IUI

At Cofertility, we believe in the equal right to parent. LGBTQ+ families have historically faced more rigorous scrutiny and challenges than heterosexual families regarding their rights to be or become parents. For example, discriminatory laws make it difficult in some states for both parents to be on the birth certificate, solely because of their gender. We stand by protections for LGBTQ+ parents and their children, and support all families equally. 

For LGBTQ+ individuals and families, what once seemed to be impossible, is now possible. A same sex male couple now has the ability to have a genetically-related child using donor eggs and gestational surrogacy. A same sex female couple can have a child through Reciprocal IVF where one partner's eggs are used, and the other partner carries the pregnancy. Transgender men may choose to carry pregnancies and transgender people can pursue egg and sperm freezing before transitioning in order to preserve the option to be a genetic parent. Thanks to IVF and egg donation, more and more people now have the opportunity to build their dream families.  

At Cofertility, we’re excited to guide you through the process and navigate it together. Below is a non-comprehensive and ever-changing guide of information and resources for families looking to start families. 

LGBTQ+ parenting stats:

According to Family Equality and UCLA:

• As of 2024, 5 million children are being raised by an LGBTQ+ parent
• Approximately 191,000 children are being raised by two same-sex parents
• 18% (2.57 million) of LGBTQ adults are parenting children, and approximately 22% of LGBTQ+ people think it is very likely they will have children
• Among LGBTQ+ adults under 50 living alone or with a spouse or partner, 48% of women and 20% of men are raising a child who is under 18 years old
• 25-50% of transgender individuals are parents 
• Almost one-third (31%) of LGBTQ+ parents are not legally recognized or are unsure about their legal parental status.

Children raised by LGBTQ+ families do well

Despite facing discrimination, research has found that children raised in same-sex parent families fare just as well as children raised in different-sex parent families across a wide spectrum of child well-being measures: academic performance, cognitive development, social development, psychological health, early sexual activity, and substance abuse.

Common questions LGBTQ+ families face:

• How will I (or we) become a parent?
• How important is it that I (or my partner) be biologically related to the child?
• Who will carry the pregnancy?
• Do we want to use an disclosed or undisclosed donor?
• What are the legal considerations for our family?
• How much will fertility treatments cost? 

Family-building options for cisgender single men or same-sex male couples:

IVF with donor eggs 

• Donor eggs can be from an egg donor match through Cofertility (or other egg donor matching service), or through a known donor, like a family member or friend
• Read the Gay Dad’s Guide to Egg Donation

Sperm from one or both partners

• Half the eggs can be fertilized from each partner, or all the eggs can be fertilized with sperm from one partner or a sperm donor

Gestational surrogacy

Adoption

Family-building options for cisgender women and female same-sex couples:

• At-home insemination with donor sperm
• IUI with donor sperm
• IVF with donor sperm, donor embryo, or double-donor embryo
• Reciprocal IVF (where one partner's egg are used, and the other partner carries the pregnancy)
• Adoption

Family-building options for transgender men and transmasculine nonbinary individuals (AFAB)

According to ASRM, the majority (62%) of trans men desire children. However, gender affirming hormone therapy and surgery (eg. gonadectomy) may result in loss of fertility potential which may be reversible or irreversible. 

While there is limited data on fertility preservation in transgender men, some choose to freeze eggs before transitioning. WPATH recommends that all transgender patients be counseled regarding options for fertility preservation (egg freezing) prior to transition. But even if this is not possible, transgender men still have many options for becoming parents:

• At-home insemination with donor or partner sperm (for individuals with ovaries and a uterus)
• IUI with partner or donor sperm 
• IVF with sperm (from partner or donor) and eggs (donor, own, or partners)
• Pregnancy (for individuals who retained their uterus) or gestational surrogacy
• Adoption

Family-building options for transgender women and transfeminine nonbinary individuals (AMAB)

Transgender women and transfeminine nonbinary individuals (AMAB) can freeze sperm before transitioning. But even if they are not able to, there are other options including:

• IUI with partner’s womb using AMAB or donor sperm
• IVF with partner’s womb using AMAB sperm, donor sperm, donor embryo, or double-donor embryo
• Gestational surrogacy
• Adoption

Egg donation for LGBTQ+ parents:

Egg donation is when a female donates her eggs, via IVF, to enable another individual or couple to conceive. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We work with anyone who is looking to build a family through egg donation. Whether you’re single or coupled, we do not discriminate, period. We believe the concept of “family” takes many forms, and we’re here to help your family grow, whatever that looks like. 

LGBTQ+ family-building resources:

• The Gay Dad's Guide to Egg Donation was written by Dr. Saira Jhutty and discusses the process of using donor eggs to build a family.
• Connecting Rainbows is a resource for people in the LGBTQ+ community who are building their families. They're particularly knowledgeable on the topic of second-parent adoption.
• Family Equality is the leading national nonprofit organization advancing equality for LGBTQ+ families.
• Men Having Babies (MHB) is a non-profit dedicated to providing gay men with educational and financial support to achieve parenthood.
• The National Center for Lesbian Rights works to ensure that LGBTQ parents and their children are fully recognized as families under the law, including low-income parents using low-cost assisted reproduction, both married and unmarried parents, families with more than two parents, adoptive parents, and parents conceiving using surrogacy.  
• Resolve vigilantly tracks state and federal legislation pertinent to LGBTQ+ family building across the United States, and works to support positive family building bills and to stop harmful legislation from being enacted. You can view the legislation they’re working on here. 
• Trans Fertility Co. was created by trans community members to make the world of fertility easier to understand and navigate.
• Gay Parent Magazine: Gay Parent features personal stories of lesbian, gay, bisexual, and transgender parents about their experiences with international and domestic adoption, foster care, donor insemination, using a surrogate and what it is like to raise their children.
• Parents, Families, and Friends of Lesbians, Gays, Bisexual and Transgender (PFLAG): PFLAG is devoted to educating and supporting everyone involved in the life of a sexual minority individual. There are local chapters all over the United States

Family by Co is our human-centered matching platform for intended parents pursuing egg donation. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Reach out if we can help. 

Read more:

• What Fertility Options are Out There for LGBTQ Families?
• The Gay Dad's Guide to Egg Donation
• How to Start a Family as a Single Dad by Choice

If you are over 40 and trying to grow your family, you may be wondering what path gives you the best chance for success. You are not alone! In fact, births among women ages 40-44 have been rising since the early 1980s, even as the overall U.S. birth rate fell to a record low. This is partly due to more people putting off parenthood for a variety of reasons, plus better access to assisted reproductive technology like IVF and egg donation.

It is absolutely possible to get pregnant and carry a healthy pregnancy in your 40s — let’s dive into the data around your possible paths to pregnancy.

Getting pregnant naturally over 40

While getting pregnant naturally over 40 tends to surprise people, it’s totally possible. Researchers found that for women 40-45, the crude probability of getting pregnant after trying (“naturally”) for a year was 55.5%. This compares to nearly 80% for women ages 25–27. However, it’s important to note that chances of miscarriage go up significantly. For women 40-45, one study found the chance of miscarriage is about 33.3% and goes up to 57% for women over 45.

But some people don’t want to wait a year to see if they are part of the lucky 55% who get pregnant, or they want to reduce their chances of miscarriage. If this is the case, read on to see the chances of pregnancy with fertility treatments over 40.   

Getting pregnant with IUI over 40

Let’s look at the data from 2,262 patients pursuing IUI, or intrauterine insemination. IUI is often used because it’s relatively inexpensive (at least compared to IVF), and quick. For the women aged 40-41, the chances of pregnancy per cycle were 9%. That number dropped to 6% for women 42-43, and to 3.5% for women over 43. 

The odds of IUI working at any age aren’t great. And it still doesn’t solve for the increased chance of miscarriage due to chromosomal abnormalities. That’s why some families turn to IVF.

Getting pregnant with IVF over 40

What are the chances of getting pregnant with IVF over 40? Age is one of the biggest factors in the ability to get pregnant. And even with IVF, the chances of success with our own eggs declines as we reach our 40s. The great part about IVF is that you can find out if an embryo is genetically normal (and thus less likely to miscarry) before you attempt a transfer. This can save time and heartache. 

Data from the Society for Assisted Reproductive Technology shows the following chances of a live singleton birth using your own eggs via IVF:

• 38.3% for women 35-37
• 25.1% for women age 38-40
• 12.7% for women age 41-42
• 4.1% for women over 42

 It’s important to remember that your age when you get pregnant is not as important as the age of the eggs with which you get pregnant.

It’s important to remember that your age when you get pregnant is not as important as the age of the eggs with which you get pregnant. That means your chances of success getting pregnant, no matter your age now, is better with younger eggs. But how do you get younger eggs? For some lucky women, they can use eggs they froze years ago. But for most of us, getting younger eggs means turning to egg donation. And that brings us to our final section: getting pregnant with donor eggs. 

Getting pregnant with donor eggs over 40

IVF can be thought of in three parts. First, there’s retrieving the eggs. Second, there’s fertilizing the eggs to make embryos. And third, a healthy embryo is transferred to the uterus to begin a pregnancy. When you use donor eggs during IVF, everything is the same except it’s the egg donor who undergoes the egg retrieval in the first part.   

Many women in their 40s still carry the pregnancy, even when using donor eggs. Although some need to use a gestational carrier for a variety of reasons. 

The good news is this: studies show that your chances of success using donor eggs does not diminish in your 40s. You read that right! Using donor eggs can greatly increase your chances of a successful and healthy baby well into your 40s.  

How many tries does it take to get pregnant with donor eggs?

For many people beginning the journey to use donor eggs, you may have already tried unsuccessfully with your own eggs and are eager to get pregnant as quickly as possible. Well here’s the good news: it is estimated that the probability of success reaches roughly 90% after three embryo transfers. This of course varies patient to patient, and your doctor should be able to give you a better idea of your chances based on your medical history. 

Can I use donor eggs over 50?

In a study of women who became pregnant from egg donation, researchers at Columbia University found that women over age 50 do not appear to face any greater risk than those under 43. That doesn’t mean there’s no risk in pregnancy over 50, and anyone in this age group should undergo thorough medical screening before attempting pregnancy to ensure the best possible outcome.

If you are pursuing donor eggs, we’d love to help. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey and are in an endless pursuit to make these experiences more positive. Sign up for a free account today. 

Read more: 

• I'm Over 40 and Considering IVF: How Do I Prepare For The Journey Ahead?
• How Does Donor Egg IVF Work?
• Will a Donor Conceived Child Have My DNA?

Families come in many forms and everyone’s path to parenthood is unique. No matter those differences, anyone striving to build a family should have equal access to resources on their journey. We’ve compiled the below list of resources that we hope will help you navigate any challenges when it comes to starting a family.

LGBTQ+ family-building resources

• The Gay Dad's Guide to Egg Donation was written by Dr. Saira Jhutty, and discusses the process of using donor eggs to build a family.
• Connecting Rainbows is a resource for people in the LGBTQ+ community who are building their families. They're particularly knowledgeable on the topic of second-parent adoption.
• Family Equality is the leading national nonprofit organization advancing equality for LGBTQ+ families.
• Gay Parent Magazine: Gay Parent features personal stories of lesbian, gay, bisexual, and transgender parents about their experiences with international and domestic adoption, foster care, donor insemination, using a surrogate and what it is like to raise their children.
• Parents, Families, and Friends of Lesbians, Gays, Bisexual and Transgender (PFLAG): PFLAG is devoted to educating and supporting everyone involved in the life of a sexual minority individual. There are local chapters all over the United States
• Men Having Babies (MHB) is a non-profit dedicated to providing gay men with educational and financial support to achieve parenthood.
• The National Center for Lesbian Rights works to ensure that LGBTQ+ parents and their children are fully recognized as families under the law, including low-income parents using low-cost assisted reproduction, both married and unmarried parents, families with more than two parents, adoptive parents, and parents conceiving using surrogacy.  
• Resolve vigilantly tracks state and federal legislation pertinent to LGBTQ+ family building across the United States, and works to support positive family building bills and to stop harmful legislation from being enacted. You can view the legislation they’re working on here. 
• Trans Fertility Co. was created by trans community members to make the world of fertility easier to understand and navigate.
• Fertility Within Reach has resources to support transgender youth and their families with fertility preservation support.
• Gay Parents To Be is an informational resource and a starting point for LGBTQ parenting.

Family-building resources for BIPOC women 

• BMMA (Black Mamas Matter Alliance) is a Black women-led cross-sectoral alliance. with resources covering a broad spectrum of maternal health issues and advocacy tools.
• Black Women and Infertility is an organization based in Boston that provides online support for Black women experiencing infertility.
• The Broken Brown Egg provides support and resources for people in the Black community experiencing infertility.
• Fertility for Colored Girls provides education, encouragement, and support to Black women and other women of color experiencing infertility and seeking to grow their families. They aim to empower Black women to take charge of their fertility and reproductive health, and provide grants to help ease the financial burden of fertility treatments or domestic adoption.
• The Infertilidad Latina Podcast is a space for women to listen and share stories about their infertility and IVF experiences.
• The Infertility and Me podcast is a Black woman-hosted show covering reproductive justice, pregnancy loss/miscarriage, and infertility.
• Moms in the Making have infertility support groups in Spanish.
• The Resilient Sisterhood Project’s mission is to educate and empower women of African descent regarding common yet rarely discussed diseases of the reproductive system that disproportionately affect them.
• This article discusses why infertility isn’t discussed enough in Latinx communities.
• This article discusses overcoming stigma in the Asian American community

Religious family-building resources

• The Jewish Fertility Foundation is a resource for members of the Jewish community to seek support for infertility. Part of their work includes destigmatizing infertility within the Jewish community and educating community leaders on how to support those with infertility.
• Resolve has resources regarding the intersection of infertility and religion for community leaders, as well as links to support groups for those of Islamic, Jewish, Christian, or Catholic faith. This can serve as a good starting point for conversations about religion and infertility.
• This article from MuslimGirl.com shares the experience of infertility for Muslim women.
• Catholic Mom is an infertility support group for Catholic families.
• ATime provides guidance and support for Jewish families facing infertility. In addition to having therapists, they have a 24-hour helpline. 
• Uprooted’s work allows those struggling to turn toward the Jewish community as they navigate their fertility journey, to break through feelings of isolation and shame, and to connect with others traversing the same path. 
• Amal Fertility is a Mississauga-based support group for Muslim women struggling with infertility.
• Hasidah offers peer support as well as financial aid for those seeking to build Jewish families.
• Stardust Jewish Fertility Foundation is a nonprofit that offers grant opportunities from $1K - $25K to Jewish singles of couples, regardless of sexual orientation or marital status.
• Jewish Family and Children’s Service of Greater Philadelphia (JFCS) provides grants to Jewish families living in the Philadelphia area facing infertility.

Military and veteran family-building resources

• Resolve has a list of affordable infertility treatment options for military personnel.
• Bob Woodruff Foundation provides up to $5,000 funding to veterans eligible for the BWF Veterans In Vitro InitiAtive (VIVA) Fund. 
• Read the Tricare white paper on why expanding service members’ access to infertility treatment is easy, affordable, and the right thing to do.
• The Military Family Building Coalition is a non-profit organization to support military members in building their families through ART, IVF and Adoption.

Cancer-survivor family-building resources

• The Alliance for Fertility Preservation is a 501c3 made up of a team of professionals who advance the field of fertility preservation for cancer patients.
• The Expect Miracles Foundation provides grants for cancer patients for family building (adoption, fertility storage, IVF, & surrogacy).
• The Banking on the Future grant is available to adolescent oncology patients through the age of 21.
• Team Maggie provides financial assistance to teens and young adults with cancer seeking fertility preservation. 
• Duke has a monthly support group for women facing fertility concerns due to cancer.

Resources for all

• Resolve is the largest and most well-respected infertility non-profit offering advocacy, support, and education for anyone facing infertility.
• The Starfish Fertility Foundation is a 501c3 nonprofit group committed to providing financial support for those struggling with infertility in the United States.
• The Gift of Parenthood provides grants that can be used to cover any expenses associated with assisted reproduction including egg donation.
• Baby Quest makes grants for family building ranging from $2,000 - $15,000 plus medications. 
• Ferring Pharmaceuticals Heart Beat Program provides select fertility medications at no cost to female patients with a cancer diagnosis.

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive.

Many states require insurance companies to cover part, or all, of fertility care expenses. But this can be very tedious to sift through, and it varies by locale. For anyone even considering fertility testing or treatment, it’s good to know just what’s up in your state. 

Can you expect some help on the testing front? What about in vitro fertilization (IVF), are there any mandates for coverage here? So with no further adieu, here’s what you can expect in terms of your state’s fertility insurance:

Alabama

No fertility insurance here. Currently out of luck.

Alaska

No fertility insurance here. Currently out of luck.

Arizona

No fertility insurance here. Currently out of luck.

Arkansas

With Arkansas fertility insurance, you do have some benefits, albeit limited. If you have an individual or group policy that includes maternity benefits, IVF must also be covered, as well as cryopreservation. 

But, there is a lifetime cap of just $15,000 here. You also can’t just move right to IVF. First, you must try a less costly fertility approach such as undergoing an intrauterine insemination (IUI). Also, HMO’s and employers who self-insure are exempt.

California

California fertility insurance looks promising, but may be far less helpful than meets the eye. You will only receive coverage here if your employer decides they want to provide fertility coverage as part of their benefits package.

Fact is, here insurance companies only have to offer infertility coverage. It’s then up to employers to decide whether they want to include fertility treatment coverage for employees or not. 

Colorado

Thanks to some new legislation, as of January 1, 2023. Colorado fertility insurance now offers eligibility for three egg retrievals with unlimited embryo transfers covered. This is true provided that your insurance coverage is from a large group of 100 or more people. 

Those with individual or small group plans will unfortunately not have access to this coverage. Also, religious organizations, even large ones, are not required to provide fertility coverage.

Connecticut

With Connecticut fertility insurance, diagnosis and treatment of medically necessary infertility expenses must be covered. You may be entitled to up to two cycles of IVF, zygote intrafallopian transfer (ZIFT), or gamete intrafallopian transfer (GIFT), up to four cycles of ovulation induction and up to three cycles of intrauterine insemination.

But, only those who have had coverage under the policy for at least one year will be eligible. Also, if your employer self-insures, they do not have to provide this coverage, or, if they are a religious organization, this is also not mandated.

Delaware

Delaware fertility insurance offers an array of services that includes IVF with eggs, sperm, or embryos from a donor, and even allows for a surrogate or gestational carrier. You are even entitled to six egg retrievals with unlimited embryo transfers. 

But there is a hitch. This coverage is restricted to those with fertility issues as a result of a medical treatment such as chemotherapy, surgery, or radiation. Also, any egg retrieval must be done before age 45 and any embryos transferred before age 50. 

Florida

No fertility insurance here. Currently out of luck.

Georgia

No fertility insurance here. Currently out of luck.

Hawaii

While you can get some Hawaiian fertility insurance coverage that may be beneficial, it’s limited. You’re entitled to one and only one IVF cycle. That’s for those with a minimum of a five-year history of issues such as endometriosis, blocked or removed fallopian tubes, DES exposure, or male infertility factors.

You also can’t move on to IVF until you’ve tried other covered fertility treatment first. So, if you are eligible, you truly don’t want to give away your shot…

Idaho

No fertility insurance here. Currently out of luck.

Illinois

With Illinois fertility insurance coverage, provided you have tried lower-cost treatments under your insurance umbrella first without success, you do have coverage for IVF, GIFT, and ZIFT. What’s more, you get four bites at the apple and if you are successful and a live birth occurs, you’re actually entitled to two more covered egg retrievals.

But this only applies to work-related group policies that cover more than 25 full-time employees. There is, however, some additional good news. As of January 1, 2022, this fertility protection extends to same-sex couples and single-women over age 35 who have a medical issue keeping them from getting pregnant.

Indiana

No fertility insurance here. Currently out of luck.

Iowa

No fertility insurance here. Currently out of luck.

Kansas

No fertility insurance here. Currently out of luck.

Kentucky

No fertility insurance here. Currently out of luck.

Louisiana

The Louisiana fertility insurance law provides a fig leaf of coverage. You are only eligible here for diagnosis and treatment if your fertility issues are the result of a correctable medical condition. Even that has exceptions. There is no requirement to cover fertility medication or to offer IVF or even other fertility treatment. Also, if you or your partner have undergone a tubal ligation or vasectomy, any reversal here is on you.

If your employer self-insures, then even if you would be eligible otherwise, there’s no requirement that you be covered.

Maine

While this state doesn’t have any coverage at the moment, a Maine fertility insurance law will kick in beginning January 1, 2024. Then, fertility patients who have health plans here will be entitled to fertility diagnostic care, treatment and fertility preservation services. 

Coverage is expected to include both individuals and couples battling infertility, those who carry a heightened risk of transmitting a severe genetic disorder to an offspring with natural conception, and those who don’t have the needed reproductive cells to conceive. This coverage will exclude anything experimental or any non-medical related cost.

Maryland

With Maryland fertility insurance, you are golden. This insurance offers coverages not only to traditional heterosexual couples, but also same sex couples and unmarried patients. Those who qualify are entitled to undergo three IVF rounds for every live birth. There is, however, a $100,000 lifetime cap here.

But, this coverage is not a requirement for religious employers, those with fewer than 50 employees, or those employers who self insure.

Massachusetts

Massachusetts fertility insurance stipulates that insurers that provide pregnancy-related benefits are also expected to offer coverage for diagnosis and treatment of infertility. This means access to artificial insemination procedures such as IVF and GIFT. It may also include procurement of eggs or sperm, processing and banking for fertilized eggs and sperm. 

There’s also no state lifetime cap on the amount of fertility insurance available and no limit on the number cycles. But, insurers are able to use their clinical guidelines and patient’s medical histories to set some limits here. 

Michigan

No fertility insurance here. Currently out of luck.

Minnesota

Not only is there no Minnesota fertility insurance, but also there’s a law prohibiting coverage for meds specifically used to enhance fertility. Talk about kicking those already down… 

Mississippi

No fertility insurance here. Currently out of luck.

Missouri

No fertility insurance here. Currently out of luck.

Montana

Montana fertility insurance offers some vague help as long as you get your insurance through an HMO. But unfortunately, there’s no definition of infertility that’s given in the law and no description of the type of services that need to be covered. So, it appears to pay only lip service here. Anyone with non-HMO insurance has absolutely no coverage.

Nebraska

No fertility insurance here. Currently out of luck.

Nevada

No fertility insurance here. Currently out of luck.

New Hampshire

If you have a group policy that offers benefits for medical or hospital expenses, the New Hampshire fertility insurance mandate provides for medically necessary fertility treatment. This includes coverage for evaluations, laboratory testing, and medication. If fertility preservation is needed, such as if you must undergo chemotherapy or radiation treatment, coverage includes both procurement and cryopreservation of reproductive materials such as eggs, sperm, and embryos, and may even include storage for a time.

But experimental infertility procedures are not included. Also, anyone covered through the Small Business Health Options Program (SHOP) or have an Extended Transition to Affordable Care Act-Compliant Policy funded by the state, is not eligible here. 

New Jersey

With New Jersey fertility insurance, as long as you are under the age of 46 and have a group policy that includes at least 50 people, with pregnancy-related benefits, you are potentially eligible for a variety of infertility treatments. This includes a menu of items such as up to four IVF cycles with ICSI, GIFT, or ZIFT, as well as use of donor eggs and even the potential to use a gestational carrier or surrogate. 

But except in cases where the patient must undergo treatment that puts fertility at risk, such as chemotherapy, cryopreservation is not covered.

Also, there are some exceptions to which insurers must follow the mandate – neither religious employers or those who self-insure are required to provide this coverage.

New Mexico

No fertility insurance here. Currently out of luck.

New York

As part of a new law enacted in 2020, New York fertility insurance offers those who have large group insurance plans of 100 or more, up to three IVF cycles. Also, those that include prescription drug coverage must provide medication for the diagnosis and treatment of infertility. 

What’s more, it’s now necessary to cover egg freezing for all private insurance companies in medically necessary cases. So, you are eligible if you have a condition such as sickle cell anemia, are undergoing chemotherapy, or are undergoing sex-reassignment surgery. 

Those who self-insure are exempt here.

North Carolina

No fertility insurance here. Currently out of luck.

North Dakota

No fertility insurance here. Currently out of luck.

Ohio

Ohio fertility insurance must be covered in cases where this is medically necessary, by HMO’s that offer “basic health services.” But don’t count on coverage for IVF, GIFT, or ZIFT. None of these are legally required. 

What you may be covered for includes diagnostic procedures to detect fertility issues, or surgical treatments to correct issues with the reproductive organs such as endometriosis or issues with the fallopian tubes.

Oklahoma

No fertility insurance here. Currently out of luck.

Oregon

No fertility insurance here. Currently out of luck.

Pennsylvania

No fertility insurance here. Currently out of luck.

Rhode Island

The Rhode Island fertility coverage is mandated for all of those with an HMO or other insurance policy that includes pregnancy coverage. Beginning at age 25 and extending up to age 42, women here with such a plan are entitled to coverage for diagnosis and treatment of infertility. 

Also, if someone is undergoing a procedure that may result in infertility, insurers must cover fertility preservation treatment. There is, however, a $100,000 lifetime treatment cap. 

South Carolina

No fertility insurance here. Currently out of luck.

South Dakota

No fertility insurance here. Currently out of luck.

Tennessee

No fertility insurance here. Currently out of luck.

Texas

With Texas fertility coverage, although insurance companies must provide this as an option, there is no mandate that any group is required to actually offer this as part of their health plan. In instances where such coverage is offered, it only pertains to those who can show that they’ve been infertile for at least 5 years or who have a medical issue such as endometriosis, tubal blockage or removal, or DES exposure. 

Also, IVF won’t even be considered until less costly measures, like IUI, have been tried. 

Utah

Utah’s fertility coverage involves a pilot program through 2024. This targets those who are on a Public Employee Health Plan. Here, if you have a maternity benefit, then you must likewise be able to receive $4,000 toward a “qualified reproductive technology cycle.” With this, just a single embryo is transferred during a cycle using reproductive technology.   

This, however, is not a mandate. The aim of the program is to determine the efficacy of providing this kind of coverage. 

Vermont

No fertility insurance here. Currently out of luck.

Virginia

No fertility insurance here. Currently out of luck.

Washington

No fertility insurance. Currently out of luck.

West Virginia

The West Virginia fertility insurance mandate is low on details. While HMOs that offer basic health services are required to cover infertility, what “infertility” actually means here is not defined. All in all, this is way too vague – more clarity needed here.

Wisconsin

No fertility insurance here. Currently out of luck.

Wyoming

No fertility insurance here. Currently out of luck.

When coverage is lacking

If you’re lucky enough to live in one of the 20 states that offers a fertility insurance mandate, that’s, of course, a big win. Still, as you can see, even these can leave you wanting. If your state doesn’t deliver on fertility coverage or if the coverage is, in a word, lacking here, reach out to Resolve: The National Fertility Organization to find out who to contact to lobby for improvements.

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

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

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

IUI

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

How it works:  

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

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

IVF

Short for: In vitro fertilization

How it works:

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

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

ICSI

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

How it works:  

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

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

PICSI

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

How it works:  

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

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

Consider artificial insemination and fertilization costs

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

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

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

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

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

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

Out of pocket expenses

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

Medications

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

Bloodwork and check-ups

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

Insemination

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

Additional fertilization costs

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

Embryo testing and freezing

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

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

Egg donors and sperm donors

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

Gestational carriers

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

Total cost

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

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

Summing it all up

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

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

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

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

What is low sperm count?

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

What causes low sperm count?

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

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

How can I treat low sperm count?

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

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

Avoiding some stuff

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

Keeping tabs on your diet and exercise

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

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

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

Thinking hard about supplements

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

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

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

Summing it all up

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

If you’ve experienced pregnancy loss, there may be a hard-to-ignore question in the back of your mind: what, exactly, causes miscarriage?

You may know that it’s common—as many as 1 in 4 pregnancies end in miscarriage, and the real number is, unfortunately, even higher when you factor in unknown pregnancies—but as frequently as it happens, many prospective parents still don’t know what actually causes it.

That giant question mark can make the miscarriage experience even worse. Grieving over your pregnancy loss is hard enough, but when you don’t know where to place the blame, and wonder if it could happen to you again, you end up facing fear, anger, and frustration on top of grief.

When miscarriage happens, it’s crushing. But the thing to keep in mind is this: miscarriage is not your fault, and there’s nothing you could have done to prevent it or change it. The universe has a pretty messed up way of working, huh?

So...what are the causes of miscarriage, anyway? And why do they happen to so many women?

Here are some common reasons why miscarriage can occur, and what you should ask your doctor if it’s happened to you.

Possible miscarriage cause #1: abnormal chromosomes

Biology may be a science, but it kind of functions like a delicate musical instrument: one wrong note and the whole thing goes out of tune. Translated to genetics, this means that if one teensy piece of the babymaking chromosomal puzzle doesn’t fall perfectly into place, the embryo may not develop properly, potentially causing miscarriage.

According to OBGYN Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine, an embryo that’s genetically abnormal is the most common cause of miscarriage. She says sometimes this abnormality occurs at the very start of the fertilization process and other times it happens a bit later.

Either way, you can’t control the genetic processing that happens when sperm meets egg (unless you did in vitro fertilization and your doctor tested the genes of your embryo before transferring it, which many do!).

You can, however, ask your doctor to do some detective work for you if you’ve had repeated miscarriages: placental and fetal tissue can be tested for chromosomal abnormalities, giving you a clearer picture of what’s going on in your body when a fertilized egg ends in miscarriage.

Possible miscarriage cause #2: advanced maternal age

You know what sucks? Because women are born with all the eggs they’ll ever have, those eggs age right along with us...and can increase your chances of those chromosomal abnormalities we mentioned.

In a 2019 study published in the British Medical Journal, the risk of miscarriage rose sharply in women over the age of 30, reaching as high as 53 percent by age 45.

Even men, who generate fresh sperm all the time, are subject to chromosomal aging, says Minkin: “Guys keep making new sperm, although there is data to show that older fathers do have more genetic issues, too.”

If you and your partner are concerned about your genetic health—whether it’s because of aging or not—you can ask your doctor for genetic screening, which may alert you to risk factors you otherwise wouldn't know about.

Possible miscarriage cause #3: infertility or hormonal issues

This is going to sound like a chicken vs. egg scenario, but hear us out: infertility issues may actually cause...more infertility issues? Basically, your miscarriage rate can be higher if you’ve struggled to conceive in the past, possibly because there’s something up with your hormones at the root of your infertility challenges.

“Occasionally, a woman might not be ovulating well enough, [meaning] she is ovulating enough to produce the egg, but not enough to make the progesterone needed from the ovary to maintain the pregnancy,” explains Minkin. This might apply to you if you experience anovulatory cycles, irregular cycles, or if you have polycystic ovarian syndrome (PCOS).

Possible miscarriage cause #4: infection or chronic illness

No, we’re not talking about colds or stomach bugs here—we’re talking about more severe infections, like sexually transmitted diseases (STDs), cytomegalovirus (CMV), and pelvic inflammatory disease. We’re also talking about chronic conditions, many of which come with the one-two punch of increasing your risk of miscarriage and infertility issues.

Kecia Gaither, M.D., double board-certified physician in OB/GYN and maternal fetal medicine and director of perinatal services at NYC Health + Hospitals/Lincoln, says maternal illnesses like diabetes, thyroid disorders, autoimmune disorders such as lupus, and blood clotting disorders can contribute to the overall causes of miscarriage, too.

Possible miscarriage cause #5: reproductive or anatomical issues

There are a bunch of congenital abnormalities in the reproductive system that can a) make it harder for you to conceive and b) make it harder for a fertilized embryo to thrive after conception.

Some of these abnormalities include:

• a misshapen uterus (like a double- or half-uterus)
• uterine fibroids
• a uterus with a septum
• blocked or damaged fallopian tubes
• endometriosis scarring

You may know about these anomalies already if you’ve got ‘em; they may have affected your menstruation or caused other symptoms. Either way, many of them can be treated if they’re contributing to infertility, so talk to your doctor.

Possible miscarriage cause #6: substance abuse

According to Dr. Gaither, frequent drug and alcohol use may also increase your chance of miscarriage. No, we don’t mean the celebratory glass of champagne you had on your birthday before you knew you were pregnant. It’s the consistent consumption of alcohol—especially as you move past week five of pregnancy—that’s affiliated with miscarriage. (And any amount of drug use, at any point during pregnancy, is potentially a problem.)

Addiction is a debilitating mental health condition; if you’re struggling, consider seeking help—especially if you’re trying to have a baby.

What to ask your doctor

If this is your first miscarriage, it may not be necessary to ask your doctor anything just yet; Dr. Minkin says miscarriage is common enough that it doesn’t always mean there are overarching fertility issues that need to be addressed. On the other hand, if you’ve been trying to conceive for a while, have a known fertility issue, or received any kind of fertility treatment, you may want to investigate any underlying issues as soon as possible rather than wait.

It’s best to talk to your doctor about a miscarriage so they are aware it happened and can make a decision, based on your overall health, about how to proceed. If your doctor feels more evaluation is needed to determine what caused your miscarriage, Dr. Gaither says there are a few things your doctor can do in terms of getting your fertility prospects checked out. These may include:

• Having miscarriage tissue genetically evaluated
• Having diagnostic tests to look for uterine or cervical anomalies
• Managing any other medical conditions that could be contributing to your inability to maintain a pregnancy

If you’re grieving a pregnancy loss, we know this information is probably pretty overwhelming. You may not be eager to dig into the reason behind your miscarriage at this point — and that’s understandable. You should take the time you need to consider your options and move forward when you feel ready.

But you should also know that miscarriage doesn’t mean you can’t ever get pregnant. Many women go on to have healthy pregnancies after experiencing loss, sometimes naturally and sometimes with assistance from a fertility specialist. We’re rooting for you.

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Read more in Does Using Donor Eggs Decrease the Risk for Miscarriage?

Let's face it: infertility sucks. Whether you've always known you want to have children or have just recently embraced the idea, learning that it won't be easy—and may require months, or even years of invasive treatments—can cause a flood (and, to be honest, sometimes a fury) of infertility emotions.

According to Dr. Sheeva Talebian, M.D., a board-certified reproductive endocrinologist at New York fertility clinic Colorado Center for Reproductive Medicine (CCRM), "the underlying infertility emotions come from having a complete lack of control over the process," which comes from the shock of failing at something that we've been led to believe will come so naturally.  

Lindsay Liben, a licensed clinical social worker (LCSW) explains that so many of the people she meets have been successful in most areas of their lives. This is the first time they're experiencing this level of adversity that's so far outside their control, so developing survival skills for this bumpy ride is essential. Don't worry, we're here to navigate.  

Don't ride alone

When dealing with infertility, the highs and lows of your emotions have a direct and immediate effect on your relationship with your partner. Carolyn Berger, LCSW, says she sees over and over again that this journey either "brings couples closer together or further apart." Keeping the latter from happening will require a lot of communication and honesty.

• Get real: If you're dealing with infertility, you might be trying to get through it as quickly and painlessly as possible. If you don't talk to anyone (especially your partner) much about it, maybe it will just go away. The hard truth is that this isn't normally how it goes: you could be in for months or even years of treatment. It's no fun, but accepting that will help you and your partner move on as a team.  
• Reclaim your body: sometimes it can feel like infertility emotions and treatments have hijacked your body. "Your areas that used to be private are no longer private. It's like Grand Central Station," says Liben. In order to feel like your body is your own, Liben advises taking a "pleasure inventory." These may include super-intimate time with your partner, taking walks and listening to your fave playlist, trying different face masks, or eating that cupcake. Bringing your partner into these experiences will help you remember that you're riding this roller coaster together—wherever it goes.

Protect yourself

Self-care is one thing, but what about when you're out in the real world? Emotional hazards come at you left and right, so here are some tips to weather the storm.

• Set your boundaries: It's ok to lie. Seriously. If sitting through a barrage of oohs and aahs at a friend's baby shower makes you want to run headfirst into a brick wall, tell your pal you have other plans. If you feel like you just have to be there, let the host know when you arrive that you have dinner plans and have to leave early. Then, reward yourself for surviving that triggering social experience: go out to dinner with your partner or take yourself to a movie.
• Tell others where to get off: Ugh—those intrusive questions from nosy friends, family members, co-workers and even complete strangers. Berger advises us to remember that "this is your information and you have a right to talk about it or not." If someone asks when you're going to start a family and you're feeling super awkward, one suggestion is to just say, "we're keeping our options open and we'll see if we get lucky." Then, change the subject as quickly as possible. Save your thoughts on how you really feel for your inner monologue.
• Stop, look and listen: Going through fertility treatments can be an all-consuming hamster wheel of thoughts. Berger advises couples to avoid talking about fertility throughout the day and instead set aside a total of ten minutes each evening. During this time, each partner takes five minutes to share all of his or her feelings about fertility, while the other simply listens, without judgment.
• Step away from the needles: Berger also recommends that time away from the process can be helpful. Beyond that, a weekend away in another city, in a yoga retreat, or a couple of good day hikes can give you the time you need to reconnect with your body and your partner.

Ask for help

It can be hard to make time and room in your budget for one more weekly appointment, but finding a therapist who specializes in infertility and pregnancy loss can be extremely beneficial. You can't have too many people in your corner. It can make all the difference between feeling isolated and feeling that you have people to turn to when you need them.  

Above all, be kind to yourself. "These are probably not going to be your best moments," advises Liben. "The goal is just to get through and just preserve your relationship and the things that are important to you, while also tolerating this acutely stressful time."

You can search Psychology Today's database and narrow your selections to therapists with infertility and pregnancy loss specialties. Take the time to carefully interview each therapist to make sure they have worked with several clients with similar struggles, and also feel free to ask if they've experienced their own personal losses or fertility challenges.

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.

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.