FAQ

Infertility is the inability to conceive a child after one year (or six months, for women over the age of 35) of regular, timed unprotected intercourse. It can affect both men and women and may result from issues with the reproductive systems of either partner.

The timeline for starting fertility treatments varies depending on how quickly certain steps are completed. One of the lengthier steps is genetic carrier screening, which typically takes about three weeks for results. After receiving those results, you’ll meet with a financial counselor and then with a nurse to finalize the next steps.

Fertility testing includes blood work, tubal patency testing, and an ultrasound. Male fertility testing includes blood work and a semen analysis. These tests evaluate an individual's or couple's ability to conceive, providing a clearer picture of reproductive health and recommended treatment.

Ovarian reserve is the number of eggs in a woman's ovaries, and is an important factor in fertility. We measure it with a blood test called Anti Mullerian hormone (AMH) and an antral follicle count on ultrasound. These parameters correlate and can predict how many eggs you have left compared to other women your age and when you can expect to experience menopause.

Anti-Müllerian Hormone (AMH) is a hormone that plays a role in the development and function of reproductive organs.

An antral follicle count (AFC) is a test that measures the number of small follicles in the ovaries to estimate a woman's ovarian reserve. It's performed using a vaginal ultrasound and can be done on any day of the cycle. Some find that early in the cycle, cycle day 1-4 is best prior to selection of the dominant follicle or egg of the month. 

Hormone Tests are important to assess a woman's fertility. These tests measure levels of hormones for ovulation. 

Ultrasound scans help see the ovaries and uterus. They can detect issues like ovarian cysts, fibroids, or structural abnormalities that might affect fertility. A transvaginal ultrasound provides a detailed view and is often used in fertility assessments.

Ovarian reserve tests measure the quantity and quality of a woman's eggs. Common tests include the AFC and AMH levels. These tests are essential for evaluating reproductive potential.

A semen analysis is the primary test for male fertility. It evaluates sperm count, motility, morphology, and volume. Abnormal results can indicate issues like low sperm count or poor sperm quality, which can affect fertility.

Hormone levels also play a crucial role in male fertility. Tests for testosterone, FSH, and LH can reveal hormonal imbalances that impact sperm production. Low testosterone levels, for example, can lead to reduced sperm count.

Genetic testing can identify chromosomal abnormalities that might affect male fertility. Conditions like Klinefelter syndrome or Y chromosome microdeletion can impact sperm production and quality.

Call us for an initial consult, complete the blood work, semen analysis, genetic carrier screen, and an ultrasound with antral follicle count. If relevant, we’ll also check if the tubes are open.

In vitro fertilization (IVF) is a type of assisted reproductive technology (ART) used to help individuals or couples conceive a child. The process involves fertilizing an egg with sperm outside the body in a laboratory setting. IVF is often used when other fertility treatments have been unsuccessful or when there are specific fertility issues such as severely low sperm counts or blocked fallopian tubes.

The success rate of IVF depends on a number of factors, however female age is the most important predictor of success. 

The average success rate of IVF on the first attempt depends heavily on female age and whether preimplantation genetic testing was done on the embryos. The success rate is about 65% live birth after transfer of a single euploid embryo.

The best age for IVF is typically under the age of 35, when egg quality is highest. After age 37, eqq quality starts to decline as do success rates. We can still have very high success in women over 40 when we incorporate genetic carrier screening. 

While IVF can be an effective treatment for infertility, it carries some risks and potential complications. Ovarian hyperstimulation syndrome (OHSS) is a potential risk from the medications and involves enlargement of the ovaries and fluid accumulation in the pelvis and abdomen.  OHSS can be prevented with frequent ultrasound monitoring visits, choice of trigger agents used to mature the eggs prior to retrieval, and use of medication called cabergaline. These risks can vary based on individual health factors and how the body responds to the treatment.in addition, the egg retrieval has the risks of anesthesia, risk of infection, bleeding or damage to organs including the bowel and bladder. These are very rare and occur <1% of the time. 

You will likely need to administer 2 injections daily for 10-12 days, with a 3rd injection started on the 6th day.The number of injections required during an IVF cycle can vary based on the individual's specific treatment plan, but it typically involves multiple injections over a period of 10-12 days.

IVF injections can cause various side effects, which may range from mild to more serious. There may be bloated, twinges of pain, or bruising at the injection site. Some experience heightened emotions, insomnia, nausea, and breast tenderness. These symptoms are temporary and most people feel back to normal when they get their menstrual cycle about 2 weeks after the egg retrieval. 

Depends on your situation, diagnosis, and family building goals.

Intrauterine insemination (IUI) is a procedure that places millions of sperm directly into the upper uterine cavity, near the entrance to the fallopian tubes. By shortening the sperm’s journey, IUI increases the chances of more sperm reaching the egg, improving the likelihood of fertilization.

The IUI process involves several steps to optimize timing and increase the chances of conception.

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1. Cycle Monitoring & Medication
2. You will report the first day of your cycle and begin taking the prescribed medications (if applicable).
3. Around Cycle Day 10 or 11 (for a Clomid/Letrozole cycle), you will come in for a mid-cycle ultrasound.
4. Mid-Cycle Ultrasound
5. A vaginal ultrasound is performed to assess:
6. Number of follicles
7. Follicle size
8. Uterine lining thickness
9. This helps determine when to take the Ovidrel (hCG trigger) injection to time ovulation accurately.
10. Trigger Shot & Insemination Appointments
11. You will be instructed on when and how to self-administer the Ovidrel injection.
12. If using a partner’s sperm, you will receive two appointments:
13. Sperm collection (if fresh sample is used)
14. Insemination procedure (IUI)

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Your provider will guide you through each step and ensure everything is timed correctly for the best possible outcome.

Medications used during IUI help stimulate ovulation and improve the chances of conception. The most commonly used medications include:

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• Oral Medications: Clomid (clomiphene citrate) or Femara (letrozole)
  • These medications increase the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) from the pituitary gland, stimulating follicle development and ovulation.
  • They can be used to induce ovulation in women who do not ovulate on their own.
  • In women who already ovulate, they can be used for superovulation, which encourages the development of 2-3 eggs to improve chances of success.
  • The choice of medication is determined by your doctor based on your individual needs.

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Clomid (clomiphene citrate) and Letrozole (Femara) are commonly used oral medications during IUI, and they may cause mild to moderate side effects, including:

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• Headaches (Tylenol is safe to use)
• Mood changes (irritability, moodiness)
• Hot flashes and night sweats
• Ovarian cysts
• Changes in cervical mucus (decreased or increased)

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⚠ Important: If you experience severe headaches or visual disturbances, contact your doctor immediately, as these can be rare but serious side effects.

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There are three main types of IUI, depending on the level of medication used:

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• Injectable IUI – Uses hormone injections to stimulate the development of multiple eggs.
• Natural Cycle IUI – Involves little to no medication, relying on the body’s natural ovulation.
• Medicated IUI – Uses oral medications (such as Clomid or Letrozole) to stimulate the development of 2-3 eggs.

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Your doctor will determine the best approach based on your individual needs and fertility goals.

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IUI is a generally safe and low-risk procedure, but potential risks include:

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• No response to medication – In some cases, the ovaries may not respond to stimulation, and the cycle may need to be adjusted or repeated.
• Cycle cancellation – If the ovaries over-respond and produce too many follicles, the cycle may need to be canceled to prevent complications.
• Multiple pregnancy – While our goal is a healthy, singleton pregnancy, there is a small risk of multiples.
  • Risk of twins with Clomid/Letrozole is ~5-8%
  • Risk of triplets with Clomid/Letrozole is ~1%
  • Multiples have a higher risk of preterm delivery and complications of prematurity
• Ovarian hyperstimulation syndrome (OHSS) – In rare cases, fertility medications may cause the ovaries to over-respond, leading to bloating, discomfort, and fluid retention.
• Mild cramping or spotting – Some women experience light cramping or spotting after the procedure.
• Infection (rare) – Though uncommon, there is a small risk of infection from the catheter used during IUI.

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Your doctor will carefully monitor your cycle to minimize these risks and ensure the safest possible approach for treatment.

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IUI is a quick and simple procedure, usually taking just a few minutes. Most people find it feels similar to a Pap smear, with minimal discomfort.

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Step-by-Step Process:

1. Specimen Verification – Your clinician will show you the sperm sample, labeled with your name and the name of your partner or sperm donor, to confirm accuracy.
2. Speculum Placement – A speculum is inserted into the vagina to allow access to the cervix.
3. Catheter Insertion & Sperm Transfer – A thin, flexible catheter is passed through the cervix and into the uterus, where the sperm is released.

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After the procedure, you may rest briefly before resuming normal activities. Your provider will advise you on any next steps or follow-up care.

The two-week wait after IUI can feel long and emotional, but there are ways to manage stress and take care of yourself during this time.

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Ways to Cope:

• Focus on self-care – Treat yourself by doing things you enjoy the most.
• Practice relaxation techniques – Try guided imagery, meditation, or breathing exercises to stay calm.
• Protect your emotional well-being – Consider limiting the number of people you share your journey with and decide how you want to update them.
• Communicate with your partner – Set aside time to talk about your feelings and agree on how you’d like to receive the news about the cycle.
• Plan ahead for all outcomes – Let your partner know what support you’ll need if the result isn’t positive. [Link to embryo transfer article]

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This is a challenging time, but surrounding yourself with support and prioritizing emotional well-being can help make the wait more manageable.

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If you are using frozen donor sperm, you will need to call our Thaw Hotline the morning of your IUI to authorize the thawing process before your procedure.

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Important Steps:

• You must call the Thaw Hotline by 9:00 AM on the day of your IUI. If you do not call, the lab will not thaw your specimen.
• Leave a voicemail with the following details:
  • Full name
  • Date of birth
  • Sperm source (include either your male partner’s full name and DOB or the sperm donor ID/name)
  • Time of your IUI procedure

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After confirming your call, you will come in for your scheduled insemination.

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I’m taking Ozempic – how does this affect my fertility treatment?

If you are planning to conceive, you should stop taking Ozempic at least 2 months before pregnancy.

If you are not trying to conceive but undergoing an egg retrieval for elective egg freezing, you must discontinue Ozempic at least 2 weeks before the procedure due to anesthesia risks.

For more details, see our journal article, "Does Ozempic affect fertility? What you need to know.".

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At Collab, the BMI cutoff for safely performing an egg retrieval at our surgery center is 45, based on our anesthesiologist’s policies and procedures. However, there is no BMI cutoff for IUI.

Maintaining a healthy weight before pregnancy can support the best outcomes for both mother and baby. We partner with nutritionists and therapists to provide guidance and support. If you are planning IUI and have a BMI over 45, we also require a consultation with maternal-fetal medicine specialists to review potential risks and ensure the safest approach for your care.

The cost of fertility treatment varies depending on the procedure and your insurance coverage. In general, IUI starts at $3,600, while IVF begins at $20,000. We recommend scheduling an initial consultation to discuss your options and create a personalized treatment plan.

Egg and embryo freezing are both ways of collecting and storing our gametes so that they can be later used to initiate a pregnancy.

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Both start out with an egg retrieval process, where eggs are collected from the ovaries. In the case of egg freezing, mature eggs are frozen. They are later thawed and then fertilized before being implanted into the uterus of the person who is aiming to become pregnant.

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With embryo freezing, the mature egg is fertilized using sperm from a partner or sperm donor, and then frozen. When it’s time for implantation, the embryo is thawed and then transferred.

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The main difference between egg and embryo freezing is whether the egg gets fertilized now, or later.

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Similar to IVF, you will take hormone injections (usually for 10-12 days) to stimulate the ovaries to produce multiple mature eggs, rather than the single egg released during a natural menstrual cycle.

Once the eggs are mature, they are retrieved through a minor surgical procedure. A needle is inserted through the vaginal wall into the ovaries to collect the eggs.

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The retrieved eggs are checked for maturity as only mature eggs have the ability to be fertilized. Mature eggs are then frozen using a process called vitrification. This involves rapidly freezing the eggs in liquid nitrogen which prevents the formation of ice crystals that could damage the eggs. The eggs can then be stored indefinitely until the woman decides to use them. At Collab, we store everyone’s gametes on site in large tanks that have multiple alarms and a back up generator.

Ideally, the best age to freeze your eggs is under the age of 35 when egg quality is highest. However, even if you are older, you should schedule a consultation to learn more about your success rates and options. We have had pregnancies from women who froze eggs in their 40s so it is never too late. At Collab, we strive to individualize treatment because we know everyone's family building goals are unique. If you are still single and unsure when you plan to start a family, we would recommend scheduling a consultation to start the conversation and do ovarian reserve testing.

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The other good news is your uterus doesn't age the same way as our eggs so we allow the transfer of an embryo up until age 55! As long as you are healthy enough to carry a pregnancy.

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For women under 35, the chance of a live birth is about 90% if you froze 20 mature eggs.

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The older you freeze your eggs, the lower the probability of live birth. For example, freezing 20 mature eggs at age 38 has about a 70% chance of live birth. This is because our egg quality starts to decline more rapidly after age 36. The cumulative success rate requires freezing a larger number of eggs (15-25 or more) to achieve a similar chance of live birth as younger women. You can use this calculator to estimate your chance of live birth based on the number of mature eggs retrieved.  

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Here is a helpful graph which stratifies your probability of a live birth by age and the number of mature eggs frozen.

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Similar to egg freezing, the age of the egg has a big impact on whether the embryo is chromosomally normal. Once we hit our mid 30s, egg quality sharply declines and so does the quality of embryos.

One advantage of embryo freezing is that we can test the embryo with preimplantation genetic testing for aneuploidy (PGT-A) to determine the genetic makeup of the embryo, including sex. A euploid, or chromosomally normal embryo has a 65% chance of live birth. If your family goals are 2 kids, we would recommend freezing 3-4 euploid embryos.

Egg freezing is the best option for people who don’t have a partner or sperm donor. Some of our patients are partnered with someone they are unsure they want to have kids with, so they opt for egg freezing.

Embryo freezing is a good choice for people who are partnered with the person they would like to conceive with, and/or are using donor sperm to conceive.

• Embryo freezing is only an option if you have a partner or a sperm donor.
• Even if you are currently partnered, you can still choose to freeze your eggs instead of embryos.
• You can also opt for both options, where you freeze some eggs and some embryos.

For more information, check out our journal article, "Should I freeze my eggs or embryos?"

While egg freezing is considered safe, it carries some risks and potential complications. Risks occur less than 1% of the time and can include ovarian hyperstimulation syndrome (enlargement of the ovaries and fluid accumulation in the pelvis and abdomen), risks of anesthesia, infection, and bleeding related to the egg retrieval procedure. Typically, over 95% of eggs survive the thaw, depending on the age when they were frozen.

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Rest assured, our dedicated and compassionate team will be with you every step of the way, prioritizing your safety, comfort, and care throughout the process.

There is no expiration date once eggs/embryos are frozen in liquid nitrogen. There have been pregnancies after 10+ years of storage. See study on long term egg / embryo storage.

There are several methods for preserving fertility through egg freezing, sperm freezing, and embryo freezing. This can be done electively or before medical treatments that may cause infertility such as chemotherapy or radiation therapy.

Yes, freezing your eggs is an excellent option to help preserve your fertility if you have cancer. Cancer treatments such as chemotherapy and radiation are gonadotoxic and can cause premature menopause and infertility.

The cost depends on whether you have insurance coverage. Even if you don’t have insurance, we have excellent self pay rates. Our team can discuss the costs with you and help you determine if your insurance plan will help cover them. We are currently in network with Cigna, United Health Care, and partner with Carrot Fertility and we have special discounts for first responders, teachers, and military families.

Genetic carrier screening is a type of genetic test used to determine whether an individual carries a copy of a gene mutation that could lead to a genetic disorder in their children. These mutations are typically recessive, meaning a person can carry one mutated gene and not have the disorder, but if both parents are carriers, there is a ¼ (25%) risk of their child inheriting the disorder.

Preimplantation genetic testing (PGT) is a screening test that can check embryos for genetic or chromosomal abnormalities. The goal of PGT is to reduce the risk of miscarriage or transferring an embryo with a genetic condition.

PGT-A

• PGT A (preimplantation genetic testing for aneuploidy) is a test that checks embryos for chromosomal abnormalities, also called aneuploidy prior to embryo transfer. 

PGT-M

• PGT M (preimplantation genetic testing for monogenic diseases) is a test that analyzes embryos for conditions caused by single gene mutations. One of the most common examples is Cystic Fibrosis. . It's used to help prevent passing on the inherited condition to the next generation.

PGT-SR

• PGT-SR (preimplantation genetic testing for structural rearrangements) is a test to detect structural chromosomal abnormalities in embryos before implantation. This testing ensures that only balanced or euploid embryos are selected for transfer. This condition often occurs in couples with recurrent pregnancy loss. 

• Genetic Carrier Screening: This test looks for genetic conditions inherited from your parents that you may pass on to your child.
• Preimplantation Genetic Testing (PGT-A): This test checks for chromosomal abnormalities in the embryo, such as Down syndrome (trisomy 21), which occur spontaneously and are often related to maternal age rather than inheritance.

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