fertility Blog

Embryologists and fertility doctors need an objective assessment guide to help them decide on the best embryos, the ones most likely to result in a pregnancy and a healthy baby, to transfer during the process of in vitro fertilization (IVF).

The number and quality of embryos a fertility doctor transfers influence the procedure's success rate. Transferring low-quality embryos may cause uterine implantation failure and ultimately hinder pregnancy.

This article discusses embryo grading, its criteria, the various grading systems available, and the role of embryo grading in IVF success rates.

What is Embryo Grading?

Embryo grading is a scoring system used by embryologists or fertility doctors to determine the quality of embryos before their use in treatment. Embryo grading provides the clinic with a priority guide as to which embryos to transfer.

During IVF, eggs are artificially inseminated inside the laboratory. After successful fertilization, the fertilized egg divides and grows to become an embryo. Before the embryos are utilized, the embryologist conducts a quality assessment using an embryo grading system. This grading system allows the embryologist to determine which embryos should be used for treatment and which should not be.

Is Embryo Grading Beneficial?

A study published in the US National Library of Medicine revealed that embryos with a higher grade had better clinical pregnancy and live birth rates compared to those with a poor grade.

Apart from an embryo grade, factors such as the genetic makeup of the embryo, laboratory conditions, experience, and skill of the fertility expert can influence the overall success of an IVF treatment. Genetics is the gold standard for embryo choice and truly drives success.

Notwithstanding, embryo grading still plays a role. Selecting only good-quality embryos provides the best opportunity that an embryo will be able to endure various types of possible treatments (e.g., PGT biopsy, cryopreservation, and thawing).

"Preimplantation genetic testing (PGT) is a more objective test while embryo grading comes from an embryologist’s subjective opinion," according to an Advanced Fertility Care embryologist. In recent times, PGT has taken over because we know that it is far more important than my subjective opinion," the embryologist further explained.

Criteria for Embryo Grading

A few hours after fertilization, the fertilized egg or zygote starts dividing to form a mass of cells that develops gradually into an embryo. The embryo cell number progressively increases within the first few days. 

The embryo cell number should be 2-4 cells after 48 hours and up to 7-10 cells by 72 hours.  Embryos are most commonly cultured to the blastocyst stage, which occurs between the 5th and 7th day of culture.

Grading Systems

There are different embryo grading systems, each focusing on specific characteristics of the dividing cells or blastocysts.

The IVF embryo grading system focuses on the following features:

• degree of fragmentation and symmetry
• the expansion rate and hatching of the blastocysts
• inner cell mass
• trophectoderm (a group of specialized tissues that differentiate and form the outer cell layer of a developing embryo.)

Generally, embryologists use the grading system based on the blastocyst expansion, inner cell mass, and trophectoderm for day five embryo grading. While day three embryo grading is typically based on the degree of fragmentation and symmetry.

Here are the common embryo grading systems most fertility clinics use to assess embryo quality before its transfer into the uterus for implantation.

Embryo Grading Based on Blastocyst Expansion and Hatching

Fertility specialists use the expansion rate of the dividing cells to score the embryo. It is also a numeric scoring system, and each embryo receives a score from 1-6.

The following is the numeric scoring system and its description using the blastocyst expansion and hatching feature:

• 1: Blastocyst development and stage status
• 2: Blastocoel cavity occupying more than half the volume of the embryo
• 3: Full blastocyst with cavity completely filling the embryo
• 4: Expanded blastocyst with cavity larger than the embryo and thinning of the zona pellucida
• 5: Hatching out of the zona pellucida
• 6: Hatched out of the zona pellucida

Embryo Grading Based on Inner Cell Mass

The inner cell mass is the group of cells in the developing embryo that transforms to produce the cellular structures that form a fetus.

Embryo grading using the inner cell mass is an alphabetical scoring system and includes the following:

• A: Many cells, tightly packed
• B: Several cells, loosely grouped
• C: Very few cells

In this system, the quality of the inner cell mass reflects the quality of the embryo.

Embryo Grading Based on the Trophectoderm

A trophectoderm is a group of cells that are the first to differentiate and form the outer cell layer of a developing embryo.

Embryo grading using the trophectoderm entails:

• A: Many cells forming a cohesive layer
• B: Few cells forming a loose epithelium
• C: Very few large cells

In this system, the embryologist uses the quality of the trophectoderm to assess the quality of the embryo.

Significance of Grades in Predicting IVF Success

Our embryologist also noted that: "just because an embryo looks good doesn't mean it's genetically normal, and just because it is a grade B doesn't mean it isn't normal. Today we use embryo grades as a way to demonstrate why an embryo was chosen to biopsy and/or freeze. The reason we do this is that poor quality embryos can't survive a biopsy and they also cannot survive the freeze and thaw process either."

Embryos with good grades have the potential to increase the chances of achieving pregnancy during an IVF treatment. In contrast, poor-quality embryos may fail to implant into the uterus, inevitably limiting IVF success.

Therefore, embryo grading provides fertility experts with the tool to make objective clinical decisions on the embryos to transfer.

Understanding Your Embryo Grade Results

Embryo grading will begin on day five. The embryos will be graded each day between day 5 and day 7. Any embryos deemed to be good quality will be utilized in treatment that day.  

Any embryos that are not chosen are allowed to continue to develop until day 7. The IVF lab routinely expects that approximately 50% of the embryos in culture will make good-quality embryos for use.

Interpreting Your Embryo Grading Report

Embryologists typically assign alphanumeric scores, such as 1AA, 2BA,3BC, etc., to embryos to indicate the quality level.

The following are possible embryo grade scores according to their exhibited degree of blastocyst expansion, inner cell mass, and trophectoderm grades:

• High-quality embryos: ≥3AA
• Poor quality embryos : 1–6BC, 1–6CB, 1–6CC

Of note, these embryo grades alone do not indicate failed IVF treatment. Other factors, such as an embryo's genetic makeup, medical history, or age, among other things, also affect your chances of achieving IVF success and pregnancy.

Do You Need Help with IVF Treatment?

Embryo grading is one of many tools that provides crucial information to fertility doctors to enable them to select suitable embryos for transfer. Transferring poor-quality embryos can reduce the success rate of IVF treatment.

If you intend to go for IVF treatment, consult an experienced fertility doctor and learn more about their embryo grading process.

Our team at Advanced Fertility Care has proven experience with IVF, and we use standardized embryo grading methods to assess quality before embryo transfer.

If you want to learn more about our process and IVF treatment, contact us or schedule an appointment with our team today. We look forward to supporting you in starting or building your family using IVF.

All genders can contribute to infertility. Early evaluation of the male partner is a common starting point when investigating fertility struggles.

Why is Early Male Evaluation Important?

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Male fertility evaluations are important for identifying potential fertility issues, ruling out medical conditions, planning appropriate treatment, and providing emotional support for couples struggling with infertility.

Early evaluation answers some crucial questions:

• Is the male a factor in the couple's infertility?
• Can the male benefit from treatment? (About 20% respond to treatment)  
• Are assisted reproductive technologies (ART) indicated?

Male Fertility Testing

Male fertility testing includes a thorough review of your history, a physical exam, and a semen analysis. The most important lab indicator is the semen analysis. Because up to 15% of infertile men may have chromosome abnormalities or other genetic defects that can be transmitted to their offspring, the analysis may include genetic screening.

Guide for Treatment

A male fertility evaluation can help to determine the appropriate treatment for infertility. Treatment options may include lifestyle changes, medication, surgery, or assisted reproductive technologies such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intractyoplasmic sperm injection (ICSI). Understanding the underlying cause will help determine the best path forward and will guide your individual treatment plan.

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‍Connect with our team today to start your journey to parenthood.

Many couples struggling with infertility are having a hard time getting pregnant because of an egg quality issue they can't seem to overcome. Egg donation is one way to help these couples fulfill their dream of having a baby of their own. Many egg donors consider the positive emotional impact of egg donation a valued addition to their compensation, citing the knowledge that they've helped someone have a family as highly rewarding.

For any couple or individual who cannot use their own eggs, an egg donor can help make the dream of a baby come true.

What is an Egg Donor?

An egg donor is a young person, usually between the ages of 19 and 30, who donates their healthy eggs to an individual or couple known as the intended parents for them to use in an in vitro fertilization (IVF) cycle in the hopes of having a baby. The intended parent will carry the pregnancy that results from the donor eggs or they will have a gestational carrier (surrogate) carry the pregnancy. Donors typically receive financial compensation for their egg donation, with the amounts varying by area, clinic, and individual legal agreements.

Egg Donation FAQ

If you're considering becoming an egg donor, you probably have multiple questions on how to donate eggs. Read on to learn about the process through these frequently asked questions (FAQ).

Question #1: How Do I Become an Egg Donor?

The requirements will vary depending on the clinic or agency you apply to. In general, to become an egg donor, you'll need first to complete a family medical history form. This will be a thorough questionnaire on your and your family's medical history. Most clinics or agencies will also want a recent photograph submitted. A reproductive specialist will review your information, and if approved, you'll be contacted to set up a consultation.

At Advanced Fertility Care (AFC), to qualify as an egg donor, we are looking for young women between the ages of 19 and 30 who reside within the Phoenix metropolitan region and have dependable transportation to our office. Additionally, candidates must be non-smokers, abstain from psychoactive or recreational drugs, have no past issues with substance abuse, and have not been diagnosed with Chlamydia or Gonorrhea in the past 12 months. Furthermore, responsibility, ability to follow instructions, and meeting height and weight requirements are also important factors considered during the screening process.

You'll receive in-depth explanations of the egg donation process, including required medications and lab testing. You may be required to meet with a psychologist to discuss the psychological aspects of being an egg donor. You'll receive instruction on properly administering the required medications, some of which may include self-injection.

Question #2: Is Egg Donation Safe?

There are risks associated with any medical procedure, but there are currently no documented long-term risks involved in egg donation. There is a potential for side effects from the medication used to stimulate egg production and from the retrieval process itself, but the risks associated are low. Before a person can begin the egg donation process, they receive consultations with qualified doctors who provide specific information on the possible risks.

Question #3: What is the Time Commitment for Donating Eggs?

After acceptance as an egg donor, the process doesn't usually begin until you're matched with a recipient. Once that happens, the time requirements will usually involve up to six or more clinic visits over a two-week period. This may vary between individual clinics. The fertility clinic you choose will cover the time commitment in your pre-donor consultation. You'll need to arrange time off from work or school on the day of the actual retrieval because you'll require sedation for the procedure.

Question #4: As an Egg Donor, Will My Identity Remain Anonymous?

Donors generally fall into two categories: known to the recipients or unknown (anonymous.) Whether your identity as an egg donor is revealed to the intended parent(s) will depend on the clinic's policy or the agency involved. With recent advances in genetic and DNA testing, and its widespread use, it is no longer possible to assure our egg donors that you will remain anonymous, even if you yourself don't do one of these DNA tests. The American Society for Reproductive Medicine recommends a discussion of the considerations for egg donation with a mental health professional before treatment begins.

Question #5: Can I Donate My Eggs More Than Once?

There are no strict rules governing how many times a person can donate eggs, but programs and state laws often limit the number of repeat donations. On average, this limit is a maximum of six times. The reason for this limit is to curtail the number of children possibly created from a single donor. Since these children will be genetic half-siblings, the limit on donations is to decrease the already small chance they could meet as adults and develop a relationship. This hypothetical situation would raise health concerns for their potential offspring.

Question #6: Will I Be Compensated for My Egg Donation?

Egg donors are typically compensated for their donation, and medical expenses are at no cost. The amount of compensation varies widely, depending on the clinic or agency used. Payment is usually not made until the completion of a donation cycle. You can request a copy of the results of pre-donation medical screening tests for your own records or give it to your primary care physician for his/her records.

At AFC, egg donors' compensation starts at $5,000. Donors who participate multiple times can earn up to $30,000 by donating eggs up to six times.

Question #7: What Are My Legal Responsibilities to Any Child Born?

When you sign the documents agreeing to donate your eggs, you give up all rights and responsibilities associated with or connected to the eggs retrieved from you. You have no legal responsibilities for or rights to any child born because of the use of your donated eggs.

Question #8: Does Egg Donation Cause Early Menopause?

No, there's no evidence that donating eggs or using the medications required for egg donation triggers premature menopause. Human ovaries contain a large number of eggs at the time of puberty — between 400,000 and 500,000. Only 400 to 500 of these actually develop to the point of ovulation. That leaves, at the least, over 399,000 "spare" eggs.

In a natural cycle, you only ovulate one egg but there are other eggs that could potentially have been ovulated that month if they had been given a chance. In any egg donation cycle, the eggs we obtain are eggs that would have "died" that month anyway, so we are not depleting your egg supply but rather rescuing eggs that would have been lost.

Question #9: Does Egg Donation Cause Infertility?

Egg donation has been possible for over 25 years. Studies over the years have shown no increase in infertility among those who donate eggs over those who don't. During a person's normal monthly cycle, only one egg is released during ovulation. The rest that matures during that cycle becomes non-viable and no longer available for fertilization. The egg retrieval process simply removes the eggs that would not be utilized during that month's cycle.

Ready to Be an Egg Donor?

If you're ready to give the gift of parenthood to someone else, apply to become an egg donor today.

Reach out to our team at Advanced Fertility Care if you have any questions about egg donation.

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What Is ICSI?

Intracytoplasmic sperm injection (ICSI) is a laboratory technique that offers a pathway to a successful pregnancy for couples with little hope of reproducing naturally or with IVF alone due to significant sperm issues. ICSI is the most used method that is a critical part of assisted reproductive technology. Its use accounts for 70% to 80% of the IVF procedures performed. 

For sperm to fertilize an egg, the sperm's head must attach to the outside of the egg. It then must break through to the inside, where fertilization takes place. If the egg's outer layer has become hardened or thickened, or if the sperm is abnormal and cannot swim effectively, it will be difficult for the sperm to penetrate it. 

Standard IVF vs. ICSI

In an IVF procedure, an egg is fertilized in a laboratory dish. Healthy sperm collected from the patient's partner or a selected donor is added to the dish to surround the egg. The sperm will naturally fertilize the egg by attaching itself to its outer membrane and breaking through into the egg. The fertilized egg (embryo) is transplanted into the uterus when it reaches a certain stage of development approximately five to six days after fertilization. If it implants into the lining of the uterus successfully, a pregnancy results. 

There are times, however, when surrounding the egg with sperm in the dish may not result in fertilization. Based on the circumstances or results of a prior semen analysis, doctors may opt for ICSI to help improve fertilization success. This procedure can frequently solve the issue of male factor infertility or poor fertilization in IVF cycles. ICSI is essentially an extension of IVF that works to control some of the variables that affect fertilization and increases the chances of an embryo resulting in pregnancy. 

How Is ICSI Performed?

ICSI is performed in conjunction with in vitro fertilization (IVF). Patients will undergo egg retrieval, and the egg will be injected with a single sperm in the lab through the process of ICSI with the hope of growing into a healthy embryo to be transferred to the carrying uterus.

Steps for Egg Retrieval

To prepare for egg retrieval, patients administer hormonal injections to stimulate the ovaries to produce multiple eggs for an average of 10 days, followed by an injection of human chorionic gonadotropin (hCG) or leuprolide acetate to assist in the eggs' final maturation.

When the eggs are ready for actual retrieval, a transvaginal ultrasound guides a thin needle through the vaginal wall into the ovary, then suction draws out and collects the eggs. This is performed under anesthesia and is a relatively short procedure lasting 10-20 minutes.

Unless frozen sperm is used, it is collected on the same day that egg retrieval occurs. The person supplying the sperm must collect ejaculate into a lab-provided container and deliver it to the lab within 30 minutes. The semen is analyzed for volume, mobility, and quality.

The ICSI Procedure

The ICSI procedure is performed with these steps:

1.    The embryologist holds the mature egg in a lab dish using a small glass tube equipped with a suction bulb.

2.    Using a thin needle, a single sperm is immobilized and picked up.

3.    The needle is inserted into the egg.

4.    The sperm is injected directly into the egg.

5.    The needle is withdrawn.

Now the waiting begins.

After the ICSI Procedure

Following the completion of the procedure, the embryology team monitors the embryos' progress to look for signs of successful fertilization. Cell division should begin within one day if the fertilized embryo is healthy. In many cases, the embryos are grown for five to six days, and at this point, if the patient elects to have preimplantation genetic testing performed (PGT) this is when the surviving embryos are biopsied (cells removed and sent for additional testing) and then frozen. 

If a fresh embryo transfer is performed, the developing embryo will need to grow appropriately for at least three to six days. When it is ready to transfer, a long, thin tube (catheter) is inserted through the vagina into the uterus under ultrasound guidance to inject the embryo into the uterus. The embryo must implant in the uterine lining for pregnancy to occur. If PGT testing is being performed, a frozen embryo transfer will be performed at a later date.

Who May Benefit from ICSI?

Male factor infertility is one of the causative factors in over one-third of male infertility cases. It usually results from complications in the sperm's production or delivery. In such a case, ICSI would be high on the list of options to overcome infertility. A man who has undergone a vasectomy reversal would also be a candidate for this procedure, even if the sperm is healthy otherwise. Other examples of infertility that may be helped through the ICSI procedure include:

•      Abnormal sperm motility. This references the sperm's ability to move effectively. 

•      Low sperm count. The male partner doesn't produce enough sperm for a successful attempt using artificial insemination or IVF.

•      Infertility that cannot be explained.

•      The semen lacks sperm because of a blockage in the reproductive tract of the male.

•      The sperm is unable to attach to an egg.

•      Traditional IVF has been unsuccessful, even with fit sperm.

•      The eggs used were matured in vitro.

•      The eggs were frozen before use.

Even when it isn't specifically indicated, some physicians may choose to use ICSI when appropriate. 

What Are the Risks of ICSI?

Compared to conventional IVF, some studies of the ICSI procedure suggest a possible connection between ICSI and an increased risk for intellectual delays, autism, chromosomal abnormalities, and birth defects such as Beckwith-Wiedemann syndrome, hypospadias, Angelman syndrome, and sex chromosome abnormalities. These are rare, occurring in less than 1% of babies conceived through ICSI with IVF. Other possible risks include:

•      Ovarian hyperstimulation syndrome in response to excessive fertility drugs 

•      Multiple births, either twins or triplets

•      Increased risk of premature labor and low birth weight

•      Slight increase in risk compared with IVF

•      The need for a cesarean section for delivery is slightly increased

ICSI Success 

On average, fertilization occurs through ICSI in 70% to 85% of cases. The rate of live births reflects the number of healthy children born following an IVF/ICSI cycle. These success rates are classified based on maternal age and will often vary due to additional factors affecting the eggs and sperm.

Take the First Step

If you'd like to learn more about IVF, ICSI, or other fertility treatments that may be a solution for you, contact the infertility specialists at Advanced Fertility Care to set up a consultation.

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Infertility is a disheartening experience for those who want to build a family. And since infertility is a common health issue affecting all genders, you likely know someone dealing with it. After all, as many as 15% of couples, and about one in five women between ages 15-49, cannot conceive after a year of trying. 

A variety of factors can cause infertility. But whatever its cause, infertility is a difficult journey. On top of that, no two fertility stories are alike. If someone you care about struggles with infertility, you may wonder how you can best support them. In this article, we'll look at ways to be there for a friend or family member struggling with infertility.

6 Ways to Support a Loved One Struggling with Infertility

Naturally, you want to be there for the people you love. Yet, infertility can be a sensitive topic, and you may be afraid to do or say the wrong things. 

Fortunately, there are some simple ways to be a safe space for your loved one as they cope with infertility.

1. Offer a Listening Ear

One of the best things you can do is just be there for your friend. Everyone needs to feel supported, heard, and validated, especially during a difficult time. 

Living with infertility can feel like a lonely path. Your friend may not know who they can talk to, even if they're in a relationship. This is because everyone experiences infertility differently; their partner is likely dealing with their own complex emotions. 

It helps to have an outside person to lean on. You can support your loved one just by letting them know you're always available if they need to talk. Some people may not want to discuss their infertility, while others do. Therefore, it's important not to pry or assume anything. Still, just knowing you're there for them can mean a lot to your friend.  

2. Don't Give Unsolicited Advice

It may be tempting to offer your own opinions and advice — but it's unhelpful in supporting your loved one. 

For example, your gut reaction might be to say things like, "you can try again next month," "maybe you should adopt," or "why don't you try IVF?" However, statements like these can feel like you're minimizing the situation or judging your friend's choices. 

Not only that, but not everyone wants to pursue fertility treatments or adoption. So instead of offering up advice, try saying things like, "I'm sorry you're going through this," "how can I help?" or "I wish I could fix it...I'm here if you need to talk." 

This way, you can provide a supportive, non-judgmental space for the person you care about. 

3. Be Mindful 

It's essential to lead with compassion and mindfulness when supporting a friend with infertility. Understand that it may be difficult for them to attend certain events, like baby showers, while they struggle to start a family themselves. Be mindful of this and let your loved one know it's okay if they don't want to attend such events. 

On the other hand, don't feel like you can't invite them to your baby shower or kid's birthday party. It may mean a lot just to be invited, even if they don't feel up to attending. Besides, your family is a huge part of your life — it would probably feel more uncomfortable if you refrain from talking about them in front of your friend. 

What matters the most is your consideration of your friend's feelings. For instance, if you're about to announce your pregnancy, you might tell your friend in private first. This way, they'll have time to quietly process any emotions. 

4. Educate Yourself on Infertility

Infertility looks different for everyone, and well-meaning friends and family often have many questions. It can be exhausting for your friend to answer these similar questions repeatedly when they're struggling with infertility. 

Educating yourself about infertility and fertility treatments is a great way to be supportive. Instead of asking for details from your friend, you can find tons of valuable information online. 

This way, you're prepared to have a meaningful heart-to-heart about any treatments your friend is undergoing. Then, they can talk freely with you on level ground rather than having to explain their medical choices. 

5. Don't Minimize What They're Going Through

Infertility can be profoundly heartbreaking on multiple levels. It's also a significant health issue, even if it's not life-threatening. Avoid comparing infertility to other medical conditions or minimizing your friend's experience. 

Statements like "at least you don't have cancer" or "at least you can sleep in" don't help your friend feel supported. Instead, let them know you understand how difficult it is to struggle with infertility.

6. Find Concrete Ways to Help Out

There are many ways to be supportive besides talking it out. For example, you could help your friend with things like watching their other children while they attend fertility appointments. Or help them find a support group in the area. 

Going through fertility treatments can be physically and emotionally draining. Offering to clean your friend's house after treatment could mean a lot to them! Sending cards, flowers, or home-cooked meals are all thoughtful ways to show your support. 

The bottom line is that there are many simple ways to show heartfelt care to a loved one struggling with infertility. Most importantly, you approach them from a place of love and understanding.

At Advanced Fertility Care, we strive to help couples and individuals achieve their family-building goals through cutting-edge technology and patient-centered care. We're always here to answer any questions about infertility or fertility treatments that you may have. Contact us today to learn more.

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There's no doubt that a healthy diet holds many benefits, from lowering heart disease risk to supporting mental health. Nutrition also plays a role in fertility and reproductive health. 

While you may not have control over some of the factors involved in fertility — like your age or a medical condition — several vitamins may help boost fertility when you're trying to conceive.

Six Vitamins and Nutrients to Help Boost Fertility

In recent years, much research has been done on the relationship between diet, nutrition, and fertility. Let's look at critical vitamins and nutrients that could benefit people who want to build a family.

Folate (Folic Acid)

Folic acid is commonly found in prenatal vitamins. Pregnant women should take folic acid supplements before and during pregnancy since adequate B vitamin levels can help prevent neural tube defects like spina bifida. 

Research suggests folic acid may also increase the likelihood of getting pregnant. Folic acid supplementation may help increase progesterone levels and support regular ovulation, which can bolster fertility. 

Folate, or vitamin B9, is the vitamin form that occurs naturally in food. When you take a folic acid supplement, your body converts it into folate so it can be used. 

Where to get it:

Folate is naturally present in dark leafy green vegetables, beans, sunflower seeds, fresh fruits, whole grains, and eggs. You'll want to take a folic acid supplement if you're pregnant or trying to conceive. Folic acid is found in most prenatal vitamins. 

Omega 3 Fatty Acids

Omega-3 fatty acids are essential fats the human body can't produce. This means we must get omega-3s from our diets. Omega-3 fatty acids have numerous benefits, such as reducing the risk of cardiovascular disease and supporting brain health. 

Although it's unclear what role omega-3 fatty acids play in natural fertility, some research suggests that omega-3 supplementation may increase an infertile woman's probability of pregnancy following in vitro fertilization (IVF).

Where to find them:

Salmon, tuna, mackerel, and several other fish are excellent sources of omega-3 fatty acids. Some plant foods also provide them, such as chia seeds, hemp seeds, flaxseed, and walnuts. There are many popular over-the-counter supplements available as well.

CoQ10

Sperm function and motility can play a role in infertility. According to an analysis of several studies, Coenzyme Q10 (CoQ10) significantly increases sperm concentration and motility.

Studies suggest that CoQ10 may also benefit women trying to get pregnant through IVF.  Women who took CoQ10 for two months before undergoing IVF had higher egg quantity, improved ovarian response, and more high-quality embryos. However, it's unclear if CoQ10 is helpful for women who are trying to conceive naturally.

Where to find it: 

CoQ10 can be taken as a dietary supplement or obtained from foods like salmon, tuna, organ meats, and whole grains.

Selenium

Selenium is another nutrient that's excellent for male infertility. One study determined that supplementation with this important trace element improves sperm count, sperm motility, and sperm quality in men. 

It's unclear whether selenium benefits fertility in women. However, another study suggested that selenium deficiency could increase a woman's risk of luteal phase deficiency. This can affect the ovulation cycle and uterine lining, putting her at risk of infertility. So it could be worth supplementing.

Where to find it: 

Besides over-the-counter supplements, selenium is present in foods like brazil nuts and seafood.

Vitamin D

This vitamin is important for healthy bones and helps the body retain calcium and phosphorous. Some research suggests vitamin D may play a role in reproductive health. For example, vitamin D may impact hormone levels in men and women and affect semen quality. 

Polycystic ovarian syndrome (PCOS) is a chronic health condition that can cause infertility. Vitamin D supplements may help with menstrual frequency and metabolic issues in women with PCOS who are vitamin D deficient, potentially boosting fertility. However, it's unclear if vitamin D improves fertility generally, especially if a person is not deficient. Still, it doesn't hurt to up your vitamin D intake, especially if you live with PCOS.

Where to find it: 

Your body makes vitamin D with sun exposure, but it may be hard to get enough sun, especially during winter in colder climates. There aren't many foods with vitamin D, so it's a good idea to supplement or eat foods fortified with vitamin D. 

Zinc

Zinc is a mineral that helps with cell function, immunity, healing, and metabolism. According to some research, zinc may also play a part in egg quality, and zinc deficiency could contribute to male infertility. 

Where to find it: 

Zinc is found in dietary supplements, as well as chicken and red meat. 

Things to Avoid When You're Trying to Conceive

Ultimately, there isn't one single vitamin or supplement that will guarantee fertility. 

But some other dietary factors could affect your chances of getting pregnant. For example, one study found that women who ate more fast food and less fresh fruit took longer to get pregnant. Interestingly, another study found that replacing animal protein sources with plant protein may lower the risk of ovulation-related infertility. 

The bottom line is that a healthy, balanced diet rich in fruits and vegetables promotes overall health and well-being. Regarding fertility and reproductive health, a wholesome diet is essential for people of all genders. It can also help maintain a healthy weight, exercise regularly, and reduce stress if you're trying to conceive. 

Support Your Fertility and Grow Your Family

Of course, infertility happens for many reasons, and your diet and nutrient intake may or may not be a factor. If you've been trying to conceive for more than a year or experiencing infertility due to a medical condition, speak to a fertility specialist.

At Advanced Fertility Care, our dedicated and experienced team will answer any fertility questions and support you on your journey to becoming a parent. Contact us today to schedule a consultation.

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Deciding to start a family is an exciting yet highly personal decision. Many people delay trying to get pregnant until later in life. You may have decided to wait because of your career, life goals, relationship status, or simply because you weren't ready. 

If you're over age 40 and want to get pregnant, you likely have questions about your chances of pregnancy. Fertility treatments, like in vitro fertilization (IVF), can help couples and individuals finally become parents. However, how do you know if you should use your own eggs or when to consider donor eggs?  

In this article, we'll look at some challenges of getting pregnant after 40 and when to consider an egg donor. 

The Challenges of Getting Pregnant After 40

Being over 40 doesn't mean you can't build the family you desire. However, fertility does decline with age. So, if you're struggling with infertility, you're not alone. 

Statistics show that the odds of getting pregnant decrease significantly as time goes on. The chances of getting pregnant naturally each month for women over 40 are only about 5%. About 22% of all women struggle with infertility after age 35, and up to 29% by 40. Over 40, the likelihood of a successful pregnancy decreases every year, so it would make sense not to delay any attempts at conception and to pursue a fertility evaluation and treatment early on. 

So why, exactly, does fertility decrease as time goes on? There are several reasons this occurs. 

Uterine, Hormone, and Menstrual Changes

Issues like endometrial polyps and fibroids can increase with age, potentially contributing to infertility. Decreased ovarian sensitivity to certain hormones can also play a role, as well as changing hormone secretion levels.

Diminished Ovarian Reserve

However, the main reason women struggle more over age 40 with fertility is the natural decline in both egg number and egg quality. Every woman is born with a limited supply of oocytes (immature eggs), which she will have for her lifetime. Women typically have 1-2 million oocytes at birth. The amount of eggs decreases with age, falling from 500,000 by puberty to 25,000 around age 37. 

Some women may experience a low egg count, also known as diminished ovarian reserve. While all women have some decline in fertility with age, for some, it happens sooner than for others. If there are a lower number of eggs in your ovarian reserve, it could decrease your odds of conceiving. However, your egg count is not the only factor in fertility. 

How do you know if you have a low ovarian reserve? Usually, there are no symptoms other than having difficulty getting pregnant after trying for months or even years. Some people can experience irregular menstruation, hot flashes, and vaginal dryness. Low egg count can be caused mainly by aging but also by some cancer treatments or autoimmune disorders.

Egg Quality

The quality of your eggs also contributes to infertility. As a person ages, the eggs that are ovulated are more likely to be genetically abnormal, which of course, means that it will be more difficult to achieve pregnancy. Since the quality of your eggs is closely tied to how genetically normal they are, having a high number of abnormal eggs makes it harder, on average, to end up with a normal egg that can fertilize and end with the successful birth of a child. This is also why we see higher miscarriage rates as women age. 

Despite these challenges, there are also effective ways to treat infertility and achieve pregnancy after 40. 

Paths To Getting Pregnant After Age 40

At Advanced Fertility Care, we offer several fertility treatments to help you start a family.

Intrauterine Insemination

Intrauterine insemination (IUI) is a treatment where sperm are collected from either a donor or a partner, then isolated, washed, and concentrated. Then, they're placed into the uterus around the time of ovulation. Typically, our patients undergo treatment with fertility drugs in combination with IUI. This is meant to help bodies ovulate more than one egg each cycle, giving you more chances that month of getting pregnant. While IUIs have a lower success rate than in vitro fertilization, that does not mean IUI won't work for you even if you're over 40. For those at 40, IUI is considered to have about an 8-10% success rate compared to 15-20% success found with IVF.

In Vitro Fertilization

In vitro fertilization (IVF) is another method that involves fertilizing eggs with sperm in a laboratory, then transferring the best resultant embryo into the uterus using a thin tube. First, eggs are extracted from the ovaries, typically after taking fertility medications. The eggs are then isolated and fertilized in a laboratory, becoming embryos. 

One of the real advantages of IVF is what is known as preimplantation genetic testing or PGT. 

•      With PGT, a few cells from the part of the embryo that eventually becomes the placenta are removed and sent for genetic (chromosome) testing. 

•      With PGT, we can identify which embryos have the right number of chromosomes and which ones have an abnormal number of chromosomes. If an embryo has an abnormal number of chromosomes, it won't result in a pregnancy, or if it does, it would be very likely to miscarry. 

•      PGT also helps us identify embryos with an abnormal number of chromosomes that can result in a live birth. The one everyone is aware of is Down Syndrome. This type of thing is seen more often in women over 40. 

Suppose we can identify an embryo that is chromosomally normal with PGT. In that case, your success rates can be as high as 70% when you have your embryo transfer, and you have to worry less about things like Down Syndrome during pregnancy. Success rates aren't 70% for everyone with IVF because many patients will do the IVF but won't end up with any normal embryos. 

IVF can have excellent success rates. However, the success of IVF often depends on factors such as egg quality and your response to ovarian stimulating medications. So how do you know when to consider using donor eggs instead of your own? 

When Should You Consider Donor Eggs?

It's entirely possible to get pregnant using your own eggs over 40. Yet, for some people, there seems to be an egg quality or quantity issue that we can't overcome. This is especially true for women over age 43 or 44. Donor eggs in this situation could greatly increase the chances of getting pregnant through IVF. 

It may be worth considering using an egg donor, especially if you have a diminished ovarian reserve or demonstrated poor egg quality. Ovarian reserve testing is one way to estimate whether your ovaries match your age which would give us a good indication of how you might respond to fertility treatment. Some testing results might indicate that it is unlikely that fertility treatment will increase the chances of you getting pregnant using your own eggs. 

At Advanced Fertility Care, we offer an in-house Donor Egg program which provides those in need of an egg donor a variety of high-quality egg donors available for matching. Preview our available egg donors here.

Ovarian Reserve Testing

Ovarian reserve testing can help determine how many eggs you may have left. Screening for diminished ovarian reserve can tell you whether the ovarian stimulation medications used in IVF treatments might work for you. A low egg count could mean your ovaries won't respond as well to these treatments, decreasing your chances of pregnancy. 

Ovarian reserve testing can also help guide your decision to undergo fertility treatments, as it may suggest how likely you'd be to get pregnant without some kind of fertility treatment. 

To test your ovarian reserve, your provider performs blood tests to assess your levels of certain hormones. Your provider may also perform a vaginal ultrasound to look at your ovaries and count the number of follicles you have. The number of follicles you have in your ovaries at the beginning of a menstrual cycle represents the number of eggs that are available to your body for fertility treatments. The higher the follicle count, the more eggs we have to work with. 

While ovarian reserve testing doesn't definitively say whether or not you'll be able to conceive, it can help you decide if using an egg donor may be a better option than pursuing an IVF cycle with your own eggs. If the tests reveal a diminished ovarian reserve, you may consider using a donor to increase your chances of getting pregnant through IVF.

Advanced Fertility Care is Here to Support Your Fertility Journey

No matter your situation, our caring and professional team at Advanced Fertility Care is here to support you in getting pregnant. We offer IUI, IVF, a donor egg program, and more. Building a family is within reach, even if you're over 40. 

To learn more or to schedule a consultation, contact us today.

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Polycystic Ovarian Syndrome, or PCOS, is a common disorder that can contribute to infertility and long-term health risks. If you think you may be dealing with symptoms of the disorder, you're certainly not alone. In fact, as many as 12% of women of reproductive age in the U.S. live with PCOS. 

If you have PCOS, you may have many questions about the condition, its treatment, and what it might mean for your chances of getting pregnant. In this article, we'll answer some common questions about PCOS.

What Is PCOS?

PCOS is a multi-system disorder affecting many women of reproductive age. The cause of the disorder is unknown, but people with PCOS commonly exhibit imbalances in certain reproductive hormones, such as androgens. As the name implies, people with PCOS often have large numbers of follicles which are the small egg-containing cysts found in the ovaries. During a normal menstrual cycle, your ovaries mature and release an egg every month. Due to the effects of PCOS, your ovaries may be unable to make or release an egg regularly. This can result in infertility issues.

What Are the Symptoms of PCOS?

PCOS symptoms vary between individuals and can range from mild to severe. Many people may experience irregular periods, erratic ovulation, infertility, oily skin, extra hair on the face or body, hair loss on the scalp, and weight gain. More recently, PCOS has been linked with depression or mood disorders. Some people with PCOS are overweight, although people who are not overweight can have it also. Being overweight can make the signs and symptoms of PCOS worse. 

A common problem in people with PCOS is insulin resistance (more on this below). People with insulin resistance can often find darkening of the skin along creased areas like the groin or neck can occur, as well as the development of skin tags.

Who is at Risk for PCOS? 

The condition affects women of all ethnicities and can develop at any time during reproductive years or any time after puberty. The precise cause of PCOS is unknown. However, you may be at higher risk if you have a family history of the disorder.

As noted above, people with PCOS often have insulin resistance. People with insulin resistance can make insulin, but their cells don't respond to insulin as they should. As a result, insulin levels in the body may increase. This can cause the ovaries to produce higher levels of a group of hormones known as androgens which causes some of the symptoms of PCOS like unwanted hair growth. 

In addition to PCOS, other factors can contribute to insulin resistance such as being overweight, having an unhealthy diet, or a family history of diabetes. These people can see a worsening of their symptoms of PCOS. It's important to take action if you have high insulin or blood sugar levels since this may increase your risk of developing diabetes. 

How Is PCOS Diagnosed? 

Since PCOS is a syndrome with many different signs and symptoms, not all experts agree on the criteria to diagnose PCOS. The three most commonly used criteria are seen here.

As you can see, some criteria rely on blood tests, others rely on ultrasound, and still, others emphasize signs and symptoms. Therefore, your doctor may perform an exam and discuss your medical history to diagnose PCOS. They may perform a pelvic ultrasound to examine your ovaries and do blood tests to determine your hormone levels. These exams and tests will help rule out any other possible causes of your symptoms. 

How Is PCOS Treated?

There is no total cure for PCOS. But fortunately, you can take steps to manage or improve your symptoms. Getting adequate exercise, managing your weight, and eating a healthy diet can all help. You may also be able to take medication to lessen physical symptoms, like hair growth and acne. Making lifestyle changes can lower your long-term risks like type 2 diabetes. 

It's not easy to hear that you may have PCOS, but you can talk to your doctor about how to lessen your symptoms. Some simple lifestyle changes may improve things.

Can You Get Pregnant if You Have PCOS?

It's possible to get pregnant if you have PCOS. While PCOS can cause infertility struggles, there are a few things you can do to increase your chances of pregnancy. 

Having irregular ovulation will make it harder to track the fertile phase of your menstrual cycle. Even so, you could still be able to get pregnant naturally. If this doesn't happen, there are fertility treatment options available. 

Can Fertility Treatments Help You Get Pregnant With PCOS?

Absolutely! If you're having trouble getting pregnant, one possible option is in vitro fertilization (IVF). During this advanced fertility treatment, a doctor extracts your eggs, fertilizes them in a laboratory with collected sperm, and transfers the fertilized egg into your uterus. IVF bypasses the fallopian tubes, enabling a fertilized egg to be placed directly into your uterus, where it can implant. IVF can be an effective choice for many people, including those with PCOS, endometriosis, or damaged fallopian tubes.

However, many patients don't require IVF to get pregnant. 

Reducing insulin resistance by lifestyle changes or medication can often result in more regular ovulation and pregnancy. Another alternative is ovulation induction with intercourse or intrauterine insemination (IUI). For this procedure, you take fertility drugs to induce ovulation before having intercourse or undergoing artificial insemination so that your eggs can become fertilized.

Does Having PCOS Increase Your Risk of Pregnancy Complications? 

If you have PCOS, there can be some increased risk of certain complications like gestational diabetes and preeclampsia during pregnancy. However, this does not always happen, and you can reduce your risks by maintaining a healthy weight and making sure your blood sugar levels are normal before trying to become pregnant. 

No matter your situation, the team of caring professionals is here to support you on your fertility journey. We would be glad to answer any questions you may have about PCOS, infertility, and fertility treatment options. Explore our website or schedule a consultation with our experts today if you'd like more information.

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Who Faces Fertility Issues?

More than 48 million couples struggle with infertility worldwide. In the U.S., one in eight couples faces fertility issues.

Who Is Using Fertility Services?

Fully one-third of Americans have either used fertility services themselves or know someone else who has.

How Long Does it Take to Get Pregnant with Fertility Treatment?

With treatment, 85% of couples will succeed in getting pregnant within the first year and 7% during the second year.

What’s the Average Age to Have a Baby with Fertility Treatment?

The odds of conceiving depend on various factors, including underlying causes and treatment types. For IVF, the age range with the greatest success is age 30 to 33.

Need help? Contact us today.

Those experiencing fertility challenges while trying to build their family may have many questions about fertility. One common question is about fertility testing and the evaluation process. Without the correct information, couples or individuals may delay consulting an infertility specialist for a fertility evaluation. We compiled specific details in this guide to help you make the proper decisions and get started with a fertility evaluation. You will learn more about the fertility evaluation process, what to expect, and the tests involved.

What is Fertility Evaluation?

A fertility evaluation assesses fertility health and involves reviewing medical history, a physical examination, and diagnostic testing. The fertility evaluation process differs for men and women. Through a fertility evaluation, are productive medicine physician can diagnose possible causes of infertility and aid decision-making. After assessing your needs, your fertility physician will recommend the most appropriate treatment plan to reach your family-building goals.

When Do You Need a Fertility Evaluation?

The reasons to seek a fertility evaluation can differ from person to person. The presence and or persistence of these symptoms are typically an indication for a fertility evaluation.

For women, here are some signs you may need a fertility evaluation:

• If you’ve been actively trying to conceive without success for one year (or six months if you’re over 35)
• history of uterine or tubal disease
• irregular periods or no menstrual periods
• endometriosis
• history of pelvic inflammatory disease
• history of having had cancer treatment(chemotherapy or radiation treatment, especially if directed to the abdomen andpelvis)
• history of multiple miscarriages
• If you’re 37 or older and want to get pregnant
• history of genetic diseases that run in your families

Here are some indications for fertility evaluation in men:

• a history of testicular trauma
• history of surgery for an undescended testicle or hernia
• treatment with chemotherapy drugs
• history of infertility with a previous partner
• if you’ve been actively trying to conceive without success for one year (6 months if your partner is over age 34)

What to Expect From a Fertility Evaluation?

During your first visit to a fertility clinic, the fertility physician will start with a detailed clinical history to collect your personal health information and identify your unique health needs. The fertility physician may ask you (and your partner) the following:

• history of medical illnesses, including STDs and past pelvic surgery
• medication uses
• sexual history
• duration of infertility
• use of tobacco, alcohol, and illicit drugs

 For women, the doctor will typically ask about:

• your last menstrual period
• menstrual cycle length and frequency
• birth control methods
• past pregnancies and their outcomes.

While for men, here are some questions the fertility physicians may ask:

• history of childhood trauma to the testis
• history of infections such as orchitis or mumps
• prior childhood disorders like cryptorchidism
• history of infertility

After the clinical history, your fertility doctor will perform a physical examination.Clinical history details help direct the physician to examine particular organs. For example, males with testicular symptoms may require further urologic examination.

To aid the accuracy of clinical diagnosis, your doctor may recommend a series of diagnostic tests.

What is Fertility Testing?

A fertility specialist uses your medical history obtained when consulting with you to help choose the most suitable diagnostic tests that fit your personal situation. Hence, consulting with a fertility specialist early in the process may save you time and money and keep you from having any unnecessary testing.

Fertility testing involves a combination of laboratory tests and imaging studies to try to identify an explanation for your struggles to conceive. The results of these tests often point to a cause of your infertility, though it is important to know that at least 20% of the time, there is no explanation identified becauseall of the tests come back normal. The testing results will help your fertility provider know what treatments are available to you and will also help them know what treatment they would recommend as the most appropriate.

Fertility testing procedures are obviously different for men and women and best requested by fertility physicians.

Fertility Testing for Women

Female fertility testing entails using specific tests and radiological procedures to assess the ovarian function of your fallopian tubes and the integrity of the uterine cavity. Here are specific tests often performed in a complete fertility evaluation:

Assessment of Ovarian Function and Reserve

Ovulation— the release of a mature egg from the ovaries occurs at a specific time point in the monthly menstrual cycle. Ovulation testing helps to determine if a female is ovulating or not. It involves hormone testing on specific days in the menstrual cycle.

Ovarian reserve testing— women, lose the ability to get pregnant as they get older due to a decline in their ovaries and egg quality. Testing of your ovarian reserve is performed using a combination of blood testing of reproductive hormones and ultrasounds assessing what is referred to as your follicle count. 

Follicles are fluid sacs with an egg, which are visible on ultrasound early in your cycle. The number of follicles you have represents the number of eggs available to your body for ovulation that month. Typically, women start with a relatively large number of follicles, even if they ovulate only one egg at a time.

Hormone testing is another important part of evaluating ovarian function. These blood tests assess the level of hormones such as follicle stimulating hormones( FSH), antimullerian hormone (AMH), and estrogen levels in the blood.

Most of these ultrasounds and hormonal blood tests must be performed on a particular day of your menstrual cycle. AMH testing, however, can be done at any time in the menstrual cycle.Your fertility physician interprets the results from these hormone tests and determines if the ovarian function and reserve are within normal range.

Assessment of the Uterine Cavity

There are different methods for assessing the uterus. Typically, fertility experts use imaging tools to inspect the uterine cavity for abnormalities such as congenital uterine defects and adhesions. In addition, fertility doctors typically use a hysteroscope (a long lighted, flexible tube) to visualize the interior layers of the uterus. The procedure is called hysteroscopy. 

There is also a specialized ultrasound that is performed at the same time saline is instilled into your uterus to better determine if there is anything abnormal that may be keeping you from getting pregnant.This is known as a saline sonohysterogram.  Your physician will determine which of these tests is/are most appropriate.

Assessment of the Fallopian Tubes

Fallopian tubes are typically assessed in the clinic with a procedure known as a hysterosalpingogram or HSG. This fertility test aims to inspect the fallopian tubes for occlusions or blockages.The fallopian tubes can become blocked due to prior pelvic infections, endometriosis, or prior pelvic surgeries.  

An HSG involves using X-rays and X-ray contrast to outline the fallopian tubes and uterus. This test is typically done in the week or so after your period ends but before ovulation occurs so that there is no chance you are pregnant when you have it performed.

Laparoscopy (an actual surgery) is another method your fertility physician may decide to use to assess the fallopian tubes. However, it is invasive and not often the first choice.

Fertility Testing for Men

Semen analysis is the primary method of male fertility testing. The andrologist analyzes the semen for various characteristics such as the quality and quantity of sperm cells. Before the test, you or your partner will be counseled to abstain from sexual activity for 2-5 days. Your fertility doctor interprets the semen analysis result to determine the impact.

Here are the specific components of a semen analysis test.

Sperm Count

What most people refer to as a “sperm count” is technically a measure of the concentration of sperm in the ejaculate. It is reported as the sample's number of sperm cells per milliliter. According to the World Health Organization (WHO), the normal sperm cell count should beat least 15 million cells per milliliter. If the sperm cell count is below this level, the fertility doctor will typically assess the possible causes and recommend the most suitable therapeutic intervention.

SpermMotility

Sperm motility evaluates the movement pattern of sperm cells in the ejaculated semen.A sperm sample should have at least 40% progressive sperm motility, which does mean that it can be normal if over half of the sperm in the sample is “dead.”

Unlike conventional laboratory evaluation of sperm motility, computer-assisted semen analysis (CASA) uses digital technology to provide an in-depth kinetic analysis of sperm cells. CASA provides details on the sperm head motion patterns and a quantitative overview of the sperm cell kinetics.

Sperm Morphology

The word morphology means the shape, and so when your sperm is assessed as part of the analysis, we take a look to see what percentage of your sperm looks normal in every respect. Here the concept is that it is only normally shaped sperm that are capable of fertilizing an egg. 

Any defects or abnormalities in the sperm head, neck, body, or tail typically affect sperm quality and increase the risk of male infertility. A normal semen analysis should have at least 4% sperm cells with a normal shape.

Other features assessed in a semen analysis include:

• pH:Normal range is 7.0-8.0
• ‍Volume:Normal should be at least 2 mls per ejaculated semen‍
• White blood cells: White blood cells are typically absent in semen. The presence of white cells indicates an infection.‍
• Sperm viability: Some of the sperm ejaculated are simply dead. The viability assay helps determine if there is too high of a percentage of sperm that are dead when ejaculated.

Do You Need a Fertility Evaluation?

Fertility evaluation involves a review of your medical history, a physical examination, and specialized diagnostic tests. This process helps a fertility physician to evaluate your fertility status and offer solutions to any fertility problems.

Getting a fertility evaluation starts with consulting a fertility expert and choosing a fertility clinic with a team of professional fertility experts with a proven track record of helping couples or individuals start and expand their families. The proper fertility evaluation is essential to move you towards achieving your dream of starting or growing your family.

The first step in your fertility journey to parenthood is an initial consultation with one of our fertility specialists at Advanced Fertility Care. We have dedicated fertility professionals who assess our patients using the most recent reproductive technology solutions. We provide personalized fertility evaluations and testing that fits your unique health needs. Schedule your initial consultation today to get started on realizing your dreams of parenthood.