Cryopreservation is the process of freezing embryos, eggs or sperm for future use.  For the purpose of this article, we are going to discuss Cryopreservation in relation to frozen embryo transfer with IVF.

Cryopreservation of embryos is done for many reasons.  Sometimes embryos are frozen during an IVF cycle because more embryos are produced than needed, so the extra embryos are frozen.  Other times there might be a disruption in an IVF cycle and the embryos are frozen for a future cycle.  If a man or woman is going to go through a cancer treatment, they can start the IVF process and have embryos frozen for future use.

When embryos are frozen, they are frozen between day one to day six after the sperm penetrates the egg.  If the quality of an embryo is poor or they are not dividing well, most clinics will not freeze them.  Depending on how far along they are in the dividing process, when embryos are thawed they will either be transferred to the woman almost immediately after they are thawed or allowed to divide for a few days before transfer takes place.  Either way they are monitored for awhile to evaluate how they are doing and whether or not they were damaged or destroyed during thawing.

Frozen embryo transfer with IVF is different than a regular IVF cycle.  There tends to be less medications involved in a frozen cycle.  Some clinics will even do a natural cycle, meaning they will monitor a woman’s hormone levels and will transfer the embryos when the time is right.  Other clinics opt to do a cycle with medications to regulate a woman’s cycle and better be able to monitor the best time to transfer the embryos.  In either case, you can expect to do progesterone injections after transfer to help with implantation.

Frozen embryo transfer is less expensive than a regular IVF cycle whether or not there are medications involved.  Reason being is there are no medications involved in follicle stimulation and no egg retrieval process.  You are basically paying for the transfer and the few medications that might be involved.

Transfer of frozen embryos is the same as transfer of embryos during a regular IVF cycle.  They are inserted into the uterus using the same methods.  Success rates for frozen cycles are almost equal to IVF without frozen embryos.  The success depends on the quality of the embryos, the reason for your fertility problems and a woman’s age, just as it does with a regular IVF cycle.  When embryos are thawed, they more than likely will not all survive to be transferred during IVF.  For this reason, most doctors opt to thaw one or two extra embryos.

While your frozen embryos are stored, you will probably have to pay a storage fee to the clinic either monthly or annually.  The fee varies from clinic to clinic.  You might also have to pay a one time freezing fee as well.

You should also discuss options for unused embryos.  Ask your clinic if they have an embryo donor program.  When we did IVF, we filled out a detailed form for what we wanted done with unused embryos.  The form even included details about what we would do if we got divorced or if one of us passed away.

The decision to freeze embryos and what to do with unused frozen embryos is a personal decision and an emotional decision.  You should discuss these issues ahead of time before you are faced with having to make the decision.  Talk with you clinic about their frozen embryo success rates.  Ask them as many questions as you need to in order to feel comfortable with doing cryopresesrvation.  For many couples, the process of cryopreservation has opened doors for options that were not available to them less than 25 years ago.  It might be the option that is right for you.

When going through IVF, your doctor will discuss many different scenarios with you.  If this doesn’t work then we’ll try this.  Then, if that doesn’t work we will try this.  It can all become over whelming and the “why and how” of each scenario often gets lost.  One of these scenarios might involve doing assisted hatching in conjunction with IVF to increase your chances of achieving pregnancy.

I had not heard about assisted hatching until after I started the fertility support group and a number of women in the group had either already done IVF with assisted hatching or were preparing to try it.  We began to do research for the group so that we would all have a better understanding of how it works.

When an embryo is forming, it has a protective layer surrounding it called the zona pellucida.  For implantation in the uterus to occur, the embryo must break through or “hatch” from the zona pellucida.

For unknown reasons, some women’s embryos have a tougher, stronger zona pellucida and need assistance in the hatching process.  Other factors also play a role in the use of assisted hatching.  Women who are over age 39 are typically recommended for assisted hatching.  Poor egg quality or quantity, poor embryo quality, a day 3 elevated FSH and previously failed IVFS also contribute to the use of assisted hatching.

There are two main techniques used to make a small hole in the zona pellucida.  Assisted hatching is typically done by laser or chemical.  The embryo is held in place and a small laser or tiny, hollow acid filled needle is used to penetrate the cell.  After the hole is made, the embryo is cleaned.  Some clinics do a direct transfer whereas other clinics will put the embryo back into an incubator for a short period of time before transfer.  The transfer occurs just as it would for IVF without assisted hatching.  Some clinics will prescribe antibiotics after assisted hatching because the embryos protective outer shell is compromised during the procedure.

A small percentage of embryos might be damaged by assisted hatching.  It should only be preformed by a qualified embryologist with experience in doing assisted hatching.  You should talk to your clinic about their success rates and you can research their embryologist to make sure that you feel comfortable with them performing the procedure.  Which assisted hatching technique is used, damage to embryos and inexperienced embryologists can all negatively affect pregnancy rates

Overall, studies have shown that assisted hatching can help improve pregnancy rates.  These studies show that IVF with assisted hatching has a higher rate of success than IVF without assisted hatching.  Assisted hatching is a relatively new procedure that gives hope to couples who would not have had the option just 15 years ago.  I would encourage you to explore more information about the assisted hatching technique and your clinic’s success rates before making a decision about using assisted hatching to make sure you feel it is right for you.

If you are considering IVF or have already started the process, your doctor has probably already discussed ICSI with you.  ICSI stands for intracytoplasmic sperm injection.  It is done to assist the fertilization process by injecting a sperm into an egg rather than letting it happen without any assistance.

ICSI is typically done when a man’s sperm sample shows low sperm count or poor mobility or motility.  Whenever any of these conditions are present, most doctors will discuss the ICSI option.  Without using ICSI there is little chance that an IVF will be successful because the sperm might not be able to penetrate the egg without assistance.  The ICSI procedure is also often used for unexplained fertility problems or if IVF has not been successful in the past.

Even if past sperm samples have not shown any fertility problems, your doctor should still discuss ICSI with you.  The sperm sample taken for the IVF procedure might show a lower count or poorer mobility or motility than past samples.  Therefore, your doctor will want to know where you stand on the issue incase the situation arises.  Some clinics will also do ICSI if only a small number of eggs were produced and retrieved to help assure success.

To do the ICSI process, a sperm sample is collected just as it is for an IVF process without ICSI.  The sperm is then washed and cleaned.  Under microscope, the embryologist will then hold the egg in place and helps the sperm penetrate the egg.  Once an egg is fertilized, the embryo is placed in an incubator until the day of transfer.

The cost of IVF with ICSI is not much higher than IVF done without ICSI.  IVF with ICSI costs an average of $1500-$2500 more depending on what clinic you are using.  Many couples are willing to pay this minimal cost as it does increase your odds of having a successful IVF procedure.

Latest studies show that children born through the use of IVF and ICSI are healthy.  In the studies, there has been a slight increase of birth abnormalities, but I must stress that this has been a very slight increase.  I would encourage you to do more research online about the clinical ICSI tests and talk to your clinic about any risks or any concerns that you might have.

For many couples, the only alternative to doing ICSI is to use a sperm donor or to do adoption.  Based on past sperm samples, your doctor should be able to discuss statistics regarding the possibility of success without using ICSI.

Of course, the decision as to whether or not to do ICSI is a personal one.  Before making a decision, it is always good to do plenty of research and weigh the positives and negatives of all your options.  Even if you have healthy sperm, you should discuss ICSI ahead of time incase you are faced with having to make this decision.  With the success rates of doing ICSI and IVF being so good even with couples with severe male fertility problems, the ICSI procedure has brought hope and choices to couples who would not have even had this option just 15 years ago.

When couples begin fertility testing at a clinic, one of the first things that the clinic will do is to do a sperm analysis on a sperm sample.  When doing this analysis they are looking for many things including sperm quantity and the motility and morphology of the sperm, also known as sperm quality.  Both the quantity and the quality of the sperm have a direct affect on the probably of achieving a pregnancy through natural means or fertility treatments.

Sperm quantity measures the number of sperm per milliliter of sperm.  Men whose sperm count measures 10 million sperm per milliliter or less have a significant less chance of achieving a pregnancy with their partner and are therefore considered to have male fertility problems.  If you are diagnosed with a low sperm count, your doctor will more than likely do more testing to see if they can discover what is causing the low sperm count.  Conditions such as vericoceles can cause low sperm count, but can be corrected with surgery.  Low sperm count can be a temporary condition.  This is why further testing is needed.

If the sperm are otherwise healthy, men with low sperm count are still good candidates for such fertility treatment as IVF.  After all, it only takes one sperm and one egg to create an embryo.  During IVF, the clinic can help the sperm penetrate the egg using the Intracytoplasmic sperm injection (ICSI) procedure.

Sperm quality is broken down into two categories.  These categories are motility and morphology.  Motility refers to how fast sperm move and what they look like when they swim, meaning can they swim in a straight line.  Men who have 60% or more sperm that move normally are not considered to have fertility problems.  If the sperm does not move in a straight line and/or moves slowly than it will have problems moving through the cervical mucous and penetrating the egg.  It could also indicate a genetic defect.  IVF procedures with ICSI have proven successful for sperm with poor motility.

Sperm morphology refers to the shape and structure of the sperm.  Sperm with poor morphology cannot fertilize the egg.  When 40% or more of the sperm has poor morphology, than the chances of achieving a pregnancy without assistance goes down.  Poor sperm morphology includes very small or large heads on the sperm, sperm with two heads, sperm with misshapen heads or sperm with tails that are kinked or curled.  Couples can still do IVF when there is poor sperm morphology, but ICSI will be necessary.  With ICSI, the doctor can choose sperm with the best morphology to inject into the egg.  Even when a majority of the sperm sample has poor morphology, the doctor may be able to find some usable sperm.

Unless the sperm analysis shows no sperm present at all, most clinics will suggest doing a procedure such as IVF with ICSI to achieve pregnancy.  Depending on the results of your sperm analysis they will be better able to discuss statistics and chances of success of various treatments.  If you know the results of your sperm analysis already, I would encourage you to do further researcher based on the numbers you have been given.

Six years ago when we embarked on our journey through the fertility process, what I knew about fertility problems was based on the experiences of the adoptive families that I met at the adoption agency where I work.  I started at the agency nine years ago and, until a few years ago, it seemed like fertility issues were still a bit hush hush.  I have always been open about our process and I knew that there were plenty of other couples going through the same thing based on the number of people I worked with doing adoption and the countless number of couples I saw at the fertility clinic.  Yet still, not very many people were talking about it out in the open.

We all know of celebrities that have adopted and we know that probably 9 times out of 10 there was some sort of fertility issues, yet we never heard anything.  Yes, I know it is a private subject and nobody else’s business, but don’t you think that we would have heard something from somebody?  Then, a few years ago things started to shift.

Fertility issues began to become not so taboo.  Celebrities like Brook Shields and Courtney Cox Arquette put a face to fertility issues.  This happened at the same time we were going through our own process and I always wanted to say “thank you” to them for being so open and honest.  Brook Shields talked openly about her IVF treatments and the emotional and physical toll they can take on you.  Courtney Cox Arquette was somewhat quieter about her miscarriages, but she still shared some of the heartache of losing a baby through miscarriage.

My question to you now is, “when did it become in vogue to have fertility problems?”  It seems that just about every TV show has some sort of fertility problem written into their script.  From Monica and Chandler on Friends to Carlos and Gabrielle on Desperate Housewives, we are seeing fertility problems pop up right and left.  One of the things that kills me with these shows is that, a majority of the time, they are written by someone who obviously has not had any fertility problems.  Like when they go to the doctor and he tells them they can’t have children…without even doing any testing!  Yes, I know that they are just TV shows and are supposed to be more entertaining than real life, but they could at least do a little research before writing about fertility issues.

My husband and I often say that we were trend setters, ahead of the pack with our fertility problems.  Back when Hollywood didn’t know about shots and IVF and the “humor” of fertility problems, we were doing our shots, taking pills and enjoying conception with doctors and nurses in the room.  We could have been poster children for what is “up and coming” like the hot new sandals for spring or sweaters for the fall.  Ah, if we had only known we could have driven the band wagon while everyone else just jumped on it.

I am thankful that there is more information about fertility issues out for the public to see now.  Education, openness and honesty is what we need to help others get through the process.  I am glad that celebrities are putting a face on fertility problems and helping to dispel some of the myths about fertility issues while letting couples know that they are not alone in what they are going through.  Unlike bad haircuts and shoulder pads this is one Hollywood trend that I can live with.