The 10 Questions Everyone Should Ask When a Fertility Cycle Fails

A negative pregnancy test can be hard for anyone to bear, particularly individuals and couples who are going through fertility treatment. It’s like studying for weeks and weeks for an exam, thinking you know the material, and then getting an F. “Disappointing” doesn’t even begin to describe how you feel. And while the first place you usually go is your significant other’s shoulders for a good cry (and for a glass of wine and a bite of unpasteurized cheese), the second should be to your fertility doctor to break down why this cycle didn’t = baby.

Here are our suggestions on what should be on your list:

  1. Why didn’t it work?

Hands down, this is the most frequently asked question when a fertility cycle is not successful. And while it is a good place to start, in order to get concrete answers, it’s better to break it down into little pieces (a.k.a. your reproductive parts). When you chat with your doctor, make sure to be specific in your line of questioning; the narrower the question, the more useful the answer. And bring a pen and paper!

  1. Did I make a bad egg?

While we are never fans of finger pointing, in many cases the culprit is an abnormal egg, which resulted in an abnormal embryo, which = no pregnancy (especially if this was an IVF cycle where the embryo did not undergo genetic screening). Unfortunately, barring genetic testing of the embryo, there is not much that we can do to predict if the egg you ovulated or we extracted was normal. While we use hormonal assays (think FSH and AMH) and female age to help guide our treatment plans and analysis of the outcome, they are limited in their abilities to predict the future. This is why we are huge advocates of embryo screening. While it can’t tell us if the extra chromosomes came from the egg or the sperm, it gives us a lot of data about where the “damage” may have started. And while it is nearly impossible to change egg quality, by analyzing the embryos that are produced by those eggs, we can find the good egg (s).

  1. Was my partner’s sperm only so so?

Although men are often sperm-making machines for years longer than we are egg-making machines, as time ticks away, so does sperm quality and quantity. Furthermore, certain medical conditions or recreational habits can hamper your other half’s sperm production. Make sure that your partner has had a semen analysis, and if the results were only so so, your fertility doctor should refer your partner to a urologist. There are procedures, techniques, and medications that can help improve sperm quantity and quality.

  1. Are things not flowing freely through my tubes?

Think of the tubes like any major New York City tunnel—they can get blocked up anytime and for any reason. And while there are certain things in one’s medical and gynecologic history that would predict a tubal closure (a.k.a. a history of pelvic inflammatory disease or multiple abdominal surgeries), in many cases they are just closed for no clear reason. Therefore, before any fertility treatment is initiated, it’s a good idea to have your “tunnels” checked. If there is a problem, you will need to take an alternate route to achieve a pregnancy—and learning this before you set out on your fertility journey will save you a lot of time!

  1. Was my uterus not ready for a guest?

Although the uterus is infrequently the primary or solo cause of infertility or a failed fertility cycle, it should be looked at from a few angles. Routine ultrasounds depict the uterus in two dimensions. And while it can look good in this mirror, it’s important to have a 3D study or a test (HSG or hysteroscopy) that shows the inside of the uterus. Unwanted guests (e.g., fibroids, polyps, or scar tissue) that can interfere with implantation can be lurking!

  1. Should I repeat the same treatment, and if I do, what is the chance it will work?

Yes and no and maybe. (Well, that was helpful advice!) But all kidding aside, the reality is that most fertility treatments doesn’t work the first time you try them. You often must try a few attempts before you see success. However, you should 1,000% speak with your doctor between every attempt and ensure he or she breaks down what happened and how he or she can make things happen next time. Additionally, make sure you have an end point. While this road can be long, it shouldn’t be endless. Make sure there is a stop and you know where and when that will be.

  1. When is it time to move on to the next step?

Unfortunately, this one doesn’t have an easy answer. However, we added it to the list to make sure you ask it. And to ensure that you know that there are options, both in what you do and where you do it. You aren’t tied to one type of treatment or one treatment center. Ask, look, and listen. There are many good resources out there with lots of information (#trulyMD).

  1. Do you have paper and pen?

Write things down! Whether it be the questions you want to ask or the questions that you had answered, remembering everything can be hard. Jotting down what you want to say and what has been said will serve you well in the future.

  1. Can I have my records?

You are your best advocate (and your best record keeper). Asking for your records and speaking up on your behalf does not make you annoying. It makes you smart. And while you don’t need to become a bookkeeper, keep track of what goes into and out of your body. It can ensure that you stay balanced!

  1. What’s next?

We love plans. Just check out our calendars! But we especially love plans when it comes to our patients. Knowing what you are going to do if your day 1, that is, your period, comes can make dealing with D day somewhat easier. Simply stated, plan for the worst (#period), but hope for the best. That way, you won’t waste any time.

Getting pregnant and having a baby are not easy. Contrary to what we thought in college, you don’t get pregnant every time you have sex! Although people use the word “fails” liberally, remember that you are so not a failure. Doing fertility treatment is hard: emotionally, physically, and financially. Staying in the game when things get hard makes you a success—no matter what that pregnancy test shows.

If Your Friend Jumped off a Bridge, Would You Do It, Too? Altering your lifestyle for fertility.

How many times do you remember telling your parents, “I did it because Susie did it”? And how many times do you remember your parents saying, “If Susie jumped off of a bridge, would you do it, too”? This usually was met with a muffled “no” and a trip to your room. Bottom line, the “because my friend did it” response never got you anything more than a grounding. And while our moms may no longer discipline us, our doctors do. And telling us that you have picked up bad habits because Susie has them is not going to go over well.

Saying that habits are hard to break might be the understatement of the century. They become a part of us, our routines, our cultures, and the essence of who we are. Whether it be smoking, drinking, drugging, or doing lots and lots of exercise, they become a part of who we are and how we see ourselves. Because of the latter, it makes them really hard to taper or totally take out. Even the best of habits (exercise, eating healthfully, or engaging in some sort of activity) can become excessive, and while they may not need to be eliminated, they may need to be reduced.

Substituting is a great concept and often works well. For cardio junkies who can’t turn up the torque during IVF stimulation, we recommend a long stroll in the park or an inclined walk on the treadmill. You don’t have to lie on the couch and eat bon bons (although it is nice to give yourself a break!); you can still do something that will build a sweat.

While some habits can be halved or quartered, smoking and drug use need to be out out completely. There is no healthy amount of smoking or toking; it’s got to go. It’s not good for your ovaries or any of your vital organs, so take this as an opportunity to go cold turkey.

When it comes to alcohol, we are definitely more lenient. I think someone said a glass a day will keep the doctor away. Although this is probably more wishful thinking than reality, a glass of wine from time to time (it even rhymes!) is nothing to stress about. You don’t have to cork the bottle when you’re trying to get pregnant.

Food is a fairly big issue when it comes to fertility. Although nothing has been proven definitively, there is a lot out there on the internet and blogs, as well as in friendly conversations, about what is best to eat. Should I can the carbs, should I forget about fat, should I say goodbye to gluten? We say no, no, and no, not unless you have been diagnosed with celiac disease (true gluten intolerance) or have been directed to follow an anti-inflammatory diet.

Dietary variety is a good thing. We need proteins, fats, and those carbs (we have such a love-hate relationship with the lattermost). While everything in moderation is the right way to go and no one ever overdosed on fruits and veggies, eliminating foods to boost your fertility probably isn’t the best idea.

What works best for you and your body may be very different than what worked best for your BFF or your pseudo BFF. As much as we may think our bodies are the same, they are not. Yes, we all have bones, brains, and muscles, but after the basics, there is a lot of variety. So while Sally had to cut out sugar and Georgia had to remove gluten, you don’t necessarily need to follow their menu plan.

Despite what you hear, fertility treatments do NOT mean you have just seen the finale of your favorite things; telephone is a dangerous game! Exercise, caffeine, and alcohol plus are okay when trying to conceive. While we may ask you to tone it down, we will infrequently ever ask you to turn it off completely. Although your friends and those who have made the fertility journey before you are a good source of information, they do not have the final word. Just because they were told to do something or had to change something doesn’t mean the same applies to you.

Leader of the Pack, Take It on Back!

For all of you runners, cyclists, and swimmers out there, you know how good it feels to exercise in the pack. There’s definitely comfort in numbers—the energy and the spirit can pull you through even the steepest of hills or the roughest of currents. Drafting off the guy or girl in front of you is also pretty nice! Follicles (a.k.a. eggs) also like the group mentality. Growing in concert or an evenly sized cohort is ideal. It increases the chances that many, if not most, will achieve maturity simultaneously. Mature eggs are the ones that get fertilized, and fertilized eggs = usable embryos!

When a follicle takes the lead, we’re not standing on the sidelines applauding and screaming, “Go, follicle, go!” We’re actually pretty bummed and do everything we can to hold it back and let the others catch up. No, we’re not believers in the “Everyone gets a trophy no matter what place you come in” phenomenon, but lead follicles can negatively affect the outcome of an IVF cycle. They can force you into scheduling the retrieval a bit early to avoid compromising the bigger ones. This can result in a bunch of eggs that are uneven in development and therefore uneven in maturity.

Additionally, if one follicle is putting the pedal to the metal while the others are strolling in the pack, there is dis-synchrony in the hormones secreted. The leader has enough juice to get him or her across the finish line. However, the fumes the leader is releasing can be toxic to the smaller follicles. Hence, it can impair their growth, development, and quality.

When an egg retrieval is performed, there will always be something of a Goldilocks story. Some eggs will be post-mature (too hot), some will be immature (too cold), and some will be mature (just right)! It’s very hard to complete 100% maturity (and probably not normal). When a lead follicle pops up, it can throw the balance off even more. To avoid the leader of the pack, we have many tricks up our sleeve, a.k.a. the birth control pill, estrogen patches, and luteal antagonists, to name a few. The purpose of pre-stimulation medications is to level the playing field and make sure everyone starts the race when the gun goes off (and not a minute before).

If a dominant should arise, we can either chose to cancel the cycle or ignore it. By ignoring it, you can recruit what’s called the secondary cohort. While this can work, it can also compromise the quality of the follicles on the B team. In this case, it becomes a pluses and minuses and pros and cons-type of situation that you and your physician need to have.

Synchrony’s a big deal in ovarian stimulation. It’s what we strive for, what we train for, and what we aim for. We know when it isn’t happening and know how to try and make it happen. When we can’t get it to happen, no matter what we pull out of our hats, it’s a sign of poor egg quality.

Follicles, just like females, like to travel in groups. We can chat, we can bond, and we can share experiences. Going out on your own can throw off the balance of everything else, and it can be lonely! If your follicles appear to be growing unevenly, have a sidebar with your doctor and talk about calling a time out. Even if you do it again and have a lower number that’s more even, that’s probably a better race to run. Think about how much you and your friends can cover if you do it together!

“Judgey” Eyes: What Are Embryologists Really Looking At?

How do I look in this dress? What do you think of these shoes? Is red a good color for me? Let’s face it: even the most down-to-earth among us has an inner diva. Who doesn’t want to look good and turn some heads? Furthermore, how we look on the outside can impact the way we feel on the inside. While we’re certainly not saying that looks matter, we are saying that how you think you look often impacts the way you feel. The same can be said for your embryos. How they look to the embryologist in the lab can tell us a lot about their health, their genetics, and their ability to make a baby.

While different labs use different grading systems, most that perform day 5 or 6 embryo transfers use the Gardner and Schoolcraft embryo scoring system. This dynamic duo introduced their scoring system in 1999 to determine blastocyst (day 5 or 6 embryo) quality.

And while it’s certainly not the Miss USA competition, embryologists are grading the embryos in three ways: development and morphology (don’t worry; we can count). Morphology is assessed for both inner cell mass and the trophectoderm, bringing the total to three!

Embryologists are looking for things like embryo expansion, cell compaction/tightness, and cohesiveness. Years of experience and tons of training have trained their eyes to be really judge-y and label these areas with letters and numbers. We don’t give an overall number; it’s more of a general impression! The cumulative score determines which embryos have the potential to wear the crown. The scoring system not only helps embryologists and fertility doctors decide which embryos to transfer but also how many embryos to transfer. Those with straight As should have a limited number of embryos transferred to avoid an octo-mom situation.

Remember, just like undergrad universities, some grade inflation may go on. An A at Harvard may be a B at Yale—grading is subjective. (Just sayin’. And no, neither of us went to Harvard or Yale). Therefore, while a patient may make all A+ embryos in lab #1, when they come to lab #2, the report card can be totally different. Usually, this is not because your eggs or your partner’s sperm went over the cliff, but because the scoring was skewed. Skewed scoring doesn’t decrease one’s chances; it just messes with one’s expectations. If you have an A+ embryo, you’ll think this is a slam dunk. If it’s really a C, you won’t expect to win the science prize.

Unfortunately, even those with the “judgiest” of eyes can’t discern a trisomy 21 from a 46XY. Visually, they look pretty much the same. Aneuploid (genetically abnormal embryos) clean up well; they can look just as handsome when it’s time for their big date. Cue modern day PGS (pre-genetic screening). PGS has allowed us to distinguish between those who have natural beauty and those who are caking on the makeup. By subjecting the embryo to genetic screening, we can take embryo selection and success rates to the next level. We know a lot more about their abilities to make a healthy baby and the reasons why IVF cycles work or don’t work.

For the type As among us (we’re both raising our hands, so you’re not alone!) we lived and died by our grades. We burned the midnight oil to get the coveted A in Chemistry and logged many sleepless nights for the Honors on our English paper. However, grades don’t mean everything. In the same regard, there are several modest-quality embryos that make the most beautiful, smartest, and kick-butt kids.

So, while we totally get your hangup with the grade, don’t obsess. It won’t change the outcome and will only increase your anxiety. You’ve studied as hard as you can; the rest is in our hands!

Where Everybody Knows Your Name

While most of you, particularly those above the age of 35, are now picturing a couple of bar stools, Sam, Cliff, Norm, Woody, and Frasier, our minds are far from a local bar in Boston. Our minds are on the waiting room of your local fertility clinic. The place where “everybody should know your name” (but should not scream it loudly for everyone else there to hear!) but never does. The place we are referring to is the waiting room of your fertility clinic.

Contrary to popular belief, the waiting room should not resemble the subway platform during rush hour! Patients are not cattle, and your lady parts are not pieces on a factory assembly line. And while we, too, are fans of a morning sweat session, it should not be achieved by racing your fellow patients to the front of the ultrasound line.  It adds anxiety to an already stressful process. Fertility treatment is not easy. The process of getting there, getting in, and getting out should not make this process even harder. Simply said, if your blood pressure rises several degrees when you walk through the door, it might be time to walk out.

The desire to have a child can be overwhelming. It can drive even the sanest of us to do crazy things. And although we can’t promise that pineapple core, vitamin supplements, and a gluten-free diet will do the trick, we can promise you that they won’t hurt you. However, allowing yourself to be treated as a number and not as a person can be hurtful. In fact, it can compromise the quality of your care and your chances of conceiving; if nobody really “knows your name,” how can they appropriately treat your infertility?

Let’s face it. You don’t need everyone in the fertility office to be your best friend, but the individual doing your ultrasound should know your name, know why you are there, and know what you might be doing next (and should give you more than 30 seconds of their time!). If you are getting the boot out of the door the moment your bottom hits the exam table, it’s probably about time to find yourself another fertility clinic.

Fertility treatment is often a journey. For some, it can take years. The relationship you form with your doctor and your doctor’s office staff should be a good one. And while you may never find yourself in a bar in Boston talking about baseball, it is important that you feel comfortable with those sitting on the stool in front of you. The fertility clinic should be a place “where everybody knows your name.” You owe it to yourself. Cheers!

How to Properly Identify Sperm, Eggs, Embryos, and Everything in Between

“License and registration” can be two of the worst words any driver hears: simply stated, you are so busted! No matter how loud the radio is playing and how good you feel driving on the open road, going 85 in a 60 is not a good thing. After the “Officer, I really wasn’t going any more than 10 miles an hour over the speed limit” and the half-hearted attempt to sweet talk your way out of the ticket without so much as a smile from the highway patrol guy or gal, you pretty much take your ticket and drive away.

And although you may vow to go to court and fight it, most of us pay our fine (ugh) and move on. And while no one likes to waste their hard-earned money, the downside of losing some cash is not so catastrophic (although points on your license can be a real bummer). However, errors in proper identification, particularly in a fertility office, can be disastrous.

In any medical practice, especially a fertility one, you want to be “pulled over” every time you set foot in that medical building. From the staff at the front desk to the chaperones who put you in the exam room to the medical assistants who draw your blood, asking to see identification is a good thing. In fact, the more people who ID you, the better (yes, we are looking at your age☺). When any gametes (eggs, sperms, or embryos) are being used, it should be even more in your face—in the changing room, in the embryo transfer room, and twice prior to the transfer. If you find yourself becoming annoyed, that means we have done our job correctly. While redundant, we want to be more sure than sure that we have who we think we have. Like the cop on I-95, we mean business!

Expect us to ask your name, your date of birth, your Social Security number, and your partner’s name and date of birth (here, we will give you a pass on the SSN). No need to call LifeLock. We’re not trying to commit identity theft; we’re just ensuring that we have the right players in this game of baby making. We ask repeatedly to eliminate the chance that any errors occur. We have systems set up to double check everything not only twice but also by two people. In fact, the most common words you will hear in an embryology lab are “Can I get a check?” No eggs, sperm, or embryos are ever moved without two sets of eyes—always.

When it comes to identification, we don’t mess around. We don’t even joke about it. So, if staff personnel don’t ask you these important questions and you feel uncomfortable, in the words of the NYPD, if you see something, say something. Voicing your concern does not make you annoying; it makes you on top of it. And if things don’t change, then maybe that is not the right fertility practice for you. In general, we are pretty good bouncers and know who should come into the club.

Trust us, even the best fake IDs don’t get past us.

Don’t Break My Heart: The Impact of Fertility Treatment on Heart Disease

Be still, my beating heart: Does fertility treatment increase your risk for heart disease? The latest results from a large Canadian study made everyone’s heart skip a beat with its recent findings. The data showed an increased risk in heart disease in women who required fertility treatment to get pregnant. And while this study got a lot of press, before you have a heart attack, here are five things that you should know:

  1. Even with the increased risk reported in the study, the absolute numbers are very low (a.k.a. the number of women who experienced cardiovascular events was pretty small). While we aren’t turning a blind eye or a deaf ear to the results, we are interpreting them with caution.
  2. IVF in the 1990s and IVF in 2017 are VERY different. The treatment protocols and techniques have changed more than the fashion trends (#bellbottoms). Therefore, it’s nearly impossible to study the aftereffects of treatments given then to the aftereffects of treatments given now. Our medications are different, our stimulation styles are different, and our dosages are different. In fact, it’s hard to find anything that’s the same!
  3. When analyzing any research study, it’s important to distinguish between correlation and causation. Although they may sound the same and start with the same letter, they are very different in what they suggest and what they mean for you. When you think of causation, think of cigarettes and lung cancer: We all know cigarettes cause lung cancer. When you think of correlation, think of cigarettes and infertility. Cigarettes do not specifically cause infertility, but they have been associated with infertility. In this study, fertility treatment has been correlated with heart disease (to a modest effect), but fertility treatment has not been demonstrated to cause heart disease. And although the distinction may seem insignificant, it’s actually pretty important!
  4. Anyone who is going to undergo fertility treatment should be in good shape. While you don’t need to join us for regular 5:30AM workouts, you do need to be in good health. Pregnancy is no walk in the park; you want your body to be prepared for those nine months and the many months that follow!
  5. The primary outcome studied was “adverse cardiovascular events.” The authors lumped stroke, TIA (think of it as a temporary stroke), MI (a.k.a. heart attack), and heart failure altogether. And while they all may affect your heart and your brain, they are not all the same. By opening up the floodgates (or adding more diseases to the primary endpoint), you will almost certainly capture more women who fall into the “I got that disease” category. So, while more women who took fertility medications may have gotten the primary outcome, the primary outcome was pretty expansive.

Your heart is as important as your ovaries, your uterus, and your fallopian tubes to us fertility doctors. While we may seem to have a one-track mind (#makingbabies), we are not only focused on your fertility but also your future health. Therefore, we will keep following the latest scientific breakthroughs and bring them to you hot off the press. We cross our hearts!

Going Long: When the Finish Line May Be Further Than You Think

For all of you runners, swimmers, and cyclists, you know what it takes to prepare for that long-distance jaunt. Aside from what you should eat (#carbLOAD) and what you should wear, how far your legs or arms need to take you is pretty important. Preparation, both physical and mental, is key to crossing that finish line.

The same can be said for individuals and couples going through fertility treatment. Knowing how many rounds or cycles it will take you to reach the finish line (#baby) will help you prepare for the journey. And while this is no straight-up calculation or predetermined training plan, information such as age, ovarian reserve, and fertility history can definitely help us estimate. Here’s how far you might need to go…

There are about 180,000 IVF cycles performed in the US each year. And from these cycles, about 65,000 babies are born. Over the years, the numbers have added up, and nowadays, nearly 2% of babies born each year are a result of IVF. Simply stated, more and more people are doing IVF, and more and more babies are born after IVF. However, the number that is less clear is how many cycles it took each person to get to her personal finish line (a.k.a. a baby).

And while this statistic may elude us, what is pretty evident is that those who hang in there longer (a.k.a. complete more IVF cycles) are more likely to conceive. In fact, a recent Swedish study demonstrated that women who did three IVF cycles had about a 65% chance of pregnancy. This was higher than women who stopped at one or two. And while we are certainly not advocating endless IVF cycles, we are recommending that you go the distance based on your doctor’s recommendations.

If your doctors think you have the potential to push on (you are still making a good number of eggs, you are having advanced embryos transferred, your embryos are passing the genetic screening test), then we recommend that you keep on keeping on. Just make sure that you know how far they think you should go, and in turn, make sure they know how far you want to go.

Going back to our original metaphor, think of it like this… If someone told you that you had to run five miles and then midway through told you it was actually 10 miles (oops!), you would be pretty peeved. You would probably doubt your ability to go the distance and maybe even decide to bow out before the race was over.

On the contrary, if you planned to do a 10 miler but midway through found out the race was only half that distance, you would feel pretty good. Energized and invigorated, you would kick that race’s butt and sprint to the finish line. Fertility treatment might make you go the distance. While we certainly hope the race is over shortly after it starts, if it goes longer we don’t want to leave you out there on the course without the appropriate gear.

Information, preparation, and participation (a.k.a. a doctor who consults with you after every IVF procedure) will guide you through this often-torturous race. But having a good idea about the course before you start will make each passing mile a bit easier.

Hey, Hey, What Do You Say…What’s the Difference Between These “Ks”

Historically, the final shot, or the “trigger” shot, in an IVF cycle was almost always a fixed amount. While there was variability in what medication was given (hCG/novarel vs. ovidrel), the dosage was pretty standard. Both medications when administered correctly were pretty good at achieving egg maturation. Their differences were in many ways limited to cost and prep time. (hCG must be mixed, and ovidrel is a pre-filled syringe). Who got what was frequently based on insurance coverage and cost. Nothing to shake your pom-poms about! Fast-forward to about 2008, and the game got more interesting with the introduction of a new player, a.k.a. Lupron (leuprolide).

It was discovered around this time that Lupron could not only achieve egg maturation but also eliminate the risk of the dreaded ovarian hyperstimulation syndrome (OHSS). Have we found ourselves both the rookie of the year as well as an MVP in one shot?

Yes and no. While Lupron is really good at avoiding OHSS for almost all, it falls short in achieving egg maturation for some. It requires the endogenous production of good amounts of LH (hormone made in the hypothalamus) to be effective. Without it, it really won’t work. Simply stated, it needs a teammate. Cue hCG or ovidrel. Giving two medications in combination (hCG + Lupron OR ovidrel + Lupron) is like drafting your dream team…dribble, shoot, score! Together, these medications (in the correct “K”) can achieve egg maturity without causing significant OHSS.

The tricky part about hCG, and where some of the confusion comes in (#most common on-call phone call for a fertility doctor!), is when we start to modify the dosage from the traditional 10,000 (a.k.a. 10K) down to 5K and then to 1K. In certain instances, we even modify it more to doses such as 2K or 3K. Why this can become so tricky is the mixing that the various “Ks” require. How you get from a 10K to a 1K dose is all about the water.

If you inject 1cc or mL of water (saline) into the powder and then give yourself a 1cc or mL injection, you have yourself a 10K shot of hCG. Not a problem if you are not cooking several dozen eggs. If you want a LOWER dose of hCG to reduce your risk of OHSS, you would increase the amount of water you inject into the powder to dilute the medication.

It would go something like this: 10 cc or mL of water into the same powder (rather than 1cc). However, you would ONLY give yourself a 1cc or mL injection of the water/powder solution. The more water = the more dilution = the less potent. Ovaries with a ton of potential that are being given Lupron alongside hCG don’t need so much oomph from the hCG. The combo is enough to get their system going without getting them sick.

While ovidrel is no slacker in terms of egg maturity, it is harder to play with the dose. Because the syringe is pre-filled it’s hard to manipulate the dosage. For this reason, many clinics have moved away from using ovidrel in exchange for hCG. It’s VERY important to discuss the trigger medication and what would be best for you and your ovaries before starting the cycle. It can be a huge bummer when you spent your hard-earned cash on a trigger medication that you can’t or don’t want to use. Also, make sure to get the playbook before you leave your doctor’s office on the morning of the planned trigger shot. Getting new instructions only a few hours before the big game can be incredibly overwhelming.

As physicians, we are here to be your cheerleaders and guide you in this “Hey, hey, what do you say?” chant as you throw the final pass. The trigger medication is the grand finale of a whole lot of plays. It’s important to get the medication and the dose right to ensure that your cycle ends on a touchdown and not on a fumble!

Where to Place Your Bet: The Difference Between Egg and Embryo Freezing

Who doesn’t love a good pre-game? Standing in a parking lot with the sun beating down on your back, relaxing with your friends: life couldn’t be better. While you may don a Giants jersey and your friend Eagles green, your pregame rituals are pretty much the same. Good food, good drinks, good times. When you enter the stadium, that’s when things start to change.

The same can be said for the difference between freezing eggs and freezing embryos. The “pre-game” part is pretty much the same—you take injectable gonadotropins (hormones) on a daily (sometimes twice daily) basis. This doesn’t change whether you are freezing eggs or embryos. Additionally, in both cases the medications and the morning visits will most likely start with the start of your period and go on for about 10 days. Therefore, in terms of the stimulation (a.k.a. the pre-game process) the two are pretty much the same. It is not until the eggs are retrieved that you run to opposite sides of the field.

If you’re rooting for team egg freeze, here’s what your game plan will look like once we start to play ball. Shortly after the eggs are retrieved, they will be evaluated for their stage of development (mature versus immature). Those that are mature will be frozen immediately. And this is where the information about your eggs and your fertility ends. You will know nothing more about your frozen friends other than quantity. We cannot tell how many will be “good” (a.k.a. make a baby) and how many will be bad (a.k.a. do nothing). But as most American possessions go, the more, the better. Women who have more eggs frozen will have a better chance of pregnancy from them in the future.

And in the blue corner, we have team embryo freezing! For those that choose to embryo freeze, after the eggs are extracted they will be fertilized with sperm. The resultant embryos will then be watched over the next several days in the laboratory. How they grow, how they divide, and how they develop is very telling for their health. Some, if not several, will drop off along the way—those that can’t hack it in the lab would definitely not hack it in the uterus.

In many ways, the lab is like the ultimate test of survival, or natural selection. At the end of the game, you may only have a few players on the field, but these players are tough, resilient, and really know how to play the game. They have weathered the storm and are your true MVPs.

In many ways, egg freezing is like drafting a player who has demonstrated potential in college but has not yet played in the big leagues. They should be good, but you can’t know for sure. It’s also hard to survey the newbies in spring training and know who and how many superstars you’ll have at the end of the season.

In the same vein, if your ovarian reserve tests are normal and there are no red flags in your medical history, you should have some good potential in your eggs. Embryo freezing is like signing a player who has already won rookie of the year. You know more about the player’s (a.k.a. embryos’) ability to hit it out of the park because they have already been vetted. Take it one step further…if your embryos undergo PGS (also called CCS or TE biopsy—the chromosomal analysis of embryos), we have even more information about their ability to make a baby. You have vetted them in the most aggressive way possible.

For many women, embryo freezing is not even an option. Unless you have a partner or chose to use donor sperm, without a sperm source, you can’t make embryos. The lack of sperm and the ability to make embryos are NOT a bad thing AT ALL! And we definitely don’t recommend using donor sperm just to make embryos and have more information about your egg quality. In these situations, egg freezing is totally the way to go! Additionally, even if you have a partner, egg freezing may be a better option for you. Not to be Debbie Downers, but nearly half of all relationships end in divorce. So be careful about who you mix your gametes with!

If you are even thinking about freezing, be it eggs or embryos, you’re being proactive. You are several steps ahead of the game. It’s like you’re planning your roster months before opening day! Either way you do it, you’re giving yourself options and choice. And that’s really why you did this in the first place. So however you get on the field, you are here to play ball—go, girl, go!