Treatment

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If you have made the decision to proceed with in vitro fertilization (IVF) to achieve pregnancy, here is your step-by-step guide to prepare for the discussion with your fertility specialist at your IVF consult.  Regardless of the reason for choosing IVF, here are 10 common considerations for every IVF cycle. We encourage you to discuss each one with your physician during the consult.

1. Stimulation protocol

Based on your age and testing of your ovarian reserve, your doctor will choose a protocol that will best balance optimizing the number of eggs available for retrieval while being careful to avoid ovarian overstimulation. There are several protocols that are used and other factors to consider such as whether you have endometriosis, polycystic ovarian syndrome (PCOS), or prior IVF cycles with low egg yield. A common question is whether there are supplements that you should be taking prior to starting that may improve the outcome. I encourage women considering IVF treatment to ask their doctor if taking supplements such CoQ10 or Ovasitol may be a good idea for their individual preparation.

2. Monitoring

In general it takes about 9 to 12 days of injections to stimulate the ovaries to produce mature-sized follicles. The dose of medications may be adjusted during this time based on your hormone values and the rate of follicle growth. Your response to the injectable medications to simulate your ovaries is evaluated by bloodwork and ultrasound. The average number of visits for monitoring is about 6 and is more frequent towards the end of the stimulation when the follicles are close to maturity.

3. Trigger

The goal is to have a reasonable cohort of follicles in the mature range before “triggering” the release of the eggs from the wall of the follicle. There are two medications that are used either individually or together to cause the eggs to release at a specific and predetermined time so that your egg retrieval occurs at a predictable timeframe. The choice of the trigger medication depends on how robust your stimulation is, whether a fresh embryo transfer is planned, and whether you have a medical history that may guide the choice. Most patients have their egg retrieval done about 36 hours after the trigger shot.

4. Egg retrieval procedure

You have done a lot of work to get to this point! With daily injections and frequent monitoring visits with bloodwork and ultrasounds, you may start to “feel” your ovaries getting full of mature follicles. We perform the typically quick (15-20 minutes to perform) egg retrieval procedure under anesthesia. The procedure requires a needle aspiration under ultrasound guidance.

5. Fertilization technique

There are two main ways to expose the eggs to the sperm. Conventional IVF involves simply putting the eggs and sperm in the same dish and allow nature to take over. Intracytoplasmic sperm injection (ICSI) is a technique where we select a single sperm to directly inject into a mature egg. We generally recommend ICSI in cases of low sperm concentration and/or motility, a lower percentage of normal sperm shape, use of frozen sperm (like donor sperm), or when we plan for additional genetic testing on the embryo. There are other techniques that are less standard but may be considered in unique scenarios such as PICSI, but talk to your doctor about whether this is right for you.

6. Assessing embryo development

After the sperm fertilizes the egg, it becomes an embryo. The embryology lab will be your embryos’ first babysitters! You should get updates at critical stages such as how many eggs fertilized normally and how many reach a stage suitable for transferring. Remember, not all eggs are mature and not all mature eggs fertilize normally. The percentage of embryos that develop into a stage that can be transferred is variable and often dependent on your age. The quality of the embryos can also vary and the lab will grade them based on their appearance and development overall.

7. Assisted hatching

Your physician will discuss with you if he/she recommends assisted hatching. Assisted hatching is a technique performed by the embryologist to create a “window” in the shell around the embryo called the zona pellucida. It can help the embryos hatch out of the shell to allow it to implant in the uterus. There are usually clear medical indications for assisted hatching so discuss with your fertility specialist his/her recommendation individualized for your unique situation.

8. Number of embryos to transfer

There are national guidelines on the safe number of embryos to transfer, which balance pregnancy success rates and the risk of multiple gestation. There should be a plan on the number of embryos that is right to transfer for you. It is important to remember that the overwhelming majority of pregnancies from IVF are singletons and IVF is the safest option to avoid multiples. If you are worried about twins, there are effective ways to select the best single embryo for transfer (eSET).

9. Preimplantation genetic screening

Your physician will discuss with you if he/she recommends preimplantation genetic screening (PGS). PGS allows you to know whether your embryos are chromosomally normal or have abnormalities such as an extra chromosome 21, which causes Down syndrome. Missing and extra chromosomes account for the majority of genetic abnormalities seen in embryos and can contribute to failed implantation or miscarriage. The likelihood of having these chromosomal abnormalities increase with age. Risk of a chromosomal abnormality may also be increased in some cases of prior recurrent pregnancy loss.

10. Embryo disposition options

If you have extra embryos created during an IVF cycle, most patients choose to freeze or cryopreserve them for the future. If you choose not to freeze them, you may choose to donate them for research or anonymously to help other couples build their families. You should take time to explore your values, family building goals, and preferences before choosing to discard the embryos.

The IVF consult is the best time to ask all the questions you have so you are comfortable that the plan is designed specifically for your needs. There are risks and potential unexpected situations specific to each stage of the IVF process, which you will have a chance to discuss at your consult as well as the process to minimize those risks and available back up plans. Most of your interactions will be with your physician and nurse but there is an entire team that collaborates in your care including the embryology lab, anesthesia team, finance team, pharmacy, and possibly the genetic testing lab if you are electing any preimplantation testing. It is important that everyone is on the same page, knows your preferences, but also has an opportunity to help guide you to make the right decisions for you. From the time you start stimulation medications until you get your pregnancy test results, it can be as quick as a month. For many patients IVF will be quicker than they thought but also easier with the right planning.

Written by: Kara Nguyen, M.D., M.P.H, of Shady Grove Fertility’s Reading, PA and Harrisburg, PA offices.

Schedule an Appointment

To schedule your IVF consult appointment with one of our reproductive endocrinologists, please call 1-877-971-7755 or click here to complete this brief online form.

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“Will I still be able to have children one day?” is often a question that’s top of mind for women who are diagnosed with cancer and faced with the need for cancer treatment but still want the option for family building in their future. For an expert’s perspective on how to navigate this challenging situation, Romper.com turned to Dr. Gilbert Mottla of SGF’s Annapolis, MD office.

Today, women can pursue fertility preservation—oocyte cryopreservation or egg freezing—to preserve their chances of having children following cancer treatment/remission. However, patients often have a short window before cancer treatment to complete this process and plan for their future—either by freezing their eggs or fertilized embryos.

Why do not all people go through with fertility preservation?

What often stops people from pursuing fertility preservation is finances. Young women with cancer must grapple quickly with some of life’s hardest decisions. About 50 percent of patients who begin the fertility preservation process complete it. “Some of those people aren’t interested in being pregnant, some are too sick to consider it, and there are a whole lot of people who don’t have the financial wherewithal to be able to do it,” explains Dr. Mottla, who testified about the necessity of oncofertility insurance before the Maryland House of Delegates earlier this year.

Fertility Preservation at SGF

When a patient with a recent cancer diagnosis comes to Shady Grove Fertility, a specially trained team guides them through the entire treatment process. This team helps to navigate patients through each step, from finding ways to afford treatment to the actual medical procedure. Due to the time-sensitive nature of treatment, women with cancer can expect an expedited treatment plan and to see a physician for consultation as soon as possible—usually within a few days of calling our office. Once you decide to move forward with treatment, it generally takes 2 to 3 weeks to complete stimulation of the ovaries for the egg retrieval.

Dr. Mottla emphasizes that the options for fertility preservation are good— “that fertility can be spared, and years of regret and grief staved off—with luck, hope, and liquid nitrogen.”

If you or a friend or loved one has been diagnosed with cancer and are interested in learning more about fertility preservation before cancer treatment, we encourage you to contact our New Patient Center at 1-877-971-7755 to schedule an appointment. SGF partners with LIVESTRONG in offering patients a significant discount off the cost of fertility medications used in oncofertility cycles. 

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When Cosmopolitan.com wanted to answer commonly asked questions about donor egg treatment, they looked to the experts, SGF’s own Kate Devine, M.D. and Michele Purcell, R.N.

SGF is the leading egg donation program in the country and our transparency with potential egg donors has garnered national attention. Our program works to attract women who are healthy, informed, altruistic, and dedicated.

What does SGF look for when screening potential egg donors?

SGF looks for all types of healthy women. While there is no “perfect” type of donor, each donor who applies is given equal consideration during evaluation and prescreening. By completing an Egg Donor Profile, the overall goal is to help people who need a donated egg to build a healthy family. SGF has a team of Donor Liaisons dedicated to evaluating potential donors and determining if they are the best candidate for donation.

There are basic criteria women need to meet in order to donate to protect her own health and adhere to the guidelines set forth by the FDA and American Society for Reproductive Medicine (ASRM) for egg donation; such as body mass index (BMI), recent travel, or sexually transmitted infection (STI) history. SGF’s program does allow for women to be deferred and re-apply when their BMI is within the accepted range. Similarly, women can re-apply if it’s been a year or more since their STI was successfully treated. We know that potential donor egg recipients want a healthy donor and we work to make sure all of our donors follow a healthy lifestyle before proceeding.

Is it all about the money?

No. While SGF does offer a generous compensation package for women who choose to donate their eggs, Dr. Devine said, “Appropriate compensation for eggs donors should be based on the local cost of living and should cover her lost wages, mileage, parking, and other expenses.” At SGF we are transparent about the time commitment associated with egg donation. We know that our donors’ time is valuable and we make sure to compensate them for all of their time with us as an egg donor. We have found that most of our donors do it for more than money. Michele Purcell said, “It’s kind of like when you go and donate blood and you leave thinking, ‘That feels really good. I hope someone was able to use it, and benefit from it,’ and I think our donors have that same type of feeling of being grateful for the experience.” Dr. Devine agreed, “The money helps, but the altruism is the driving factor.”

Why is prescreening important for donor egg treatment?

All egg donors in our program undergo an intensive prescreening process before being fully accepted into the program. From the very beginning of the egg donation process at SGF, egg donors are our patients too. Women go through a medical and psychological screening to help determine their eligibility to donate. Medically, we look for healthy ovaries and hormone levels. Psychologically, we want to check in and make sure donors understand how their generosity makes a tremendous impact on both their life and that of the recipients. Dr. Devine explained that the screening process for an egg donor is usually mutually beneficial. “This [info] may serve that egg donor very well, whether or not she’s ultimately accepted to donate her eggs, because she gets information on her own fertility and reproduction that she otherwise might not have.”

Why wouldn’t a possible donor be accepted to donate their eggs?

It’s important to keep in mind the requirements for egg donors are incredibly strict and not every woman applying will qualify to donate. SGF has a 3 to 4% acceptance rate for our program. Michele Purcell says that prospective donors may not meet the age requirements for donation, or sometimes they don’t live locally enough (a person from California applying for an East Coast based fertility clinic), or perhaps BMI requirements have not been met.

Learn more about SGF’s pre-screened egg donors and how donor egg treatment makes parenthood possible.

Schedule an Appointment

 To learn more about donor egg treatment or to schedule an appointment with one of our physicians, please contact our New Patient Center at 1-877-971-7755 or complete our brief online form.

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The continuous progress and innovation that surrounds egg freezing has led to immense change in the societal perspective of women who freeze their eggs, as well as the availability and popularity of egg freezing itself.

Prior to 2009 when the use of vitrification (a fast-freeze technology, whereas older slow-freeze methods would produce crystals inside the eggs ultimately damaging them) was introduced and proven to be a highly reliable method for freezing eggs, egg freezing was only utilized by women looking to preserve their fertility prior to undergoing cancer treatment. Then, it wasn’t until 2011 that the ASRM (the American Society for Reproductive Medicine) declared the use of vitrification no longer experimental for elective egg freezing, which catapulted egg freezing popularity and availability into the next generation.

Fast forward to 2017, and thousands of women, including celebrities and outspoken advocates,  are electing to freeze their eggs (with the highly reliable method of vitrification) and feeling empowered to pause their biological clock and pursue family building when their life’s timetable—not necessarily their body’s timetable—dictates it’s time.

With the help of celebrities who have opened up about their egg freezing stories, more and more women are now aware of their options to preserve their fertility.

Age is the Primary Reason Women Choose Egg Freezing

Age is a leading factor in infertility; a woman’s eggs deteriorate in quantity and quality over time. However, with the technology and resources available to silence the constant ticking of the “biological clock,” women are now freer than ever to take their reproductive options into their own hands.

As the workforce continues to change and more and more women are pursuing advanced academic degrees, ultimately extending the age at which they may get married or start having children, egg freezing has become more commonly known and widely accepted.

Over the past several years, a few big names have become strong advocates for egg freezing and have used their position to raise awareness and share the benefits they have reaped from egg freezing.

Preparation is Key: Kim Kardashian

Kim Kardashian took the same stance years ago when she decided to freeze her eggs. “I think now I can just be proactive,” she said at the time when she shared during an episode of her hit TV show Keeping Up with the Kardashians, “I want to make sure when the time is right, I want to be prepared. I want to be safe.”

Postponing Motherhood: Rita Ora 

Rita Ora froze her eggs in her early 20’s. She said “she always wanted a big family and had been thinking about children since her early 20s.” While Rita is still young she is a, “big believer in using what we have and making the most of it.” While freezing in your earlier 20s is optimal because of a woman’s egg quality, many women freeze in their early and mid 30s.

Endometriosis and Egg Freezing: Halsey

Halsey revealed that at 23 years old she’s freezing her eggs because of her endometriosis. When I tell people that, they’re like, ‘You’re 23, why do you need to do that? Why do you need to freeze your eggs?’ What people don’t know that is that surgery for endometriosis can impair a woman’s fertility. In order to preserve her fertility and treat the endometriosis, Halsey is freezing her eggs so she can protect her fertility and have options for the future.

A Back-Up Plan: Olivia Munn

In 2016, Olivia Munn came forward to tell fans on Anna Faris’ podcast Anna Faris is Unqualified that “years ago, [she] froze a bunch of eggs” and encourages others to do the same. She admits that the pressure is off as she can focus on her career and that the dating landscape has changed. Women are able to form relationships that aren’t coerced by the need to have children quickly and, by having a back-up plan, women may still have more children after a failed relationship despite her age.

Free and Fierce: Sofia Vergara

Sofia Vergara came to appreciate the dating freedom that egg freezing provided; with a boyfriend younger than her who aims to have children, she is able to comfortably explore her relationship without the pressure of time having an impact. “I just wanted to plan ahead,” Vergara, 40, told ABC News in regards to her decision to freeze. She explains that she doesn’t plan on having children now but, for her boyfriend, it leaves the option open.

Dating Deadline: Whitney Cummings 

Comedian, Whitney Cummings decided to freeze her eggs because “I was dating people just because I was on a deadline.” Egg freezing now gives her the option to find the right partner to have children with when the time is right. She said “I’d be happy to have kids and dogs in the next 10 years.”

Taking Control of Her Future: Kaityn Bristow

The bachelorette star, Kaitlyn, announced that she is freezing her eggs. “I’m taking control of my future.” “As a woman there’s always pressure to have babies, and this puts my mind at ease for when I’m ready.” For Kaitlyn, egg freezing is a back-up plan, so that she can have options for when her and fiancé Shawn Booth are ready to grow their family. 

A Leading Voice: Sarah Elizabeth Richards

Sarah Elizabeth Richards is a journalist who has contributed to the New York Times, The Wall Street Journal, Time, Elle, and more and is the groundbreaking voice behind her book Motherhood, Rescheduled. Her book accounted for her own experience in egg freezing as well as the impact that egg freezing has had on other women. Since learning about egg freezing at 35 and doing multiple cycles of her own in 2011, Richards has continuously advocated for the life-altering effects that deciding to freeze your eggs can have on a woman. She describes the process as a “profound sense of relief,” leaving her feeling proud of herself for taking control of her future and her fertility. Motherhood, Rescheduled serves to educate women on what egg freezing really is as well as divert from the old stigma that egg freezing is an act of desperation rather than a wise, proactive decision. She recognizes society’s lack of familiarity with the process and the common tendency for OB/GYNs to neglect discussing egg freezing as an option for their patients. Richards felt that she was lucky enough to know to ask, and wants egg freezing to be more widely talked about among communities and between doctors and their patients. Her piece in the New York Times, “We Need to Talk about Our Eggs,” focuses on the need for widespread information so women can make educated decisions regarding their lives before it is too late.

Education Comes First: Radell Peischler

As a former SGF patient who has been very active in sharing her experience with other women, Radell Peischler made it her goal to increase education and awareness about egg freezing. In 2014, 4 years after learning about the option to freeze her eggs, Radell went forward to complete a cycle and has been an advocate for women putting themselves first ever since.

Schedule An Egg Freezing Appointment

Egg freezing allows women to alleviate the pressure of finding healthy and happy relationships, commit to their careers, and take control of their futures without fear of age having an impact on what they are capable of. Like a weight off your shoulders, as many celebrities shared, egg freezing offers the opportunity to put your mind at ease for when the time is right to have a baby.

For more information about Shady Grove Fertility’s Egg Freezing Program, including our new financial option with monthly payments as low as $195/month, call 1-877-411-9292 to speak with one of our New Patient Center Liaisons. 

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Surrogacy has been a hot topic in news because last week, Kim Kardashian and Kayne West announced they are expecting their third child through a surrogate. New York Magazine’s The Cut turned to SGF’s own Ryan Martin, M.D., of Shady Grove Fertility’s Bala Cynwyd, PA, office, to provide some surprising facts about surrogacy.

Surrogacy and Gestational Carriers are NOT the Same

In the case of a gestational carrier, the woman carrying the pregnancy is in no way biologically or genetically related to the child she is carrying. She is merely providing a nurturing environment in the form of a uterus for the child to grow for the gestational period of, ideally, 40 weeks. A gestational carrier is not a traditional “surrogate,” as a surrogate is someone who donates her egg and then subsequently carries the child.

Same sex male couples and women unable to use their own eggs would be candidates for a traditional surrogate. While, if the woman is able to use her own eggs, SGF will treat the female partner as a traditional in vitro fertilization (IVF) patient, with her cycle culminating in an egg retrieval. Her egg and her partner’s sperm will then be fertilized in the lab and a physician will transfer the embryo to the gestational carrier.

according to Dr. Martin, before a gestational carrier is implanted with an embryo, she would have a mock embryo transfer. “We try and thicken the lining of the uterus up like it would during a normal cycle,” Martin said. The goal of this mock transfer is to see if the uterus responds appropriately and to make sure the gestational carrier or surrogate doesn’t have any problems.

Surrogacy Can Be Expensive

For celebrities like Kim Kardashian and Kanye West, money is no object, but for most fertility patients cost is a major concern. Costs can include the IVF process and compensation for the carrier.  “The cost of transferring an embryo is not expensive; the cost is more so for paying the carrier to carry the pregnancy,” said Dr. Martin.

Surrogacy Isn’t a “Career” For the Carriers

Gestational carriers are able to serve as a surrogate more than once, but this is dependent on her health, age, and ability to successfully carry a pregnancy. However, Dr. Martin notes that these women aren’t able to necessarily make a “career” out of surrogacy, although they do of course receive compensation. “Sometimes we have carriers that will do it multiple times for people, it’s a way for many women to give back to those who have been less fortunate reproductively,” he said.

 While Shady Grove Fertility does not recruit gestational carriers, we work with many partners that meet Shady Grove Fertility’s standards for quality. Surrogacy and gestational carriers are both ways that SGF continues to make parenthood possible for everyone.

Schedule an Appointment

 For more information about surrogacy and gestational carriers, or to schedule an appointment with one of our reproductive endocrinologists, please contact our New Patient Center at 888-971-7755.

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Since 2013, Shady Grove Fertility has seen the number of women freezing their eggs increase by 83 percent. According to a new report by the Centers for Disease Control and Prevention, more women in America are having children in their early 30s than in their late 20s, which contributes to the rise in egg freezing but also emphasizes the critical importance of the availability and reliability on egg freezing as a medical option for women.

Why is the increase in age of women having their first child such an important conversation to have? Maternal age is the leading factor when it comes to fertility potential—and there is something women can do to safeguard their options.

Age is the Leading Factor of Infertility

As women age, the quality and quantity of their eggs decrease, causing age to be a leading factor of infertility for women and couples who want to have a baby. With a variety of distractions keeping women from focusing on family planning, and not realizing that, despite living a healthy lifestyle, fertility potential will still decrease, it’s quite common for women to be naïve to importance of proactive planning.

With the trend being women are starting families later and later, more and more are finding themselves with fewer family building options the older they are. Egg freezing puts a safeguard in place and allows for some leeway for women who want to bring home a baby (or babies) … eventually (but not just yet).

Continued Developments in SGF Egg Freezing 

While age plays a significant role on each egg’s probability of resulting in a baby, the expertise of the fertility center in successfully freezing and thawing eggs is also of paramount importance.  As the largest fertility center in the country, Shady Grove Fertility’s specialized staff is adept at performing these highly sensitive procedures.

Furthermore, in 2016, the SGF research team, led by Dr. Joseph Doyle of our Rockville, MD office, produced and published success rates for women returning using frozen eggs, bringing actual success rates front and center, in the spirit of full transparency—a SGF virtue.

SGF Egg Freezing is Affordable

Our financial programs take into careful consideration the scientific data related to age, ovarian reserve, and egg thaw outcomes and provide the recommended number of eggs to freeze.
Affordability and excellent care are priorities for our team. Our egg freezing program continues to evolve as we better understand and learn the needs of our patients.

We first introduced Assure Fertility in 2014, the first flat-fee financial egg freezing program; patients are provided with the best egg freezing scenario recommended to have a baby – i.e., freeze enough eggs to ensure you have options when the time is right.

Second, we developed the Shared Risk 100% Refund for Returning SGF Egg Freezing Patients, a guarantee program that includes a 100% refund for the cost of using frozen eggs should you not take home a baby.

“The best family planning decisions come from a place of experience. Shady Grove Fertility is a leader in reproductive research and technological development. Being able to give women who are contemplating freezing their eggs actual data, based on such extensive, unique research, is reassuring for both myself, as a clinician, but also for prospective patients,” explains Dr. Joseph Doyle of Shady Grove Fertility’s Rockville, MD office.

Schedule An Egg Freezing Appointment

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