General

Step four: Fertilization

Prior to embryo development, fertilization must first occur. Once the eggs and sperm are collected, sorted, and prepared, Shady Grove Fertility’s specially trained embryology team begins the fertilization process. There are two methods used for fertilization:

Conventional fertilization
Conventional fertilization is a standard form of fertilization used during the IVF process and frequently used in cases such as blocked Fallopian tubes or unexplained infertility. The embryologist starts by “washing the semen” allowing him/her to isolate the healthy sperm, which are then placed around each egg so fertilization can occur.

Intracytoplasmic sperm injection (ICSI)
ICSI is used in cases when the quantity or quality of sperm is poor and therefore unable to effectively penetrate the egg on its own. The embryologist selects a single sperm and injects it directly into the center of each egg. Since fertilization only requires one healthy sperm, ICSI has become one of the most incredible advancements in treating severe male factor infertility.

The decision about which method to use is based on the quality of the sperm. To test sperm, a semen analysis is completed as part of the initial basic fertility work-up for diagnosis before treatment and then again when the semen sample is provided on the day of the egg retrieval. If the results from this analysis do not meet the parameters required for conventional fertilization, the embryologist will make the decision to switch to ICSI so that the cycle can still produce embryos and increase your chances of success. The clinical team will let you know if an unplanned ICSI procedure is recommended.

Embryo development

Embryo development begins when the fertilized eggs are placed in an incubator overnight. Embryo development begins when the fertilized eggs are placed in an incubator overnight. Then, the lab provides a report on the patient’s developing embryos the day after retrieval and again on day 5.

The goal is to see the slow and steady development of a 4-cell embryo on the second day of development into an 8-cell embryo on the third day. After the 8-cell stage, cell lines begin to blur and the embryo enters what is called the blastocyst stage at day 5 or 6. The blastocyst has a protective jelly-like shell called a zona pellucida and defined areas of cells within it. The organization of what is called “the inner cell mass” is a key indicator of how likely the embryo is to implant.

Step Three: The Trigger Shot And Egg Retrieval

The stimulation phase ends with a trigger shot. The trigger shot provides final maturation to the developing follicles and sets ovulation in motion. Timing is crucial in this phase because egg retrieval must be performed prior to the expected time of ovulation. The doctor decides when you are ready to trigger based on the two key factors that have been monitored during the stimulation phase:

Size of the follicles
The goal is to have the majority of follicles between 18mm to 22mm since these are the follicles most likely to contain mature eggs.

Level of estrogen (estradiol)
The estrogen level directly correlates with the number of follicles in the ovaries and is used to help your physician determine the appropriate medication to use for the trigger shot. The cells inside each follicle produce estrogen so a patient with eight follicles will generally have a blood estrogen level that is lower than a patient with 16 follicles.

The egg retrieval

Approximately 36 hours after the trigger shot the egg retrieval will occur at one of our three accredited ambulatory surgery centers (ASC) in Rockville, MD; Chesterbrook, PA; or Towson, MD. Your partner’s (or donor) sperm is either collected the day of the retrieval or if he is unavailable, as is the case for many out-of-state or international patients, previously frozen sperm will be thawed and used.

The day of your egg retrieval you will meet with two different providers, the first is a Shady Grove Fertility physician who will be performing the egg retrieval. At this time you will discuss your protocol and what will happen during the fertilization phase in the embryology laboratory. Next, you will meet with an anesthetist who will review your medical history and start an intravenous (IV) that will deliver the anesthesia medication. This is not general anesthesia but a quick-acting sedation that lasts for the duration of the procedure.

The egg retrieval itself typically takes about 20 to 30 minutes. During the procedure, an ultrasound is used to guide a needle into each ovary to remove the follicular fluid and egg.

Step Two: Ovarian Stimulation

In a normal ovulation cycle, one egg matures per month. In an IVF cycle, the goal is to have several eggs mature, as this will increase your chances of success with treatment. In the ovarian stimulation phase of the IVF cycle, injectable medications are used for approximately 8 to 14 days to stimulate follicular development.

Ovarian stimulation medications are derivatives from the hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are the body’s hormones involved in the natural ovulation process. Your protocol may recommend taking one or more of these hormone medications.

Monitoring Ovarian Stimulation

During the ovarian stimulation phase, you will come into the office approximately seven to eight times for morning monitoring appointments. Monitoring appointments consists of:

Transvaginal ultrasound

• The ultrasound measures the growth of each follicle (that contain an egg) and the thickness of the uterine lining, both of which should be increasing as you take the injectable medications.

Bloodwork

• Blood is drawn and tested to measure the estrogen level. The levels of estrogen in the blood are another indicator of the growth and maturation of the eggs—rising as the follicles grow.

After each monitoring appointment, you will receive a phone call from your nurse, usually in the afternoon. It is extremely useful to be available to speak with the nurse when she calls to make sure you receive any important instructions and clarify any aspects of your care. During the update your nurse will explain to you the progress of your cycle, any medication modifications, and when you should return for the next monitoring appointment. This is also an opportunity for you to ask any questions about your cycle, test results, and discuss any side effects you may be experiencing.

Five tips to make the most of the tax deductions for medical expenses

*NOTE: Each patient’s circumstances are unique. Please consult with your personal tax advisor to determine how these deductibility rules may apply specifically to you.

At Shady Grove Fertility, we are dedicated to helping each patient feel confident about their ability to grow their families through outstanding treatment success rates and innovative financial options. In addition to our financial programs, we also strive to make patients aware of cost-saving measures, including one very surprising option: Uncle Sam.

For tax returns filed in 2021, many patients may be able to take advantage of an IRS rule that allows qualified, unreimbursed medical expenses that exceed 7.5% of their 2020 adjusted gross income to be itemized and deducted from their annual tax bill. Itemizing medical deductions can result in a significant refund of the money patients pay for fertility treatment.

1. Compile Every Receipt

Compile your saved invoices and receipts – even the ones you think you won’t need – because infertility treatments are just part of the total that may be deductible. Many patients are surprised to learn the types of expenses that may qualify. You should consult your tax advisor for specific guidance on your individual circumstances, but here is a list of expenses that you may be surprised to know are deductible (click here to view the full list of medical expenses):

• Co-payments/Co-insurance
• Laboratory fees
• Prescription medications
• Fertility treatment fees that are paid out of pocket
• Travel expenses for trips related to medical care including mileage, tolls, parking, hotels, and meals

For the most thorough and up-to-date information on deductibility of medical expenses, go to the IRS website.

2. Utilize a detailed log of expenses

Using a detailed record of when each expense occurred is vital in the event you are contacted to verify your deductions. The IRS form where you itemize your deductions does not provide space for you to explain why your medical expenses are higher than usual. Therefore, you may be contacted by the IRS and asked to provide additional information to verify your deductions. The more accurate and detailed your records are, the better prepared you will be to provide the information that may be requested.

3. Keep all of your records

The IRS recommends taxpayers keep their returns and any supporting documentation for three years after the date of filing or two years from the date you paid the tax, whichever is later, if you file a claim for credit or refund after you file your return.

After that, the statute of limitations for an IRS audit expires. If you’ve under-reported income by 25 percent, however, the IRS can go six years back, or seven if you claim a loss for bad debt or worthless securities. If you don’t file, or if you file a fraudulent return, the IRS has no statute of limitations; so it may be best to keep your records indefinitely.

4. Forgot to write off your fertility treatment last year? it’s not too late.

If you had fertility expenses you didn’t deduct last year, you can file IRS Form 1040X to amend previous tax returns to include your deductions. Form 1040X must be filed within three years from the date of your original return or within two years from the date you paid the tax, whichever is later.

5. Flexible spending accounts & health savings accounts

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) provide alternative ways for patients to pay for out of pocket medical expenses with pre-tax dollars. Employers who offer FSA/HSA plans allow employees to save a portion of their pay in an account specifically earmarked for medical expenses. This money is not taxed. If your FSA or HSA account is not large enough to cover all of your expenses, the remainder can still be itemized as deductions.

Whether you are still researching treatment, currently undergoing treatment, or have already completed your treatment, the IRS’s rule on deducting medical expenses can help you. Itemizing medical deductions or using an FSA account will require some diligence and a little extra paperwork, but it may save you thousands of dollars in taxes.

Using these tips, along with the other programs provided by Shady Grove Fertility, can put fertility treatment – and your dreams of parenthood – within your reach.

About 40 percent of patients who undergo IVF have an additional embryo(s) that they choose to cryopreserve (freeze) to use for another attempt, should their first cycle be unsuccessful, or to continue to build their family at a later date. This process is called a frozen embryo transfer (FET). But what goes into a frozen embryo transfer process, and what are the chances that those frozen embryos will result in a positive pregnancy test?

“For patients with a good prognosis who are 35 years old or younger, we can offer an approximately 60 percent pregnancy rate per embryo transfer,” says Dr. Anitha Nair of Shady Grove Fertility’s Washington, D.C. – K Street and Arlington, VA offices. “In turn, this means that the success rates for FET cycles are very similar as IVF cycles using fresh embryos.”

How do you freeze an embryo?

Once a couple has gone through a fresh embryo transfer, any extra embryos that were not transferred and have made it to the blastocyst stage (day 5) are frozen via vitrification. This process is done by placing the embryo into a solution and then rapidly freezing it in liquid nitrogen. The rapid freeze increases the cooling rate and prevents the formation of ice crystals, which may cause breakage later. The most important part about this technique is the benefit of being able to thaw and transfer back fewer embryos compared to the “slow-freeze” process that was traditionally used, as the embryos frozen via vitrification have higher survival rates through the freeze and unfreeze process. Ultimately, this increases the chances of pregnancy for patients using frozen embryos.

“[Prior to vitrification] in order to optimize a patient’s chances at pregnancy, we would transfer back one additional thawed embryo than we would transfer in a fresh IVF cycle,” explained Dr. Nair. “But with vitrification, we’re more often transferring the same numbers of embryos, fresh or frozen with nearly the same pregnancy success rate.”

What to expect during an FET cycle

When the patient decides it’s time to use the frozen embryo(s), the frozen embryo transfer process begins with a pre-medication ultrasound to ensure there are no cysts or other structural problems. Once cleared to start a cycle, you will take medication to optimize the lining of your uterus for implantation. You will give estrogen and progesterone injections every third day for up to 2 to 3 weeks, and your uterine lining is checked by post-medication ultrasound.

Dr. Nair explains that, although there are still medication protocols to follow, when a patient comes in for a FET cycle, there is typically significantly less medication, and patients find the process far easier and less stressful than undergoing a fresh IVF cycle.

“The whole frozen embryo transfer process is less intense and requires far fewer office visits,” explains Dr. Nair. “The patient will use less medication since all we’re doing is stimulating her uterine lining to prepare for implantation. No ovulation medications are called for with an FET. Plus, there’s usually only need for one ultrasound monitoring appointment to check her lining, as opposed to the frequent monitoring done with fresh cycles.”

After a couple weeks of preparation, it’s time to thaw the frozen embryos and transfer them to the hopeful mother. Thawing takes very little time, just about an hour, so transfer day is eventful.

“We’re conservative and start thawing only the number we intend to transfer,” Dr. Nair explains. “If those initial embryos don’t come through the process in good shape, we’ll thaw more if necessary. Generally, almost nine out of ten embryos survive the thawing process.”

Dr. Nair says that one of the interesting benefits of FET for many patients is that it’s a little like freezing time. “Let’s say a patient goes in for her IVF at the age of 33 and freezes some of the resulting embryos,” she said. “When she returns in a few years for an FET for her second baby, her ovaries and eggs will have aged and her fertility will have statistically decreased somewhat, but her frozen embryos are just as good cellularly as they were when she was younger. It’s like a head start in the getting-pregnant process for older women.”

If you’re interested in learning more about the frozen embryo transfer process, please connect with your SGF medical team. To schedule a consult with a physician, please call 1-877-971-7755.

Editor’s note: This article was most recently updated in September 2016.

Step One: Getting Started With Ivf

For nearly 40 years, in vitro fertilization (IVF) treatment has helped millions of couples worldwide overcome a wide variety of infertility diagnoses and enabled them to realize their dreams of becoming parents. IVF helps infertile couples become pregnant by joining the egg and sperm together in an embryology laboratory where embryos are created that can later be transferred back into the woman’s uterus. While most of us have heard about IVF, many don’t know the details of the IVF process.

The IVF process can be broken down into six parts from pre-cycle appointments and preparations through the pregnancy test. Whether you’re just starting to research fertility treatments or are already a patient planning to begin IVF, knowing more about the process can reduce any anxiety and help you feel more prepared for treatment.

Initial IVF Consultation & Preparing The Ovaries For Stimulation

Following the completion of the pre-cycle testing, you will meet with your physician to review the results and plan the treatment protocol. The protocol is like a blueprint that is used by you and your medical team. It is important to remember this plan provides tentative dates; frequently, treatment timelines will need to be adjusted based on how you respond to medication. You should anticipate changes and block time as needed in your work and travel schedules.

In preparation for an IVF cycle, you will undergo a mock embryo transfer. This procedure is a practice run before the actual embryo transfer and allows the doctor to test the size and placement of the catheter with your particular anatomy before the big day. During the procedure, an ultra-thin catheter is inserted into the uterus while a sonogram guides the process on a monitor. Many patients compare the mock embryo transfer to a Pap smear, as it is relatively painless and takes only a few minutes.

Many women start an IVF cycle by taking birth control pills for a set number of days, to help:

• Decrease the chances of creating cysts that could interfere with the cycle start.
• Synchronize the egg follicles so they all start at the same stage, on the date collectively chosen by the doctor and patient.
• Allow the physician and patient to control the timing of the cycle.