Fertility

For anyone who’s thinking about using donor eggs, there’s of course lots of focus on the odds of success. But some of you may also be thinking, is it even safe to use donor eggs in the first place?

You may wonder if there is anything about this process that could possibly put you, your partner, or your baby at risk. And these are important questions to ask! However, rest assured, every step of the donor egg process has been carefully thought through with the egg donors’ and the recipient’s health in mind.

Egg donor screening

Before an egg donor can even be considered for donation, Family by Co (along with any other egg donor agency or bank) will ask many questions and conduct extensive testing. This is not something that just any woman is eligible to do. 

The United States Food and Drug Administration has established eligibility requirements for anyone who wishes to donate tissue. This includes those donating eggs.

Egg donors must demonstrate that they are free from any communicable diseases.  A clinic will test potential donors for infectious diseases and for a variety of bacteria and viruses. These include chlamydia, gonorrhea, syphilis, hepatitis B and C, HIV, and HTLV-1 (a virus that has been linked to some cancers). This process helps ensure that there are no infectious diseases associated with the transfer of an embryo made from a donor egg.

There are also many other requirements for egg donors, according to the guidance of the American Society for Reproductive Medicine.

The donor must:

• Provide a detailed medical and psychological history about themselves and any close relatives. The potential donor disclose alcohol and drug use; some programs even conduct random drug tests.
• Undergo a physical exam, as well as a pelvic examination. She’ll also do an ultrasound and bloodwork to evaluate her ovarian reserve (egg supply).
• Provide a detailed medical history for herself and her close family members. This will help identify any serious genetic conditions that could run in her family. The clinic will screen her for family history of birth defects or required surgeries like a heart defect, a cleft lip, or a spinal condition. The clinic may also perform genetic carrier screening. Their goal is to identify if she is a carrier for genetic diseases such as Tay Sachs Disease, Sickle Cell Anemia, or Huntington’s Disease. If your partner or sperm donor is a carrier of a genetic disease, you will want to make sure that your egg donor doesn’t carry the same disease.
• Undergo psychological screening to ensure that she is truly a good fit for egg donation.  In some programs, psychological tests will also be part of the process.

All of this will help to ensure that using an egg donor is as safe as possible, with the donor free of diseases and also in good physical and psychological shape.

Recipient assessment

You and your partner will be evaluated as egg donor recipients as well. Before you can begin, you will both need to give an extensive medical history. Your doctor will test for things like blood type and RH factor. They will also screen for any sexually transmitted diseases such as chlamydia, syphilis, gonorrhea, hepatitis, and HIV.

Both you and your partner may meet with a mental health counselor. This will help ensure that using an egg donor is right for you.

Your doctor will perform an analysis of the sperm you intend to use. The quality of the sperm may help to determine the technique the lab will use to fertilize the eggs. Also, genetic carrier screening to assess for any recessive genetic diseases.

Meanwhile, the person planning to carry the pregnancy will need to undergo some testing. First, she will have a complete examination of the uterus to help ensure the inside of the uterus is normal. This may include a saline ultrasound or a hysteroscopy. The doctor will look to see if there are any fibroids or polyps in the uterus that may get in the way of implantation or safely carrying a pregnancy to term.

If you are over age 45, you may undergo a more extensive evaluation. This may include a consultation with a maternal fetal medicine specialist, an evaluation to make sure that the heart is functioning properly, an evaluation of blood pressure and other exams to ensure that there is minimal risk of any pregnancy-related diseases.

Older recipients may also be advised to find an obstetrician who specializes in high-risk pregnancies, who can help ensure that all proceeds smoothly.

Moving forward

When deciding whether to move forward with the donor egg process, discuss any safety concerns with your doctor and ask questions. The more you know about the process, the more confident you are likely to feel.

When it comes to using donor eggs to build your family, even those who are veterans of traditional in vitro fertilization (IVF) may not be clear on what to expect from the donor egg process. But you’ll be happy to hear that those who have already worked with a fertility clinic using their own eggs will absolutely not be starting from the beginning. If you’re in this situation, you already have a solid understanding of what goes into an IVF cycle, which is the foundation of the donor egg process.

Women consider using donor eggs for various reasons. Some have low ovarian reserve (egg supply). Some have been through several IVF cycles before without success. Others have been told that their egg quality makes it unlikely that they will become pregnant using their own eggs. In these situations, using a donor egg can significantly improve the chances of having a baby. Especially if someone is over 40, the success rates with donor eggs will be considerably higher than many women can expect with their own eggs.

According to the Society for Assisted Reproductive Technology (SART), if someone is over 40, IVF success rates after one cycle can range from five to twenty percent if she uses her own eggs. But when using donor eggs, the success rate for one cycle is around 50%. So, depending on the situation, using a donor egg can significantly increase your chances of having a baby through IVF.

For others, donor eggs may be the only way to build a family. Whether you are a single dad, LGBTQ+ couple, or cancer survivor — every conception needs an egg.

Getting started

If you’ve already been through IVF before, you’re most of the way there in terms of understanding the how a donor egg cycle will go. There are just some additional steps with a donor egg that you may not be aware of yet.

Before beginning any donor egg treatment, many clinics will have you and your partner initially speak with a counselor.  He or she will talk through using donor eggs to help ensure that this is the right path for you. The idea is to consider how you feel about using a donor egg to help create or expand your family. You may also consider how you will talk to your future children about using an egg donor, including what information you will share and when.

You will then go through an egg donor selection process to find the best donor for you. There are tons of factors to consider here: the egg donor’s education, medical history, values…the list goes on. So it’s worth spending some time with your partner to decide what factors to prioritize.

Also, if you are over age 45, the American Society for Reproductive Medicine notes that you may need to undergo more intense screening, such as a visit with a high risk obstetrics doctor or a heart workup, to make sure that you are a good candidate for an embryo transfer and can carry a healthy pregnancy.

If you choose a matching platform like Family by Co or an egg donor agency, your egg donor will go through a screening process at your clinic to determine if she is eligible for egg donation. You will also sign a legal contract with her regarding the details of the egg donation process. If you match with a donor in our fresh egg donation program, after her screening, she will do an ovarian stimulation cycle and an egg retrieval. If you have been through an IVF cycle before, you are well aware of all the medications and monitoring she might need during her cycle. If you match with a donor in our frozen egg program, we will help ship the already-frozen eggs to your clinic.

Fertilizing and growing embryos

Whether you obtain donor eggs from a fresh egg donor cycle or from a frozen egg bank, once your clinic is in possession of the eggs, they will need to be fertilized and grown into embryos. Your IVF clinic will update you to let you know how many of the eggs fertilized and how many developed into embryos. Some intended parents decide to do genetic testing on embryos. If so, the clinic will biopsy the embryo at the blastocyst stage (day 5-6) and then freeze the embryos while they wait for the result. 

It’s important to remember that not all eggs become embryos. In general, approximately 70% of eggs will fertilize and of those, about 50% will grow into day 5 embryos.

Preparing for embryo transfer

If you’ve already gone through IVF, you may have already been through the pre-transfer testing. This testing includes infectious disease testing and an assessment to make sure your uterus is normal. Your clinic may do a saline ultrasound or a hysteroscopy to evaluate the inside of your uterus before a transfer. This test rules out fibroids or polyps inside the uterus that could interfere with pregnancy.

At some centers, doctors like to also perform a mock embryo transfer. During a mock embryo transfer, the doctor will pass a transfer catheter into your uterus in advance so they’ll know the embryo transfer catheter will pass easily on the transfer day. If you’ve already done IVF with your own eggs, they may already have this information and can skip this step.

Prior to an embryo transfer, you (or your gestational carrier) will first likely use medication to quiet your own cycle, such as birth control pills or the drug Lupron. Then, you will then be put on estrogen to mimic what would happen during your normal cycle. The estrogen can be given orally, vaginally or with an estrogen patch depending on the protocol your doctor chooses. 

Once your lining reaches a good thickness (many clinics have a goal of 7-8 mm), you’ll then start taking progesterone. The progesterone can be in the form of vaginal suppositories and intramuscular injections. This progesterone will stabilize your uterine lining for embryo implantation. Keep in mind, though, that if by some chance you ovulate on your own during the first stage, any embryos will be frozen and the transfer will be postponed.

Embryo transfer

Your clinic will then schedule your embryo transfer. The embryo transfer is typically performed on the sixth day of progesterone, in order to synchronize the embryo development with your uterine lining.

On the day of the embryo transfer, your doctor will perform a speculum exam and clean the cervix. They will then place the embryo transfer catheter through your cervix into your uterus. An abdominal ultrasound is typically performed so that you and your doctor can see the embryo transfer catheter inside the uterus. The embryo is often loaded into the catheter with a small amount of fluid and an air bubble. At the time of the embryo transfer, you may see a small flash of bright white on the ultrasound screen - that’s where your embryo was placed!

Pregnancy

Your clinic will schedule a pregnancy test following your embryo transfer. If you are pregnant, you’ll need to continue to take estrogen and progesterone during the first part of your pregnancy. Although taking these hormones may seem inconvenient (especially the injectable progesterone!), keep in mind that they are essential to sustaining your pregnancy until your body can effectively take over. If a pregnancy test shows that you are in fact pregnant, you will need to continue to take hormones until your placenta can ultimately support the embryo at around week ten.

Hopefully, this provides a solid overview of the donor egg IVF process. The first step here, however, is to find a donor match. We encourage you to take a look at our incredible donors, who are ready to match with your family. Unlike egg donation agencies and banks out there, our donors aren’t motivated by traditional cash compensation. Rather, they get to freeze their own eggs for free when they give half of them to another family — so every donor we work with is not only altruistic and kind, but also motivated for her own future fertility. 

No matter what avenue you choose, we’re wishing you all the best!

For many, using donor eggs wasn’t part of the original plan. You may have simply wanted to seek some assistance with your own fertility with an eye toward in vitro fertilization (IVF). But now the doctor is saying that you have a very low chance of successfully conceiving with your own eggs, and you and your partner should consider using a donor egg.

If you’re like most people in this situation, you may not be sure what to do next. But not to worry, others have already been down this road. You will be able to navigate this situation as well. It’s just a question of breaking things down into manageable steps.

Finding an egg donor

The first thing you need to do is find the right egg donor for you. This may mean doing some research on how to find an egg donor, assuming you are not using someone you know.

Donor egg banks

One option is to use a frozen donor egg bank, which might be quicker than using an egg donor agency. The eggs in a donor egg bank are already frozen and available. With this, you have a good idea of when your embryo transfer can be. You can browse through detailed profiles of available donors, which may include everything from her interests, education, physical characteristics, and family health history.

In some cases, you may also have some flexibility in whether the donor will remain anonymous or is open to some type of contact. Keep in mind, nothing is truly anonymous in today’s day of genetic and ancestry testing.

Donor egg agencies

Another option is to use an egg donor agency that can help you identify women with specific characteristics or interests that you and your partner find important in an egg donor. An egg donor agency can function a little like a matchmaker.

With this approach, you decide the qualities you are looking for in an egg donor and the agency will look for someone who fits your description. Many agencies have a list of potential donors ready to go. Usually, though, these donors provide “fresh” eggs, meaning their eggs are not already frozen. You’ll have to wait for the donor to undergo a retrieval cycle.

Your own fertility clinic

You may also find that whatever fertility facility you are already working with has a donor egg program available. Keep in mind, however, that depending on your clinic, limited donor options may be available. So, particularly if you have a set of characteristics that you’re looking for, you may find yourself wanting more.

What to expect from a fresh donor cycle

Once you’ve selected a donor, the next steps depend on whether you are doing a fresh cycle or a frozen one. If you are using a donor who has not yet frozen her eggs in the egg bank, there will be some extra steps.

The medication involved

If you have done IVF before, you may already be somewhat familiar with the process. Your egg donor will take stimulation medications and undergo an egg retrieval similar to the process for IVF. The recipient who will carry the pregnancy will also take medications to prepare the uterus for an embryo transfer.

Often, you will first use medication to quiet your own cycle, such as birth control pills or the drug Lupron. You will then be put on estrogen to mimic what would happen during your normal cycle. Once your lining reaches a good thickness, your doctor will start you on progesterone. This progesterone will stabilize your uterine lining for embryo implantation.

The fertilization process

It's also important for the male partner to coordinate and produce a semen sample during the same day that the eggs are retrieved from the donor. Some couples use already frozen sperm, which works also. Then, using in vitro fertilization, the eggs are fertilized with this sperm and the potential embryos are created. At this point, some intended parents opt to genetically test the embryos to rule out any abnormal embryos.

Keep in mind that if there are more embryos created than you need for one cycle, some can be frozen and saved for later.

What to expect when using frozen eggs

As we mentioned earlier, if you do a frozen egg cycle, the definite upside is that these eggs are already available to use. You don’t have to worry that the donor may not produce as many as you were hoping for.

The eggs are there, ready when you are. The recipient does not have to synchronize her cycle with the donor’s, which can mean more flexibility for you. Also, you may have wider geographic choices since the bank can get egg deposits from all over. With a fresh cycle, you are limited to donors in the area or willing to travel (another expense).

Frozen donor eggs may be offered as a package with lab tests, genetic screenings, and medications bundled together at an overall lower cost than for a fresh cycle. With frozen eggs, as opposed to a fresh cycle, you know exactly how many eggs you are getting. Once your clinic receives the frozen donor eggs, they will thaw them and fertilize them with sperm. Similar to a fresh donor cycle, you will use estrogen to thicken your uterine lining, followed by progesterone to stabilize your lining and prepare it for an embryo.

Summing it up

Hopefully this helps you feel confident in knowing that, while it contains many steps, the donor egg process can be manageable. But the more informed you are, the better. Do check out our other resources that can answer other questions you might have about the donor process. Whether you’re just beginning to consider the idea of using donor eggs, or on the cusp of starting a cycle, we’re here to help make this process a little bit easier.

As if you're not being poked, prodded and dosed up enough during the whole IVF process, your doctor might prescribe some progesterone for good measure. So what you want to know is, how bad is this going to be, really? We've got answers about progesterone during IVF, including its side effects (and hopefully it won't be so bad). So here goes.

What's the point of progesterone during IVF, anyway?

Progesterone is a sex hormone that exists in the body. It does a lot of things, but in essence, it's necessary for a healthy pregnancy, most notably because it helps get the uterine lining (the endometrium) ready for an embryo to make a home there.

For IVFers, progesterone might be prescribed in addition to the usual injections. You probably already know that your injections—a.k.a. gonadotropins such as Follistim, Gonal-F, Pregnyl, Repronex, etc.—help you ovulate. Progesterone, however, is taken later, often starting the same day the eggs are retrieved during a fresh cycle.

According to Dr. David Diaz, MD, reproductive endocrinologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California, progesterone supports the lining of the uterus, which helps during embryo implantation. Implantation is what you want—that embryo needs to "stick" to the uterine wall, so you can officially get pregnant and stay that way.  

The nitty gritty on taking progesterone for IVF

Don't kill the messenger, but although some IVF clinics will prescribe progesterone orally, you're likely going to have to take this drug through one of two not-so-fun ways:

• Shots: For IVF, progesterone can be taken via intramuscular injection. By intramuscular, we mean in your butt cheek, or maybe a hip or thigh. The shot will contain the hormone, as well as a little bit of natural oil for dissolving purposes.
• Vaginal capsules: Yep, a suppository inserted your lady parts could be an option for you if the shots are a no-go. "[The capsules] dissolve internally," says Dr. Diaz." They work well and provide a good alternative to patients unable to tolerate the injection or those allergic to the injectable form." Basically you'll insert it similar to how you would put in a tampon.

You'll have to take progesterone according to doctor's orders until you get your pregnancy test results. If you do get pregnant, your doctor may want you to continue taking progesterone throughout your first trimester, says the ASRM, since it may help prevent pregnancy loss.

Side effects of progesterone during IVF

Watch out for progesterone side effects during your IVF journey. Common side effects include:

For the shots

• Pain at the injection site
• Swelling at the injection site
• Small knot in the muscle at the injection site

For the vaginal suppositories

• Vaginal itching or burning
• Yeast infection

For either

• Dizziness or tiredness
• Mood swings
• Bloating
• Nausea
• Cramps

No matter how you're taking your progesterone for IVF, you'll want to notify your doc if you have serious or sudden side effects. According to the University of Michigan Medicine, this could include:

• Signs of allergic reaction
• Unusual vaginal bleeding
• Pain or burning when you pee
• Symptoms of depression
• Lump in your breast
• Sudden vision problems
• Severe headache
• Chest pain or pressure
• Jaundice (yellow skin or eyes)
• Sudden numbness or weakness
• Sudden severe headache
• Slurred speech
• Other problems with speech or balance
• Sudden cough or wheezing
• Rapid breathing
• Pain, swelling, warmth, or redness in one or both legs

Pro tips

None of this sounds like a walk in the park, but we do have some tips that can make the whole progesterone process a little easier.

If you're doing shots

• Have your partner or a trusted friend or family member help. This is not an easy solo feat.
• Invest in both a heating pad and ice pack. "We recommend using a cold pack alternating with a warm pack to minimize discomfort," says Dr. Diaz.
• Switch injection sites. Shooting in the same place on the body will just cause more pain and possibly tissue damage.
• Massage the muscle gently after injecting.

If you're doing vaginal suppositories

• Use an applicator if it came in your pack. But throw it away after use. (Reusing is just a hard no.)
• For a PM dosage, insert it before bed, so gravity's on your side.
• Use panty liners, since you'll probably have some oily discharge. (Ew.) You'll thank us later for this tip.

Always take your meds according to the doctor's or nurse's instructions. If you're doing progesterone shots, you'll likely get a full run through of the whole process. Ask lots of questions about anything that's confusing or weird.

And let's hope that progesterone—no matter how you take it—helps this IVF stick. Good luck!

FAQs about progesterone for IVF

Why is progesterone given after IVF? Progesterone helps get the uterine lining ready for embryo implantation to occur. It might be prescribed in addition to your other IVF injections, but often starts the same day as eggs are retrieved during a fresh IVF cycle and continues on until you take a pregnancy test—if it’s positive, you’ll continue to take progesterone as long as your doctor recommends (usually through the first trimester) to support a healthy uterine lining.

How long do you take progesterone after IVF? In a fresh IVF cycle, progesterone often starts the same day as an egg retrieval. You’ll continue taking progesterone according to your doctor’s orders until you get your pregnancy test results. If you do get pregnant, your doctor may want you to continue taking progesterone throughout your first trimester, which may help prevent pregnancy loss. If not, your doctor will likely want you to stop taking progesterone. ‍

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Does progesterone help implantation? The goal of taking progesterone is to help get the uterine lining ready for implantation, and hopefully, for that embryo to “stick.” It also may help prevent pregnancy loss, according to the ASRM, which is why if you do get pregnant, you may be told to continue taking the medication for a period of time.  

What are the side effects of progesterone injections for IVF? When taking progesterone shots for IVF, you may experience pain or swelling at the injection site or small muscle knots near the injection. If you’re taking the vaginal capsules, this may result in vaginal itching or burning or even yeast infections. Keep a close eye on symptoms and report anything unusual to your doctor. For either method of taking progesterone, you may experience dizziness, fatigue, mood swings, bloating, nausea, and/or cramps.  

Does progesterone affect implantation? That’s the point of progesterone in the first place! Taking progesterone during IVF is meant to support your uterine lining (endometrium) so that embryo implantation can occur. Effects of progesterone go beyond implantation, though. According to the ASRM, continuing to take progesterone beyond a positive pregnancy test—often through the first trimester—may help prevent pregnancy loss.  

We know that after being bombarded with hoards of hormones, supplements, and the struggles of infertility, making changes to our diets is probably the LAST suggestion you want to hear. 

But especially if you’re about to do an IVF cycle, you’ll want to get your body in tip-top shape to prepare for a healthy pregnancy. But don’t freak out; we’ve got the lowdown on the nutrients you need to support your fertility mission, and where to find them.

Dara Godfrey, a registered dietician at Reproductive Medicine Associates of New York, notes that there’s no one-size-fits-all nutrition guide. We’re all different, but there are some foods that can help support the body to hopefully function more optimally. But before you make any significant changes to your diet, be sure to speak with your doctor and maybe a registered dietician, who can tailor an individualized diet for your body’s specific needs.

Five A+ foods for fertility

Godfrey’s top five foods that she recommends to support clients’ fertility goals include: 

• Green veggies
• Wild salmon
• Walnuts
• Black beans
• Eggs 

Fertility-friendly nutrients FTW

Here’s a breakdown of the seven nutrients Godfrey says your fertile body needs, and a wide variety of foods where you can find them:

1. Omega 3s are known to help with hormone regulation. To get those good juices flowing, look for high-fat fish like sardines, anchovies and wild salmon. You can also find Omega 3-enriched eggs (which also have protein bonus points). Godfrey mentions that recent research also suggests that Omega 3s can improve embryo quality, reduce inflammation and can even help with sperm quality. If you’re vegetarian, vegan, or just not that into fish, you can get Omega 3s from walnuts, flax seeds, and chia seeds.

2. Some recent research shows that Vitamin D can increase IVF success, as well as potentially help regulate blood sugar. Keep in mind that Vitamin D supplementation may be especially needed during the winter months, when we’re not getting as much sunlight. There aren’t too many foods that are naturally fortified with Vitamin D, but Godfrey suggests include wild salmon, sardines, eggs and milk (yep, those guys are gonna come up a lot). Our favorite Vitamin D supplement? Natalist's Vitamin D Gummies. Use code COFERTILITY20 at checkout for 20% off!

3. Iron is important during pregnancy to deliver oxygen to the baby and to prevent anemia in the mother. While the supplements in prenatal vitamins are great, Godfrey says you can also find iron naturally in foods such as lean beef, shrimp, chicken, and fish. Animal-free sources of iron also include oatmeal, organic tofu, enriched whole grains (Godfrey loves cereals like All Bran or Shreddies), which are also high in fiber. Iron loves to hang out with Vitamin C, so if you’re having shrimp, chicken, fish or tofu, Godfrey suggests throwing in some red peppers. In the morning and for snacks, sprinkle strawberries on your iron-rich cereal.

4. Folate. The first trimester is the most important time to prevent neural tube defects, and folate and folic acid are shown to have a protective effect, which is the main reason doctors and dietitians recommend you take a prenatal vitamin. The food form of folic acid is folate and it’s super easy to find it in dark leafy greens like brussels sprouts, kale, asparagus, avocado, black beans, kidney beans, lentils, oranges and sunflower seeds.

5. Vitamin C, especially during food and cold season, is super important while trying to conceive. Most people think of citrus right off the bat, and yes, oranges and grapefruit are great, but Godfrey also suggests red peppers and broccoli. Other fruits include strawberries, papaya, kiwis, pineapple, mango and watermelon. Keep frozen fruits (ideally organic) in mind when they’re out of season. Apparently, according to Godfrey, they’re actually more concentrated in nutrients, since they’re picked and frozen at peak ripeness. Mind blown. 

6. Vitamin C’s best friend is calcium. If you want to make sure that you’re getting the most out of your Vitamin C, Godfrey suggests pairing it with a source of calcium. She suggests pairing strawberries with yogurt to help with each others’ absorption, or trying a stir-fry with red peppers and other veggies, paired with a sprinkling of Parmesan cheese on top. One important note on dairy: go for organic and keep in mind that men and women have opposite needs here in regards to fat content. Women need whole fat: “the fat in milk is where the female hormones like estrogen are found,” explains Godfrey. So when that fat is taken out, what’s left are the male hormones (like androgen) which aren’t helpful to a female body seeking to conceive. Contrastingly, men should avoid whole fat yogurt for the same reason: their fertility could be adversely affected by the higher concentration of the female hormones. If you’re dairy-free, you can get calcium from broccoli, bok choy, collard greens, kale, almonds, organic tofu, and black beans.

7. Hydrating with water is important year-round. In the winter months, it helps to clear your body of mucus, getting rid of viruses and airborne infections more rapidly. This may not sound like it relates to fertility, but as Godfrey points out, “if your immune system is strong, your body is working more efficiently.” And that’s always a good thing.

Men can use a boost, too

For men seeking to improve their fertility, Godfrey adds zinc and selenium to this list.

• Zinc is shown to increase testosterone levels, improve quality and quantity of sperm and help prevent sperm from clumping together. It can be found in seafood like oysters, crab and shrimp, as well as pork, beef, chicken and venison. Vegetarian sources include sesame seeds, raw pumpkin seeds and low-fat yogurt.
• Selenium is necessary for the creation of sperm, and is best sourced from Brazil nuts, liver, snapper, cod, halibut, tuna, salmon, sardines, shrimp, turkey and broccoli. 

We love the Natalist Male Prenatal, which is especially formulated for male fertility.  

Every time is snack time 

If you’re looking for healthy ways to get your snack on, Godfrey also serves up these easy, on-the-go ideas:

• Bag up a mix of walnuts, sunflower seeds, pumpkin seeds, and flax. Grab a cup of full-fat, organic yogurt and sprinkle your healthy mix on top.
• Ladle some black beans (or kidney beans, or chickpeas) into a glass jar as a wholesome, satisfying snack at your desk.
• Pack your commuter bag with an iron-enriched cereal and some strawberries and almonds.
• When you’re traveling, you can sometimes find ready-made hard-boiled eggs in airport cafes.

The bottom line on fertility foods

Beyond diet, Godfrey stresses that improving your body’s fertility has to include changes to your overall habits and environment. Bottom line: you can eat a perfect diet, but if you’re not taking care of yourself in other ways, the foods you eat can’t work as efficiently. It’s probably a good idea for you to start reducing your wine and coffee intake (we know, we know). Coffee wise, getting down to one or two cups (think 6oz, not a 20oz Venti!) per day will make the transition easier if and when you do get pregnant. Be sure you drink your morning joe after you’ve had breakfast and a glass of water. 

Godfrey is also pretty permissive when it comes to alcohol—within reason. Practitioners vary with their recommendations on this (so make sure to talk to yours), but evidence that Godfrey has seen at her clinic suggests that having three to four glasses of wine per week shouldn’t have an effect. The larger concern about booze are the habits that surround it. Avoid having drinks on an empty stomach, and remember to hydrate. Otherwise, Godfrey observes, “your inhibitions are lowered and you choose poor quality foods and larger volume.” (Hey, we’ve all been there). 

Finally, Godfrey assures us, you don’t have to deny yourself all your favorite things. “For me, there are no absolute ‘no’s,’ because that’s unhealthy, too!” Pass the nachos, please?

If you've been trying to have a baby with no luck (yet), the idea of IVF can be exciting...but the costs can sound scary. After all, more than 8 million babies have been born as a result of this procedure. But it's known to be pricey, too. So how much money would IVF cost you, really?

According to the Society for Assisted Reproductive Technology (SART), the average cost of an IVF cycle in the US is $10,000-$15,000. But, like with any fertility treatment costs, that completely depends on your insurance coverage, your own health status, and your clinic. A Journal of Urology study, for example, showed that out-of-pocket IVF costs averaged at around $19,000. And for those doing multiple cycles, each additional cycle cost about $7,000.

In other words, it depends. And, unfortunately, there may be additional costs for some people. Don’t shoot the messenger!

Why IVF costs vary so widely

Insurance is one of the biggest factors. Some health insurance plans cover some or all of infertility treatment costs and some don't. Some cover the cost of procedures but not the cost of medications—or vice versa—and others don't cover either.

Currently, only some states have laws that require insurance to cover (at least some) IVF costs. If your employer is located in one of those states, you're more likely to have coverage than if IVF assistance isn't mandated. Check out this article to see how your state is handling fertility treatment insurance. 

Your area's cost of living can also influence costs greatly. In some parts of the country, fertility procedures may cost twice as much as they do in others, says David Bross, co-founder and Vice-President of Parental Hope, Inc., a non-profit that provides financial support to couples battling infertility. And different fertility clinics may offer different rates.

Plus there's your own unique infertility situation to take into account. For example, couples who will need to use an egg donor will have additional costs related to that. Fortunately, our Family by Co platform makes that process more positive, transparent, and affordable than other options out there.  You can read more about our pricing and commitment to you here.

So, what's included in IVF costs?

Here's how IVF costs typically break down:

Monitoring

Everyone who undergoes IVF has to have a basic workup, evaluation and monitoring via ultrasound and bloodwork. This can cost around $2,500 before any insurance coverage, but because of different plans, some of that may be covered and your personal out-of-pocket costs can vary drastically. Some plans don't cover the costs at all, others pay part or even most or all of it. For more specifics, call your health insurance carrier to see what your policy covers.

Retrieval and labs

Your egg retrieval is a procedure that needs to be done under anesthesia to (you guessed it) retrieve those eggs (a.k.a oocytes). Then, in a lab, those eggs are fertilized with sperm. The egg retrieval and fertilization process can cost around $7,000.

Embryo transfer

If you're lucky enough for at least one of those fertilized eggs to grow into an embryo, then there's another procedure to transfer it into your uterus. This part can cost around $1,400.

Here's what's *not* included in typical IVF costs

Heads up: there may be extra costs involved with IVF too, like additional testing or procedures. This could include:

• PGS or PGD testing: Preimplantation genetic testing can be performed before the transfer to check the embryo(s) for chromosomal abnormalities or inherited genetic disease.
• Frozen embryos or sperm: If you decide to freeze embryos or sperm as part of your IVF plan, then there's the cost of freezing, plus usually an annual fee for storage, which can be around $600 to $1,200 per year.
• Medication: Medications are given to stimulate the ovaries and trigger ovulation in preparation for retrieval. Medication can cost $2,500 to 5,000 for one round of IVF, says Bross. Some prescription plans cover all or part of it and some don't.

You can totally reduce IVF costs

While the actual total cost can vary widely from person to person, there are ways to reduce them for you.

Research health insurance options as early as possible

Lilli Dash Zimmerman, MD, Fertility Specialist at Columbia University Fertility Center (CUSFC) recommends that people interested in IVF take a close look at their health insurance options when they first start considering it. See what plans are available to you and what they cover, as far as fertility treatments are concerned. In some cases, it may make sense to pay for a pricier plan if it saves you money in the long run.

Compare costs (and success rates) at different clinics

If you're considering more than one different fertility clinic, don't just look at the fees they charge, says Bross. "First look at the quality of the clinic. What are their success rates?" he asks. "Number two should be prior patient satisfaction." If the fees end up being about the same at the different clinics, a higher success rate could translate to being less money spent in the long run.

Look into medication discount programs

Some pharmaceutical companies offer discount programs, where people under a certain income level can apply for a certain percentage off their medication. Check out our Find a Grant tool for some of these opportunities.

Weigh your payment options

Cost structure can vary widely, so find out what offerings your clinic has. For example, some clinics offer bundle pricing, in which one dollar amount covers monitoring, retrieval, labs, and a certain number of embryo transfers—whether you need that many or not—says Travis Lairson, director of operations at Inception Fertility. This can take some of the guesswork out of how much you'll pay and could help you feel confident you'll be able to afford the full amount of IVF, even if you have several transfers.

Apply for grants

There are a variety of grants available to help people financially through their fertility journey. Don’t be afraid to put yourself out there! 

Bross tells us that, sometimes, he's surprised how few people apply for certain grants. Your odds of getting one could be higher than you think.

Crowdfund

Many people look to friends and family for help paying for fertility treatments like IVF, and so if yours are supportive, you may want to reach out for potential financial help.

Work closely with a finance coordinator

Fertility treatment is expensive, and your clinic knows this. That’s why your clinic likely has an in-house finance coordinator to help you through the process. They can answer all your questions about pricing and your own individual needs, and may also be able to help you choose a payment plan for costs you can't pay upfront.

Summing it up

With all the unknowns, it can be scary trying to figure out how and if you can afford IVF, but don't go it alone. Start with your insurance company, work closely with your fertility clinic, and don't be afraid to put yourself out there by applying for grants or asking family and friends for help. Finances can be totally tricky, but the resources available may help you save some costs for this investment in a (hopefully) future family member.

NOTE: Cofertility works hard to recommend products and services that align with our brand mission of improving the family-building process for all. We sometimes earn a sales commission or advertising fee when recommending various products and services to you. As an Amazon Associate, we earn from qualifying purchases. Always be sure to consult with a doctor if you have any concerns. Prices and terms listed on our website are subject to change.

Let’s face it—there are a lot of things that can go wrong with your (or your partner’s) sperm, and a ton of reasons why you might be looking for the best male fertility supplements. 

We’re taught as kids that “nobody’s perfect,” and this couldn’t be more true than when it comes to male factor infertility; it’s actually super common and affects a third of all fertility troubles, according to the National Institutes of Health. But when you’re faced with sperm issues (sperm count, sperm morphology, or low sperm motility) it doesn’t matter how common it is. It’s still overwhelming, and you want to do whatever you can to make them go away. We get it. And while they won’t necessarily magically rid you of your sperm issues overnight, thankfully, male fertility supplements can help. Here’s the lowdown on male fertility supplements.

What do male fertility supplements do?

It’s often recommended that a woman takes prenatal vitamins while she’s trying to conceive, but it takes two to tango. It’s important to give sperm just as much attention as eggs.

Here’s what male fertility supplements (claim to) do:

• Increase sperm count: Nutrient deficiencies can lead to decreased sperm concentration or count. Male fertility supplements claim to help men get the right nutrition they need to get that “strength in numbers” kind of sperm. The more sperm you’ve got, the higher the likelihood one will make it to an egg. 
• Preserve sperm quality: Regardless of sperm count, getting pregnant can often come down to sperm quality. This matters, for example, when doing IVF — in order to fertilize the egg in a lab, an embryologist will need to utilize high quality sperm (and thanks to ICSI and PICSI, this process has become easier). Male fertility supplements claim to provide the nutrients needed for healthy, quality sperm. 
• Protect sperm as they mature: While most men produce millions of sperm each day, getting those little guys to stick around and mature is another story. Making sure your sperm is mature and high quality at the time of conception is key here.
• Boost overall health: Aside from the more tangible/direct benefits upon your sperm, just getting your overall health in balance prior to conception is always a plus and may have ancillary fertility benefits. Increased energy and better sleep are two outcomes many male fertility supplements tout.

Because we know busy enough worrying about your sperm health, we’ve taken out some of the legwork for you and rounded up some of our favorite male fertility supplements below.

Best male fertility supplements

Beli

The lowdown

Beli contains vitamins specifically designated to improve sperm count, sperm growth, sperm quality, and sperm motility. Every single ingredient in Beli is thoughtfully included due to research indicating how that particular ingredient will improve a man’s sperm (you can check out that research for yourself here). 

What makes it unique

Rather than a one-and-done bottle (which, honestly, might not do you many favors), Beli explains that it takes about three months of taking the male fertility supplements to ensure your sperm matures and strengthens. For truly optimal results, you should start taking Beli at least six months before trying to conceive. It’s a marathon, not a sprint. If you’re serious about improving your sperm long-term and achieving pregnancy, Beli is an awesome option. 

Check out Beli here. 

Natalist

The lowdown

In our opinion, Natalist makes one of the best male fertility supplements out there. Created just for men’s fertility, The Natalist Male Prenatal Daily Packets is a high-quality, antioxidant-rich multivitamin formulated for male fertility with key nutrients designed to support sperm health. The formula development was led by Dr. Andrew Sun, a Harvard-trained urologist and expert in the field of male fertility and Lauren Manaker, RD, an award-winning registered dietitian-nutritionist and specialist in male fertility.

Natalist is basically the gold standard of male fertility supplements, and they’ve really done their diligence to make sure they’ve included everything you need and none of the junk that you don’t. Plus, they come in convenient daily packets so you can take them on the go. Use code Cofertility20 for 20% off your purchase.

What makes it unique

In addition to being super super high quality, the wonderful thing about Natalist is that it’s on autopilot. Once you sign up, you get a new 30-day supply delivered monthly. Sometimes it’s hard to remember ordering new vitamins, but with Natalist, you basically set it and forget it. That said, if you’re just not feeling it, there’s no commitment. You can cancel at any time. 

Natalist is all about consistency, hence the subscription model. For truly optimal results, you should start taking Natalist’s Male Prenatals at least six months before trying to conceive. It’s a marathon, not a sprint, guys. If you’re serious about improving your sperm long-term and achieving pregnancy, this is an awesome option. 

To purchase Male Prenatal Daily Packets, click here. Be sure to use code COFERTILITY20 to get 20% off!

Conception Men Fertility Vitamins

The lowdown

These male fertility supplements focus primarily on zinc and lecithin, two ingredients that they claim to help boost sperm production and health. Conception Men is meant to be taken at a minimum of 12 weeks prior to trying to conceive, in order to achieve its full effect on sperm. As an added bonus, we’ve seen lots of positive customer reviews claiming that these pills also helped out their (or their male partner’s) sex drive. 

To purchase Conception Men Fertility Vitamins, click here.

What makes it unique

We love the do-good philosophy behind these male fertility supplements. When you take Conception Men, you aren’t just helping yourself out; with every purchase, Eu Natural, the supplement manufacturer, will provide one year of vitamins to children under five, new mothers, and pregnant women at risk for malnutrition. Win-win. 

Check out Conception Men Fertility Vitamins here.

Summing up the supplements

When deciding on the best male fertility supplements, it can feel super overwhelming to find the right fit for you. But you got this. Hopefully, these supplements set your swimmers well on their way to becoming Olympic-level in both skill and form. We’ll be here, playing Eye of the Tiger and cheering you on.

Between IUI vs. IVF vs. ICSI vs. PICSI...looking into fertility treatments can feel a lot like you're trying to make sense out of all those noodles floating around a bowl of alphabet soup.

At first glance, it seems like IUI vs. IVF are similar. They both have an I in them...so maybe they're related? And what's with ICSI and PICSI? Is that P just a typo? Don't worry, you don't need a crystal ball to figure all of this out. Consider this your secret decoder ring for all those fertility treatment acronyms.  

There are plenty of new terms to learn when you're starting the fertility journey—or at least terms to dig out of your brain from your high school science class days. But there are four major acronyms that tend to come up when you sit down with a fertility doc to talk options.

IUI

Short for: Intrauterine insemination (although it's also sometimes called artificial insemination)  

How it works:  

• IUI involves donated or a partner's sperm being placed in the uterus. Sperm are "washed" (essentially, sorted to weed out the strongest, best swimmers) and injected through a catheter up through the cervix directly into the uterus, at the time of ovulation. That's the end of expert intervention when it comes to IUI—the goal is for fertilization to occur in the body, up in the fallopian tube, in the same exact way it would if the sperm swam there on its own.  
• This procedure may be combined with medications to induce ovulation, such as Clomid or Letrozole, typically given for five days, or medication prescribed after the procedure, like progesterone (which can be used during IUI or IVF).

Who does it: Usually a reproductive endocrinologist, though it can also be performed by a general OB/GYN.

IVF

Short for: In vitro fertilization

How it works:

• IVF typically involves stimulating the ovaries with medications in order to boost the number of eggs you produce and mature them enough to the point of almost ovulating. However, donor eggs can also be used with IVF. If a donor egg is used, the mother-to-be will typically take medications meant to sync her cycle with that of her donor.  
• Next step? A mom-to-be or her donor has to undergo minor surgery to retrieve the eggs. "The eggs are collected using ultrasound guidance, using a syringe to withdraw the eggs from the ovaries," says Dr. Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.  
• Eggs are later mixed with donor or a partner's sperm in a lab—this process is called insemination.
• If insemination is successful and the embryo continues to mature after a few days, the embryo (or sometimes more than one, depending on your situation) is transferred directly into the uterus by a specialist, again using a catheter. Some first undergo genetic testing to ensure the embryo is chromosomally normal and/or isn't a carrier for certain conditions. If all goes well, the embryo will implant in the uterus, getting you pregnant.

Who does it: The retrieval and embryo transfer portions of IVF are typically performed by a reproductive endocrinologist, while the insemination process is handled by a clinical embryologist in the fertility clinic lab.  

ICSI

Short for: Intra-cytoplasmic sperm injection (usually pronounced ick-see)  

How it works:  

• The ICSI procedure is a part of the IVF cycle that's often used in cases of male factor infertility, such as poor sperm count or quality, says Dr. Alyssa Dweck, M.D., an OB/GYN at CareMount Medical in Westchester County, NY.
• A male partner's sperm is usually collected into a collection cup, though it may be retrieved surgically by a urologist from a male partner's testes or epididymis (that's a tube in his testicles where sperm collects).
• It is then studied in a lab to determine which specific sperm cell (sometimes called the spermatazoa) is the best candidate for potentially inseminating the eggs retrieved during the IVF process. "This technique allows a single sperm to be injected directly into a mature egg," Dr. Dweck says, hopefully resulting in a fertilized egg.
• The fertilized egg develops into an embryo, which is then placed in the uterus via the IVF process. And you know where this is going now, right?

Who does it: The ICSI process is typically performed in a fertility clinic or center's lab by an embryologist.  

PICSI

Short for: Physiological intra-cytoplamsic sperm injection (usually pronounced pick-see)

How it works:  

• No, that P isn't a typo. PICSI is essentially ICSI with an extra step, says Dr. Jaime Knopman, M.D., a reproductive endocrinologist at New York fertility clinic Colorado Center for Reproductive Medicine (CCRM).
• This procedure involves adding a special enzyme to the sperm to enhance insemination chances, but it otherwise mirrors ICSI. After an embryo forms, it's transferred to the uterus, and all fingers crossed…pregnancy hopefully occurs.  

Who does it: Like ICSI, PICSI is typically performed by lab specialists called embryologists.  

Consider artificial insemination and fertilization costs

It all depends on the treatment type. Something like IUI can cost you around or just over $400. Where on the other hand, IVF can cost upwards of $8,000, not including the required medications or ICSI treatment that can range from an additional $1,000 - $2,500. Surrogacy can exceed $100,000. 

With all of these different methods of insemination and fertilization, these processes can’t be cheap, or can they? This lies in the hands of your health insurance coverage.

If you’re looking to become pregnant and require one of these methods, you may save yourself a decent chunk of change by opting for a plan that covers fertility treatments. While each plan will vary as to what degree of coverage is provided, don’t forget to read the fine print before choosing your insurance plan.

The insurance policy carrier will determine what all is included. For example, if the man is the carrier of the policy, the plan may include fertility treatment for him but not for the female partner including the main event of the actual insemination.

If your employer doesn’t offer insurance that covers fertility treatments, you should take the issue to HR or a higher power to see if it’s possible. If it’s a large organization that has other employees dealing with the same issues, it may be something they’d be willing to change.

You should also conduct some research around grants offered by non-profits. There are many that exist to help with the cost of insemination.

Out of pocket expenses

If you are unable to obtain a plan that fully covers the artificial insemination process from start to finish, you’ll likely find yourself fronting the artificial insemination cost which can be an accrual of numerous things.

Medications

These are required to ensure that the woman is ovulating one or more eggs at the right time. There will typically be medications prescribed at each cycle and also one used to induce ovulation (otherwise known as a “trigger shot”). These medications vary in cost. For IUI, a prescription could cost you as little as $10. For IVF, depending on your insurance coverage, you could rack up a cost of $5,000 or more.

Bloodwork and check-ups

During the process of artificial insemination, it’s important that the woman is frequently monitored and evaluated. Not only will this require doctor appointments, but also blood work that can monitor hormone levels and the status of follicles throughout the process. While these costs vary, you might see costs of $500-$1,000 during each cycle.

Insemination

The event you’ve been working so hard for, the actual process of artificial insemination may cost around $150 to $400. However, sometimes an additional injection is suggested the day after the initial to improve success rates, so double that number if your doctor recommends this approach.

Additional fertilization costs

There is a chance you might need some additional assistance throughout the process, which may — you guessed it — make things more expensive. 

Embryo testing and freezing

Embryo testing for chromosomal abnormalities can cost $1,000 or more. Depending on timing or if you want to use them at a later date or after a lengthy transfer protocol, embryos will require freezing. This can cost a couple of hundred dollars. Freezing for a year will cost closer to $800. 

If you use a frozen embryo, the transfer will also come with a cost. The average cost to transfer a frozen embryo is $3,000-$5,000.

Egg donors and sperm donors

If you need an egg donor, you’re looking to endure a cost for just one cycle somewhere between $25,000 and $30,000. If you need a sperm donor, on the other hand, it’s significantly cheaper. On average, it can be about $15,000 per cycle. 

Gestational carriers

In the event that you need a gestational carrier, this will put you in the upper tier or near the top range of the total cost of insemination. This cost can range anywhere from $50,000 to $100,000. 

Total cost

Again, costs will vary depending on the treatment. It’s best to consult with your doctor to determine which route you should go and what additional costs may be required in your situation. Some fertility treatment costs can be offset by insurance and potential grants. 

To ensure you can afford IUI, IVF, or whatever fertility treatment you might need, it’s best to consult with your fertility doctor beforehand so you can determine how much you will have to pay in the end.

Summing it all up

Starting your fertility journey is a lot like learning a new language, and it can feel a little overwhelming at times. Don't be afraid to ask your fertility specialist to slow down, back up, and explain if you didn't understand the medical jargon they threw at you or simply spoke too fast.  

And hey, now that you've got the big four acronyms under your belt, you can start dropping some knowledge on those Facebook support groups like you're a pro…or at least understand what the heck they're all talking about.

Maybe your doctor just informed you that your sperm count is low, which may contribute to fertility issues. Or maybe you just have a sneaking suspicion that low sperm count is at the root of your fertility challenges. If so, you’re probably thinking: Why me? What does “low sperm count” even mean? How can I fix it?

The first thing to know is that you’re not alone. In fact, up to 50% of fertility problems can be attributed at least in part to male factor infertility. Still, depending on the cause of the low sperm count, there may be several avenues on which you can proceed.

What is low sperm count?

When you have a semen analysis, there are several parameters that are assessed. Two of the main aspects doctors look at are sperm concentration, or how many sperm there are in each milliliter of the sample provided (normal concentration is greater than 15 million sperm per milliliter), and sperm motility, or what percentage of the sperm in the sample is in motion (normal motility is greater than 40%). Low sperm count would be defined as a semen analysis with results less than these normal values.

What causes low sperm count?

A number of things can cause low sperm count, including certain cancer treatments, hormonal disorders, history of groin or testicle surgery, reproductive tract infections (including sexually transmitted infections) and certain medications such as chronic opioids and testosterone supplementation.

Varicocele is the most common surgically correctable cause of low sperm count and male factor infertility. This is characterized by dilated veins in the scrotum. The majority of men with low sperm count, however, may have no identifiable cause, as frustrating as that may be.

How can I treat low sperm count?

If you have been told you have low sperm count with associated fertility issues, it’s a good idea to chat with a urologist who specializes in male infertility. They can perform a thorough evaluation to assess for possible causes and potentially recommend medical or surgical treatments.

But don’t freak out. There are actually a few things you can try on your own to treat low sperm count while waiting for your appointment or the results of your workup:

Avoiding some stuff

Plain and simple, cigarette or e-cigarette usage has a negative effect on sperm counts; regular cannabis use (more than once per week) and excessive alcohol intake similarly are associated with low sperm count. Anabolic steroids or supplemental testosterone use can affect the hormones in the body that stimulate the testicles to make sperm and thus can cause low sperm counts.

Keeping tabs on your diet and exercise

Obesity is associated with low sperm count. There is data to suggest that weight loss in obese men may improve semen quality. And further, obese men tend to have hormonal abnormalities, which can improve with weight loss.

Moderate- or high-intensity physical activity (activities that force you to breathe somewhat harder or much harder than normal) has a positive effect on semen parameters. But interestingly, elite physical activity — when a person performs exhaustive endurance exercises — may negatively affect semen parameters.

Lastly, adherence to a healthy diet, notably the Mediterranean diet, can improve semen count. Increasing intake of fruits, vegetables, fiber-rich foods, fish, seafood, poultry and limiting full-fat dairy, cheese, red meat, soy and sugar-sweetened foods can improve sperm quality.

Thinking hard about supplements

There’s a lot of mixed information out there about supplements and male fertility. We know that oxidative stress (when cells that use oxygen to function produce toxic end products, known as reactive oxygen species or free radicals) can play a role in male subfertility. While many antioxidants and dietary supplements may reduce oxidative stress, the data on improving semen parameters is limited and occasionally contradictory.

Further, many supplements that claim to improve male fertility have limited or no scientific support. However, there is data that Coenzyme Q10, L-carnitine, Folic acid, Zinc, Vitamin C and Vitamin E may improve certain semen parameters. Just make sure that you chat with your doctor before taking any supplement used for male fertility management.

Unexplained low sperm count can be super hard to process. Still, some lifestyle modifications can have a positive effect on semen parameters. “Sperm health is a measure of overall health,” Dr. Sarah Vij, the Director of the Center for Male Fertility at Cleveland Clinic explains. “Anything you can do to improve your overall health, eating right, staying active, avoiding cigarette smoking and limiting alcohol, can improve your fertility.”

Summing it all up

When it comes to sperm count, there isn't always a definitive answer, and more research is needed to truly understand all that's involved. The good news is, there are promising low-risk strategies to improve sperm count. Good luck!

So you’re thinking of lining up to get the COVID-19 vaccine but maybe you’re worried about your fertility. Leave it to the pandemic to open up a whole new world of questions!

Maybe you saw posts making the rounds on social media that make some pretty scary claims that the new COVID-19 vaccines will hurt your fertility, or maybe you’re simply uneasy after a year of health news that’s put everyone on edge. We get it. 2020 will go down in history as the year that made us all second guess, well…just about everything.

But we know you came here for answers, not more questions! So what do the doctors (and not your high school best friend who went to Google University Medical School) have to say about the coronavirus vaccine and your fertility?

Will getting the COVID-19 vaccine affect fertility?

According to Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University, there are no definitive answers because the pharmaceutical companies didn’t purposely recruit pregnant women for their trials. And yet we know that health experts, including Dr. Anthony Fauci of the White House's coronavirus task force and World Health Organization Director-General Tedros Adhanom Ghebreyesus, all say COVID-19 vaccines are a must to end the pandemic.

So, what do you do next if you’re trying to take your fertility into account?

Well, for starters, Minkin says the lack of pregnant women in the clinical trials doesn’t necessarily mean that the vaccine poses a problem — for pregnant women or women who are trying to conceive. It simply means the researchers don’t have data on these particular folks. Right now, there is no known reason why a woman shouldn’t get the vaccine.

Currently, Minkin says most doctors are advocating women get the shot (or series of shots — depending on which vaccine you get), and some of the major medical organizations are pushing doctors to collaborate with patients to help them make the right decision.

Did you notice that we said *some*? The World Health Organization released a statement in late January advocating against the COVID-19 vaccine for most pregnant women unless the risks of getting the disease outweigh any potential vaccine side effects. That means they’re still advocating the vaccine for pregnant women who work in a healthcare setting or similar setting with high exposure risk, as well as for women with high risk pregnancies. 

The WHO is not advocating testing for pregnancy prior to vaccination, and its statement made special note that it does not recommend delaying pregnancy after getting the shot. 

So, what about the rest of the experts?

The CDC, American College of Obstetricians and Gynecologists (ACOG), and Society of Maternal Fetal Medicine are all advising doctors not to withhold the COVID-19 vaccine from patients who are planning to conceive, currently pregnant, or breastfeeding. Joining them is the American Society for Reproductive Medicine (ASRM), which came out with a statement on December 16, suggesting that both patients undergoing fertility treatment and pregnant patients should be encouraged to receive the vaccine — based on eligibility criteria.

The folks at ASRM say doctors and patients should work together to make that decision. You can expect your provider will consider these criteria in helping you choose:

• Local COVID-19 transmission and risk of picking up the virus in your area
• Personal risk of contracting COVID-19
• Risks of the vaccine and any side effects
• The lack of data out there about the vaccine during pregnancy

Honestly, like any medical decision, it comes down to individual women and their doctors to make the choices that are right for them.

Benefits of the COVID-19 vaccine

Doctors give multiple reasons for recommending the COVID-19 vaccine for both men and women on their fertility journey.

For women

If you’re fully vaccinated before conceiving, Minkin says “you'll have the benefit of immunity before conception.” That’s important. Data indicates pregnancy is associated with a higher risk of severe COVID-19 impact, and the American College of Obstetricians and Gynecologists is recommending pregnant women and lactating women have the vaccine made available to them to keep them safe.

The WHO, despite its cautions for pregnant women, is also advocating breastfeeding mothers get vaccinated — they say it’s both “biologically and clinically unlikely” to pose any risk to a breastfeeding child.  There’s currently no evidence (yes, we know we keep saying this) that contracting COVID-19 will affect your fertility, and experts like the WHO continue to say there’s no reason to put off pregnancy just because you’ve gotten a vaccine, but researchers are still monitoring this as more people contract the virus and more time passes. Vaccination is intended to prevent the virus as well as any potential side effects of getting sick.

For guys

Scientists are already seeing some cases where men who’ve experienced COVID-19 end up with impacted sperm production, which could impair their fertility. Preventing him from contracting the virus at all could prevent that from happening.

What if you’re already undergoing fertility treatment?

Many hopeful parents-to-be had to put fertility treatments on hold during the COVID-19 pandemic, but maybe that’s not you. You’ve been faithfully doing those injections, and your body is riding that gonadotropins rollercoaster.

Should you still get the vaccine? Minkin says this is another unknown simply because of a lack of data, but again this isn’t a sign that the vaccine is off the table.

The lack of data goes both ways, she says. There’s no evidence that being on hormones will affect how your body handles a vaccine AND there’s no known evidence that taking the vaccine can affect your treatments either.

Do we know anything about the COVID-19 vaccine?

We have thrown a lot of “we just don’t know” at you. So what the heck do we know?

Well, we know that the COVID-19 shot is an mRNA vaccine, rather than a live virus vaccine. That means:

• It doesn’t affect your genes. Any time scientists go poking around the human DNA strand, folks get nervous (and hey, we get it). But the one letter difference between RNA and DNA is a biggie — an mRNA or messenger ribonucleic acid vaccine never enters the nucleus of human cells. That means your basic DNA will not be changed if you choose to get the vaccine.
• The effect of mRNA vaccines on a fetus has been evaluated: And the folks at the Society for Maternal Fetal Medicine say there are no risks of an mRNA vaccine to fetal health.
• It’s similar to the make-up of vaccines for influenza, Zika, and rabies: According to the CDC, this is not the first time mRNA vaccines have been developed and used.
• It has undergone testing by the Food and Drug Administration: The FDA gave the Pfizer coronavirus vaccine a thumbs up for emergency use, but only after doing what they call a “benefit-risk assessment.” That means the experts at the FDA evaluated every bit of information from the company’s clinical trials. They’re expected to do the same for other pharma companies and their vaccine trials too.

When will we have some data?

Now that vaccines are being administered, researchers are already kicking off studies to get more information about the effects of the vaccine on the body, and that includes fertility concerns. Here’s what’s on tap:

• Experts at the American Society for Reproductive Medicine have called on doctors to encourage more patients to participate in vaccine trials and post marketing surveillance.
• Scientists are already looking to see if the vaccine affects a man’s semen and for how long.
• Although pregnant women weren’t sought out for vaccine trials, there have been some reported pregnancies in women involved, and the pharmaceutical companies are tracking them. The Moderna trial, for example, ended up including 13 women who have gotten pregnant along the way — six who had the vaccine and seven who were in the placebo group.

What about THAT article?

But wait a second, what about that article you saw all over everyone’s Facebook feed claiming a link between the vaccine and fertility? The one warning you that the vaccine is “female sterilization”?

The article showed up as a screenshot on Facebook in early December, seemingly pulled from a blog called “Health and Money News.” In it, you’ll see claims that the COVID-19 vaccine is “training the female body to attack syncytin-1,” a spike protein that’s part of the building of placenta, which would result in “female sterilization.”

That sounds frightening, we know. But it’s also fake news.

Minkin sums the viral article up in one pretty clear word: “bogus.” As for all the details the article goes into about spike proteins and syncytin-1, the Yale professor says it’s got no “significant scientific validity.” There you have it.

Bottom line

As of right now, there just isn’t a lot of clinical data or guidance to be found. You’re caught between a rock and a hard place, and we know it’s scary!

If you’re on your fertility journey and considering whether or not you should get vaccinated against COVID-19, we suggest you ignore the bogus myths and go directly to your doctor’s office. They’ll be able to help you plan out the best path forward.

First of all—and most importantly—if you have recently miscarried (or think you may have), we are so, so sorry. Experiencing a miscarriage is probably one of the most, if not the most, emotionally painful things you’ll ever experience. Having your baby’s life taken away from you is so incredibly gut-wrenching and life-changing...and we really wish we could just give you a giant hug right now.

Know that you are not alone, and we’ve been there. In fact, the March of Dimes estimates that as many as half of all pregnancies result in miscarriages, though the majority of those happen before someone even realize she’s pregnant. Of women who do see that plus sign on a pregnancy test, 15 to 20% will experience a miscarriage—most often, those occur in the first trimester.

There are actually a few different types of miscarriage, but the one thing they share in common is that no miscarriage is your fault. As incredibly awful as a miscarriage is to experience, please, please, try not to place blame on yourself.

Here are some of the most common types of miscarriage:

Chemical pregnancy

A chemical pregnancy means that your body may be producing some of the hormones like you’re pregnant, but no placenta or fetus forms. The embryo is usually lost right after implantation, and this type of miscarriage often occurs very early in the pregnancy, maybe even before you’re aware you’re really pregnant.

Blighted ovum (AKA missed miscarriage)

This type of early miscarriage is similar to a chemical pregnancy—except you start to grow the placenta and surrounding tissue, but there’s no fetus inside it. Unlike the chemical pregnancy, you might even start to develop pregnancy symptoms.

A missed miscarriage is usually discovered by your doctor, when you go in for your first ultrasound and discover there is no fetus. Chromosomal abnormalities are usually what leads the baby to fail to grow and thrive.

Incomplete miscarriage

An incomplete miscarriage happens when a miscarriage starts, but some of the fetus or the placenta is left behind in your uterus. If this happens, your doctor will need to monitor you—or she may prescribe misoprostol or perform a D&C (dilation and curettage) to help things along.

“Intervention becomes necessary if the woman is unstable from blood loss or if she becomes infected,” says Dr. Marra Francis, MD, FACOG, executive medical director at Everly Well. As long as you remain stable and don’t experience significant blood loss, your doctor can just monitor you and do a final ultrasound to confirm that all of the tissue is out of your uterus.

Complete miscarriage

When all of the pregnancy-related tissue has left the uterus, and the bleeding has ended, you’ve had a complete miscarriage. The doctor will likely conduct an ultrasound to ensure that nothing’s left behind that could lead to an infection or another complication.

Ectopic pregnancy

This dangerous condition occurs when the egg and sperm meet somewhere other than your uterus—and then stays there. The embryo latches on and starts growing in your fallopian tube or your ovary, where eventually, it could rupture and cause a hemorrhage of your tube.

In an ectopic pregnancy, if it isn’t caught early, you’ll develop severe pelvic pain and heavy bleeding that will likely need emergency care to manage.

Stillbirth

A stillbirth happens when the baby dies in the uterus later in the pregnancy—at least 20 weeks in. Only one percent of pregnancies end in stillbirths, according to the March of Dimes. You may experience some bleeding and cramping if it’s happening, but most often, the baby’s lack of movement is the only sign that there’s a problem.

Usually, labor starts on its own within two weeks of the baby’s death, but your doctor may induce labor or conduct a dilation and evacuation to remove the baby to help protect your health.

When should I see a doctor?

“If you see (or feel) something, say something,” should be your motto throughout your pregnancy. If you experience something that doesn’t seem quite right, don’t consult Doctor Google or us—see an actual doctor.

Common signs of a miscarriage or stillbirth that definitely need to be checked out immediately include cramping, pelvic pain, and spotting or bleeding—or later in pregnancy, a lack of fetal movement. But you should mention any changes that seem unusual to your doctor: It’s better to have a false alarm than to miss a warning sign that could potentially put you or your baby in jeopardy.

If you know you’ve had a miscarriage or are in the process of one, watch out for symptoms that you’re developing a uterine infection. If the bleeding and cramping continues beyond two weeks, or if you develop a fever, tenderness in the abdomen, or a foul-smelling vaginal discharge, see a doctor immediately.

This is so hard. How can I cope?

No matter how early in the pregnancy a miscarriage happens, it can be absolutely devastating. What makes it even tougher is that for centuries, people have been conditioned to stay silent about miscarriage and keep their grief to themselves.

Maybe it’s time to change the idea that you should deal with the pain of a miscarriage on your own. Being open and sharing your sadness with loved ones could help reduce the stigma of talking about miscarriage, and bring you strength and support from your circle.

Jessica Zucker, Ph.D., a clinical psychologist who specializes in reproductive and maternal mental health and the creator of the Instagram account @ihadamiscarriage shares, “The sooner we address the antiquated silence surrounding pregnancy and infant loss, the sooner women and families will receive the necessary support they deserve while grieving. It is time to disband the age-old silence when it comes to miscarriage and replace it with storytelling.”

Once again, sending virtual hugs and support. Take your time to grieve, and know that we’re right here with you.

All over the internet, there are articles about what miscarriage is from a technical standpoint but it’s rare that, as women, we can find the actual nitty-gritty details about what symptoms to expect during and after a pregnancy loss. The more we know, the better we can advocate for ourselves and receive support from those around us.

When I went through my first miscarriage, it was three weeks after learning that our baby was no longer growing. It took my body three whole weeks to recognize what was happening and those weeks were torture for my husband and I. Even though it took three weeks to recognize the loss, it only took about three hours from start to finish, to miscarry our first child. I have never been so broken in my entire life, nor had I ever been so unprepared for something.

Within six months, we suffered a second pregnancy loss and chose to undergo medical treatment to prompt uterine cramping to miscarry at home, thinking we would be more prepared the second time around. Unfortunately, that did not prove to be true and I had to have a D&C a few days later. What I’ve learned from my experiences could save you from feeling as unprepared as I was.

Obviously, we know that during a miscarriage, we go from being pregnant to no longer being pregnant. But what does miscarriage really look like? What symptoms should you expect during the physical loss and the weeks that follow? Here’s everything you need to know about miscarriage symptoms.

Important things to know about miscarriage

You have options

In many instances, you have options when it comes to how you miscarry. If you are afraid of miscarrying at home (which we totally get), ask your doctor about having a dilation & curettage (D&C). This scenario may, however, be the other way around — your doctor may recommend a D&C, but you may have a hard time affording the procedure, even through insurance. It’s important to know what your options are. And, as always, don’t be afraid to ask questions.

How to physically prepare for a miscarriage

• You won’t be able to use tampons during your recovery, so make sure to stock up on extra wide, large maxi pads. The overnight ones work best.
• Other items to buy would include adult diapers for comfort during the first few days after loss, especially if you miscarry at home without any intervention.
• A heating pad will work wonders for cramps you may experience for 2-4 weeks after your loss as your uterus shrinks to it’s pre-pregnancy size.

What miscarriage symptoms to expect

The most important thing for you to know about miscarriage (and pregnancy loss in general) is that it’s in no way your fault that this is happening to you and your family. Most women will feel self-blame during and after a miscarriage but it’s important for you to know that this is happening to you, not because of you.

If you think you might be miscarrying, here are some tips for what to expect. Of course, we *in no way* mean to freak you out. We just want you to be prepared. If you do miscarry, it will undoubtedly be incredibly tough in so many ways. But hopefully, these tips help give a heads up for what you might expect.

At-home miscarriage

What you should know:

• While some women experience bleeding that’s heavier than their period, other women experience intense cramping during a first-trimester miscarriage. If you do not already experience heavier PMS or cramps during your period, you may be caught off guard with your miscarriage experience.
• Even at a young gestation, these miscarriage symptoms can be physically taxing
• Many women describe miscarriage as labor, with painful contraction-like pains (even during the first trimester)
• If you are miscarrying at home, here are some reasons to go to the nearest emergency room/call your doctor.
• Abdominal pain that cannot be tolerated, despite treatment with over the counter medications such as tylenol or motrin.
• Heavy vaginal bleeding, or more than 2 pads per hour in the first few hours of bleeding. If you are feeling lightheaded, dizzy, have palpitations, chest pain, or shortness of breath, it could be a sign that your blood pressure is low from losing large amounts of blood.

What you might see:

• It’s possible that you’ll see a mixture of dark and bright red blood mixed with blood clots that range in size from dime size to as big as a lemon
• During the process of a miscarriage, you may pass tissue, or even an intact pregnancy sac that is recognizable.
• Depending on the gestational age of your pregnancy, you may be able to identify the pregnancy after the birth.

How to prepare:

• Don’t be afraid to ask your healthcare professional for a pain reliever recommendation or prescription. During the thick of miscarriage, the pain may be heightened, and having something available to alleviate pain will be one less thing to worry about.
• Have your partner, a family member, or friend with you during the physical loss. Although it seems like something you would rather do on your own, you will need support from others.

Recovery may look like this:

• Once you have passed the pregnancy, recovery will begin. You may experience heavy bleeding for another few days and then the bleeding will start to fade into lighter and lighter until it stops. Some women bleed for a few days to a few weeks after their physical miscarriage.
• You may feel sore and physically weak during the first few days after your miscarriage. This is normal as your body just went through a lot, both physically and mentally, and needs to rest. Give yourself the time to rest and begin to heal. If possible, take off of work for at least 3-5 work days. Taking more time off from work may benefit your mental health as you cope with your miscarriage. Don’t be afraid to ask your employer for bereavement leave.
• It’s important to check in with your doctor and partner during your recovery period. This may also be a good time to look into therapy or behavioral therapies. Experiencing miscarriage may be traumatic and taking care of your mental health is a priority.It can take 3-6 weeks (sometimes even longer) for the pregnancy hormones to leave your body entirely, which will ultimately trigger your first period post-miscarriage. Give your body time to recover chemically, and remember that recovery looks different for everyone.

Taking Cytotec (Misoprostol) for miscarriage

What you should know:

• Cytotec is not the same medication given to terminate a pregnancy. It’s actually most commonly used to induce labor at all gestations, including live births in the third trimester.
• The medication can be given orally, vaginally, or be dissolved in between the gums and the inner cheek.
• From the time you take the medication, you may start to feel the effects 30 minutes after to a few hours.

After taking the Cytotec, many of the same tips above for an at-home miscarriage will apply. The only change to look for would be intensified cramping due to the medication. At any point in your miscarriage if you fill a pad in under an hour or feel that your blood loss is more than expected, please call your OBGYN or go to the nearest emergency room.

Having a D&C (Dilation & Curettage):

What you should know:

• Most often performed in the operating room and under general anesthesia, but may also be performed in your doctor’s office with controlled pain medications.
• They’re covered by most insurance plans but could require high out-of-pocket costs.

How to prepare:

Follow the directions of your physician and prepare yourself for the recovery period. There may be restrictions on eating prior to the procedure, requirements with hydration, or other protocols to follow.

Recovery may look like this:

• You may experience bleeding for a few days to a few weeks after the D&C.
• Slight cramping is considered normal for multiple weeks after the procedure.
• Even though having the procedure seems like a less physically demanding process compared to miscarrying at home, the recovery may look very similar and the emotional recovery still exists. Give yourself time to begin healing, but don’t put expectations on yourself to grieve and move on within a week.

We’re here for you

Although there are a few different options for experiencing a miscarriage physically, each comes with its own aspects and recovery process. It’s important to know your options, understand what they mean, and move forward from a knowledgeable place.

After you physically miscarry, it’s so important to take the time necessary to grieve, or begin to grieve, and think of how you want to move forward with your family. This may look like taking some time off to heal — although, let’s be honest, you don’t ever fully heal and these experiences stick with you. For those undergoing fertility treatment, speaking to your doctor about how the miscarriage may impact the treatment timeline, especially if you want to try to conceive again as soon as possible.

Know that this is a difficult part of the journey, but you will get through it. And we’re right here with you.

You probably expect the word “mosaic” to show up when you’re searching Pinterest for a new art project to brighten your bedroom walls…not so much when you’re sitting down with your fertility specialist to talk about your embryos. But if you just got the news from your fertility clinic that you’ve got a mosaic embryo, you know they’re not talking about aesthetics. 

So, what is a mosaic embryo, and what does this mean for your chances of having a healthy baby?

What is a mosaic embryo?

Let’s cut through some of the big words that might have been floating around in that doctor’s office, shall we?

A mosaic embryo is an embryo that has what Emily Jungheim, MD — a reproductive endocrinologist at Northwestern Medicine — calls two more “chromosomally distinct cell lines.” Yes, we know, we said we’d cut out the big words. We’re getting there, and this will all make sense in a moment.

The way Jay Flanagan, MD, health expert for the National Society of Genetic Counselors and a clinical associate professor at the University of South Dakota, explains it, embryos are made up of two parts: 

1. Inner cell mass (ICM). That's where the baby comes from.
2. Trophectoderm (TE). That’s where the placenta comes from.

Genetic testing of embryos typically occurs during the in vitro fertilization process about five to seven days after an egg is fertilized — when the egg has grown to what’s known as blastocyst stage. That’s when your doctor will sample some cells from the TE for testing. If some (but not all) of the cells they test have different numbers of chromosomes from the magic “normal” number — 46 — the lab report will describe the embryos as mosaic.

“Think of a mosaic table, they have lots of different rocks or shells,” Flanagan explains. “A mosaic embryo has more than one cell line.”

So how is a mosaic embryo different from any other embryo?

If you look at one of the mosaic tables Flanagan described, you’ll see all sorts of different shapes and sizes of rocks or shells. The same goes for embryos and the cells they’re made from. So you could have an embryo that’s made up of:

Only aneuploid cells

Human cells typically have 46 chromosomes, Jungheim explains, but aneuploid cells have what the doctors call an abnormal number. If your tested cells are all aneuploid, you have what doctors call an “abnormal” embryo, and you’ve also got a much higher chance for failed implantation, miscarriage, or — in some cases — having a baby with developmental or intellectual concerns, Flanagan says.

Overall, most fully aneuploid embryos will either not implant or if they do implant, they will eventually stop developing and result in a miscarriage. A small number of chromosomal imbalances (i.e. having 3 copies of chromosome 21) have the potential to turn into a liveborn baby, but these children will have significant medical issues, like Down Syndrome.

Only euploid cells

Euploid cells are the opposite of aneuploid. They’ve got just the right number of chromosomes — 46. If your test shows only euploid cells, your embryo is not considered mosaic. It’s important to know all euploid cells don’t automatically mean the embryo will result in pregnancy, Flanagan says, but a higher percentage will.

A mix of aneuploid cells and euploid cells

If you’ve got a mix of both kinds of cells, you’ve got a mosaic embryo. And that’s not necessarily a bad thing. It’s possible that, in all likelihood, some of us are even mosaics with more than one cell line, but most of our cells are normal. In other words? Mosaic embryos are…well…not necessarily abnormal.

Should I transfer a mosaic embryo?

This is the question of the hour, and we wish we could just make up your mind for you, but we can’t. You should be talking to your doctor and getting their advice on how to move forward if they’ve identified a mosaic embryo.

Here’s what we can do: Tell you what you might need to consider when considering the risks of transferring a mosaic embryo.

Is it a "high level" or "low level" mosaic embryo?

There’s no exact math here, but if most of the cells are abnormal, your mosaic embryo is likely to be called high level. If there are fewer abnormal cells, it will likely be considered low level.

Should I hold out for a "normal" embryo?

The word “normal” is pretty complicated, isn’t it? No one wants to be called “abnormal,” and an “abnormal” embryo is not ideal. But there’s a whole lot of nuance in embryo descriptions, according to Northwestern’s Jungheim who says to take those descriptors with a grain of salt…and have a long talk with your doctor. “It is important to recognize that even with an embryo that has a ‘normal’ result, the chance of a live birth is still not 100 percent,” she says. This is where finding a reproductive endocrinologist you trust makes all the difference.

Can the embryo "self correct"?

You might have heard this from some other folks in your fertility community. But “self-correcting” mosaic embryos are a bit controversial in the medical community. “More than likely, normal cells have a growth advantage over abnormal cells,” Flanagan says.

We’ll put it in math terms. Say there are 10 “abnormal” cells and 10 “normal” cells. If the 10 normal cells grow and divide more successfully than the abnormal ones, over time there could be 100 normal cells but just 15 abnormal ones. That “could” be a self-correction.

Then again, sometimes the abnormal cells your reproductive endocrinologist found when they were testing the TE cells were only in the TE. Genetic testing is done on TE cells — remember, those are the ones responsible for creating the placenta — because doctors don’t know what would happen if they biopsied the ICM cells (the ones that actually make a baby!). And it turns out sometimes the ICM cells are just fine…even if the TE cells showed mosaicism.

“The TE is prone to cells with chromosomal issues, while the ICM does not tolerate abnormal chromosomes well,” Flanagan explains. “Therefore, an embryo with a very ‘abnormal’ TE can still result in a healthy pregnancy and baby if there are few or no abnormal cells in the ICM.” The only way to know? Like everything else, talk to your doctor or find a genetic counselor who can help you through it all.

Putting it all together

The words “mosaic embryo” may not mean the end of the road for your fertility journey. It just means a long talk with your fertility specialist. As Jungheim says, it all comes down to the specific chromosomes involved and the proportion of cells. Good luck!

If you're having conversations with your doctor about doing intrauterine insemination (IUI) or in vitro fertilization (IVF), you're probably hearing a certain word come up over and over again: twins.  

Since both procedures could involve multiple eggs or embryos, the chances of becoming pregnant with multiple babies is higher than your average conception—but we're here to tell you that those chances are probably not as high as you think.

Will you have to buy twice the number of diapers? Maybe...we can't predict the future. But we can tell you that your pregnancy will not become fodder for a basic cable reality TV show. Here's why!

IUI actually carries the bigger twins risk...but it's not even that big

Dr. Jane Frederick, reproductive endocrinologist at HRC Fertility in Orange County, California, says about 10% of IUI patients will get pregnant and about 10% of those patients will get pregnant with multiples. That makes the overall chances pretty low, though there's always a possibility of multiples with IUI because the treatment involves taking medication to stimulate egg production. This increases your chances of an egg being fertilized with sperm—which increases your chances of pregnancy—but also means that more than one egg could be fertilized during the whole process.  

Here's why you shouldn't freak out, though: Dr. Frederick says your doctor will be monitoring you before giving you the green light for insemination to make sure you didn't produce too many eggs. Most doctors will cancel an IUI cycle if a patient has 3 or more follicles, so while you could in theory get pregnant with twins, a responsible doctor won't put you in a situation where you could have triplets, or quintuplets, or—gasp!—octuplets.

What if I'm planning to do IVF?

Actually, there's not as much left to chance with IVF compared to IUI; you're more in control of the fertilization process. (Well, technically your doctor is the one in control, but you know what we mean). Dr. Frederick says that once your eggs have been fertilized in preparation for IVF, you have the choice to only transfer one embryo, which eliminates the chances of accidentally winding up with more than one baby.

Wait. Doesn't only implanting one embryo reduce my chances of winding up with any baby at all?

That's not necessarily true anymore, thanks to something called pre-implantation genetic screening (PGS), which helps reproductive endocrinologists determine which embryos are most likely to develop into pregnancies. This advance in assisted reproductive medicine reduces the need to put 5 or 6 embryos back into the uterus during IVF.

With PGS, your clinic's lab can genetically test each embryo to see which is the healthiest. This decreases the risk of multiples while increasing the chance of a successful implantation with a healthy embryo.  

When might my doctor recommend transferring more than one embryo?

We just told you that genetic testing has eliminated the need for a "let's transfer as many embryos as possible and see how many stick" approach to IVF, but is there ever a time when your doctor might still want to transfer more than one embryo?  

Yes—although it's not often and definitely not for everybody. According to Dr. Daniel Kort, a reproductive endocrinologist practicing at Neway Fertility in New York City, the overwhelming trend in the U.S. over the last several years is single embryo transfer (two embryos, max).

"In 2019, I hardly ever transfer more than two embryos," he says. "Our goal is singleton pregnancies, because the majority of twins do well but the rates of maternal and fetal complications are still greater."  

That said, Dr. Kort describes the times when your doctor might recommend transferring more than one embryo:

• When the quality of IVF embryos is lower or less likely to result in pregnancy
• When embryos were not genetically tested, so there's some uncertainty about their quality prior to transfer
• When a patient is older, i.e. over 40
• When more than one of these criteria is met at the same time (like if a woman is over 40 and the embryo quality is not stellar)

The health risks of IUI or IVF twins

Look, we're not here to scare you, and your doctor—who actually knows your medical history—is definitely the best person to counsel you on the specific problems you could face when carrying multiples. But you came here for info, so we're going to give it to you!

The biggest health risk when you've got more than one bun in the oven is premature delivery, defined as birth before 37 weeks gestation. This is because babies born early, a.k.a. preemies, are more likely to have physical problems in both the short- and long-term (which could include anything from breathing problems, heart defects, and infections to cerebral palsy, learning disabilities, and vision or hearing loss). According to the March of Dimes, certain fertility treatments may also increase your risk of having a low birth weight baby or one with birth defects.  

Dr. Frederick says premature birth is 4 times more likely with twins and 8 times more likely with multiples, so it's unlikely you'll go full-term if you're having more than one baby. All of that said, many preemies do completely fine, and an early delivery is not a guarantee that your babies could have health problems.

Is there anything I could do to minimize those risks?

We'll give you the bad news first: not really. Both Dr. Frederick and Dr. Kort say the only real "treatment," so to speak, for the risks associated with multiples is prevention—meaning that once you're officially expecting double bundles of joy, there's not much that can be done to reduce the chance of complications.  

Now for the good news. As you begin your fertility treatments, your doctor is going to be working that whole prevention angle pretty hard, because they really just want you to have a healthy single pregnancy.

"My goal is to proactively try to prevent a patient from having multiples by not transferring more than one embryo [in IVF], canceling Clomid cycles if they look dangerous, and offering intense counseling prior to transfers about the risks of multiples," says Dr. Frederick.  

What if I don't really mind the idea of twins?

Hey, we get it. If you're talking about IUI or IVF with your doctor, then you've probably worked really hard and waited a really long time to have a baby. It's not crazy at all to be excited about the possibility of rocking two sweet little bambinos in your arms at the end of this complicated road to parenthood.  

That said, you don't want to play it fast and loose when it comes to a twin pregnancy; your health is important, so make sure you're listening to your doctor's recommendations, whatever they are.  

So basically, you're saying that doing IUI or IVF won't give me octuplets?

Yup, thats what we're saying. But seriously, talk to your doctor if you're still nervous about having twins...they can definitely make you feel better about the odds.

You’ve probably just received the worst news of your life—that you’re no longer pregnant. And we know just how shocking and upsetting that can be. We’ve been there, too, asking the same horrible question: How could you possibly feel so pregnant, but not be?

According to your doctor, you’ve had a missed miscarriage (also known as a blighted ovum). But you’re not alone. About half of the first trimester miscarriages are due to blighted ovum, according to the National Center for Biotechnology Information.

What is a "missed miscarriage," anyway?

Whether it’s called blighted ovum, anembryonic pregnancy, early pregnancy loss, or missed miscarriage, it all amounts to the same awful thing. Your body has started growing placenta for a baby, but a baby isn’t growing inside it. It occurs when the fetus either dies or never grew, but the placental tissue and sac are still there, according to Dr. Marra Francis, MD, FACOG, executive medical director at EverlyWell.

You’ll likely try to search out the reason it happened, and you might even place the blame on yourself for it. But your miscarriage didn’t happen because you drank a glass of champagne or you cleaned out the cat’s litter box before you knew you were pregnant. Repeat after us: it was. not. your. fault. In most cases, actually, a missed miscarriage happens because of a chromosomal abnormality, a problem with the genetic code of the embryo.

In fact, there was nothing you could do to cause this miscarriage to happen—and there was nothing you could do to stop it from happening. No matter how well prepped you are (modifying your diet and exercise routines, limiting stress, taking prenatal vitamins), unfortunately, that won’t stop chromosomal abnormalities from happening, says Dr. Stephanie Zobel, MD, an OB-GYN with Winnie Palmer Hospital.

How it's diagnosed

There’s a reason it’s called a “missed” miscarriage, and that’s because all the common signs of miscarriage, like heavy bleeding and cramping, are missing. Your levels of hCG (human chorionic gonadotropin), the pregnancy hormone that the placenta produces, may rise just as they should—leading to the breast tenderness, nausea and other symptoms common in early pregnancy.

In fact, the only unusual symptom women might experience is a bit of brown spotting, says Dr. Francis. A missed miscarriage is only caught when you go in for an ultrasound, and there’s no baby.

What happens if you're diagnosed with a missed miscarriage?

Once it’s been confirmed that you’ve miscarried, you and your doctor can decide the best course of action to deal with your miscarriage. You might decide to simply wait for your body to expel the placenta and other tissues on its own, or you may opt to take a medication like misoprostol to help remove the remaining tissue.

In some cases, it might make sense to have a dilation and curettage (also known as a D & C), where the doctor will dilate the cervix and surgically remove everything. That’ll be helpful if you’d like a pathologist to investigate what happened—which might be important for you if you’ve multiple miscarriages.

But the grief, anger, and myriad of other emotions you’re feeling in the wake of the miscarriage can be much more challenging for you and your partner to handle. Take time to grieve, seek out supportive friends and family members (or even a support group), and be kind to yourself. Remember that you’re not alone. According to the March of Dimes, 15 to 20 percent of all recognized pregnancies end in miscarriage—so odds are, you have some friends who have dealt with this themselves.

How soon can you try again?

Most doctors recommend waiting at least one to three menstrual cycles before you try to get pregnant again after a miscarriage, but you should check in with your own OB/GYN to see what she recommends for you.

It can be scary to try again after a missed miscarriage, but keep in mind that the odds are in your favor that the next time will, hopefully, be a success. We're keeping our fingers crossed for you. In the meantime, take all the time you need to grieve.