Fertility

If you’re thinking that a surrogate might be the answer to your “how will I become a parent” question, you’ve probably already started doing some math in your head to figure out how you’re going to cover all those surrogacy costs.

But just how much does working with a surrogate cost? You’ll likely be using a gestational carrier — that’s the term you’ll hear thrown around a lot to describe a woman who gets pregnant to help someone else fulfill their dreams of parenthood but is not biologically related to the baby. She is impregnated via in vitro fertilization (IVF) and carries an embryo made up of someone else’s sperm and someone else’s egg.

But does she get compensated? And what about the surrogacy costs after the baby is born?

How much does working with a surrogate cost?

The cost of surrogacy can run you anywhere from $100,000 to $200,000 in the United States — depending on where you live, who your gestational carrier is, and just exactly what fertility services you need along the way. It’s a pretty big range — and you’re probably wondering what’s included in that figure. 

According to Amira Hasenbush, a California lawyer and founder of All Family Legal who specializes in surrogacy, it can totally vary depending on the individual or couple’s needs and decisions.

What do surrogacy costs include?

Even if the costs are still a question mark, by now you’re probably familiar with the basics of the surrogacy process. A gestational carrier becomes pregnant, and after 40 weeks (give or take), a baby is born. But it’s the lead-up to the day that you get to hold your sweet little bundle of joy that will determine which end of that price range you’ll end up on. 

You’ll likely need to pay for IVF in some capacity, whether it’s to fertilize an embryo from you and your partner or via donor eggs or sperm. IVF costs can totally vary between $8,000 - $30,000, but can have varying degrees of insurance coverage depending on where you live.  In addition to those fees, here’s what other surrogacy costs could include.

Agency fees

First things first! You’ll need to find a surrogate, and you may need to engage an agency to help you find the perfect person. Or maybe you’re lucky, and you’ve already got someone in your life who’s more than happy to help make your parenting dreams come true by carrying the baby. If that’s so, you can likely strike the surrogacy agency fee from your list. Next, however, you’ll have to consider whose eggs will provide half of the baby's DNA.

Egg donor compensation and medical coverage

If you’ll be going the egg donor route, you can review the Family by Co matching platform to see if you find a good fit for your family. Our model of free egg freezing when our donors give half of their eggs to another family who can’t conceive ensures that all donors on the platform are not only altruistic, but ambitious and excited to preserve their own fertility. 

To better understand costs involved with working with Family by Co, please review more about our commitment here.  

Sperm donation

If you need donated sperm to help this process along. If you don’t have a friend or family member on board to help (which most of us don’t), expect to pay somewhere around $700 to $1,000 to get frozen sperm from a sperm donation bank. 

Embryo donation

For parents-to-be who opt for an already fertilized egg, there can be cost savings — many embryo donations are handled by religious non-profits that will match unused embryos to would-be parents for free. You’ll still need to consider the costs of the IVF procedure, however, just as you will with sperm and egg donations or even transferring your own embryo into your gestational carrier’s uterus. 

Legal fees

Agreements will need to be made with the egg donor if you have one, as well as the surrogate herself. Intended parents pay not only their own legal fees but those of their donor or surrogate, Hasenbush says. These fees vary by location, and again by what a parent- or parent-to-be needs in the process, but overall the lawyer and legal fees could cost around $8,000 - $15,000. 

Insurance

Your surrogate is also going to need insurance “The medical/insurance often surprises folks,” Hasenbush warns. “The insurance coverage needs professional review to make sure it covers surrogacy.  Premiums can be very high, and if they buy surrogacy-specific insurance, it is particularly expensive.”  

Some surrogates have health plans that will cover her costs once she starts getting treated by an OB, but it’s important to get this all evaluated up front, and to have it re-evaluated every fall to make sure that it hasn't changed from one year to the next, Hasenbush says. Some other insurance stuff to keep in mind:

• Out-of-pocket maximums start over each calendar year.
• Some insurance companies have a lien policy where they can put a lien on the surrogate's compensation to recoup their costs. This doesn't mean that the surrogate loses her compensation, Hasenbush says, but it does mean the intended parents have to set aside the maximum amount that the lien could be as an additional amount in escrow for if/when the insurance company requests it.
• Some surrogacy contracts require other insurances for the surrogate including life insurance and loss of reproductive organs insurance (should something happen during the pregnancy).
• Egg donor and IVF complications insurance may also be recommended.

Surrogate base compensation

Unless you have a family member or friend who will be acting as gestational carrier, one of the biggest costs will be compensating the surrogate herself — anywhere from $35,000 to over $55,000. This is the portion of pay to the surrogate that acts as a salary for the service she’s providing, but it’s not all she gets. 

Multiples compensation

Expecting twins or triplets? You may need to pay an extra $5,000 to $10,000 as part of your surrogate’s base fee. 

Additional surrogate fees

Typically, surrogacy contracts include an itemized list of compensations that come on top of that base, so that your gestational carrier will be covered for other difficulties and expenses she’ll incur while pregnant. That can include things such as

• Lost wages for surrogate when she is on bed rest or traveling for the surrogacy
• Lost wages for a surrogate’s partner while she’s on bed rest or traveling for the surrogacy
• Surrogate (often and a companion) travel for medical visits, including visits for embryo transfers, regular check-ups, and any other pregnancy-related doctor visits
• A monthly allowance to cover odds and ends such as parking at doctor’s offices, postage, etc.
• Clothing allowance for maternity clothes
• Additional compensation if delivery has to happen via C-section instead of via a vaginal birth
• Childcare and housekeeping costs if the surrogate is placed on bed rest
• Therapy coverage for the surrogate to work with a counselor during the pregnancy if she wishes to

Escrow fees

Surrogate and egg donor fees are typically held in an escrow account. Intended parents will place money upfront in a special, locked account according to the agreement outlined in the contract. Many surrogates are paid in monthly installments after pregnancy is confirmed.   

Any medical out-of-pocket surrogacy costs not covered by insurance

From over-the-counter medications to medications and procedures the insurance company decides not to cover, there may be additional costs that add up.

Surrogacy costs after baby is born

Once the big day arrives and your baby is born, you’re going to have a ton of diapers to buy. But before you start thinking about all the costs of getting a child to 18, you’ve still got some surrogacy-related bills you’ll need to pay.

• Legal fees: Yup, there are more of them after the baby’s born. Because your baby was delivered by a gestational carrier — even if the baby is biologically related to you — you may have to establish parenthood in the eyes of the court, which means attorney fees and court costs. If you traveled internationally to find a surrogate, you may also have to pay to establish your child’s citizenship.
• Breast milk: You may want your surrogate to pump her breast milk for your baby. If she’s amenable, you’ll need to compensate her as well as paying for her supplies such as the breast pump and bottles. If she isn’t local, you’ll also need to factor in shipping costs for the milk.
• Lost wages: Maternity leaves aren’t just for moms to bond with baby — they’re also for a woman to recover from delivery. You should expect to pay your surrogate for the time she may be out of commission after the baby comes — anywhere from four to 8 weeks.
• Health costs for the surrogate: As her body heals, you’ll likely still be paying for your surrogate’s medical care. Health and life insurance premiums are typically paid by the parents for at least three months after the delivery, but it could be extended to six months if there were complications during the pregnancy or delivery, Hasenbush notes.

Is that everything?

The fertility journey can be a bumpy road, and sometimes Mother Nature doesn’t cooperate. If a surrogate does not get pregnant after three rounds of IVF or if she suffers a miscarriage, you may need to find an alternate surrogate and this could incur more fees. Your agency will help you find another surrogate most likely, but you may not recoup the money paid to or on behalf of the first surrogate.

Anything else?

At the end of the day, surrogacy does cost money. There’s just no way around that. But we recommend you take advantage of the resources out there — talk to the doctors and lawyers in the business and form your team to make it happen. We’re here for you, keeping our fingers crossed.

On the surface, surrogacy might seem like a rather simple arrangement: find a healthy woman, willing to carry a child for someone else. But there are many legal scenarios that can quickly complicate the relationship between the surrogate and the intended parents if the process isn’t navigated correctly. So, here’s a quick primer for those just beginning to understand this process, to help you decide if it’s right for you and your family.

Surrogacy 101: the basics

There are two types of surrogacy, traditional and gestational:

• Traditional surrogacy is when the same woman contributes the egg and carries the pregnancy, and is actually very rarely done these days for many reasons, including legal ones traced back to the Baby M case of the 1980s. In this case, a surrogate was inseminated with the intended father's sperm and then sued for custody of the baby after giving birth.
• Gestational surrogacy is more common by far, and is when the egg comes either from the intended mother or an anonymous donor. That way, the baby has no biological link to the woman who carries the pregnancy. This is the ideal arrangement for most families.  

One more point on vocab: while most of us are only familiar with the word "surrogate" when talking about the woman who physically carries the pregnancy, the more medically accurate term is "gestational carrier." So for the purposes of this piece, we're going to refer to the process as surrogacy and to the women who carry the pregnancy as gestational carriers.

Who might consider surrogacy?

Surrogacy can be a great option for a variety of people facing challenges on conceiving their own biological children. This includes:

• Same sex male couples
• Women who've had recurrent miscarriages, implantation failures or other medical issues that preclude them from getting pregnant
• Women who have had to have a hysterectomy as a result of other health issues
• Women with breast cancer or a form of cancer that may prevent them from carrying a baby safely

OK, I'm interested. What else do I need to know?

Find a reputable agency

Surrogacy requires a deft hand navigating medical and legal requirements but also jumping through complicated medical insurance hoops. In order to make sure every legal T is crossed and I is dotted, you'll want an established, experienced agency on your side.

Check your bank account

Most agencies list the total expenses to be anywhere between $60,000 and $125,000, including all legal fees as well as the medical care and payment for the gestational carrier. Some states also allow what’s called altruistic surrogacy (where the gestational carrier is not financially rewarded—say, if your cousin offered to carry the baby), but the vast majority of gestational carriers are paid.

Understand the process

The first step is to work with the agency to find the right gestational carrier, and a separate egg donor. Here is an average timeline, according to Dr. Sheeva Talebian, reproductive endocrinologist at Colorado Center for Reproductive Medicine (CCRM) in New York:

1. Recruiting and matching the gestational carrier: 3-4 months to over a year.  
2. Egg retrieval, insemination and embryo transfer: 1-2 months
3. Pregnancy: 40 weeks

Line up all your legal ducks

Surrogacy is a huge legal undertaking. Fun stuff, right? Because laws vary so widely from state to state, every stage of the surrogacy process might take place in different locations. For example, if the intended parents live in New York (where surrogacy is illegal), they may have to collect the sperm sample in New York, then send it to California, Oregon or another state deemed "surrogacy friendly" where they can find a gestational carrier and egg donor.

That said, surrogacy laws have been changing, and while it may not be legal in your state today, it may be as soon as next year. Fingers crossed!

Who are these "surrogates" you speak of, anyway?

Almost all agencies require the following of potential gestational carriers:

• She has been pregnant before and has delivered a healthy child of her own.
• She must be medically healthy, have no history of drug use and no history of infectious disease.
• She has to demonstrate that she has no mental health challenges. This may involve home visits, extensive psychological interviews and group meetings with the gestational carrier and the intended parents.

Exceptions are sometimes made for an altruistic carrier, but again, most surrogacy arrangements involve the carrier being paid for her 9+ months of "work."

Summing up surrogacy

If you're interested in surrogacy, talk to your reproductive endocrinologist about third party reproduction services offered through your clinic and what's possible in your state. If you can afford it, it could be an awesome way to make your parenthood dreams come true, and a good RE will hold your hand the whole way through.  

So your doctor wants you (or your partner) to undergo a semen analysis for infertility, huh? If you've never given a sperm sample before, you're probably imagining all kinds of embarrassing and/or awkward scenarios. Will a random stranger accidentally burst in at a critical moment? Will you be able to "make the magic happen" under pressure? Will it be exactly like that scene at the sperm bank in Road Trip? (Spoiler alert: no, it's nothing like that.)

Chances are, if you're facing infertility and your doc has asked for a semen analysis, he or she's got a pretty good reason—there's a lot that can be learned from that precious cup of bodily fluids, so it's definitely worth going through the process even if you don't totally love the idea. But relax: a semen analysis is not as bad as you think. Here's everything you need to know.  

Why do I have to do a semen analysis?

The most obvious reason is because you're dealing with infertility issues—male factor infertility is found in 40% of couples struggling to conceive, so a semen sample is the best way to determine if something's up with the quality of your sperm. But Dr. Mark Trolice, reproductive endocrinologist at Fertility CARE: The IVF Center in Orlando, Florida, says there are some other possible reasons for needing to give a semen sample, like if:

• You're trying to become a sperm donor
• You want to freeze your sperm for future insemination or conception
• You're going to be away during a planned fertility treatment cycle (like if your wife is undergoing in vitro fertilization while you're deployed with the military)
• You've had a vasectomy but want to make sure there's no remaining sperm in your ejaculate

Will it be like in the movies?

Well...yes and no. Basically, you do have to set up shop in a private room at the fertility clinic and manually stimulate yourself until your efforts are, you know, fruitful. Clinic staff will give you a sterile collection cup to fill up with ejaculated sperm. Remember, they see this kind of thing every day—there's no need to be embarrassed or ashamed about what you're doing.

Now, as far as successfully setting off the fireworks show, there's a certain amount of flexibility in how you go about it. Dr. Trolice says that usually your partner can go into the room with you to help out or make things less awkward, and of course there are always helpful materials available if you need them.  

If you're still totally stressed out about the idea of a) manual stimulation or b) ejaculating in a semi-public place, there may be some options to get around those obstacles, too. In some cases, a couple can use a special condom during intercourse at home to collect semen (but it can't just be any old condom, because regular ones might contain lubricants or other residues that can kill sperm).  

If you go this route—or just want to collect your sample at home through masturbation—you'll need to be able to rush your semen down to the clinic within 30-45 minutes, says Dr. Trolice. Any longer than that and you risk affecting the sample; if it gets too cold, for example, the motility of your sperm could slow down and skew your results.

What am I going to learn from this?

According to Dr. Trolice, there are four things your doctor will be looking for in your sample:

1. Volume, or the amount of fluid you produced. Typically, about 1 ½ to 2 milliliters or more of semen will give you an adequate total number of sperm.
2. Density, or the amount of sperm per milliliter of semen.  
3. Motility, or how many sperm are moving around, and forward, in the sample (and how well they're moving forward).
4. Morphology, or the size and shape of your sperm (the Mayo Clinic says you want sperm with an oval head and straight tail, i.e. sperm that can successfully penetrate an egg).

In 2010, the World Health Organization (WHO) released a new set of guidelines for a normal sperm analysis; in order to be considered fertile, semen should have at least 15 million sperm per milliliter, a motility of 40% or more, and a morphology of 4% or more. Dr. Trolice warns patients to take these guidelines with a grain of salt, though.  

"It's important to know that just because your numbers are below the cutoff, that doesn't mean you can't father a child or will definitely need to do IVF," he says. In some cases, a patient might be referred to a urologist or possibly considered for hormone therapy or surgery if the problem can be corrected.

Your feelings about it are totally normal

Look, we know you probably don't want to do a semen analysis, but if you're struggling with the possibility that you could have male factor infertility or worried that you'll receive abnormal test results, know that those feelings are 100% normal—and it's okay to find someone to talk to about it. Until then, remember that this kind of thing happens all the time...and is pretty much always less eventful than it was for Seann William Scott.  

Fertility issues are hard enough to deal with when you actually understand what's causing the problem. But if your infertility is unexplained—as is the case for 30% of infertile women or 50% of infertile men — not knowing what's keeping you from getting pregnant can get pretty damn frustrating.

For the sake of this post, we’ll be addressing unexplained infertility in females. Don’t worry, we talk allllll about the guys in other posts.

What the heck is unexplained infertility? 

Unexplained infertility means not only are you not getting pregnant, but also that the usual suspects don't seem to be behind your problem. According to Dr. Nataki Douglas, M.D., Ph.D., director of translational research for the Department of Obstetrics, Gynecology and Women's Health at Rutgers University in New Jersey, it's the diagnosis given to an individual or couple trying to conceive after a thorough evaluation already reveals normal ovulation, a normal uterus and patent fallopian tubes, and a normal semen analysis.  

That means you've probably already done a huge battery of tests (egg assessment, an ultrasound and hysterosalpingogram (HSG), and semen analysis), and basically only up with a big shrug of the shoulders. So that leads to hunting elsewhere for a problem, and dealing with a lot of uncertainty in the meantime. We know. Not fun.  

So, what's happening?

Unexplained infertility doesn't exactly mean that there's no explanation at all. You may have undergone all the routine tests, but there is likely some explanation for your infertility hiding somewhere. Here are some of the additional factors that could be at play:

Diet

Consider this the perfect reason to clean up your diet, if you haven't already. Recent research from the Harvard T.H. Chan School of Public Health and Harvard Medical School has shown that diet plays a role in conception.

For women, that means boosting your intake of folic acid, vitamin B12, and omega-3 fatty acids, along with following a generally healthy diet, while men need to follow a healthy diet and reduce their intake of trans fats and saturated fats. Bottom line: If you think your diet could be a factor, it may be worth seeing a nutritionist to see if you can find a fertility-enhancing diet that works for you.

Autoimmune issues

If you've been diagnosed with an autoimmune disease like lupus, your medical team has likely already weighed in on how your condition and your treatment could impact your fertility. But even milder autoimmune issues could be a factor in your fertility, according to the Oncofertility Consortium, either by attacking your ovaries, uterus and other tissues, or by interfering in the ability of a fertilized egg to implant.

However, the jury is still out on what role autoimmune issues may play in unexplained fertility—and some doctors aren't convinced. "Autoimmune testing is controversial amongst different leading reproductive endocrinologists today in the field," says Dr. Janelle Luk, medical director and founder of Generation Next Fertility in New York City. "But I say try anything and everything within your means to get pregnant."

Weight

Several studies have shown that being overweight or underweight can impact your chances of getting pregnant. A 2015 study found that obesity, for instance, can increase levels of chemicals called adipokines, which causes insulin resistance and impacts your fertility. There's also a link between being overweight and developing polycystic ovarian syndrome (PCOS), which can wreak havoc on your menstrual cycle and reduce your chances of conceiving.

On the other end of the spectrum, being underweight (a body mass index of 18.5 or lower) could cause your body to stop producing estrogen, which could keep you from ovulating.

Egg quality

The initial fertility workup may only look at whether eggs are present and ovulation happens, but unfortunately, won't be able to address egg quality. You may need to move into more aggressive fertility treatments like IVF to get a picture of whether your eggs are viable.

While [IVF] will cost you some change, it could be the most proactive way of figuring out what's going on.

Dr. Luk advises her patients with unexplained infertility to not make IVF the last resort. While it'll cost you some change, it could be the most proactive way of figuring out what's going on—and could uncover some egg quality answers.  

Stress

You've probably heard "just relax and it'll happen" so many times, you fantasize about punching the next person who suggests it (hey, just being honest). But there is some science to back up the idea that the impact of stress on your body could be a factor in your fertility. And yes, we totally get the irony that the stress of not getting pregnant could be keeping you from getting pregnant.

While research is conflicted about the effects of stress itself, some studies indicate that stress can impact your sleep patterns, your mental health, and other factors that may play a part in your fertility.  

If you're feeling stressed, a little me time can't hurt. Dr. Francis suggests investing in some yoga, meditation, or acupuncture to help you feel more zen.  

How to avoid freaking out

In many ways, unexplained infertility feels a lot worse than dealing with an actual diagnosis. The Type-A planners in us like answers and explanations. "Our psyche just does better knowing 'why,'" says Dr. Marra Francis, MD, FACOG, an OB/GYN in The Woodlands, Texas.

If you're going through infertility, you might feel like a train stuck between stations. Definitely not a good feeling. Communication is key to getting through this; you're not a mind reader and neither is your partner. "Check in with each other," says Crystal Clancy, MA LMFT, PMH-C, owner of Iris Reproductive Mental Health. "Don't assume that you know what the other is thinking and feeling."  

As you're working through your feelings—you've got a lot of 'em—and your action plan, it may pay to get a little professional help, too. Don't hesitate to seek out a mental health professional who understands infertility to help guide you. A strong support system is always a good thing.

So, you're ready to start fertility treatment. Or at least, you think you're ready...but there's one question that you just can't get past. Is IUI or IVF actually going to work?  

You've probably read up on your clinic's success rates. It may even be why you picked them. But what do those numbers actually mean for you and your chances of getting pregnant?  

Success rates

What they are

We're going to take a quick trip back to elementary school math class for this one. IVF success rates are calculated by the federal Centers for Disease Control (CDC), using information provided by individual fertility treatment providers around the United States. The Feds take the number of assisted reproductive technology (ART) cycles performed each calendar year at every reporting clinic, then divide them by the number of resulting births to get a success rate. Rates can be broken down even further by a host of factors, including:

• Clinic
• The use of fresh eggs vs. frozen eggs
• The use of a woman's own eggs vs. donor eggs
• Fertility diagnosis
• A woman's age
• How many embryos are typically transferred
• How many embryos typically implant
• How many live births result
• Singleton, twin, and triplet births

The result is intended to give you a sense of your chances of having a baby at that clinic, with your specific fertility concern and that specific method. Makes sense, right?

What they're not

While success rates are an important factor in determining if you should proceed with treatment at a particular clinic, they're not the be-all-end-all, says Dr. Jaime Knopman, M.D., a reproductive endocrinologist at New York fertility clinic Colorado Center for Reproductive Medicine (CCRM). She advises to take the following into account:

• More data is better: When asking for a clinic's statistics, Dr. Knopman says you'll want to see how successful the clinic has been over time, not just in one year. "You want to see numbers in the thousands," she says of number of treatments the clinic has provided. "You want to see long-term data."  
• Live birth vs. pregnancy: Unfortunately not every pregnancy results in a birth due to miscarriage and stillbirth. Make sure the number your clinic is giving is not just their success rates in achieving pregnancy but their rate for producing bouncing, cuddly babies. After all, that's the goal, right?  
• Nothing is set in stone: Remember that success rates are not a guarantee that your treatment will (or won't) be successful. Everyone's fertility journey is different, and we humans can't be captured in a mathematical equation.  

Donor egg IVF success rates

According to the Society for Assisted Reproductive Technology (SART), donor egg IVF success rates depend more on the age of the donor, not the mother (recipient). During 2010, CDC data shows an average birth rate per embryo transfer of 55% for all egg donor programs.

At Cofertility, the average number of mature eggs a family receives and fertilizes is 12. Some intended parents want to do two egg retrievals with the donor which is definitely possible. We also ask each of our donors whether they are open to a second cycle as part of the initial application — many report that they are!

You can see how many eggs are retrieved in the first cycle and go from there. If, for any reason, the eggs retrieved in that round do not lead to a live birth, our baby guarantee will kick in and we’ll re-match you at no additional match deposit or Cofertility coordination fee. If you are considering working with an egg donor to grow your family, our donors are ambitious, kind, and eager to help — find your match today.

Wait, what about IUI?

The CDC tracks data on the IVF process, but what about IUI success rates? Because IUI does not involve the the manipulation of eggs, it's not considered an ART procedure. That means success rates are not tracked by the CDC. That doesn't mean you can't ask your OB/GYN or fertility clinic to supply individual data on how their rates of IUI match up with the delivery of babies. There are also national figures to keep in mind:  

• The American Pregnancy Association estimates IUI has an average success rate of 20% per cycle (but they don't account for fertility diagnosis, age, etc).  
• The CDC estimates the chance of having a term, normal birth weight and singleton live birth using fresh embryos and non-donor eggs is 21% per ART cycle for women younger than 35, progressively dropping as a woman ages.  

But will IUI or IVF work for me?

Ah, the magic question. If only we had a crystal ball to tell if fertility treatment will work for us and which one is going to work the best.  

You can probably guess that the answer is going to be extremely personal, and your best bet is to have a candid heart-to-heart with your doctor. You've probably heard more than a few (hundred) times that a woman's age has a major impact on fertility.  

It's true, Dr. Knopman says. "The sooner you do it, the better you're going to do," she says of fertility treatment. That said, there is good news—fertility doesn't suddenly shut down overnight, and you do have time to make the important decisions, and go for treatment.  

Dr. Knopman offers up a breakdown of age to keep in mind when it comes to fertility (take a deep breath):

• 32: This is what Dr. Knopman calls "the first inflection point," or the age at which fertility slowly starts to decline. Notice we said, slowly? You'll get three years before your fertility is likely to begin to change again.
• 35: Often dubbed the beginning of "advanced maternal age" by doctors (which sounds crazy, but hear us out), 35 marks another inflection point. "The rate of decline gets faster," Dr. Knopman notes. But this doesn't mean your fertility journey automatically ends on your 35th birthday.  
• 37-38: Two to three years after 35, the decline rate will again pick up.  
• 40: This is a general age when fertility gets more complicated. "That's when you're losing [egg] quality," according to Knopman. But as with all the other ages on this timeline, the numbers are just general guesstimates, not an indication of what your body will necessarily do.  

If you have the means, tracking your own mother's fertility journey may help you get an idea if your body will follow this path too, Knopman notes. Family history can sometimes (though not always) be an indicator of fertility.  

Bottom line

Picking a clinic with good success rates is a big part of the fertility equation, but it's not the only one. Don't be afraid to get personal and talk to your doctor about your own unique concerns!

When you identify as LGBTQ+, you know from the get-go that having a baby is probably going to be just a little bit more complicated for you than it was for your cousin Mackenzie and her boyfriend. 

So what do you do?

First a little good news: An increasing number of fertility clinics in the United States are throwing open their doors to make sure members of the LGBTQ+ community can live their dreams of becoming parents. No matter your sexual orientation or gender identity, there are options open for you in the fertility world. 

I identify as a...

Lesbian

Pregnancy comes down to two things: An egg and sperm. Once these come together, ideally, they make an embryo, which grows into a baby, and you know where this is going.

Sperm donation

You can ask a friend or family member, or you can opt for donor sperm purchased from a sperm bank.

Intrauterine insemination (IUI)

Once you’ve got your sperm lined up, an OB/GYN or reproductive endocrinologist can insert it directly into the uterus in a process known as IUI. Hopefully (fingers crossed!) the sperm will do its job and fertilize the egg on its own.

In vitro fertilization (IVF)

This process takes some of the “hopefully” out of the fertilization equation. A reproductive endocrinologist will collect your eggs and send them to the lab. Once they get there, a specialist called an embryologist will take your donor sperm and use it to fertilize the egg(s), creating embryos. One or more of those embryos will then be transferred into the uterus, where the hope is they’ll implant and you’ll become pregnant.  

Gestational surrogacy/reciprocal IVF

Typically, when a woman carries a baby created with an egg that isn’t biologically hers, it’s called gestational surrogacy. If you’re opting to carry a baby created with your partner’s egg, that’s called reciprocal IVF. This option is growing in popularity, Diaz says, as it offers each mom an added connection to their baby.

Sometimes, couples even opt to undergo IVF together, each carrying the embryo created with the other’s egg—so they can both enjoy the process of pregnancy and bringing their partner’s biological child into the world.  

Gay man

You already know you’ve got the sperm part of the baby-making equation. Now you just need two things: An egg...and someone to carry the baby through nine months of pregnancy to make your dreams come true.

Egg donation

Just like sperm donation, eggs can be procured from a “known” donor such as a friend or family member. You can also match with a new egg donor on a platform like Family by Co. 

Surrogacy via IUI

Friend? Family member? Stranger? Any one of these folks could potentially carry a baby created with their own egg and your sperm inserted into the uterus via IUI. Known as traditional surrogacy, this process is only legal in some states, which limits its usefulness for many couples. It also means your surrogate will have a biological connection to baby—which can get complicated and that relationship should be worked out ahead of time.

As for which male partner will have a biological connection, even though both partners can provide sperm samples for insertion during IUI, there are no guarantees, Dr. Diaz says. “The strongest sperm usually prevails,” he notes.

Gestational surrogacy via IVF

As with lesbian couples, this option means no biology tying the pregnant woman to the baby. It requires a donor egg from another female, but it’s legal in more states than traditional surrogacy (although still not all). As for which partner has the biological link to the baby, only one sperm can technically fertilize the donor egg. That said, IVF does allow for two embryos to be transferred — one fertilized by one partner’s sperm and the other fertilized by the second partner’s sperm. If both transferred embryos implant, each partner will have a biological link to one of their twins. 

Transgender man or woman

If you’re transgender and thinking about having a baby, the path for you is a matter of personal preference and how far along you are in your transition, Dr. Diaz explains.

“If hormonal therapy has already been started, the hormones can be temporarily discontinued,” he says, “inducing the genitals to resume production of sperm or eggs respectively within 2 or 3 months.”

That could mean a biological tie to baby for either a transgender man or a transgender woman. As for carrying the baby, if the uterus has not been removed, that can be an option for someone assigned female at birth, although it requires remaining off of hormones for the entirety of the pregnancy.

If you’re early on in your transgender transition but plan on having kids down the line, Dr. Diaz recommends freezing your sperm or eggs before proceeding with transition to ensure you have a supply when you’re ready for a baby. The frozen gametes can be used later on via IUI or IVF.

Bottom line

Families look different, and they’re made differently too. So call that fertility clinic. They can help you find the right way to make your family grow.

While surrogacy has opened the possibility of parenthood to so many who may not otherwise be able to carry a child on their own, surrogacy laws can be pretty darn confusing. But don’t worry, we’ve got your back. Before committing to surrogacy, let’s untangle the various complex legal questions that this form of assisted reproduction raises.  

Here’s an overview of surrogacy laws to hopefully make this process a little less complicated.

First things first: lawyer up

To make surrogacy laws less straightforward, in the United States, there are actually no national policies or laws governing surrogacy, and state laws vary widely state by state. While some states are more surrogacy-friendly, other state surrogacy laws actually make it a crime to pay for a surrogate. Mind blown, right?  

Some states may not even have laws directly addressing surrogacy at all.  What’s more, there are a few different ways to define surrogacy—traditional (using the surrogate’s eggs) and gestational (with no biological link between the surrogate and baby). Different states treat these forms of surrogacy differently.

Basically, surrogacy brings up a ton of stuff to figure out. Hiring a surrogacy attorney for the process is important to protect the rights of both intended parents and prospective surrogates.  Being informed about any restrictions or unique laws will allow for a much smoother process, and enable you to feel calm, cool and collected as you gear up for parenthood.

Protect those rights

One critical reason to hire a lawyer to dig into those surrogacy laws is to protect the parties’ rights. Each state will likely have different requirements to establish those rights, and an attorney will know what those steps are in your unique situation.  

For example, in some states, even though a gestational surrogate is not genetically related to the baby, she may have rights to the child, or the intended parents may not have automatic rights to the child, (particularly if a sperm, egg or embryo donor is used). Wild, but true. An attorney knowledgeable in your state’s surrogacy laws and requirements will ensure that you avoid any custody disputes over a child born via surrogate.

Surrogacy agreements

Intended parents and gestational carriers also usually put together a “surrogacy agreement.”  While surrogacy contracts aren’t always enforceable, in states where they are, it’s smart to retain a good attorney to help draft the contract between the parties. Many fertility clinics may even require a surrogacy agreement before moving forward with actual medical procedures. It’s just good to iron out logistics ahead of time. Makes sense, right?

The surrogacy agreement will answer many of the complicated legal questions that may arise during pregnancy and may also prevent disputes by laying out various “ifs and thens” beforehand.  Some topics to cover might include: the method of pregnancy, sensitive issues like termination and selective reduction, requirements and restrictions during the pregnancy, birth arrangements, custody, and financial compensation.

Some state-specific surrogacy laws to consider

Now that you’ve gotten the download on why it’s important to consider surrogacy laws, let’s dive into some state-specific laws, shall we? Here’s a quick overview of what surrogacy looks like in a few states that have more complex surrogacy laws, for better or for worse.  

California surrogacy laws: as friendly as they come

California Code, Family Code section 7960 governs California surrogacy laws. Unsurprisingly, California has a great reputation for being super surrogacy-friendly. Unlike some other states, California surrogacy laws allow intended parents to establish legal parentage rights before birth without requiring separate adoption proceedings. And good news for the LGBTQ+ community in California: you’re included in all of this, too, married or not (yay!). Unfortunately, that’s not the case in all states, so it’s worth calling out here.

But don’t get too excited yet. Surrogacy in California isn’t 100% simple, and California law does maintain certain requirements. For example, California surrogacy laws require that intended parents and carriers are represented by separate legal counsel and the parties will need to create a California surrogacy legal contract before beginning any medical intervention.

New York surrogacy laws: surrogacy agreements recently approved

New York has recently changed courses with respect to surrogacy contracts. The Child-Parent Security Act (CPSA) took effect on February 15, 2021 and amended various laws establishing the statutory framework for assisted reproduction and legal parentage. The CPSA is detailed, and complex — all the more reason to lawyer up. In fact, parties to New York surrogacy agreements must be represented by separate legal counsel, just like in California.

Here are a few highlights: 

The CPSA only applies to gestational surrogacy. Traditional compensated surrogacy agreements are still prohibited. 

Under the CPSA, married as well as unmarried couples can obtain a court order declaring them legal parents, same-sex and different sex couples alike.  

A surrogacy agreement will need to meet certain criteria to be enforceable. For instance, the surrogate’s rights must be protected including: the right to make all health and welfare decisions regarding herself and the pregnancy, the right to terminate, reduce or continue the pregnancy, and the right to request and receive counseling to be paid for by intended parents among others. 

Interestingly, New York will create a voluntary tracking registry to collect data on the long-term impact of surrogacy.

Texas surrogacy laws: careful with those dollars

Section 160 of the Texas Family Code governs gestational surrogacy. Making sure to abide by the code section, intended parents and gestational carriers may enter into a written agreement governing surrogacy which will be judicially approved prior to the start of the surrogacy process. 

When it comes to Texas surrogacy laws, the funkiest part is definitely the payment piece. Navigating the surrogate’s compensation in Texas is complex, and it’s important to understand what’s legal and what isn’t.

• Legal: In Texas, a gestational surrogate may receive base compensation to cover her time, the physical risks surrogacy poses, and any lost wages.  
• Not legal: Paying a woman in exchange for birthing a baby—the compensation must strictly be in exchange for time and effort.

Also, in Texas, current surrogacy laws only apply to married couples (same-sex as well as opposite sex). However, courts do sometimes issue parentage orders to unmarried couples pursuing surrogacy in Texas.

You got this

The roadmap to surrogacy definitely varies widely depending on the state’s laws. Importantly, the surrogate’s state of residence—not yours—is likely where the majority of the legal process will take place, and her state will impact the journey the most. Interstate surrogacy is an option, particularly if your state is not surrogacy-friendly.  

Surrogacy agencies and attorneys will help detangle this complicated web, protect your rights, and hopefully make things much less overwhelming. In the meantime, we’re here for you along the way.  

If you’ve got any state-specific surrogacy tips, throw them in the comments!  

Disclaimer: This document is provided for information purposes only and is not intended as legal advice. If you need legal advice regarding your specific situation, we strongly recommend that you consult a competent, licensed family law attorney who is familiar with these issues. It is also important that you understand that the information provided here in no way constitute, and should not be relied upon, as legal advice.

One in eight. That's the startling statistic of how many couples trying to conceive actually struggle with some sort of fertility challenge. Whether it's PCOS, low sperm count, endometriosis, or (ugh) "unexplained," infertility takes many forms, and is so much more common than we all think when we—with innocent, almost-naïve hope—begin to think about starting a family.

Even in busy reproductive endocrinologist waiting rooms, there seems to be an unwritten rule: avoid eye contact at all times, and don't you dare utter a word to another patient. Infertility affects so many, but oftentimes, we don't talk about it with anyone other than our partner and maybe our family. But why?

Opening up is hard to do

We're not going to lie, taking that first step is intimidating AF. There are tons of reasons why we might choose not to talk about our fertility struggles, like:

• They just won't understand: Before opening up about infertility, you might think nobody else could possibly understand, let alone empathize with your situation. I mean, how could they, if they haven't been through this themselves? They might say the wrong thing—and to be honest, they probably will at one point. But keep in mind, this doesn't mean they don't care about you, your infertility, or your overall well-being. Remember that.
• You're not picture perfect: It's super tough to come to terms with the fact that your life isn't the rainbows-and-butterflies false reality that social media often portrays. If you're actively trying for a baby, chances are your Instagram feed is filled with photos of babymoons, birth announcements and "X-months-old!" blocks. It's hard enough to accept that you're not there yet, so opening up to others? Yeah, that feels damn near impossible. Just know that you might not see what's behind the screen—for all we know, that birth announcement came years after trying for a baby.
• It'll make you upset: You cry enough in your alone time. So, we totally get wanting to skip the emotional breakdown that might happen if you open the floodgates and talk openly about your infertility. We've taken a totally uncensored, unfiltered approach to fertility, though, and we've got to say…it feels really good.
• It's really (really) personal: Let's face it: you might not exactly want to share that you don't ovulate or that your husband has poor sperm motility. These are super intimate topics that most people usually save for the bedroom. So, it's totally okay to pick and choose who you open up to and make sure it's a judgment-free zone.
• There could be repercussions: Being worried about getting held back at work because your coworkers know you're undergoing fertility treatment is a legit concern. For this reason, many choose to not share their fertility struggles with coworkers. But be kind to yourself. Prioritize your health. If the daily monitoring and hours spent on the phone with insurance are taking a toll on you, talk to your manager or an HR rep at your company. Or maybe a vent sesh in the bathroom with a trusted colleague is enough to do the trick.

No pressure

We get it. There are lots of reasons we don't talk about our fertility struggles. Your comfort zone is determined by (a) the type of person you are and (b) the type of people in your circle.

If you choose to open up at all, choose the recipients of your news wisely. We all have that person in our life who might shrug off an emotional conversation, or someone who may come off as judgmental. Maybe go ahead and skip over those people. While they might love you, that shoulder for you to lean on is precious real estate. You don't owe your story—or trust—to anyone.

That said, while we are firm believers in breaking the stigma around infertility, if talking about it with others makes you upset or super uncomfortable, take the pressure off. Do you. Just make sure to take care of yourself and find some kind of outlet for the emotions you're most definitely feeling around this time.

Something else to consider? Talking to a therapist with experience in infertility. You'd be surprised; sometimes, it's easier to talk to a professional than your closest friends. There's so much value in having someone who just "gets it." In the meantime, we'll try to be that for you here at Co.  

We've got the power

We were so surprised that there wasn't a fertility resource out there that kept it real and honest, and didn't bury fertility information among pregnancy or motherhood content. So, we decided to build it.

The more we talk about fertility, the more attention the issue of infertility will receive. And that, my friends, can actually affect real change. Like:

• Better medical coverage and benefits for infertility
• More scientific research
• Actual legislation, like state mandates for fertility coverage
• General openness and more emotional support for those with fertility challenges

So, let's talk—no, SCREAM—about infertility. Cause a commotion. Start that uncomfortable conversation. Say "hi" in that waiting room.

Get ready, because Co is here to talk about fertility. A lot. And we aren't going anywhere.

Ever heard of the “two week wait”? That refers to the period of time between your, IUI, or IVF embryo transfer and that ever-nerve-wracking blood pregnancy test. Depending on certain factors, like your average cycle length, your clinic’s protocol, or how many days after retrieval your embryo was transferred, the two week wait might not be exactly two weeks. That being said, whatever the actual length of time, you may spend it feeling like you’re going a little crazy! 

The two week wait = basically more of the same

The two week wait can be tortuous. Not only have you likely already been waiting for months, or even years, to become pregnant or have a pregnancy go to term, but you’ve also probably been in tons of other holding patterns throughout this journey.

In other words, even outside of the two week wait, if you’re trying to conceive you’re basically always waiting. Waiting for test results to evaluate your fertility. Waiting to ovulate for timed intercourse. Waiting to get your period so you can start a new cycle. Waiting for your doctor to determine your treatment plan. Waiting for your medication to arrive. Waiting to see how your follicles are developing. Waiting to see how many eggs were retrieved. Waiting to see how many fertilized. Waiting to see if any embryos developed to blastocyst and then, if you’ve opted to test your embryos, to learn how many are chromosomally normal. The list goes on and on.  

It’s draining and exhausting to constantly wait for the next piece of information to arrive, anticipating what you might hear. You’ll probably feel anxiety in advance of the actual news, and then, of course, disappointment if it doesn’t meet your hopes and expectations.

The ultimate culmination of this particular brand of purgatory is the final wait to learn if you’re pregnant after a treatment cycle. You’ve likely already invested mightily in this process—financially, emotionally, physically, and mentally. You’ve postponed and cancelled plans, changed your whole life around to accommodate this challenge, and generally been a slave to the process. You’ve been to hell and back, and probably already feel like a human pin cushion by the time you arrive at this point.

What the two week wait actually feels like

One of the hardest parts about the two week wait is trying to read your body for clues as to whether or not this cycle worked. “Are my breasts tender? What was that twinge in my abdomen? If I actually felt it, is it good or bad? Do I feel nauseous? Has my appetite changed? Could that bloat mean I’m pregnant? Is that blood? If it was, is it my period or could it be implantation bleeding? Should I do a home pregnancy test? Will that better prepare me for the news? What does it all mean?!”

During the two week wait, minutes can feel like hours, hours like days, days like weeks, and weeks like months while you wait to have your fate delivered to you. The second week often feels harder than the first, as the reality of finding out whether or not there will be a return on this massive investment looms even closer. Sometimes, you can feel very alone during this wait: perhaps you’ve chosen not to share with certain friends or family to avoid all those awkward questions or having to deliver bad news.

And if you have a partner, that partner might not fully understand what you’re experiencing during the two week wait. Or maybe your partner is able to compartmentalize his or her own feelings more effectively, because your partner is not the one whose body has become a barometer of success or failure. No matter how you slice it, the two week wait is brutal.

15 ways to survive the two week wait

So, what can you do to cope with the anticipatory anxiety and stress of the two week wait? Especially when many of your go-to coping mechanisms, e.g., heavy exercise, an occasional alcohol beverage, or certain foods you may like to indulge in, aren’t currently available to you? Glad you asked—here are our tips:

1. Brace yourself. Head into your two week wait knowing it may be incredibly difficult. Acknowledging this will help you feel more prepared to process it.
2. Get your crew on board. Prepare your loved ones who do know where you are in your #ttcjourney for the likelihood that the two week wait will be a challenging time for you, complete with instructions or feedback as to how to best support you. Help them help you, even if that means asking them to give you space or not ask you questions about it.
3. Make plans you can flake on. If you’ve found in the past that you do better with distractions when dealing with a stressful time, make loose plans during your wait. Just make sure they’re the type of plans that you can easily cancel if you find you aren’t up for them.
4. Or...don’t. If, on the other hand, you know you do best without commitments, clear your schedule as much as possible.
5. Check yourself. Know that your moods will go up and down and keep in touch with your needs. If you feel like you need a quiet day, give yourself permission to lie under the covers and binge your favorite show. If you feel like you need air, movement, or company, go ahead and take a walk with a friend. Whatever works for you. The two week wait is a highly personal, individual, and customizable experience. Just listen to your heart, head, and body for what they’re telling you they need at any given time.
6. Step away from the internet. We know you might be looking for reassurance. However, Googling during the two week wait typically can often lead you down a number of anxiety-ridden rabbit holes, supporting many of your worst fears about what may happen, or providing conflicting “information” that just creates confusion.
7. Prep for test day. On the day you know you’ll be getting bloodwork results, think about where you might be, who you’ll be with, and what you might be doing—and prepare accordingly. If there’s a way to orchestrate whatever scenario would feel most helpful to you (whether the result is positive or negative), such as taking the afternoon off of work, try to do it.
8. Stay skeptical. Remember that whatever physical sensations you experience during the two week wait aren’t indicative of cycle success or failure. If you’re undergoing fertility treatment, you’re probably on numerous meds that can create changes to your body, and it could be too early for you to actually be symptomatically pregnant. Know that whatever you’re feeling or not feeling, or think you may be feeling, is normal and doesn’t tell you whether or not you’re pregnant. Use this information to comfort you, e.g., “That twinge neither confirms nor denies a pregnancy,” not to create fear, e.g., “Oh no, that definitely means I must not be pregnant!”
9. When in doubt, skip the home pregnancy test. Holding up a pregnancy test to the light to see if the faintest line came through? Is the uncertainty killing you yet? Keep in mind, the only way to absolutely know for sure if you’re pregnant at this stage is to do a blood pregnancy test with your doctor.
10. Treat yourself. Indulge yourself as much as possible during the two week wait, with whatever works for you (within clinical parameters, of course). The word, “selfish,” doesn’t exist right now. Read what you want, watch what you want, do what feels like it might de-stress you without guilt.
11. If there are things that make you feel empowered during the wait, be proactive. There may be certain actions you choose to take during the two week wait that support your emotional needs, and foster a sense of control and agency. If you feel like more of a participant in the two week wait by, for example, eating certain recommended foods, engaging in meditation, regularly doing acupuncture, etc.,go for it. If your doctor has said they are safe, and they help you to feel involved in your process without a sense of obligation, embrace your chosen program.
12. Acceptance is key. Validate WHATEVER feelings you may have, and try to love and nurture yourself in ways that feel beneficial and helpful. You’ve already been through so much—you don’t need to feel unnecessary negative emotions! The sadness, fear, sense of loss/grief, anxiety, and disappointment you may have already experienced are enough. If you can, remove guilt by accepting that at this point the outcome is beyond your control and you aren’t to blame if the cycle doesn’t work. Release yourself from self-blame and guilt. There is no such thing as “fault” here.
13. Let go of control. During the two week wait, it’s important to remind yourself that you won’t affect the result by feeling certain emotions or doing certain things. You might want to feel in control of the process, so would rather beat yourself up for what you did or didn’t do than accept that the outcome is out of your control. Trust that you’ve already done everything you could possibly do, whatever that looked like for you (there’s no one prescription for making this work!).
14. Live in the now. The two week wait can be an anxiety-inducing spiral full of scary stories we tell ourselves, like, “If this doesn’t work, I will be that person who can never get pregnant.” You may want to be emotionally prepared for disappointment, but trust that you’re already well aware of that possibility. The goal is to maintain as much emotional equilibrium as possible during the wait, for YOUR well-being. You deserve it and have earned that right; you are more than just a potential vessel for pregnancy.
15. But make a backup plan. Even if you’re taking things one day at a time, feel free to at least plan your very next steps in the event of an unsuccessful cycle. Just as long as you give yourself permission to reevaluate them as soon as you actually know where things stand.

Remember that the two-week wait will inevitably end. It may feel like an eternity, but you will get through it! And you will survive it, because you are even more resilient than you know—just make sure to show yourself lots of love, no matter what the outcome.

Ready for a big number? There are about 480 fertility clinics scattered all across the United States.  

The good news? Depending on where you live, you hopefully have plenty of places to choose from to take the next step in your fertility journey. The bad news? Pretty much the same thing—you've got to choose between 480 different clinics, spread all across the United States.  

So how do you find the best fertility clinic for you? There are plenty of factors to consider, but here are some of the biggies to help you decide between the clinic your OB/GYN suggested and that hotshot doc your friends are raving about.  

Location, location, location

Don't start packing your bags just yet. While you may have heard amazing things about a nationally-known doctor, it's best to start your search close to home, says Dr. Paul Lin, M.D., a reproductive endocrinologist with Seattle Reproductive Medicine and president-elect of the Society for Reproductive Technologies (SART). If possible, he even recommends starting with a clinic within 50 miles of home.

The benefits of sticking as close to home as possible?

• Less stress: Traveling always has the potential to create some degree of stress. Now imagine adding that to the stress you might already have when going through fertility treatments. These treatments are often specifically timed with your cycle, and you may need daily monitoring or to head into the clinic on super short notice (say, if your period comes a day or two earlier). In most cases, save your sanity and go where is most convenient.
• Lower costs: Even when health insurance pays for fertility treatment, it rarely pays for travel to and from a clinic, so Lin reminds couples to consider whether or not they can afford airplane tickets and hotel bills if they choose a clinic far from home.  
• Time to build a relationship with your clinic: Clinics try their best to make things easier on patients who have to make a long haul to get to them. Typically that means phone or Skype sessions in place of face-to-face meetings with everyone from the billing department to the actual doctor when you can't make the trip. It's good when necessary, Lin says, but the more time you have to sit face-to-face with everyone on staff, the easier the process can be.

What if you don't find the right clinic close to home? Don't worry. There are other factors to keep in mind that may end up being more important to you than location.  

Treatments offered

They all get the same degrees and go through the same kind of training, so every reproductive endocrinologist (that's the doc who you'll see at a fertility clinic) must offer the same treatments, right?  

Well, no.  

Some clinics run the gamut from providing patients of any age with follicle stimulating hormones through working to help them achieve pregnancy with a gestational donor, Dr. Lin says, but others focus solely on in vitro fertilization (IVF), and they limit their patient pool to women 35 and up.  

When you start scoping out an office, it's best to find out just what sorts of procedures they offer, and what they'll do if you end up requiring treatments that they don't currently offer. Some questions to ask:

• Do you have an age requirement for your patients?  
• Do you have an embryologist on staff, or are the lab portions of IVF done by an independent lab?
• Do you have an in-house egg donor team or would I have to find an agency?
• Do you work with gestational carrier surrogates, should I need one?

Practice size

Does size really matter? That depends on what you're looking for in a clinic.  

When a doctor has a small office, they may not get much demand for certain procedures, Dr. Lin says. In turn, the treatment you need may not be available at that smaller clinic.  

Other things you'll need to consider when it comes to practice size:

• Do you expect to see one doctor, every time? Small practices tend to offer more one-to-one time with your chosen doctor, while you may see a mix of practitioners in a large office, including nurse practitioners and/or physician's assistants.
• Could you use a (free) second opinion? At Dr. Lin's clinic, for example,there are 12 reproductive endocrinologists, and they're constantly bouncing ideas off of one another. Larger practices offer a second opinion that's just one chat between colleagues away.
• Is there a support team to help you? Regardless of how many doctors are in the practice, it's standard for clinics to have a billing office. But not every office has people available to help walk you through all your concerns and help you talk to your insurance company or find grants to pay for your treatment.

Costs

OK, deep breath. You already know fertility treatment can be costly, and when it comes down to it, the right clinic for you might just be the only clinic you can afford. Don't be shy when it comes time to talk dollar figures. This is your future on the line.  

• Do you take my insurance? If you've got insurance coverage for fertility treatment, this is the very first question to ask.  
• Do you have a global fee, and what does it cover? Many clinics lump their costs into a flat or "global" fee, says Amanda Garcia, practice administrator at New York fertility clinic Colorado Center for Reproductive Medicine (CCRM). But just because it's "global" doesn't mean it covers everything. Ask the billing office to address everything that's included and anything that's not—such as medication or the freezing of embryos.  
• Do you have any grants I can take advantage of? Some clinics have their own grants, while others are partnered with nonprofits to provide them. In New York State, there are even clinics designated to receive state funding to cover patients' treatment. So look around, and choose wisely.

Success rates

Why did we save this factor for last? Surely, it must be the most important one. Yes, and no, says Dr. Lin. In fact, SART, which maintains a database of all accredited fertility clinics within the United States, also keeps track of clinic data—the same data that's collected by the federal government—to confirm their reported outcomes are actually true.  

"If they're doing Octomom-level practice, we're going to ding them and go and see what's going on," he adds, alluding to a clinic that made headlines in 2009 after one of its patients gave birth to octuplets. That doctor eventually lost his medical license.  

Success rate data is yearly, providing a look at the number of patients, their ages, types of procedures performed, and how many babies were born as a result; i.e. how successful the treatments were at creating brand new bundles of joy.  

So why did we leave this one for last? SART discourages patients from using the data to compare clinics en masse because different fertility clinics, with their different treatment offerings and patient population, are like apples and oranges.  

Instead of picking the "best in the country" based solely on numbers, Dr. Lin suggests using the data to find out:

• Individual clinic experience with patients your age and with like diagnoses
• An across-the-board look at the chances that a new patient to the clinic (regardless of age or fertility diagnosis) will end up giving birth

To sum it all up

You've got a lot to consider. But believe it or not, there's not as much variation from clinic to clinic as you might think, at least not according to Dr. Lin. All fertility specialists undergo similar training, and all labs are held to rigorous standards. At the end of the day, what matters most might just be the relationship with your doctor.  

PGT, PGS, PGD, chromosomal abnormalities…if you’re undergoing IVF and considering genetic testing, you’ll probably hear these terms getting thrown around a lot. So, unless you have a fertility dictionary on hand at all times, you might be left wondering—what the heck does it all mean? Here’s what you need to know.

What is PGS testing, anyway?

First things first. PGS (“Preimplantation Genetic Screening”) and PGD (“Preimplantation Genetic Diagnosis”...more on that later!) both fall into the category of PGT (“Preimplantation Genetic Testing”). They each provide a way to test an embryo for genetic abnormalities prior to transferring it in hopes of it growing into a healthy baby. Sounds pretty self-explanatory, but since we’ve been through this infertility rodeo, we know there’s nothing about this process that isn’t complicated.

What PGS testing means

These days, PGS is actually called PGT-A, or “Preimplantation Genetic Testing for Aneuploidies,” but for the sake of this article, we’ll continue to refer to it as PGS. PGS testing looks at an embryo to see if it contains the correct amount of chromosomes. Embryos with the right number of chromosomes — 46 — are considered “euploid,” and those with extra chromosomes or chromosome deletions are considered “aneuploid.”

Different doctors have different philosophies on PGS testing. But there are a few reasons Dr. Knopman cites that PGS can be beneficial:

• It can increase pregnancy rates: While an embryo might look awesome to an embryologist, morphology might not tell the whole story. According to Dr. Knopman, doing PGS may help you avoid moving forward with a transfer that might not yield you anything positive—especially in women between the ages of 38-41.
• It can reduce the risk of miscarriage: If you do get pregnant, some data shows that you’re less likely to miscarry with a PGS tested embryo. If you’re a numbers gal, consider this: a Fertility and Sterility review indicated a decrease in miscarriage rates from 28% in the natural conception group to 9% in the group using a PGS embryo. This mostly applies if you fall into any of the categories outlined below (see “Who should do PGS testing?”).
• It can explain previously “unexplained” infertility: Sometimes, PGS can solve the conundrum of why you aren’t getting pregnant. It’s possible that you and your partner have been creating abnormal embryos, and PGS can clarify that.

Who should do PGS testing?

If you’re undergoing IVF and fall into any of these categories, it might be worth chatting with your doctor about PGS testing to see if it’s right for you if you:

• You’ve faced recurrent pregnancy loss: if you’ve suffered multiple losses, there could be a chromosomal abnormality at play that prevented those embryos from developing. PGS may give a glimpse at what’s going on and (hopefully) yield at least one “genetically normal” embryo that some doctors believe will give you the best shot at a successful transfer.
• You’re over 35: if you’re in this age bucket, you may not want to spend the time waiting to see if other embryos “take” (hey, who does?) and risk deteriorating egg quality over time.
• You have a lot of blastocyst-stage embryos: if you have many embryos that have made it to blastocyst stage (developing steadily for 5-7 days) — first of all, that’s awesome. Hopefully your good luck continues! But if you can swing it, it might be worth conducting PGS testing to see which of the bunch may give you an extra boost of confidence pre-transfer.

How does PGS testing work? How long does it take?

In summary, the PGS testing process looks a little somethin’ like this:

• Day 1: Eggs retrieved and (hopefully) fertilized
• Days 2-5: Fertilized embryos continue to grow to blastocyst stage
• Days 5-7: Blastocyst embryos are biopsied with the material sent to be analyzed for chromosomal abnormalities.
• Days 14-28: PGS testing results return, telling you a yay/nay if the embryos are “chromosomally normal.”

PGS testing requires an embryo that has already grown to blastocyst stage, which usually isn’t until 5-7 days after the egg has been fertilized. A biopsy is taken from the blastocyst embryo, specifically of the trophectoderm cells (that ultimately end up becoming placenta) — not of the inner cells that eventually form a baby — and analyzed to understand the chromosomal makeup of that cell. The full PGS testing analysis usually takes 1-2 weeks.

How much does PGS testing cost?

As with all IVF costs, the cost of PGS testing totally varies by clinic. Some clinics charge a flat rate for PGS testing, no matter how many embryos they’re looking at. Other clinics charge per embryo or with tiers. So PGS testing for 4-6 embryos might cost one amount while testing 7-10 embryos might cost another amount.

Before beginning your IVF cycle, ask your clinic upfront how they bill these costs. Unfortunately, PGS isn’t always covered by insurance. Plans are beginning to cover it more, but your clinic must deem it medically necessary.

If you’re paying out of pocket for PGS testing, it can run in the thousands — we’ve seen up to $3,000 for testing 11-14 embryos. If your clinic charges by tier and you know you will end up doing more than one round of IVF, it may be worth waiting (read: cheaper) until you’ve completed all retrieval cycles so you can pool your embryos together and test them in bulk.

Are there any risks of PGS testing?

During PGS testing, it’s largely believed that biopsying trophectoderm cells from a blastocyst embryo is safe and won’t harm the embryo. But, back in the day when embryos were only grown for 3 days (to “cleavage stage”) and not to blastocyst, there were far fewer cells (and no trophectoderm cells) to work with. So biopsying a few of them made more of a difference, resulting in a 39% decrease in implantation rates. Insert *head explosion emoji* here.

That being said, there is still some debate about whether or not PGS testing still affects the health of an embryo. One factor that may affect this is the amount of cells taken during the embryo biopsy. The more cells that are taken could lead to that embryo having a harder time developing afterwards. It’s also preferred to use a more developed embryo, or a blastocyst that’s already “hatched.” By and large, though, with today’s technology, PGS is considered safe, A 2018 Fertility and Sterility article specifically notes that, “To the best of current knowledge, embryo biopsy is not linked to fetal malformations or other identifiable problems in offspring.”

One thing to consider, though we hate to say it, is that a PGS normal embryo is not a sure bet for a successful pregnancy or even implantation. While it could feel like the holy grail, nothing on a fertility journey is ever guaranteed, unfortunately. We suggest talking to your doctor about what makes the most sense for you and those embabies of yours.

I’ve also heard about PGD testing. What’s that?

Sure, PGD is just one letter off from PGS. But swapping out that “S” for a “D” actually makes a big difference in what’s being looked at.

PGS vs. PGD testing: the showdown

While PGS testing examines the number of chromosomes in a biopsied cell, PGD looks for the existence of specific inherited genetic abnormalities or chromosome rearrangements. PGD testing falls into two categories:

• Preimplantation Genetic Testing for Monogenic/Single-Gene Disorders (PGT-M): Looks for specific genetic abnormalities controlled by a single gene, like Fragile X syndrome or the BRCA mutation.
• Preimplantation Genetic Testing for Chromosomal Structural Rearrangements (PGT-SR): Examining specific inherited chromosomal abnormalities, like reciprocal translocations.

In short, PGS testing gives you a bird’s eye view of which embryos might be genetically abnormal, while PGD gives you a more detailed picture — but you’d need to know what, specifically, you’re looking for. Which brings us to...

Who should do PGD testing?

Although it would require undergoing IVF, if you fall into any of the below categories, conducting PGD testing could help you get closer to having a baby that is not a carrier of that particular genetic condition or chromosomal abnormality you’re trying to screen for.

If any of these apply to you and your partner, it might be worth chatting with your doctor about PGD (PGT-M) testing:

• You are a carrier of an X-linked condition
• You and your partner both carry the same autosomal recessive condition (like Cystic Fibrosis)
• You or your partner have an autosomal dominant condition
• You or your partner have a mutation associated with a hereditary cancer
• You already had a pregnancy (or child) with a single gene disorder

How much does PGD testing cost?

If you’re undergoing PGD testing, you’ve probably been through the fertility ringer, so we’re here to tell you some good news — PGD is often covered under most insurance plans as long as the patient and partner are carriers for the same disease.

Out of pocket, PGD can cost anywhere between $4,000 - $10,000, depending on the cost of creating a specific probe needed to check for the presence of that particular gene. If you’re seeking to check for more than one gene, that would involve building a separate probe and an additional cost.

Some stuff to think about re: PGS and PGD testing

Genetic testing isn't for the faint of heart...or wallet. So here are a few commonly-asked considerations to take into account before taking the plunge.

Should I do PGS testing on previously frozen embryos?

In short, it depends. While it’s definitely possible to thaw embryos, biopsy, and re-freeze, there are, unfortunately, always potential embryo survival implications whenever you thaw. Just something to keep in mind as you manage your own expectations.

If you’re thinking about thawing your embryos to conduct PGS testing, Dr. Jaime Knopman, reproductive endocrinologist at CCRM NY, advises to consider how many embryos you have, in addition to your age and if/how many times you have had previous failed transfers. “It’s definitely a conversation to have with your physician,” she says.

It also matters what type of embryos you're thawing. A 2011 study published in the Journal of Human Reproductive Sciences, for instance, states that thaw survival rate improves when the embryo has reached blastocyst stage (versus, say, a day-3 embryo or zygote). And, according to Dr. Knopman, the same goes for the actual process of PGS: the more advanced the embryo is, the fewer risks you’ll encounter—biopsying a couple of cells of a day-5 embryo gives more to work with than one cell of a day-3 embryo—and the more accurate the results may be.

Some good news to think about: according to the Ethics Committee of the American Society of Reproductive Medicine, as we’ve mentioned, current research does not indicate any risks of birth defects associated with biopsied normal embryos vs. embryos that haven’t undergone PGS. In other words, conducting PGS on an embryo shouldn’t contribute to any additional risks beyond the existing risks of IVF.

What about mosaic embryos?

You may have heard the term “mosaic embryo” and wonder what the heck that is. A mosaic embryo is an embryo that, during PGS testing, is found to contain both normal and abnormal cells.

In the past, any found abnormalities would render the embryos useless for transfer and doctors would recommend discarding them no matter what. However, today, some doctors believe that transferring mosaic embryos can still lead to success — with any abnormal cells likely going to non-essential pregnancy tissue that don’t contribute to the baby’s chromosomal development.

If gender is especially important (say, if the only girl embryo you have is mosaic), or if your IVF cycle did not yield as many embryos as you’d like to have, find out if any of your embryos are considered mosaic and chat with your doctor about the best course of action.

What should I do with “abnormal” embryos?

What you might do with any abnormal embryos is obviously a very personal choice (and a tough one, we’ve been there), but in some cases, your clinic may have policies in place that may dictate next steps.

Data shows that transferring an abnormal embryo increases the risk of miscarriage, diseases or birth defects. Because of this, most clinics will refuse to move forward with a transfer of such embryos and some will even require you to discard them. Other clinics may take the opposite approach, hanging on to all embryos until you are 150% certain that you are done having children. Either way, when you have abnormal embryos, your options include:

• Discard them: Any abnormal embryos will be destroyed and not available for use in the future.
• Save them: Keep them in the freezer until you either (a) decide to destroy them at a later date after thinking it through, or (b) decide to use them (if your doctor and clinic allows this) after taking all risks into account.
• Donate them for research: If you aren’t planning on using any abnormal embryos, donating them for research could help embryologists, REs, and future #ttcwarriors learn a ton down the line.

You are typically required to determine your choice of what you’d hypothetically do with any abnormal embryos prior to retrieval and transfer. That being said, we’re all humans who sometimes change our minds. Before moving forward with any actions taken on abnormal embryos, make sure you’ve given it a lot of thought and, if necessary, discussed it at length with your partner and doctor.

Summing it up

As if IVF wasn’t already overwhelming enough, throw PGS and PGD testing into the mix and your head might be spinning. If this sounds like you, we get it. Set up a dedicated time to chat with your doctor (or, better yet, an embryologist at your clinic’s lab) to get clear on your options.

We know the path to parenthood isn’t always easy, but we’re here to make sure you know that this tough decision-making can be so worth it. Good luck!

So, you (and your doctor) have made the big decision about your fertility future. It’s time to try IVF. Now comes the question of the hour: How are you going to pay for it all? 

It might be time to apply for a grant. Yup, IVF grants are out there, and they’re not that different from the funds your local fire department gets to outfit their firefighters or the grant a city snags to provide extra programs for the local kids. 

Could you qualify for an IVF grant or is this all too good to be true? Let’s take a look.

Where are IVF grants hiding? 

Ok, so you know the basics about grants. The money comes from the government or a non-profit with beaucoup bucks to fund something worthwhile. But where is this magic money for IVF?

• Local grants: You may not have to look too far to find the money you need. Several IVF grants are limited to folks living in very specific geographic regions. At the Starfish Fertility Foundation, for example, one grant is awarded only to uninsured folks living within a 50 miles of Nashville, TN. Others are offered through specific clinics. 
• State grants: Time to cast your net a little wider? There are grants out there that cover entire states. In New York, for example, the state’s Department of Health funds grants that are open to residents across the Empire State (provided they use an approved clinic). Other grants come via non-profits that cover care in specific states, and sometimes, you don’t even need to actually be a resident of that state—just willing to travel there for treatment. Stardust Foundation provides financial assistance to all types of jewish couples and/or individuals, regardless of their Jewish denomination or involvement, sexuality, or marital status, in the Tri-state area who are struggling to begin or grow their family.
• National grants: These grants come from non-profits located throughout the country. The good news? You don’t have to travel far from home to find fertility help, as the funds can often be used at clinics across the US. The bad news? The competition for national grants is fierce. You’re no longer up against just the folks in your town or state. You’re competing against applicants from everywhere. 

Do IVF grants cover it all? 

Maybe you’ve already put some savings aside for fertility treatments. Do you need to keep saving or will a grant be your golden ticket? 

The answer is a little bit of both, says Dr. Camille Hammond, M.D., CEO of the Tinina Q Cade Foundation, a Maryland non-profit that funds fertility treatment grants. Some grants have funding limitations to keep in mind: 

• Parent match: Grants can take some of the burden off, but many grant funding sources expect a parent or parents to kick in some of the cost of treatment. This shows the teams who comb through grant applications that you have the financial means to provide for a baby after they’re born. It also shows your level of commitment to the process. “If you’re telling me this is the most important thing in your life right now, I’m not sure how important it is to you if you’re not willing to contribute at all,” Hammond says. 

• Number of rounds: You never know just how many rounds of IVF you’ll need. Sometimes it just takes one; sometimes you’ll need more. Be aware your grant may have a specific number that are covered, warns Amanda Garcia, practice administrator at New York fertility clinic CCRM NY. 
• Just the meds: Sometimes insurance will cover your procedure, but the medication cost is dragging you down. Good news: some grants are tailored to pay for just the meds! 
• A flat number: Many of the grants out there provide a flat dollar amount to folks, regardless of what their treatment plan looks like. So you might be able to get as much as $5,000 or $10,000, but it will be up to you to allocate it wisely, balancing out any insurance coverage or help from the clinic that you might have wrangled. 

Sounds good, sign me up! 

Hold up, not so fast. Aside from location stipulations for local and state grants, most of the funding out there comes with eligibility guidelines you need to meet right out of the starting gate, including:

• Age limits
• Income limits
• Insurance coverage: Some grants will only cover treatments if you have 0 insurance coverage; others require you’ve exhausted all fertility coverages.
• Marital status: Some grants are allocated specifically for married couples; others will help single parents. 
• Diagnosis: Some grants require a diagnosis of infertility, but some will make exceptions for same sex couples or single parents.
• Religious affiliation: Some grants are specifically focused for individuals who identify with a particular religion, or even a specific denomination within that religion.

Grants for egg donation

IVF plus egg donation can be a huge expense. Fortunately, most grants do not exclude egg donation. This means that you can use the grant towards the cost of matching with a donor, as well as the egg donor’s egg retrieval procedure and medications.

Affordable egg donation options 

We get it, egg donation and IVF can be a huge expense. At Cofertility, our $500 match deposit and one-time coordination fee of $7,500 come with a baby guarantee. We want to help you bring your baby home, and we will re-match you for free until that happens. 

What does that mean? If a donor doesn’t pass your doctor’s screening, we’ll help you match again (or you get your money back). If a cycle leads to no blastocysts, we’ll match you again. If none of the blastocysts turn into a pregnancy, we’ll match you again. We’re doing things differently around here, and hope this guarantee can bring you peace of mind.

Press and public relations requirements

Charities that dole out funds depend on awareness of their mission to keep donors donating. That’s why many will require grant awardees to be willing to do occasional interviews with press about their fertility journey, says Pamela Hirsch, co-founder of BabyQuest, a California non-profit that funds fertility grants. And it’s not just moms-to-be who have to be willing to be open. If there’s a dad in the picture, he may also be called on to speak openly about his part of the process.

How to apply

Checked all the boxes on the guidelines, and you’re a match? Congratulations. Now it’s homework time! Most grants require you to fill out an application, and that’s going to come with a fair amount of paperwork. 

• Proof of income: This might include last year’s taxes, paystubs, and other means to prove how much you make a year.
• Medical records: Your doctor’s office can provide these, and they may also need to write a letter to describe your treatment plan and why you’re a worthy candidate. 
• Your personal story: Why should they pick you as a grant recipient? You (and your partner if you have one) are going to have to share your fertility journey and your hopes and dreams for a family. 

Nailing that application

With thousands of applicants and only so much money to go around, there’s no one secret to nailing that application. Still, there are a few things you can do:

• Follow the instructions: No. Really. Do everything exactly the way the grant application directs you to do it. “A lot of people want to make up their own instructions,” Hammond says. All that does is make it harder for the reviewers—and more likely you won’t be chosen.
• Double check everything: Doctors are well-meaning but they’re also juggling myriad patients. Hirsch advises re-reading everything they’ve sent over to support your application, just to make sure they haven’t missed a crucial piece of the puzzle that could sway things over to your side. 
• Be honest: It may sound obvious, but Hammond says people are often surprised that her team really does look at those tax documents and other supporting paperwork. The numbers need to match!
• Be sincere: One major red flag for Hammond’s team? When a couple applies, and they’ve copied and pasted their answers so they’re an exact match. “We really want to hear from everyone who has a stake in this,” she says. 

The bottom line

IVF grants are just one way to fund a fertility journey, but if you fit the eligibility guidelines, applying may be worth it. We’re wishing you the best of luck on your journey!

Learn more

• 10 Donor Egg Grants to Know About

For lesbian and other LGBTQ+ couples, a fertility journey isn't always straightforward. After all, you've got to work out the whole sperm + egg + uterus thing, and you may not have all of the above. Needless to say, things can get complicated; not to mention any fertility hiccups along the way.

One option for lesbian couples (and for some couples where at least one partner is transgender or nonbinary) is called reciprocal IVF. In reciprocal IVF, one partner's egg is used, but the other partner carries the pregnancy. This way, each partner gets to play a role: one is the biological parent, and the other gets to feel all the kicks and jabs (and morning sickness…blah) and deliver the baby. This could help both partners feel super involved in the pregnancy and connected to the baby.

Sounds kind of perfect. But with reciprocal IVF, there's a lot to understand and consider before diving in.

Reciprocal IVF 101

Here's how it works: First, you'll both have to take drugs that will get your periods synced up. It's important that you're ovulating at the same time. Then, the partner donating the eggs will take fertility meds to help her ovulate, and hopefully one or more eggs can be retrieved. They'll be fertilized in a lab with donor sperm in hopes of getting at least one viable embryo.

Resulting embryo(s) can then be transferred fresh or frozen to her partner. Basically, it's pretty similar to the standard IVF process, except the transferred embryo was made with the other partner's egg.  

If your fertility specialist recommends freezing embryos (and possibly chromosomal screening), syncing your cycles is not a necessary step. Eggs can be extracted first, embryos created and frozen and implant planned in the future. The menstrual cycles don't need to be synced.

Who's doing what

You'll have to decide: Who's going to be pregnant for nine months, and who's going to go through the egg retrieval process? You may be able to choose based on the question of who's more into the idea of being pregnant. But you might not have the luxury of choice—if one partner has trouble with her egg reserve or her uterus, for example, or has a health problem where pregnancy is dangerous.

Neither role is free of risks. Because you'll both be taking fertility medications, you may experience side effects. The woman carrying the baby will carry all the risks of pregnancy and childbirth.

Sperm: anonymous vs. known

You're going to need some sperm to make reciprocal IVF happen, so part of the process is choosing where it comes from. Would you want an anonymous donor from a sperm bank? Or is there someone you know who'd be willing to donate some sperm to you?

Going with a sperm bank is pricey, but the sperm is screened for illnesses, and in the U.S., usually the donors have signed paperwork waiving any parenthood rights. If someone in your life donates, they often do it for free (besides the necessary costs of sperm workup/bloodwork you’ll need to consider), and you both can go through this process with someone important to you. However, as the Family Equality Council suggests, you should draft a contract with that person. Also, with widely available genetic testing, bear in mind that no donation is truly anonymous these days. 

But what about money?

If neither you nor your partner have been diagnosed with infertility, your health insurance may not cover the costs of reciprocal IVF. Bummer, we know.  

Reciprocal IVF costs are similar to that of regular IVF. A cycle of IVF can cost anywhere from $16,000 to more than $30,000 when all is said and done. And, we're going to be candid here: it doesn't always work the first time. If you're using frozen embryos left over from the first cycle, additional transfers  may cost less—more like $3,000 to $5,000 per cycle, plus fertility meds.

The laws aren’t great

Parenting laws are complex and vary from state to state. And frankly, they haven't quite caught up with fertility technology. So they may not automatically recognize both parents as biological parents of the child, whether you're legally married or not. So, so frustrating.

An attorney experienced in assisted reproduction laws can help you through all the legal rigamarole. Some states allow "second parent" adoptions, where one parent is deemed the biological parent and the other is able to adopt the child, so they both have equal rights and responsibilities as parents.

If your state doesn't allow second parent adoption or doesn't allow married or unmarried same-sex couples to adopt (yes, both are a thing), the Human Rights Campaign suggests drafting a co-parenting agreement or custody agreement with your partner. A good attorney can help you through all of that.  

What about being pregnant at the same time?

Some couples even choose to both be pregnant at the same time, which is known as concurrent IVF.

In concurrent IVF, each woman goes through IVF followed by embryo freezing for each. Once each woman's uterus is deemed by her doctor as ready to receive the embryos created from her partner's eggs, each partner's embryos are transferred to the other. They can therefore carry each other's baby at the same time.

But keep in mind, concurrent IVF could pose some challenges. "Their babies could possibly be born very close to the same birth date," Dr. David Diaz, MD, reproductive endocrinologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California notes. While it could be a wonderful option, "If one woman's pregnancy is complicated, it may be difficult for her pregnant partner to easily care for the woman struggling with the complication."  

And then you'll have two newborns. "After the birth, it may add physical stress and fatigue in caring for two newborns by both moms who are recovering from childbirth," says Dr. Diaz.

Think about the future

If you're hoping to have more than one child, you may consider a few different options. Perhaps you freeze some of the embryos from this cycle for a later transfer. Or you could swap roles: the egg donor becomes the pregnant partner and vice versa next time.

All that said, reciprocal IVF can be a good choice for lesbian partners who want to have a baby together—so long as you've discussed all the above with each other, your doctors and a lawyer. Be sure you'll both be comfortable with your role in the pregnancy and beyond. And get ready to become parents…together!

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.

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.