IVF

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.

For those who are deep into the nuances of their own fertility, the idea of needing donor eggs is something that may not come easily at first. This may have been something that you vaguely considered as an option. Now that it appears this will be your best route to parenthood, all kinds of emotions can surface.

But don’t let that deter you from moving forward with a fertility plan that may offer you a chance to build the family you’ve hoped for. Building your family via an egg donor can be an option that brings you greater chances of success in building the family of your dreams. Still, it doesn’t come without concerns, all of which are incredibly normal.

If you’ve been working to build your family through your own IVF cycles, you may have already faced grief and loss. For some people, the idea of increasing chances of success with donor eggs is a relief. But for others, it may take some getting used to.

Common concerns

All kinds of fears may be percolating. You might have questions like:

• What if I can’t bond with the baby?
• What if my child doesn’t look like me?
• What if the child is mad when they find out?
• What if my family rejects the donor-conceived child?
• What if I just can’t forget that we aren’t genetically related?

Believe it or not, many successful parents of a donor-conceived child had to move through these same fears to get to a place where they felt comfortable claiming this route for themselves. So, while these fears may feel overwhelming and feel like you can’t possibly overcome them, nothing could be more untrue.

Strategies for gaining confidence

Begin by giving yourself credit for the journey you’ve already been on to put yourself in a position to have this child. Be proud of yourself for all the early mornings in traffic shots given, time in waiting rooms for bloodwork and ultrasounds, and, yes, for handling the expense of it all.

Think about it, many times children are conceived with virtually no thought. But you can one day tell your child about all the steps you took to get them to be a part of the family. How wanted and loved they were. I think of this as a story of loving a child so much that you would have done anything to bring them into the world.

If you’re worried about your child perhaps one day looking at you differently, the answer is to be transparent and open from the beginning (research shows normalizing the truth early on leads to better outcomes). If you speak to your child from the start about how they came from an egg given by a very generous woman and you and your partner weave it into your family narrative of how much you wanted this egg and how lucky you were to get it, this can help decrease any shame or stigma attached to it. Your child will always know where they came from and how wanted they were, and will look at you with that in mind.

Handling fears

But what about not being able to forget that this child doesn’t share your DNA? In my opinion, fears like this are not something to move past, they’re something to move through. It’s about living with this in whatever shape it takes. It's about coming to realize that love is boundless, as is the definition of family.

I have met with many families who have been built via egg donation. And all of them say the same thing. After the child is born and they begin their new life, they rarely think about it. All the worry melts away. The child is yours and you know that this exact family is the way things were meant to be.

Throughout your fertility journey, you’ve already had to continue to adjust your expectations about how this was going to go and how your family was going to look. This has not been easy and likely has taken a toll. This can be very draining. You need to be gentle with yourself and your partner. Show yourself some compassion and grace as you hold these feelings and process them. The idea is to get inside the feeling and move through it.

If a negative feeling comes up, allow yourself to have it. Give yourself permission to experience these feelings. Then, make space to safely indulge yourself in whatever way helps you to cope.

This may mean designing a ceremony such as lighting a candle or planting a garden to deal with your grief. You might think about writing a letter to the child you were unable to conceive and how hard you tried. The fact is, not being able to use your DNA can still feel like a loss. Some find this kind of approach very meaningful, however, it is not for everyone. If it feels somewhat forced to you, try something else.

Some look to the donors themselves for connection. They may point out how they also played the violin in middle school, or ran track, or even how they also had dark curly hair or were the same height.

Airing your worries

Talking is also an effective way to allow yourself to process feelings. This may mean talking honestly with your partner if you have one, a close friend, or a therapist. It’s all about having a safe space to discuss your feelings. .

For those who do choose to speak to a therapist, I would recommend trying to find somebody who specializes in the fertility or third party-reproduction space. There are many great general therapists who can help you with a wide variety of issues. But working with a specialist means you don’t have to spend time helping your therapist understand what you’re going through.

It can also be extremely helpful to talk with others who have either already been through the donor egg process or who are considering this like you. With having what may be conflicting emotions, being able to share your concerns with others who can relate can be invaluable. Don’t forget to check out our Instagram community to find others who are building their families through donor eggs.

Throughout it all, be gentle with yourself. Pick and choose the strategies that feel right to you in building a family this way. You may imagine yourself in 15 or 20 years telling someone else how happy you were with the family you built and the strategies that worked for you.

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

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

Finding an egg donor

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

Donor egg banks

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

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

Donor egg agencies

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

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

Your own fertility clinic

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

What to expect from a fresh donor cycle

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

The medication involved

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

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

The fertilization process

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

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

What to expect when using frozen eggs

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

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

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

Summing it up

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

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

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

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

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

Getting started

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

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

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

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

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

Fertilizing and growing embryos

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

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

Preparing for embryo transfer

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

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

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

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

Embryo transfer

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

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

Pregnancy

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

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

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

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

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

Egg donor screening

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

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

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

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

The donor must:

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

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

Recipient assessment

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

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

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

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

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

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

Moving forward

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

The moment you make the decision that you’d like to use donor eggs to help grow your family, you’ve got a big question on your mind: How do I find an egg donor? Or really, how do I find the very BEST egg donor out there?

The best egg donor is pretty subjective, we know. Some intended parents may feel it’s important to find a family member who shares their DNA, asking them to donate their eggs. Others may want to find an egg donor who isn’t related, but is a kind, altruistic person who may or may not look like them. Some might decide the best egg donor for them is one whose eggs are already frozen or whose schedule aligns with theirs for a retrieval. So how do you choose? And how do you know who is the very best?

Finding an egg donor

First things first: There are three common paths for finding an egg donor that can help get you started on your journey to find the best egg donor for your family. It’s important to pick the right path because it can be the key to finding the best donor for you.

Options to consider are:

A matching platform

When you work with Family by Co, you’ll have access to view our donors for free. All women on our platform are incredibly impressive, if we do say so ourselves. 

With a matching platform like ours, you can evaluate various donor matches based on criteria you’ve set forth. Our goal is to be as human-centered, transparent, and ethical as possible — giving you a real glimpse into who all of our donors are as true humans, including their personalities, values, and backgrounds. Of course, this is in addition to their medical profile, genetic history, and more. 

When you select a match, the donor has the opportunity to learn more about you and accept the match, ensuring the matching is the right fit for all before moving forward. And we’ll walk with you every step of the way. You can read more about our matching platform here.

A donor egg bank

Donor egg banks help connect intended parents to donor eggs that have already been frozen. There are a few big differences between banks and agencies. In addition to compiling all the helpful and necessary information you’d want to know about your egg donor, donor egg banks screen for both health and genetic concerns ahead of time.  They also cover the process of egg retrieval and freezing the eggs. 

When you turn to a donor egg bank, you don’t need to plan how she’ll donate, because the eggs are already there.This process is usually the fastest path when using donor eggs, and you’ll know exactly how many eggs you are getting.

An egg donor agency

Egg donor agencies can connect you to willing egg donors and share information about them — the same information that you’d get from an egg bank — like family medical history and education. The agency will work with you to figure out which donor is the best for your family. 

With an agency, any donor you choose would need to go through a medical screening and an egg retrieval cycle. If you find the right donor, you’ll move forward with her, paying the agency for making the connection. If she is an “anonymous” donor (keep in mind, “anonymous” doesn’t truly exist, read more about this here), the agency will continue to manage the process. In other cases, you and the donor will then hammer out your relationship directly and the donor will begin the medical processes required for egg retrieval and donation.

Ask a friend or family member

This is known as a “directed donation” — meaning the egg donor directly chooses who they want to receive their eggs. This can be a great option for intended parents who want to have a continued relationship with their donor or who want to use eggs that they themselves are tied to biologically.

But how do I find the best egg donor?

Okay, so there are different paths to finding an egg donor, but you want the best egg donor out there. After all, you’re talking about making a baby, one of the most important decisions of your life.

The best egg donor is going to be different for every single family, and you’re probably going to find your best donor isn’t the same as the donor your best friend might choose! Maybe you want a donor who is super creative, just like you. Or a donor who is outgoing. Or a donor who is really tall!

In short, things can get pretty personal when it comes to finding an egg donor.

Here are some of the things every intended parent should consider when making this important choice:

• Will your fertility clinic work with the egg donation partner? It may sound obvious, but not all clinics work with all egg donation partners. A simple check can save you a lot of headaches down the line. 

• What is your donor’s genetic background? Some intended parents opt to use an egg donor due to genetic concerns, and knowing your donor’s genetic background can be vital to ensure they’re not carrying the very gene you’re trying to avoid. If you use a donor egg bank, that sort of testing will likely already be done for you.
• How does your donor feel about a relationship with you or the child? This is as much about your feelings on the subject as it is the donor’s — do you want them to be involved? You’ll want to make sure you and the donor are on the same page. Read more about the spectrum of donor relationship options here.

To find the best donor for your family, we highly recommend doing some soul searching with your partner. What attributes are most important to your family? How important is it that the child looks like you? Think about the donor-conceived person you hope to bring into this world. This is a huge decision, and it’s better to get on the same page before you begin the search.

Bottom line

There is a LOT to consider when you’re looking for an egg donor, so we’ve got your back. 

One of the things that those considering using donor eggs may wonder about is whether any child born from those eggs will have their DNA. Every embryo will contain DNA from both the egg and the sperm in equal amounts, so any embryo made from the donor egg will contain the egg donor’s DNA. If this embryo was made from sperm from you or your partner, it will also contain that DNA.

Some of what is being asked here is, of course, what may it mean if your DNA is not part of the embryo (and your child’s) makeup? This is something that many may wrestle with as they navigate this journey. And understandably so — it’s complicated!

Concerns about connection

It can be natural to worry about raising a child that does not necessarily share your DNA. For years you may have dreamed about having “mini-me,” who everybody would know immediately was yours. And you’re not sure you can think of them as yours without this connection. This is a very valid concern, and one that so many intended parents face.

It may take a little time, but it is possible to overcome concerns about lacking a genetic connection. A 2014 Reproductive BioMedicine Online study shows that once the child is born, for many parents, concerns about genetics fade away. On the other hand, belief in the importance of parenting increases. This is what you hear of as “nurture” vs “nature.”

The idea of conceiving via donor egg may take some getting used to. But, it doesn’t necessarily impact how you and your child will interact. A 2007 Journal of Psychosomatic Obstetrics & Gynecology survey of women pregnant with donor conceived babies showed that 80% of mothers had some concerns about not being genetically related to the child during pregnancy; however, that feeling dissipated after giving birth. For most mothers, having a donor conceived child did not ultimately influence the relationship they had with their child. The concerns are real and very common. But take heart in the fact that others who were in your shoes are happily parenting children who got their start from donor eggs.

Strategies for embracing donor eggs

While conceiving via donor egg may initially be daunting, it is very possible to successfully navigate this. As the American Journal of Psychology discusses, there are some strategies that have helped other donor recipient parents successfully embrace their roles as parents:

Understanding the role that epigenetics plays in development

While the egg donor contributes 50% of the DNA to the genetic makeup of the child, research discussed in a 2014 Frontiers in Cell and Developmental Biology article shows that it is actually the birth mother or surrogate who determines which of these genes get turned on or off. Things like maternal diet, stress during pregnancy and smoking can all make a difference in what genes get expressed.

Leaning into the decision-making process about the type of egg donor to use

Focus on where you have control of the situation. Think about the criteria for the type of egg donor that would be a fit. What’s most important to you and your family?

Emphasizing the importance of having carried the child during pregnancy

With this approach, you can focus on the fact that it was your body that supported your baby through the developmental process. Your body made it possible for your child to be born.

Thinking about the fact that there are all kinds of families

In a blended family, someone may feel closer to a step-sibling who’s nearer in age or more similar in personality than to a genetic one. Think about friends, in-laws, or step family in your life who you have strong ties to. As you know, biology is only one part of what makes a family.

Connecting with the baby

For most intended parents who use a donor egg, a strong bond with their baby begins in the womb or at birth, and helps them to feel a closeness, even without a genetic tie.

Embracing how wanted the child is

Focus on how much you have been through, how hard you worked to have this child and how irreplaceable this baby is. You may view this as meant to be, looking at all the steps that had to align for this specific child to be yours.

Emphasizing the importance of nurture

Think about how your parenting will influence your child. Knowing how important “nurture” is in the development of children, you can focus on how your parenting will shape who your child becomes. Perhaps, they will have certain mannerisms they have picked up from you or personality qualities that your parenting style may have influenced.

Thinking of egg donation akin to other types of donated tissue

This strategy looks at this as part of a medical procedure like an organ donation. With this approach, you may also consider the fact that the egg donor is just offering a very small amount of tissue as part of the process.

Also, the donor egg selection process itself can make a difference here. The more you know about the donor, the better you can feel about her being the right choice for your family. That’s why our egg donor matching platform is so incredible — you can truly get to know your egg donor on a human level. 

Hopefully, all of these strategies can help you feel comfortable with using a donor egg if that’s the path you choose. Not having DNA in common by no means lessens the parent-child relationship that you will develop and you will still be an amazing parent. 

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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.

If you’re considering using an egg donor, you might be wondering, “just how exactly can I find one?” There are so many different things to think about, like what qualities or attributes you care most about. With all of these new thoughts swirling around your head, you might be wondering where to even begin. Fortunately, we’ve got you covered. Read on to find out what you need to do to begin your hunt for an egg donor.

Here’s how you find an egg donor

Sometimes, the fertility clinic that’s helping you through your in vitro fertilization (IVF) will have a selection of approved and vetted donors for you to choose from. Other times, you may opt to contract with an outside agency or donor egg bank, or a matching platform like ours, to find your perfect match.

You may even already have a donor in mind, especially if you have a close friend, sister, or cousin who has already volunteered for the position.

1. Working with Family by Co

Finding your egg donor match on the Family by Co platform has its advantages. Not only will you know that all women on our platform aren’t doing it for cash (rather, to help another family while freezing their own eggs for free), you can also rest assured that all donors on our platform have undergone a rigorous screening process and are all-around incredible. We’d love to help build your family.

2. Using your clinic

If you’re using your fertility clinic, you may need to go through their pre-approved registry to find a donor. This might mean going on a waiting list, since your clinic is likely to have other hopeful parents interested in donor eggs. 

3. Using an outside agency

For those who are able to pick a donor outside of their clinic’s network, there are egg donor agencies that help to match potential donors with hopeful parents. While they may have a larger pool to choose from than your clinic, you may also find yourself vying for the same donor eggs as several other families. Additionally, there may be additional fees involved in going through an agency.

4. Using a frozen donor egg bank

There are also frozen donor egg banks available for hopeful parents looking to secure eggs from a larger pool of donors. 

If you’re considering a donor egg bank, you’ll just want to confirm that your clinic will allow you to make the transfer from an outside source.

5. Sourcing your own donor

There are two very different scenarios when it comes to finding your own egg donor:

• Using the eggs of someone you know: When you do this, it’s very important that you are both on the same page about what will take place and how you’ll handle everything, from medical payments to potential emotional conflicts down the road. You’ll also need a clear and concise legal contract drawn up by a lawyer spelling out the terms of your arrangement. Some clinics will even require both parties to undergo a psychological evaluation.
• Asking around: Intended parents might post on social media about what they’re looking for, or take out an ad in the paper.

There’s really no wrong way to find an egg donor, but some ways are certainly more complicated than others. For instance, when you’re sourcing your own donor you’ll likely need to take care of all of the legal, psychological, and medical screenings yourself. Additionally, you’ll need to help coordinate pieces of the retrieval process.

Considerations when trying to find an egg donor

It can be overwhelming when you sit down and start reviewing possible egg donor candidates, but some things should definitely be top priorities when it comes to selecting the best potential donor.

Donor health

If you’re hoping to find an egg donor, first and foremost, you’ll want to make sure any candidates you look at are healthy and have no major medical problems. Our matching platform adheres to all industry guidelines when it comes to donor screening. And, for the most part, most donor matching services or fertility clinics will have screened donors in advance. However, you should still give any health records you receive a thorough review. 

You’ll want to not only check for any obvious issues, but also be mindful of how your genetic makeup or that of the person whose sperm you’ll be using, could potentially cause problems. For example, make sure your egg donor does not carry the same recessive genetic disease as the fertilizing male partner.

You will also want to see if they have any family history of any major medical issues that might be genetic. If you have any questions, talk to your doctor about specific concerns. 

Donor appearance

While this can seem superficial, appearance can be important, especially if you’re hoping to use donor eggs from someone that is a close match to your own personal appearance. For example, if you’re petite, you may prefer to use eggs from a petite donor as well. Our platform provides photos of the donor, both as a child and also as an adult as well. This can give you an idea of the donor’s physical traits. 

Donor values, personality, and education

Similarly, if you enjoyed your time at college so much you went back for your Masters degree, you may want to find a donor that shares your passion for learning. It’s okay to want to have certain things in common with your donor — and sharing values is important! When you find your donor match with Family by Co, we’ll conduct a background check to verify education and employment. 

Good luck!

Beginning your quest for the perfect egg donor can feel overwhelming, but it’s also the beginning of an exciting and hopeful time. Choosing a donor can be a special time in your life because it’s the beginning of a new part of your journey. One that we hope will end with you holding a beautiful baby. We’re here to help make that happen.  

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If you’re an intended parent who is planning to use an egg donor to help build your family, you’re probably wondering how much that egg donor is going to cost.

You’re certainly not alone on this journey — there were 24,042 donor egg cycles in the US in 2019, the most recent year for which data was available from the CDC. That’s up nearly 6,000 from data collected just nine years prior.

But knowing you’re far from alone doesn’t answer a question that’s been weighing heavily on your mind: How much does using an egg donor really cost? Is any of this covered by insurance?

How much does it cost to use an egg donor?

There’s no way around it — there are costs involved in getting pregnant with donor eggs. After all, there’s a lot that goes into retrieving eggs from an egg donor, fertilizing them and growing embryos in the lab, and then transferring an embryo into the uterus.

Typical egg donor costs can range anywhere from $5,000 – $30,000, but fees can go much higher. So what goes into that big range? Let’s take a look at some of the biggest cost factors, so you know what to expect along the way.

Costs of using a fresh egg donor through an agency

One option is to work with a donor egg agency to find a donor that will go through a fresh IVF cycle.

Egg donor agency fees

The Cost: $5,000 to $9,000

An egg donor agency will identify women interested in donating their eggs, and likely perform some initial health screenings on prospective donors to ensure they’re qualified to donate. In return, you’ll pay the agency a fee for helping you find your perfect match.

Donor compensation

The Cost: $5,000 to $60,000

Wait, can the range really be that wide? Well, yes.

There are no federal laws that regulate how much an egg donor can — or even should — be compensated. Some states, like New York, forbid donors from being paid for their eggs themselves, but allow for donors to be compensated for things like medical risks, physical discomfort, and inconvenience. Others, like Maine, have no regulations on the process.

That means donor fees can range wildly, and some donors are compensated five digit fees as high as $60,000 — particularly donors who attend Ivy League schools. Typically, however, the range for a donor fee is closer to $5,000 to $10,000 for a single egg donation cycle, says Janene Olega, a reproduction lawyer from Maine. That compensation may increase if a donor agrees to additional cycles, she adds.

Legal fees

The Cost: $1,500 to $2,250

You need to set aside money for legal fees which will be used to put together a contract to protect both the rights of the donor and your rights as the intended parents. You will also be required to pay the legal fees for the donor who will need her own lawyer to review the contract.

If you need to go to court to establish your parental rights, you may also need to hire a lawyer. Unfortunately, parentage intent laid out in egg donor contracts is not necessarily enforceable in all states without a court order to enforce it, Hasenbush explains. Because donor eggs are not biologically related to the child’s mother, that can sometimes present a problem without proper legal steps.

The good news: If a judge declares a single parent or a couple parents of a child, that judgment is required by the US Constitution to stand in every state in the union!

Egg retrieval and fertility medicine

The Cost: $9,500 to $25,000

Medical fees for a fresh egg donation cycle will include the cost of screening the egg donor, the stimulation cycle and the egg retrieval.

First things first: In order to donate, all egg donors go through a number of health screenings, including infectious disease testing, genetic carrier screening and a physical exam. After these screenings, your doctor will either approve or decline an egg donor.

Your agency may have already done certain screenings as part of their fee, but depending on your situation, you may end up wanting additional testing — for example, if you or your partner are carriers of a genetic condition and you want to ensure your donor isn’t. Be sure to ask your agency upfront about what screening is included in their fee.

Egg donors then use injectable medications to help their ovaries produce mature eggs. The cost of injectable medications will depend on the dose of medication needed, but generally these medications cost at least $2,000.

Throughout the stimulation cycle, the egg donor will be seen for regular monitoring visits including ultrasounds and labs. The cost of the monitoring will depend on how many visits the donor needs throughout her cycle. Most stimulation cycles involve between 5-8 visits to the clinic for monitoring. Some clinics will charge a flat fee for the cycle and others will charge per monitoring visit.

When ready, an egg donor undergoes a medical procedure called an egg retrieval. During the egg retrieval, egg donors go under anesthesia (costing about $700) and a fertility physician removes eggs from her ovaries. The egg retrieval procedure can cost as much as $7,800, but costs will vary depending on your specific clinic.

Laboratory fees and embryo transfer

The Cost: $3,500 to $10,000

Yes, this is another large range. However, there are a few variables to consider.

For everyone using an egg donor to create embryos, after the egg retrieval, the eggs will be fertilized with sperm and grown into embryos in the laboratory. An embryo will then be transferred into the uterus of an intended parent and any extra embryos can be frozen for future use.

Post-retrieval, intended parents may spend about $3,500 to $5,000 for the laboratory fees associated with fertilization and culture of embryos. Some intended parents may choose to do genetic testing on embryos (PGT-A). Genetic testing may cost approximately $3,000 in addition, but that cost might depend on the number of embryos tested.

Finally, the mother-to-be will need to prepare her uterus for an embryo transfer. The cost of an embryo transfer, including medications, monitoring visits and the embryo transfer procedure may be around $5,000, depending on your specific clinic and the medications used.

You may also need to consider the costs of freezing extra embryos that aren’t used right away. The freezing fee may be approximately $2,000 with a storage cost of around $300-600 per year. You may not have extra embryos to freeze — but it’s good to keep the costs in mind ahead of time.

The cost of donor eggs through an egg donor bank

Some intended parents use a donor egg bank to find already frozen eggs. In that case, the donor egg bank will already have frozen eggs available. This means the donors have already gone through the medical screening process, stimulation cycle, retrieval and legal consultation.

The costs of using a donor egg bank are somewhat similar to using an agency. The egg bank covers the donor costs, then charges the potential parent or parents a fee.

Going this route is also a lot faster — after all, eggs are already frozen. But there are still fees to contend with.

Egg donor bank fee

The Cost: $2,400 to $6,000 (per egg)

If you’re going the route of using frozen donor eggs from an egg bank, the costs are a bit more straightforward.

An egg donor bank takes care of much of the work of screening donors, helping them through the process of taking medicines, egg retrieval, and even takes care of legal fees, and getting legal permission from the donor for the use of their eggs.

As an intended parent, you then pay the egg donor bank a fee, either per egg or batch of eggs, depending on the donor egg bank. This is different from going the agency route, where you pay for the donor’s individual cycle.

Are there any other fees?

Laboratory fees and embryo transfer

The Cost: $3,000 to $5,000

Similar to going with an agency, the donor’s medical fees aren’t the only ones to think about here!

Whether you opt to use an egg donor agency or an egg donor bank, you will also have to pay medical fees for the in vitro fertilization process, including medications that an intended parent will have to take, and the transfer process.

Will insurance cover egg donation?

The answer to this question is a tough one: while there are some insurers that cover fertility treatments for the intended parent, they may not cover egg donor cycles.

Right now just 19 states require insurers to cover fertility treatments in some capacity. Even in those states, the amount of coverage varies. In California, New York, and Louisiana, for example, insurers are not allowed to cover IVF, a procedure that is necessary for intended parents who have turned to egg donation.

You may want to start by calling your insurance company directly. If your employer supplies your health insurance, their human resources department may also be helpful in pointing you to parts of your policy that can help cover the costs of your fertility journey. If they don’t already cover it, consider pushing them for this benefit — you’d be surprised what a difference some persistence can make.

How can I get financial help for egg donation?

Even if health insurance doesn’t cover your fertility treatments or only covers a small portion of the costs, there are other options:

• Tax deductions — If your insurer hasn’t covered the costs of your fertility expenses, talk to your accountant. Some medical expenses for egg donation may be used as tax-write-offs, although there are limitations. For example, write-offs do not apply if the intended parents have used a gestational carrier to conceive.
• Grants and discounts — Yup, there is money out there to help intended parents achieve their dreams! There are grants available to folks who have served in the armed forces, money for those who live in specific states, and more.

Bottom Line: While there are costs involved in using an egg donor, the growing number of intended parents opting for this route means there are more and more options out there for you.

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

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

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

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

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

The nitty gritty on taking progesterone for IVF

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

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

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

Side effects of progesterone during IVF

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

For the shots

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

For the vaginal suppositories

• Vaginal itching or burning
• Yeast infection

For either

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

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

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

Pro tips

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

If you're doing shots

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

If you're doing vaginal suppositories

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

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

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

FAQs about progesterone for IVF

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

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

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

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

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

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

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

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

Five A+ foods for fertility

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

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

Fertility-friendly nutrients FTW

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

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

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

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

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

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

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

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

Men can use a boost, too

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

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

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

Every time is snack time 

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

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

The bottom line on fertility foods

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

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

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

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

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

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

Why IVF costs vary so widely

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

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

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

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

So, what's included in IVF costs?

Here's how IVF costs typically break down:

Monitoring

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

Retrieval and labs

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

Embryo transfer

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

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

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

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

You can totally reduce IVF costs

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

Research health insurance options as early as possible

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

Compare costs (and success rates) at different clinics

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

Look into medication discount programs

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

Weigh your payment options

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

Apply for grants

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

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

Crowdfund

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

Work closely with a finance coordinator

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

Summing it up

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

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!

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

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

What is a mosaic embryo?

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

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

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

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

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

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

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

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

Only aneuploid cells

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

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

Only euploid cells

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

A mix of aneuploid cells and euploid cells

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

Should I transfer a mosaic embryo?

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

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

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

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

Should I hold out for a "normal" embryo?

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

Can the embryo "self correct"?

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

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

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

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

Putting it all together

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