Elective single embryo transfer (eSET)

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One of the common misconceptions about fertility treatment is that multiples are standard and nearly inevitable. According to the CDC, the national rate of twins and higher order multiples (e.g. triplets or more) increased from 1998 to 2009. While historically twinning makes up about 2 percent of the live birth population, over this 21-year period the rate doubled. An important driver of this increase was the number of couples undergoing fertility treatment. Thankfully, and especially at SGF, rates of twins from fertility treatment are now declining due to improved IVF practices, such as blastocyst culture, preimplatation testing of embryos, and blastocyst vitrification, which enable highly successful single embryo transfer. For the story, “7 Things You Need to Know if You’re Pregnant with Twins,” US News talked to Dr. Kate Devine, Shady Grove Fertility’s Director of Clinical Research.

Looking back, why did couples experience more twins from fertility treatment?

Dr. Devine tells US News that until recently, fertility experts were more limited in their ability to examine the quality of embryos created during the in vitro fertilization (IVF) process. Determining which embryo(s) were best to transfer was done according to their rate of development and morphologic characteristics alone, and usually only over the course of the first two to three days of their development.

However, in recent years, improvement in embryo culture techniques have greatly improved our ability to observe and assess embryo growth and development for longer duration in the IVF lab. In addition, we now have the ability to do genetic testing on embryos to select a chromosomally normal embryo for transfer. If there are additional high-quality embryo(s), we can store them for the future. Prior to the advent of these technologies, it was difficult to select a single embryo with a high probability of implanting in a woman’s uterus and resulting in a healthy baby.

Therefore, physicians would typically transfer two and sometimes more than two embryos in hopes of successful implantation. And yes, multiple births were more common. Dr. Devine says, “The goal was to boost the woman’s chances of delivering a baby, since it wasn’t clear which embryos would make it.”

New Technology Results in Fewer Twins

Today, technology allows embryologists and physicians to examine embryos much more carefully and select with confidence the one with the highest chance of implanting and resulting in a successful pregnancy. At Shady Grove Fertility we’ve long been proponents of elective single embryo transfer, or eSET. We observe all fertilized embryos until they reach the blastocyst stage. This is the stage when the embryo has differentiated into two parts: the inner cell mass, which is the potential fetus, and the trophectoderm, which has potential to become the placenta. It is also the stage at which the embryo implants in the uterus in both natural and IVF pregnancies. By combining blastocyst culture with single embryo transfer, we have drastically decreased the number of multiple pregnancies, while maintaining excellent IVF success. And by increasing the proportion of singleton pregnancies, we dramatically decrease health risks to both baby and mother.

The assumption that fertility treatment means twins is no longer correct or close to it. Thankfully, due to improvements in technology, SGF’s standard of care has changed to singleton pregnancies, enabling “one healthy baby at a time.” We are now better able to offer the best care for our patients leaving them with healthier choices for not only themselves, but for their baby and future children.

Schedule an Appointment

To learn more or to schedule an appointment with an SGF physician, please call our New Patient Center at 1-877-971-7755 or fill out this brief form.

Editor’s Note: This blog was originally published in Feb 2017, but has been updated as of July 2019. 

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Read the full article “Upgrading IVF with the Help of Artificial Intelligence” by Melissa Pandika at Ozy.com.

Recently, Melissa Pandika, writer for Ozy.com, spoke with patients who have undergone fertility treatment to understand the emotional toll of infertility and failed cycles in the article, Upgrading IVF with the Help of Artificial Intelligence. Pandika also spoke with several fertility physicians including SGFs Co-director of Research, Kate Devine, M.D., of the Washington D.C. K Street office, to learn about various IVF treatment strategies and techniques, and why patients and physicians alike should be cautious of new, unproven techniques.

Why conduct fertility research?

Continually researching and improving processes to achieve high pregnancy outcomes from IVF, IUI, and all forms of fertility treatment is a never ending goal for fertility researchers, scientists, and physicians alike. The emotional, physical, and financial strain fertility treatment can take on the couple who is trying to grow their family is the primary reason improving the experience is a priority. It is for these reasons SGF has a dedicated Research Program—to improve your likelihood of becoming a parent.

As stated by Pandika, the goal of research is to “reduce IVF to a single cycle and eliminate the possibility of carrying twins or triplets, which poses risks for mothers and infants alike.”

Using Proven Techniques to Improve Pregnancy Outcomes  

A primary area of focus for improving success rates is monitoring and selecting the best embryo, one that will result in a viable pregnancy. One of the primary techniques to limit the number of IVF cycles is through the use of genetic testing (PGS and PGD).

In the article, alternative methods are proposed, such as evaluating tenacity of embryos as well as shape and rigidness. However, according to the article and Dr. Kate Devine, “While these selection methods are “much needed … patients should be wary.” The article continues, “Scientists still need to confirm they are more likely to lead to successful pregnancies than PGS. Even then, they would complement, not replace, the embryologist’s skilled eye. And, ultimately, they may prove no match for Mother Nature.”

How to Optimize Fertility Treatment

At Shady Grove Fertility, we use several techniques to optimize fertility treatment in addition to genetic testing. Some techniques include evaluating medications, adjusting treatment protocols, and completing a free-all cycle (and subsequent frozen embryo transfer (FET) cycle when conditions are more conducive to pregnancy) when progesterone levels are too high, to name a few.

Single Embryo Transfers, a Very Good Option

It is our recommendation for (most) patients transfer one embryo into the uterus to ensure the health and safety of both the mother and baby. Over time, data has shown increased health risks associated with multiple pregnancies. With experience, careful observations of outcomes, and improvements in embryo culture techniques, elective single embryo transfer (eSET) has become a very good option for patients. In fact, 52 percent of patients of all IVF cycles (under the age of 35) used eSET at the Rockville, MD lab.

Schedule an Appointment

To learn more about genetic testing or alternate fertility treatment options at Shady Grove Fertility, or if you would like to schedule an appointment with Dr. Kate Devine or one of our other 38 physicians, please call 877-971-7755 to speak with one of our New Patient Liaisons.

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Medical contribution by: Stephen J. Greenhouse, M.D.

When choosing a fertility center, it’s important to research the many different options available to you. Finding a center relatively close to your home; a center that values patient care; and a center that has reproductive endocrinologists with extensive experience, are all very important components of the decision-making process. But the most important factor to research often comes down to the center’s infertility success rates. By learning a few simple points, you’ll be able to determine what infertility success rates really mean, without needing an advanced degree in statistics.

Reporting Infertility Success Ratesgraphs and charts

In 1992, Congress passed the Fertility Clinic Success Rate and Certificate Act—endorsed by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART)—which requires clinics to collect and make public the results of assisted reproductive technology (ART) treatments including in vitro fertilization (IVF), frozen embryo transfer (FET), and donor egg treatment. On SART’s website, you can view infertility success rates for individual fertility centers and also view the national data summary, which depicts the national average, based upon data from every fertility center in the country.

Learn the Appropriate Lingo

Before viewing infertility success rate data, it’s helpful to learn the terminology associated with reporting assisted reproductive technology.

Initiated cycle: An initiated cycle refers to the start of medications with the intent to proceed with in vitro fertilization (IVF) treatment.

  • Example: The center had 4,900 initiated cycles in 2013.
  • Explanation: As patients can go through multiple cycle attempts within 1 year, it’s worth remembering that the number here does not mean 4,900 individual patients. It is merely the amount of IVF cycles that a center initiated and may or may not have continued forward.

Cancellation: Unfortunately, some cycles will have to be cancelled before an egg retrieval can occur. This is usually due to a poor response to medication. It’s in the best interest of the patient to cancel the cycle rather than continue to egg retrieval if a positive outcome is unlikely. Age can also be a factor that affects how well a woman’s body responds to the medicinal stimulation.

Eggs after retrieval.

Retrieval: An egg retrieval is the actual attempt to obtain eggs from the ovarian follicles. In order to get to the stage of embryo transfer (in which a physician places a fertilized embryo into the woman’s uterus), a successful retrieval must occur.

  • Example: The center had 4,900 initiated cycles, but only performed 4,400 egg retrievals.
  • Explanation: The missing egg retrievals are due to cycle cancellation.

Transfer: An embryo transfer is the placement of one or more embryos back into the uterus. Transfer can only occur after fertilization between the retrieved eggs and sperm has taken place in the lab and the embryo is given 5 days to develop, ideally into a blastocyst.

  • Example: The center performed 4,400 egg retrievals but only performed 3,900 embryo transfers.
  • Explanation: Why is there a discrepancy here? Unfortunately, some embryos do not develop to the point of transfer. The physician and embryologist want the highest quality embryos for transfer, and if they’re not developing properly in the lab, they are unlikely to properly develop in utero. Another reason a transfer may not occur is due to genetic testing. Genetic testing affords couples the ability to ensure that they do not pass certain diseases and disorders onto their offspring. Thus, sometimes genetic testing reveals that an embryo is abnormal, and therefore the physician would not schedule a transfer. Finally, egg and embryo freezing would also mean that a transfer would not take place. Women who electively freeze their eggs may return one day, but for now the intention is to preserve their eggs for the future, not for immediate transfer. For other women, the physician may perform a freeze-all cycle, in which the patient elects to freeze all of the embryos, rather than transfer. Among other reasons, this most commonly occurs if a woman’s progesterone levels are too high leading up to transfer, which has been shown to increase the potential for miscarriage. By freezing the embryos and then waiting to transfer when progesterone levels have returned to a normal level, women are afforded the best possible chance to conceive.
  • Extending Your Fertility Treatment: Frozen Embryo Transfers (FETs)

Clinical pregnancy: A clinical pregnancy refers to the identification of a pregnancy sac in the uterus—not just a positive pregnancy test.

  • Example: Out of 3,900 embryo transfers, the center had 1,800 clinical pregnancies in 2013.
  • Explanation: That seems like a very significant drop, and probably rather alarming to patients new to fertility treatment. It’s important to think about the natural rate of fertility each month: women under the age of 35—who are trying to conceive on their own—only have a 15 percent chance of conceiving each month, which declines each month after 4 to 5 months of trying. After trying for 2 years, the chance of conception each month drops to approximately 1 percent. Not every egg will become a pregnancy, and that statistic holds true for fertility treatment as well. While the physicians and embryologists do everything in their power to help patients build their families, there is an element of ‘nature’ at play here, not just science. It’s important to also remember the 15 percent chance of naturally conceiving each month when you view success rates. Even the best centers only show success rates that range from 40 to 60 percent. So while at first glance, that may not seem very high, it really is impressive when you think about the natural rate of conception being only 15 percent in any given month.
  • Understanding Infertility Success Rates Infographic

Miscarriage: Unfortunately, miscarriages are common for both women going through fertility treatment and women who conceive without assistance. In fact, it is estimated that 1 in 4 pregnancies result in a miscarriage, sometimes even before the woman realizes she is pregnant. Given the occurrence of miscarriages, it’s important to look at a fertility center’s ongoing pregnancy/live birth delivery rate.

Ongoing pregnancy/live birth rate: The ongoing pregnancy/live birth rate represents the number of patients who have delivered a baby or are still pregnant. This number will always be lower than the clinical pregnancy rate due to the possibility of miscarriage. The ongoing pregnancy/live birth delivery rate is the most important number to Shady Grove Fertility, as we define success in the same way you do—taking home a baby.

How do fertility centers calculate infertility success rates?

Success rates can vary for many reasons. The age of the female partner (as mentioned earlier) is the most important factor when women are using their own eggs. As women age, success rates decline, particularly over the age of 35. This decline is partially due to a woman’s reduced chance of getting pregnant through ART (and without ART) as she gets older, but it is also due to the higher risk of miscarriage associated with increasing age, especially over 40. Evidence of age’s effect on pregnancy rates is undeniable, especially when viewing donor egg treatment success rates: the eggs that a donor recipient uses are from a woman who donated her eggs in her 20s to early 30s, leading to much higher success rates.

Success rates can also vary based on the number of embryos transferred. Transferring more embryos at one time does not increase the chance of live birth significantly, but it can increase the risk of a multiple pregnancy. At Shady Grove Fertility, we advocate for single embryo transfer (eSET) in good prognosis patients, because the risks associated with multiple pregnancy (twins, triplets, etc.) are too great on the health of the mother and the babies. The ideal fertility center maintains high success rates while transferring the fewest amount of embryos. At Shady Grove Fertility, we have been successful at reducing multiple pregnancies over time, due to our practice of eSET.

As SART says on their website, “It is important to note that patient characteristics vary among programs; therefore, success rates should not be used to compare treatment centers.” Additionally, success rates are important, but they can vary greatly between individuals, with many patients requiring several treatment cycles to have a baby.

When researching a center, it is important for one to evaluate a combination of outcomes—delivery/live birth rate per initiated cycle, implantation rate, rate of multiples, and the average number of embryos transferred. The time it can take to become pregnant is a major concern for couples who are struggling with infertility. Thus, it’s important to view a center’s ongoing pregnancy/live birth rate in comparison to the initiated cycle rate. If a center has a high ongoing pregnancy/live birth rate, it’s an important indicator of how effectively a center can help you to conceive. Before deciding on a treatment center, we recommend that you schedule a consult with a physician so that he/she can help you interpret the success rates as they apply to your medical profile and history.

If you would like to learn more about infertility success rates or would like to schedule an appointment, please speak with one of our New Patient Liaisons at 877-971-7755.

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Medical Contribution by Naveed Khan, M.D.

Dr. Naveed Khan of SGF’s Leesburg, VA office.

In the past decade, one of the greatest advancements in fertility treatment has been vitrification. Vitrification is a flash-freeze technology used for freezing eggs and embryos for the purpose of using them at a later date. While cryopreservation had existed to fulfill the same purpose for many years, the process frequently resulted in the formation of ice crystals in the eggs and embryos, often rendering them unusable. Vitrification’s flash-freeze technology, though, has remarkably advanced the freezing process and corrected earlier flaws. “One of the largest benefits of using vitrification has been increasing the success rates when using frozen embryo transfers (FET), as vitrification has doubled the ongoing pregnancy rate per embryo transfer in the past five years,” says Dr. Naveed Khan of Shady Grove Fertility’s Leesburg, Virginia office.

In order to undergo a frozen embryo transfer though, you must first perform a fresh in vitro fertilization (IVF) cycle. Oftentimes, there may be additional unused embryos from a  fresh cycle. This is where vitrification can be used to preserve the embryos for a later date and a patient can eventually return for a frozen embryo transfer cycle.

Who will utilize a frozen embryo transfer (FET)?

A frozen embryo transfer (FET) can be performed by any patient who has frozen leftover embryos from a fresh autologous IVF or donor egg cycle. The use of frozen embryos may come immediately following an unsuccessful fresh cycle, or, for patients who were successful with their fresh cycle, a FET can be used at a later date to have additional children.

What are the benefits of FET in comparison to performing another fresh (stimulated) cycle?

FET is often a good choice over completing another fresh IVF cycle when a patient has frozen embryos to use, as they have a lower cost (see the financial programs section below) and there is no need to have an egg retrieval. “Additionally, the date of the frozen embryo transfer is much more predictable than that of a fresh cycle, as you do not have to wait for the embryos to develop and mature. A FET cycle works much better in terms of planning around the transfer itself,” explains Dr. Khan.

What are the success rates for IVF with FET compared to that of a fresh cycle?

The success rates for FETs have doubled in the past five years, with an ongoing pregnancy per embryo transfer rate equal to – or sometimes even greater than – that of fresh transfers. In 2013, women under 35 had a 51% ongoing pregnancy rate per frozen embryo transfer. In comparison in 2013, women under 35 had a 48% ongoing pregnancy rate per fresh embryo transfer. FET cycles had a slightly higher success rate than fresh cycles, which can happen due to the presence of more balanced hormones and the fact that only high-quality blastocyst-stage embryos are being used for FETs.

How long does a FET cycle take?

A patient will contact our office with her desire to begin a frozen cycle. Her records will be reviewed to ensure that her prescreening is up-to-date. This can include – but is not limited to – infectious disease bloodwork, pap smear, an updated mock embryo transfer (to accurately measure and map your uterine contours), consents, and an injection review.

Prior to the frozen cycle beginning, most patients will be on a cycle/month of oral contraceptives. Soon after, the patient will come in for their first monitoring appointment, which is a baseline evaluation before the medications are started. Patients will then begin sequential injections of estrogen to build the uterine lining. Mid-cycle, the patient will have to have a ‘lining check,’ to ensure that the uterine lining has thickened. Patients will then be instructed to add in progesterone. A frozen embryo transfer date will be confirmed and then the patient will return for her actual frozen transfer. Approximately two weeks after the transfer, the patient will have a blood pregnancy test (known as the beta hCG).

What types of medications are required for FETs?

“Unlike in a fresh IVF cycle, medications to stimulate the ovaries are not needed for a FET,” says Dr. Khan. “Instead, supplemental estrogen and progesterone are the chief medicinal components of a FET cycle.” Estrogen will be given in the form of an injection every three days to build the uterine lining. Progesterone will be administered in the form of an injection every day as instructed after the mid-cycle ‘lining check,’ to ensure that the uterine lining has thickened, increasing the chances of implantation for the embryo. The estrogen and progesterone supplements will continue to be taken through the point of the patient’s beta hCG, with the progesterone continuing for up to eight weeks after the hCG. Once the pregnancy is confirmed though, the progesterone is taken as a vaginal suppository instead of an injection.

What financial programs are available for FETs?

For patients who have frozen embryos available for transfer, they may be eligible for the Shady Grove Fertility Shared Risk 100% Refund Program for FET. Once a patient is approved for this program, they will pay a flat-fee and then receive unlimited FET cycles while in the program, for as many frozen embryos as that patient may have. They can only use embryos that were vitrified at Shady Grove Fertility though, not embryos from other locations. In terms of program completion, a patient has the following possible outcomes: they will have a successful pregnancy and delivery; they will withdraw from the program at any time and receive a full refund; or they will use all of the embryos that are available without conceiving and then receive a full refund as well (some exclusions apply).

What are additional benefits of FET cycles?

While FETs have been beneficial in increasing the chances of conception per egg retrieval (when including fresh and frozen embryo transfers), they have also helped to change the treatment process in other areas of reproductive medicine.

On a large scale, FETs have helped to widen the practice of elective single embryo transfer (eSET), resulting in safer singleton pregnancies. In the past, multiple embryos were often transferred because technology was not as strong and IVF was not as successful. “Advances in technology and the embryo culture environment have resulted in the ability for embryos to develop to the blastocyst stage, two days longer than in the past. As a result, embryologists can now more accurately identify which embryos have the highest quality, making possible the selection of a single embryo that is a likely candidate for success, which has significantly decreased the risk of a multiple pregnancy,” Dr. Khan states. “In conjunction with this, vitrification allows additional embryos to be safely preserved. So even in the event that an eSET cycle is unsuccessful, patients may have additional embryos available for future FETs and do not have to feel the need to transfer multiple embryos initially.”

Another lesser known benefit of FETs is the ability to freeze all of the embryos for a later transfer. This is commonly seen when patients are choosing to genetically test the embryos or when an increased progesterone level is found in the patient. SGF’s research team has extensively studied rising progesterone levels and their effect on the chances of a successful pregnancy. Studies have shown that women who have higher progesterone levels at the time of their ‘trigger shot’ before the egg retrieval have a decreased chance of implantation and pregnancy. Dr. Khan says, “As a result, women who are found to have these prematurely rising progesterone levels now have the option to freeze all of their embryos. This allows the progesterone to return to more normal levels, providing the embryo with the best possible environment for implantation.” This two-step process of freezing the embryos following the fresh IVF cycle and then transferring during a FET cycle will allow a patient to have the best chance for a successful pregnancy. While this option only impacts a small percentage of our IVF patients, it depicts yet another way in which this newer technology has helped to improve our patients’ chances of conception.

Frozen Embryo Transfers are Changing the Face of Fertility Treatment

Since the advent of vitrification technology, FET cycles have represented one of the most revolutionary changes in fertility treatment. These cycles provide patients with additional options, whether it’s because they have an unsuccessful cycle or because they want to come back in a few years to further grow their family. FET cycles can also be beneficial because they are easier to plan around and an additional egg retrieval will not be needed. Additionally, FETs have helped to increase the ability for patients to have singleton pregnancies through eSET or to provide the ‘freeze-all’ option for patients. In all of these instances, FETs represent a way to extend fertility treatment. Freezing or suspending these embryos in time preserves them at their current quality, providing patients with an optimal chance for future success.

For more information or to schedule an appointment with one of our physicians, please speak with one of our New Patient Liaisons by calling 888-761-1967.

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The nature of infertility care has changed dramatically in the last 30 years, as technology has paved the way for patients to have the best chances of conception. This revolution in care has particularly affected the embryo transfer stage of in vitro fertilization (IVF). When a woman undergoes IVF, her eggs are retrieved and then fertilized with her partner’s (or donor’s) sperm. Once the fertilized embryos have matured into high-quality embryos (usually on the fifth day after fertilization), it is time to decide how many embryos should be transferred. This is where Newsweek’s article “Twins: The Fetal Paradox” comes into play.

In the early days of IVF, fertility specialists would often recommend transferring multiple embryos. “People were hedging their bets,” said Dr. Robert Stillman, medical director emeritus at Shady Grove Fertility, who was interviewed for this piece. The technology was not strong enough in the past, so transferring multiple embryos provided a patient with the best possible chance to have at least one healthy embryo develop. In the modern era though, laboratory conditions have developed extensively, enabling embryologists to accurately assess the highest quality embryos to transfer. In good prognosis patients (see below), transferring a single embryo (known as elective single embryo transfer or eSET) will yield the same results as transferring multiples – but without the risks associated with a multiple pregnancy. SGF has been a long-term advocate of eSET and the number of patients who select eSET at our practice is nearly five times higher than the national rate.

eSET Frequently Asked Questions

What characterizes a good prognosis patient during IVF treatment?
Women who statistically have the best possible chance of success with treatment are considered good prognosis patients. Factors that determine a good prognosis are the following: the American Society for Reproductive Medicine (ASRM) age guidelines (see below); women without a history of failed IVF treatment; and/or the availability of high-quality blastocyst-stage embryos.

SART/ASRM Transfer Guidelines: Blastocyst-Stage Embryos by Age

What health risks are associated with multiple pregnancies?

While plenty of healthy twins and triplets are born every day, multiple pregnancies can present additional risks for both the mother and her babies. There is an increased chance of miscarriage, bleeding, extended periods of bed rest, gestational diabetes, pregnancy-induced hypertension, and the need for cesarean sections. The babies can have low birth weights, sometimes with one twin growing at the expense of the other. They are more likely to be delivered prematurely, need intensive care after birth, suffer from developmental disabilities, and even have increased mortality rates. Due to these risks, we encourage our good prognosis patients to select eSET, ultimately reducing the possibility of a multiple pregnancy.

What are my chances of pregnancy if I only transfer a single embryo?

Whether transferring one or two high-quality blastocyst-stage embryos, patients with a good prognosis can expect the same conception rates. As a result, in 2013, nearly 80 percent of all pregnant patients in the SGF IVF Program had a singleton pregnancy. Additionally, 66 percent of patients under the age of 38 participated in the eSET program.

If eSET is the safer choice and has equivalent success rates, why do some patients still transfer multiple embryos?
At SGF, we often talk about how we provide patients with individualized care. This is important for a very obvious reason: no two patients are alike. Each patient’s history of trying to conceive and their individual diagnosis helps physicians recommend the best course of treatment. While our physicians ideally like to transfer high-quality blastocyst-stage embryos, this isn’t always possible for every patient. Thus, in incidences where embryo quality is a bit less than hoped for, the physician will determine if transferring multiple embryos would be beneficial. For those patients who have had earlier unsuccessful cycles with a single embryo, the physician also may recommend transferring an additional embryo.
The decision ultimately lies with the patient when it comes to eSET or transferring multiple embryos. But our physicians will always encourage eSET for those patients who have a good prognosis.

Insurance Companies Begin to Encourage eSET

One of the largest motivators for patients who want to transfer multiple embryos is the cost associated with fertility treatment. Many insurance companies do not cover the cost of treatment at all, or some will cover one cycle, but not additional ones. This is a concern for some patients, who think that transferring multiple embryos provides them with a better chance of conception in one cycle versus having to possibly perform multiple cycles. Due to the risks involved with multiple pregnancies, we do not encourage transferring multiple embryos in good prognosis patients, but we are conscious of the financial investment of treatment and have many financial programs to help our patients on their path to parenthood.

Some insurance companies are also starting to change their practices – if patients choose eSET and the first IVF cycle fails, the insurance company will cover the cost of the second transfer. “We’re hoping that this will be the wave of the future,” Dr. Stillman said. “It’s in insurance companies’ best interest: IVF costs are minimal. Premature twins or triplets can present lifelong complications and costs.”

Read the complete article to learn more about elective single embryo transfer.
If you have questions regarding infertility treatment or would like to schedule a new patient appointment, please call our New Patient Center at 877-971-7755 or click to schedule an appointment.

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Jessica and Zak went into IVF treatment with high hopes, and they were not disappointed. Jessica got pregnant on their first cycle of IVF.

In the Spring of 2012, Jessica and Zak welcomed baby Adriana into their lives, and they have never been happier. “It’s been incredible,” beams Jessica. “I am loving every minute of it. It was definitely worth everything we went through – and I am seeing a whole new side to Zak. Adriana is definitely ‘daddy’s little girl’.”

Looking back on her IVF cycle, Jessica says she had very few difficulties. “Everything went pretty well,” she remembers. “The education Dr. Khan and our nurse, Chris, gave us about what was going to happen during the cycle was really excellent, so there was never a time that I felt confused.”

Though she had been apprehensive about it, Jessica mastered the task of giving herself the daily injections required during the ovarian stimulation phase of her cycle. Zak, however, was not game for giving her the last injection, the intramuscular Trigger shot, before her egg retrieval. “Zak was really worried about hurting me or doing the shot wrong,” Jessica recalls. “My nurse had given me the number of a service that would provide a nurse to do injections at our house, so I just hired the nurse to come and do it. It worked out well.”

The only issue Jessica had during her cycle was related to her inventory of medication. She says, “The dosage of one of my medications was increased, and I suddenly realized I wouldn’t have enough to do the shot that night. Of course, it had to be a weekend! So, we ended up flying up to Rockville because the pharmacy at the Shady Grove Fertility office was the only place that was open and able to fill my prescription.”

jessica and zakJessica had a very successful egg retrieval, with 29 eggs retrieved. Because the couple had had a low sperm count on some of their previous cycles, the laboratory used ICSI to fertilize the eggs. ICSI is a special procedure where a single healthy sperm is injected into the center of each egg, allowing fertilization to take place even in cases of severe male factor infertility. Fortunately, 27, almost all of the eggs fertilized and developed.

Jessica was surprised when Dr. Khan called her himself to let her know how everything was going in the laboratory. “None of my other doctors have ever called me themselves, so I was so really impressed that Dr. Khan took the time to call me personally and talk to me about how our embryos were doing,” she says. “He told me they looked really good and that we would do a day 5 embryo transfer.”

Because Jessica is young, had a high number of quality embryos developing and was on her first cycle of IVF, Dr. Khan suggested that the couple consider doing elective Single Embryo Transfer or eSET. In patients like Jessica, eSET does not reduce the chances of pregnancy but greatly reduces the chances of high risk multiple pregnancy. Jessica says the decision was an easy one for them, “We were in favor of it because we really did not want to have twins.”

Jessica and Zak ended up with 13 high quality blastocysts that could be frozen. If she had not gotten pregnant on this cycle, she would have had 13 more chances to get pregnant with Frozen Embryo Transfer (FET) cycles. FETs are less expensive than a fresh IVF cycle and much simpler to perform. Since they did get pregnant, the frozen embryos give them options for growing their family in the future.

After her embryo transfer, Jessica had to wait the standard 2 weeks before she was able to take a beta pregnancy test. “That was the longest two weeks of my life,” Jessica says. “It was definitely the hardest part of the cycle for me. I went back and forth between feeling sure it wouldn’t work and sure I was pregnant. I questioned all of my symptoms, which I probably wasn’t really having anyway. The day of my beta test, I was so preoccupied, I could barely fill out the sign-in sheet at the lab – and then waiting that day for the results seemed like eternity.”

Jessica had learned from her previous IUI cycles to be home when the test results came in. “During one of my IUI cycles, I was out when I got the call that I had a negative on the beta test, and I was really upset. So, I learned that it’s best to stay home and wait for the call there.”

When her nurse called with the positive results, Jessica says, “It was all I could do not to cry. I was so excited.” Her next two beta tests showed a healthy growth in the embryo and were followed up by an ultrasound to confirm the pregnancy. “We saw the heartbeat at 6 weeks and then, shortly after that, we graduated from Shady Grove.”

jessica and zakJessica had used the Shady Grove Fertility Facebook page throughout her fertility treatment to get support from the community of patients who are active there. Now, she’s also using the Shady Grove Fertility Graduates Facebook page to talk to other women who became moms through fertility treatment. “I think all new moms want to talk to other moms,” she says, “but to be able to talk to moms who also went through IVF is really special. They give me a lot of great advice.”

While she extols the virtue of the Shady Grove Fertility Facebook community, Jessica still believes that the Internet can be stress-inducing for fertility patients. “I still say – stay off of the Internet – especially during the 2 week wait. You can drive yourself crazy reading websites about symptoms and pregnancy. It’s better to get support from people you know and trust.”

Looking back, Jessica says she has no regrets about fertility treatment. She’s even found a silver lining. “Even though I had to do more to get pregnant than a lot of my friends, I got to see my baby as an embryo. That was such a cool moment and that’s not something other parents get to see.”

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.

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