. They may require you to agree to undergo three cycles, rather than just one at a time. Why? Screening donors cost clinics money. Donors have to undergo a range of medical tests, be screened by psychologists and genetic counselors, and other logistics. Donors also have to be instructed on how to self-administer injections and other logistics. The screening process costs staff time and money. If a donor decides to only undergo a single donation cycle, the clinic invests more time and money screening and preparing the donor for her cycle than donors who undergo up to six cycles. However, you cannot possibly know ahead of time if you really want to do multiple cycles. Your decision to do so likely depends a lot on your experiences the first time, how you reacted to the fertility medications, how easily you recovered, and whether or not you had a good relationship with agency personnel or medical staff and doctors who were in charge of your cycle. Rather than agreeing to sign up for multiple cycles at once, it is in your best interest to negotiate to do one cycle at a time so that you have the freedom to consider whether or not this is something you want to do again. You should also know that even if you agree to do multiple cycles in your contract, and you change your mind after your first (or subsequent) cycle, no one can force you to undergo a medical process or procedure. But you may face some extra expense and hassle if you try to get out of your contract. What is the timeline for my egg donation cycle? Your contract should indicate when you will start your egg donation cycle. Sometimes you will start medications as soon as you sign the contract and are matched with a recipient. Other times, the clinic or recipients may want to wait, based on their schedule, or perhaps to sync your cycle with the intended mother or gestational surrogate. You can also negotiate your start date and let them know when you are and are not available. If you have a vacation

Fertility Treatment

Dealing With IVF Injections When You’re Scared of Needles

/

Anyone who has previously gone through in vitro fertilization (IVF) knows that if you once had a fear of needles, you won't anymore. Because the truth is, when it comes to infertility treatments, we often don’t have any other choice. Since I’ve done plenty of shots over the years, I’m here to tell you that yes, you can do it, and yes, you will also survive them. Dare I even say they become no big deal after a while? Get Educated Before any of the actual shot giving can occur, your clinic will need to know you are OK with giving them, and if not, who will be administering them. This usually happens at a nurse consult appointment, typically following a consultation with your doctor when IVF is given the go-ahead. You or you and your partner will meet with the nurse to go over your medications, and you’ll get a crash course in injections. Get Organized After you’ve received the IVF medications and supplies from the pharmacy, you’ll administer them according to your doctor’s orders. Most women have to do several shots a day, at specific times, and it’s necessary to keep a calendar of it all. Most clinics provide a calendar in their information paperwork, but if it doesn't work for you or you prefer digital, make your own. Related: The Complete IVF Process Explained 16 Tips to Prepare for IVF What Research Says About Stress as a Cause of Infertility Books About Infertility What to Expect When You're Injecting Here is what you can expect when dealing with IVF injections, the different places you may be giving them, as well as tips for—you know—actually going through with it. Types of Injections With fertility medications, there are typically two different types of injections that are required: Subcutaneous Injections (SC) Subcutaneous injections go right under the skin before you reach the muscle. Usually, the best injection site for these is right in your abdomen or “love handles.” Other places can be the fatty part on the back of your arm or your thigh, but depending on the type of medication, these places could be more painful. The syringes are small because the maximum dose of a medication is only one milliliter. These needles are tiny, and you may not even feel them go in. They have a gauge of 19-27 (the smaller the number, the smaller the needle's width). When you’re going to inject yourself with an SC shot, it can help to pinch up the skin if there isn’t a lot of fat in the area or inject it at a 45-degree angle. Likewise, if there is plenty of padding, you can spread your skin with your fingers or inject it at a 90-degree angle. The most common medications you would give this route are the stimulation medications to grow your follicles and your hCG trigger shot right before your egg retrieval. This might include : Menopur Lupron Gonal-F Follistim Bravelle Intramuscular Injections (IM) Intramuscular injections are just as they sound: they are the injections that go right into your muscle, and understandably, these are bigger in all aspects. Most of the time, intramuscular injections go into a muscle called the dorsogluteal, and it’s located almost on your buttocks. By dividing the buttock into four quadrants, this area is located in the upper-outer quadrant. Another place you could inject is the area on your thigh, but since the dorsogluteal area has more fat, it’s the best site for lessening the pain. These syringes usually are for two to three milliliters of medication, and the most common IM medication is progesterone. I hate to say it, but these needles are one to two inches in length and a lot wider than the subcutaneous ones with gauges of 26-30. Tips on Giving Yourself IVF Injections If you’ve made it this far, I have good news. There are things you can do to make the experience of injecting yourself easier. And yes, it is fair to expect some discomfort. You can expect to have some pain and bruising at the injection site. Considering the number of shots you will likely be required to give, the odds are that you aren’t going to execute the perfect shot every time. And depending on what the medication is (the blood thinner Lovenox, for example, can cause some wicked bruising), you could have different degrees of pain and bruising. One of the stimulants, Menopur, also burns upon injection. Read: What You Need To Know About Ovarian Hyperstimulation Syndrome (OHSS) Ice and heat With subcutaneous injections, it’s beneficial to ice the area before injecting so you can numb it, and it won’t hurt as much going in. The same is true for IM injections, but sometimes it’s actually better to use heat for ten minutes before and after the medication. This is especially true for progesterone because of the thick oil you have to inject. The heat helps to spread out the oil because it can “clump” and cause painful knots. Pressure and Massage With some blood-thinning medications, you don’t want to put pressure on the site after or massage, but this can be OK for other medications. Your pharmacy instructions will state when to use pressure or not. With IM injections like progesterone, pressure and massage will be your friend. As discussed above, it helps to prevent painful lumps from forming under your skin. Massage is great to help dissipate the medicine and be sure to hold pressure over the site when you pull out the needle and find blood. Getting Over the Mental Roadblock Make sure to relax. Easier said than done—right? But really, this is important. Practice some deep breaths and make sure the muscle you are going to inject is loose. Don’t tense your fingers. Pretend you’re braver than you feel. Remember the reason why you are doing this. Count to three and shoot. Much of this process is a mind game and a lesson in overcoming. Count to three and

Fertility Treatment, Third Party Donation

Egg Donation Risk and Recovery: What We Know and What We Don’t

/

When considering egg donation, one of the first questions most women ask is: Are there risks? Unfortunately, this is one of the most difficult questions to accurately answer. Most clinic and agency websites, and advertisements to recruit egg donors, state that egg donation is safe and that the “risks are less than 1%.” “Less than 1%” sounds reassuring; however, this number is not accurate, due to little short-term—and no long-term—research on egg donor health and well-being. Read: Navigating The Decision to Become an Egg Donor In reality, no one knows how frequently egg donors experience side effects from the fertility drugs, surgical complications, or immediate or long-term complications because there has been no research conducted on egg donors’ experiences over time. Most of the information available in scholarly journals pertains specifically to women who have undergone egg retrieval for their own fertility treatment—not egg donors, who are younger and more fertile. This is one reason why I started my research on egg donors—so that women considering egg donation can have more information about the range of egg donors’ experiences, make informed decisions, and know-how to advocate for themselves throughout the process, should they decide it is something they want to do. What We Know Every medication has possible side effects. Every time a person undergoes a medical procedure there are possible surgical complications, as well as possible reactions to anesthesia and post-surgical infection. We do not know how frequently egg donors experience either side effects from the drugs or surgical complications because no one is systematically keeping track of this information. Different clinics may also have different egg donor outcomes, depending upon the protocols they use, how many eggs they aim to take, and the skill of the person performing the surgery. For egg donation, there are different categories of complications, that can occur at different stages of the process, some of which are more serious than others. These can include: Fertility drug side effects Surgical complications and reactions to anesthesia Post-retrieval complications Ovarian Hyperstimulation Syndrome (OHSS) Ovarian Torsion Read: The Egg Donation Medical Process: For Egg Donors Fertility Drug Side Effects There are different types of fertility drugs used during an egg donation cycle. Some are commonly used by women to prevent pregnancy, such as birth control pills. Other drugs are used to stimulate the ovaries to produce more eggs. And others are used to release the eggs from the follicle so they can be surgically retrieved. Different medication protocols have different effects on your body, and no two women are alike. Some medication protocols require more injections than others over a longer period of time, and some physicians may prescribe higher dosages than others, both of which expose your body to more hormones. It is important to understand what fertility medications you’ll be taking and the effect they can have on your body. Some of the commonly used medications and their immediate side effects can include: Lupron—Dizziness, body pain, headaches, hot flashes, appetite loss, nausea or vomiting, trouble sleeping, constipation, redness at the injection site, bone pain Pergonal—Abdominal or stomach pain, bloating, chest pain or trouble breathing, decreased amount of urine, feeling of indigestion, general feeling of discomfort or illness, headache, nausea, vomiting, or diarrhea Gonal-F—headache, nausea, vomiting, stomach/abdominal pain, pelvic pain, bloating, injection site reactions (redness or pain), breast swelling, numbness, runny nose, sore throat, acne, skin rash, swelling, weight gain Follistim—severe abdominal pain, shortness of breath, nausea, diarrhea, bloating, vomiting, swelling in hands or legs, weight gain, numbness, pain or redness at injection site Ganirelix—nausea or vomiting, diarrhea, shortness of breath, severe pelvic pain, swelling in hands or legs, stomach bloating, headache, vaginal bleeding, pain or redness at injection site Fertimax/Clomid—headache, upset stomach, bloating, dizziness, vaginal bleeding, mood changes, breast tenderness Cetrotide—nausea/vomiting, headache, pain/bruising at injection site, rapid weight gain, rapid fluid build up in stomach/chest/heart area (OHSS), decreased urination hCG—headache, irritability, restlessness, fatigue, depression, swelling in feet/legs, pain at injection site, blood clots, rupturing or swelling of ovaries, increased risk for OHSS Different women react differently to these pharmaceuticals. Some may have no or minimal adverse reactions, and others may have severe allergic reactions and need to be seen by a doctor immediately. Throughout an egg donation cycle, if any of the medications cause you to feel dizzy enough to faint or cause serious discomfort you should call the clinic right away. Surgical Complications The ovaries are near other major organs and arteries in the body. With almost any surgery there are risks of injuring surrounding organs. In some cases, there may be heavy bleeding from the ovaries following egg retrieval. Pelvic infection within days following retrieval can also occur. If you wake up from your retrieval in severe pain or feel light-headed or dizzy before you are sent home to recover, don’t leave the retrieval without being seen by a doctor. If you have any doubts about your health post-retrieval or any concerns at all, it is important to contact the clinic or, if necessary, go to the emergency room. If your clinic or agency tells you what you are experiencing is “normal” and will go away in a few days, trust your gut and ask to be seen, to be on the safe side. Your health and future fertility are important, and you are your own best advocate. Post-Retrieval Complications Within one-to-two hours after the retrieval, you will likely be sent home with antibiotics in order to prevent infection. It is a good idea to rest for at least the rest of the day, if not a few days. Some donors recover within a few hours after retrieval surgery and can get back to a normal routine pretty quickly. Others may experience pain, swelling and bloating. The doctor should have you come back for an exam and ultrasound about a week after retrieval, to make sure your recovery is on track. If you feel back to normal pretty quickly after your retrieval surgery, it is still important not to engage in any

Fertility Treatment, Third Party Donation

The Egg Donation Medical Process: For Egg Donors

/

Becoming an egg donor can feel overwhelming and scary—especially the first time! Once you’ve been selected, the process can move pretty fast. Here is what you can expect from the medical process of providing eggs. Every month, in a natural menstrual cycle, women produce multiple egg follicles (sacs in the ovaries that hold the developing eggs), but only one follicle will become a mature egg and be released from the ovary during ovulation. The remainder of the other developing follicles do not receive enough hormones from the body to develop into mature eggs, so they pass from the body during menstruation. Some women naturally have more developing follicles than others—what’s known as your resting antral follicle count—and the number of eggs your body produces may change from month to month, and reduces over time. In an egg donation cycle, a physician prescribes medications, or fertility drugs, to stimulate the ovaries to get more follicles to develop into mature eggs than the usual one per month. There are many different medication protocols that can be used to create a higher number of mature eggs than usual, a process known as superovulation. Your egg donor medication protocol may vary depending upon which doctor you go to, your resting antral follicle count and other fertility tests, and how many follicles are developing mature eggs in a single cycle. If you’re a repeat donor and have your protocol information that worked well for you (or didn’t) from a prior cycle you can share that information with the doctor, and they may use the protocol that already worked for you. Others will prefer to stick to a protocol they’re comfortable with. It is important that you understand which drugs you will be taking upfront, what trigger shot the doctor plans on using, and how many eggs they aim to retrieve. The first stop in the medical process is any pre-screening that is initially done. Read: Becoming an Egg Donor: The Recruitment and Screening Process Medical Pre-Screening When you sign up to become an egg donor, after being selected by recipients, you will be required to undergo a series of medical tests. Some clinics or egg banks may conduct these tests before you are chosen by intended parents (IPs), but most conduct the medical screening after you have been matched with recipients. Not all clinics do genetic testing or counseling, and there is some variation from clinic to clinic in the tests you may undergo. Usually, the initial medical screening includes: Blood draw on the third day of your menstrual cycle to check your hormone levels, anti-mullerian hormone (AMH) to make sure you have a good ovarian reserve and how your ovaries might respond to hormone injections Blood tests to check for sexually transmitted infections, HIV, Hepatitis, Zika, and other afflictions Urine drug screening tests Transvaginal ultrasound to check your ovaries After you have completed the above medical screenings, and are selected by IPs to be their egg donor, you will be ready to start your “egg donation cycle.” If you’re providing eggs to an egg bank, you will not need to wait to be matched with recipients. There are four different phases to the medical process of an egg donation cycle: Regulating your cycle with the recipient The stimulation phase to make the ovaries produce more eggs The trigger shot to release the eggs from the follicles so they can be retrieved Retrieval surgery to remove the mature eggs and the fluid from the follicles 1.Regulating Your Cycle If you are doing a fresh egg donation cycle when you first get “matched” with a recipient your doctor or nurse coordinator will want to coordinate your cycle with the cycle of the person receiving your eggs. The clinic will provide you with a calendar, so you can track your monthly cycle and keep track of the different prescriptions and dosages throughout. In most cases, you will start taking the birth control pill on the first day of your menstrual cycle and continue taking the pill for the next three weeks, or so. The recipient of your eggs could be either an intended mother who plans to carry the pregnancy herself or a gestational surrogate, someone who plans to carry a pregnancy for someone else. In either case—unless all of your eggs are being frozen—your monthly cycle will need to be timed, so that your eggs are ready to be retrieved around the same time the recipient’s uterus is ready for the fertilized eggs (or embryos) to be transferred. To coordinate donor and recipient cycles, different drug protocols can be used. Some use what’s called a “long Lupron” cycle–also known as a “long GnRH agonist” protocol. Lupron is a drug that was initially used to treat men with prostate cancer and is used “off-label” for fertility treatment—meaning it was not approved specifically for this purpose. Lupron is used to shut down the ovaries, which some refer to as a medically induced menopause. A long Lupron protocol means you will be taking Lupron injections for many weeks throughout the cycle. Long Lupron cycles require that hCG be used as a trigger shot to release the eggs before retrieval surgery. HCG triggers are associated with a higher risk for ovarian hyperstimulation syndrome (OHSS), to be discussed below. On a long Lupron protocol, donors start on both Lupron and birth control pills simultaneously to suppress and control when ovulation occurs. Most physicians no longer use this method—especially for egg donors—because it is more costly, it requires more injections over a longer period of time, and because it may increase donors’ risks for complications. If the doctor in charge of your egg donation cycle wants to use this protocol, you might consider talking to your own doctor to find out if this is the best option for you. Young women, and women who produce large numbers of eggs (high responders), are usually not good candidates for this protocol. 2. The Stimulation Phase After several weeks, once your cycle is regulated

Fertility Treatment

16 Tips to Prepare for IVF

/

After going through three rounds of in vitro fertilization (IVF), the entire process has become second nature to me. But with that first one—I remember those overwhelming feelings of inadequacy and confusion like it was yesterday. Along the way, I've collected all the tips, tricks and ways I organized myself throughout my cycles to share with you. Here are 16 ways you can help to prepare yourself for your own IVF cycle. 1. Get Your Finances In Order In preparation for the enormous price tag of IVF, try and pay down that credit card debt as much as you can before you start. Put together a budget and stick to it. If you can, put away as much money as you can afford into savings. A baby is the goal, but coming from someone who spent all of their money trying to conceive one, it’s no fun to be a new parent and broke. 2. Think About How You'll Save For Your Cycle While you are getting your finances in order, think about how you will pay for your cycle. Does your insurance cover anything fertility-related? Will you take out a medical loan or a second mortgage? Does your 401K or equivalent have an option to borrow against? Do you need to start saving or hold a fundraiser? Perhaps you have a rich relative? IVF is expensive and the financial side needs to be addressed long before you actually transfer. (And just kidding about the rich relative part. But if this is you, consider yourself lucky!) 3. Do Your Research This likely isn't a new tip, so why include it? Because everyone who has gone through IVF will tell you the same thing: You have to be your own advocate. Getting informed is your first step to being able to properly advocate for yourself. Research different clinics and figure out how the payment process works and what the success rates are for each clinic. Start to become more knowledgeable about the range of fertility procedures. Read: 12 Things I Wish I Had Known As An Infertility Newbie 4. Make a List of Questions To Ask Your Doctor at Your Consultation It’s overwhelming meeting your doctor for the first time when you decide to pursue IVF. Write down your questions a few days before your appointment, and make sure to bring a pen and actually write down your doctor’s answers, because your IVF consultation will probably be an overload of information. 5. Practice Your Injection Technique I’m a nurse who’s given plenty of injections. However, giving them to myself was quite a different matter. Ask your clinic nurse to help teach you, and if giving them to yourself is not your thing, get your partner or support person on board, or find someone who has experience. Read: Dealing With IVF Injections When You Are Afraid of Needles 6. Ask Your Questions Your doctor and the clinic nurses are there for you. That’s what you’re paying them for. Don’t ever feel like you’re an inconvenience, or have a stupid question. Many clinics have someone available on call for after-hours as well. 7. Find Others Who Are Doing IVF at The Same Time as You Having a “cycle buddy,” someone who is going through IVF at the same time as you, can be a life-saver. You'll have someone to lean on who is going through the same thing to bounce ideas off of or share injections tips and tricks with. Some of my closest friends came about because we were going through IVF simultaneously. 8. Keep a List of Relaxation Techniques It’s always good to have this handy list to pull out when things are getting overwhelming. Having some ideas as to what helps keep you calm so you can avoid doing things like stress eat or some other unhealthy habit you may use to cope. Think about what will be effective for you. 9. Create a Calendar of Your Shots and Appointment Schedules This one is so important. Most clinics have a booklet they give you with a calendar you can use to write in medication times and appointments. The injections can be given multiple times a day at different doses, and this is the best way to stay on top of things and avoid missed doses. With IVF, timing is important. Create your own schedule if you don’t receive a template, or if another method works better for you. 10. Decide If You Will Test Early—or Not Some people start using home pregnancy tests right away and some refrain from any testing until they hear the results of their blood tests. Both are perfectly fine, but if you’re a person like me who gets a little obsessive over that pink line and drives themselves crazy, you may need to be mindful of early testing. Thinking about how you might feel in advance might help a bit with those two-week wait nerves. Read: 10 Ways To Survive the Two Week Wait After Infertility Treatment 11. Decide Who You Are Going to Tell Your best people are those who will be there to uplift and encourage you. Decide in advance with your partner who you will tell about your cycle and those who aren’t supportive don’t need to know. This time is about you and it’s important to surround yourself with the positive influences in your life. Read: Why It's OK To Be Selfish While Experiencing Infertility 12. Nurture Your Relationship If you’re partnered, take some time now before the flurry of doctor’s appointments takes over. Get out on dates, keep in touch with each other on how you’re feeling, and find new ways to reconnect. You will need your partner when going through your cycle. Read: What Men Should Know About Emotions and Infertility 13. Don't Plan on Starting Intense New Exercise Routines It's not time to start marathon training or take on a crazy new routine. Walking is a great exercise for when you’re going through IVF. It's likely that

Fertility Treatment, Third Party Donation

Becoming an Egg Donor: The Recruitment and Screening Process

/

Becoming an egg donor requires a series of steps, from navigating the initial decision from selecting and signing up with an agency or clinic, going through the screening process and meeting their criteria, being selected by intended parents, signing legal and medical consent forms and going through hormone injections and surgery to retrieve the eggs. From first signing up to be matched with recipients, to the egg retrieval surgery date, it could be a matter of weeks, months or longer. Knowing what to expect in the egg donation journey can help you navigate terms you are comfortable with and advocate for yourself in an often confusing, sometimes overwhelming, process. Different clinics, agencies and egg banks may have different criteria for recruiting, screening and approving egg donors for their programs. Some are more restrictive than others, and many do not include things like genetic screening or testing. But from beginning to end, the egg donation process generally includes: Filling out an egg donor application, Including personal and family medical history If accepted, building a donor profile, with photos, education information and personal statement Getting selected by recipients Psychological screening Genetic screening or testing Medical pre-screening Signing legal contracts and consent forms More medical exams, blood tests, and screening Starting birth control and hormone injections Egg retrieval surgery under local or general anesthesia Post-retrieval recovery, payment and being asked to donate again As you can see, becoming an egg donor is not a quick and easy process. Some people considering egg donation think that as soon as they sign up with an agency, clinic or egg bank, they will start the process and receive a check-in as little as a few weeks. In fact, while some donors are chosen quickly, others may wait years before being selected, or not ever be selected at all. 1. Decide What Kind of Egg Donation Arrangement you Prefer The first step is identifying whether you want to choose to donate through a clinic, agency, egg bank or to a private party. If you plan to go through an egg bank, you will not need to wait to be matched with a recipient and will start the medical and psychological screening process right away. (You can read more about the difference between these options here: Becoming an Egg Donor: Agencies, Clinics & Private Arrangements). Once you decide which kind of egg donation practice is right for you, you can contact the clinic or agency of your choice to inquire and begin the application process. They will likely ask you to complete an application in person or online, with questions about your Body Mass Index (BMI), family health history, age, weight, height, education, and other criteria. Assuming you meet all the initial requirements, you will then proceed to the next step. Filling out the initial paperwork and forms can take about a week or so, depending on how much information you have to collect. Most agencies and clinics will connect you with an egg donor coordinator to facilitate the application process. 2. Creating an Egg Donor Profile The donor profile is often described as being like a Facebook profile or a profile for an online dating site. The idea behind the profile is to present yourself in a way that an intended parent chooses you to be their donor. For the agency or clinic—and even for donors—the profile can be seen as a marketing tool. Egg donor profiles used to be stored in physical catalogs and categorized by hair color and ancestry; for example, blondes, brunettes, Asian, African descent and so on. Now that most agencies and clinics have their profiles online, intended parents can search the database by donor characteristics they desire—whether hair color, eye color, ancestry, education level, and other traits. Your profile will have your donor ID number, and possibly a fake name, but not your real name. To create a profile, you will likely be required to upload current photos and photos of yourself as a child or infant. Some agencies have professional photographers do photoshoots with their donors. You will probably also provide a biography, about your likes and dislikes, height and weight, your hobbies, aspirations, what you study in school, any sports you may play, love for music, or other things that describe who you are. Part of your written information may include your reasons for becoming a donor, or any message you would like to give to the children born from your eggs. Once you finish your profile you can make it go “live.” When your profile is live, an intended parent could choose you the next day, or you may end up waiting a while. It is possible that multiple potential recipients will choose the same donor at the same time. If that is the case for you, it is advisable to not commit ahead of time to multiple recipients. If this is your first cycle, you do not know how your body will respond, or if you will want to donate again. It is ideal to go through the process first so you know how your body responds and to make sure that you like working with the people at the agency or clinic you chose. While recruiters may try to encourage you to commit to multiple cycles right away, this is likely not in our best interest, for the reasons mentioned above. 3. Matching With a Recipient When someone selects you to be their egg donor it can feel pretty exciting to know that someone wants your eggs. Most donors report that it feels like a huge compliment and how happy they are to be chosen. Some agencies/clinics require that you have little information about who gets your eggs. The recipients, though, may receive a lot of information about you from your profile and medical information. The amount of information you receive about them varies from practice to practice. Other agencies/clinics maintain that the selection process should be a two-way street, meaning that even if an anonymous

Fertility Treatment, Third Party Donation

Becoming an Egg Donor: Agencies, Clinics, Egg Banks & Private Arrangements

/

So you’ve seen the ads, you’ve thought about it and now you’re seriously looking into egg donation. Take a look at Navigating the Decision to Become an Egg Donor for a good overview of what you might want to consider when deciding to donate your eggs. The next steps include deciding what kind of egg donation arrangement you prefer. There are multiple options to choose from if you are interested in providing eggs for someone else to have a child. Some of the main options include: An egg donation agency A clinic with an internal egg donation program An egg bank Using an online forum for people looking for “known” donors Which is the ideal arrangement for you? Each of these options involves different circumstances and requirements that may affect your experiences as an egg donor, legally, medically and emotionally. Let’s take a deeper look at the different options available for providing eggs and what you’ll want to consider. Egg Donation Agencies Egg donation agencies are businesses that act as go-betweens between donors, intended parents (or recipients) and medical clinics where egg donation is performed. Each business may operate differently and have different standards when it comes to looking out for their donors. Your agency coordinator is supposed to be your advocate throughout the process and help look out for your interests and medical care. But this does not always happen. It is important to ask around before signing up with any particular agency to find out about other women’s experiences donating through them. In some online forums, such as We Are Egg Donors, current and former donors may share their experiences—good and bad—with specific agencies and help you decide on a practice that is right for you. You can also see if the agency will connect you with other donors in their program. Once you sign up with an agency most will have you go through an initial screening process. In the screening process, they will want to know your family’s genetic history, such as any heritable diseases in close or distant relatives. You will probably also have to be within a particular weight and height ratios with a Body Mass Index between 18-29. They will want to know your hobbies, educational background, and other information as well. The process of gathering all of this information, and for them to sort through it, may take several weeks. The majority of women who apply to become donors—almost two-thirds—are rejected at this point. Once you are accepted into a program, they will ask you to create an online profile. This is similar to building a Facebook profile, and may include: Baby photos Current photos Your bio—or description of who you are and why you want to donate eggs Health information You should know upfront how much the agency pays per donation. You should also know in advance if they require donor anonymity. Some donors want to have their identity open, so any child can reach them at some point in the future. Some want to be known from the outset and exchange emails or phone calls with recipients. And some want anonymity. With genetic test kits, however, anonymity can never be guaranteed. It is also important to only agree to one cycle at a time. Some businesses try to get donors to agree to multiple cycles before they have ever done one. Since you may not yet know how your body responds to the hormones used to stimulate egg production, or if you will want to commit to more than one cycle, it is important to only agree to one egg donation cycle at a time, with plenty of time off between cycles so that your body can recuperate. Do not feel pressured to commit to more than what you are ready for. Egg donation agencies work with a number of different clinics. If you sign up with an agency, you may have different standards of care depending upon which clinic the agency and recipients decide to use. For example, some clinics or physicians use more aggressive hormone protocols than others and have higher rates of complications such as ovarian hyperstimulation syndrome (OHSS). Some physicians or their staff may make you feel more comfortable and well cared for than others. It is not uncommon for a repeat donor to have a good egg donation experience at one clinic and then go on to have a horrible experience at another. Not only do you have to do your background research on the agency, but also the different clinics they may send you to. They may not tell you, but most in the industry know which medical practices or individual physicians have higher OHSS rates. Some insurers now refuse to provide coverage for physicians with donors who have high rates of complications like OHSS. Private Fertility Clinics with Egg Donor Programs Some egg donors choose to go to a private fertility clinic with an internal egg donation program. Using a private clinic, rather than an agency, will improve your chances of having the same standard of care throughout each egg donation cycle, assuming you see the same physician every time and build a relationship with the clinic staff. Private clinics, or clinics in university hospitals, often offer lower compensation than some agencies, but not always. But if you are a donor at a clinic that has doctors you are comfortable with, and who closely monitor how many eggs you produce and adjust your hormone dosages accordingly, you should have a more consistent standard of care throughout repeat egg donation cycles. At the same time, if you are not happy with the clinic or physician at a particular practice, you should avoid them. Some clinics match a single donor to a single set of recipients—what is called a “one-to-one cycle.” Other clinics have different kinds of programs and fees for different kinds of cycles, including “shared cycles.” One type of shared cycle may include saving and freezing some eggs for yourself—at a reduced

Fertility Treatment

What to Expect When Your Gestational Surrogate is Pregnant

/

Congrats! You’ve just found out your gestational carrier is pregnant. Finally, after years of waiting and innumerable months of planning, your dream of parenthood in starting turn into a reality. You also may find yourself in uncharted and unfamiliar prenatal territory. What should you expect if your gestational carrier is pregnant? Spoiler and cliché alert: Expect the unexpected. Each surrogacy partnership and pregnancy is uniquely different. There are many outliers and unforeseen factors that can take place over the course of the next 9 months. Here are few pointers on what to expect during your gestational carrier’s pregnancy. People Will Ask Questions About Surrogacy…Strange Questions People are naturally inquisitive. As surrogacy is not all that common, the vast public may not fully understand it. This means that you will receive strange questions. Know that, accept it and anticipate them. Here is the good news—you will get really good over the next 9 months of predicting when they will be asked and how you prefer to respond. Identify Potential Triggers Some instances will be centered around baby preparation such as signing up for your baby registry and selecting a pediatrician. Other questions are likely to be focused on when you decided to announce that you are expecting via gestational surrogate. Keep in mind that your family, friends, and co-workers are most likely rooting for you and will be happy to hear that you and your partner are expecting— they just might be a bit confused at first. Consider How You’ll Respond Personally, I received an onslaught of oddball questions when we first announced that we were expecting via gestational carrier. At first, I was downright appalled by some of the questions that were asked, but quickly I realized that this was an opportunity to educate people around me on why I choose the option of surrogacy to build our family. A small sample of the really bizarre questions includes: Did your husband have intercourse with another woman and how are you OK with that?! Answer: *sips wine first* (A great perk of being an intended parent is that it is still an option.) Actually, my body cannot carry a pregnancy but we were able to create an embryo through in vitro fertilization (IVF). So for us to have a child we needed our wonderful gestational carrier, assisted reproductive technology to create and transfer the embryo— and a lot of money. Will the mother have visitation rights? Answer: The baby is biologically our child, which means we have full parental rights and I will be my future baby’s mother. Think of it as our bun that is just baking in another oven. A selfless and amazing oven, that is! Check-ups With a Gestational Carrier The finer details of your gestational carrier’s prenatal care is a topic that was likely worked out in the mass print of your gestational surrogacy agreement (GSA). (Check out What to Include in a Surrogacy Agreement) However, there are some non-traditional logistics to expect in regards to check-ups and her various appointments. Meeting Medical Service Providers It starts with meeting the people who will be overseeing your gestational carrier’s prenatal care and talking through their process of how they manage and communicate in a surrogacy pregnancy. When you do meet with the OB/GYN be aware that although they handle prenatal care routinely, surrogacy arrangements are very rare. This means that not all medical professionals will have a surrogacy policy in place. Also, because there are more people involved and invested in the care of the fetus, it can complicate things concerning communication. Your gestational carrier will likely see many providers within the practice, and not everyone will know or remember that this is a surrogacy pregnancy. They will always default to asking your gestational carrier questions about future gestational tests, birth plans, and other various prenatal care-related questions. As an intended parent, this can be frustrating. The best way to overcome these communication challenges is to make sure that your gestational carrier always requests that you are present during conversations that involve prenatal care (if possible) or that she simply indicates that this is a surrogacy pregnancy and the intended parents will need to provide their feedback in as it relates to fetal care decisions. As for disclosure of information, your gestational carrier will be filling out a HIPPA form that will allow you access to information regarding her care. This is both necessary and helpful to have in place for intended parents who may not be able to attend many of the appointments. Non-Baby-Related Issues May Warrant Discretion Discussing with your gestational carrier prior to pregnancy about her comfort level of you and/or your spouse attending prenatal appointments is key. Some intended parents want to be present and others cannot or simply prefer not to. Yes, you should know about any matters that can impact the health of your growing baby but be sure to give your gestational carrier some space and an opportunity to discuss the nitty-gritty details of her symptoms in a private setting with the overseeing provider. Hemorrhoids, yeast infections, middle of the night leg cramps and leaky bladders are examples of the many other not-so-fun physical changes that can occur during pregnancy. The Hospital Tour Might Be Awkward The hospital tour can be both exciting and rather awkward for intended parents. It is likely that your gestational carrier has a preferred hospital either because it is close to her home or because she has had previous experience with it. This also means that it is likely she has sat through a few tours already and it is not necessary for her to attend. This both makes sense and also can make the scenario slightly weird. Most tours are conducted in groups of expectant parents all who are visibly showing and waddling from room to room throughout the tour. As intended parents, you might stand out a bit and that’s OK! Explaining you are expecting via gestational carrier at the beginning of the

Fertility Treatment, oldposts

Assisted Hatching for IVF

/

Assisted hatching is a technique sometimes used during an in vitro fertilization (IVF) cycle where a hole is made mechanically or chemically in the shell of the embryo before an embryo is transferred back into the uterus. This procedure is done: With the hopes of increasing the chances of the embryo attaching to the uterus (implantation) and achieving pregnancy. To make trophectoderm cells accessible for embryo biopsy. Why Assisted Embryo Hatching? To understand exactly what assisted hatching is, you need to first know the anatomy of eggs and embryos. Every egg has a natural shell around it which has two jobs: The first is to only let one sperm enter, making sure the embryo doesn’t have too many chromosomes. The second job is to protect the cells of the dividing embryo and ensure that implantation doesn’t happen too soon in the fallopian tube (rather than the uterus), where a pregnancy would not be viable. This shell is called the zona pellucida, and it is a thin, gelatinous layer made up of proteins that you can see as a halo around each egg and embryo down the microscope. Here is a photograph of a fertilized egg; you can see the shell around the embryo, which is still a single cell. Does Assisted Hatching Help Implantation? Once the embryo has developed to the blastocyst stage, it has to escape from the shell to implant in the uterus. (Read more about the different stages of embryo development.) If the shells of the embryos are thicker or tougher than usual, it may be difficult for blastocysts to hatch naturally. In such a case, the embryo cells cannot come into contact with the uterine lining, meaning that implantation fails and there will be no pregnancy. With assisted hatching, once the embryos are hatched in the lab, there is no chance of them being trapped inside their shells after they are transferred. This does not guarantee implantation. How is Assisted Hatching Done? Assisted hatching can be done in several ways; the most common way is using a laser attached to a microscope. This allows the embryologist to make a small precise hole in the shell using short laser pulses. This may also be called laser-assisted hatching. Other ways are by partial zona dissection or cutting the shell with microtools and acid tyrode’s, which is a chemical that dissolves away part of the shell. These methods are all good for making a hole in the shell and are easily done by a proficient embryologist. You can see a blastocyst that has had assisted hatching with a small section of the shell missing. The three embryos in the photograph below are all hatching out of their shells and are ready for implantation. Is Assisted Hatching Necessary? While several studies have suggested the benefits of assisted hatching, it is not necessary a procedure well-suited for everyone. Some studies have shown no benefit from hatching embryos when comparing two similar groups of patients. It is, however, a standard practice at most clinics and is used in all cases of frozen/thawed embryos and with patients who meet the following criteria: Have a raised FSH level or low ovarian reserve Are over 37 years of age Have poor-quality embryos Have thickened shells around the embryos Have previously failed attempts at IVF Are using frozen and thawed eggs or embryos Assisted Hatching & Chromosome Testing All embryos that are going to undergo chromosome testing have assisted hatching before freezing. This is so the embryologist can easily do the biopsy and take a small number of cells for analysis. The embryo biopsy procedure can be seen in the photograph below; you can see the hatched area allows removal of cells for chromosome testing. Read more about preimplantation genetic testing for aneuploidies (PGT-A). Can Assisted Hatching Damage Embryos? The zona pellucida is not a living part of an embryo, so there is no damage done by penetrating the shell. Assisted hatching is considered to be a very low-risk procedure and will not usually cause any damage to the embryo. Rarely, an embryo can be damaged to the point that it is unusable. Can Assisted Hatching Create Twins? It may increase the chances of an identical twin, but the risk of an embryo splitting is still very low (and does also happen without assisted hatching). Talk to your doctor if you think you might benefit from this procedure.

Scroll to Top