That’s why so many patients ask: “How many follicles are good for IVF?” 

What Is an Antral Follicle? 

Women are born with all the eggs they will ever have. Over time, that supply naturally declines until menopause.   

An antral follicle is a small fluid-filled follicle, typically 2–9 mm in diameter, that can be seen on ultrasound during your baseline appointment performed within the first five days of the menstrual cycle. These are sometimes called resting follicles because they represent the group of follicles just beginning to grow.  

Each visible antral follicle represents one egg that could potentially mature with the help of fertility medications.   

The number of resting follicles visible on ultrasound is strongly associated with the total number of remaining microscopic follicles, which contain eggs that could develop in future cycles.  

What Is an Antral Follicle Count Ultrasound? 

An antral follicle count ultrasound is a transvaginal ultrasound performed at the beginning of the menstrual cycle, usually on cycle days 1,  2, 3, or 4. 

At this point, follicles have not yet been stimulated by natural hormones, making the count more accurate. 

During the ultrasound, your provider: 

• Examines each ovary 

• Counts visible 2–9 mm follicles 

• Estimates the overall ovarian reserve and expected response to medication 

Because AFC doesn’t change dramatically from month to month, this test offers a reliable picture of ovarian function and IVF prognosis. 

Why Does AFC Matter for IVF? 

A higher antral follicle count usually means: 

• Better response to stimulation medication 

• More follicles growing to maturity 

• Higher egg yield at retrieval 

• Higher chances of success in IVF 

A lower antral follicle count often indicates: 

• Reduced response to medication 

• Lower egg yield 

• Higher chance of cycle cancellation 

• Lower overall pregnancy rates, especially after age 35 

However, AFC is not perfect. Ultrasound interpretation can vary slightly among clinicians, and IVF success depends on many factors beyond follicle count, including age, egg quality, sperm quality, embryo development, and uterine health. 

Normal Antral Follicle Count by Age 

AFC naturally declines as ovarian reserve decreases with age. Multiple nomogram studies in diverse populations demonstrate that the antral follicle count declines by approximately 0.4–0.8 follicles per year with increasing age. Exact numbers vary, but typical ranges look like this : 

Women with polycystic-appearing ovaries will have a high antral follicle count, sometimes well over 30, and often respond strongly to even low doses of medication.  

Women with very low AFC may respond weakly, even with high doses of medication, and may produce zero, or only one or two mature follicles. 

How Many Follicles is Good for IVF? 

There is no universal “perfect” number, but AFC ranges can offer useful guidance: 

These ranges are estimates, not rules. Many patients with a low resting follicular count will still conceive, and some with high counts, like those with PCOS, may produce many eggs but still require thoughtful monitoring to avoid ovarian hyperstimulation. 

The most important point: egg quantity and egg quality are not the same. 

While AFC reflects the number of potential eggs, age remains the strongest predictor of genetic normality and embryo health. 

What If My AFC Is Low? 

A low antral follicle count doesn’t automatically mean IVF won’t work. Many patients with low AFC still respond to medication and develop mature eggs. However, low AFC may: 

• Require higher medication doses 

• Increase the chances of cycle cancellation 

• Reduce the number of eggs retrieved 

• Lower the overall probability of pregnancy 

In some situations, fertility specialists may discuss modified protocols, mild stimulation, or (depending on age and goals) donor egg IVF. 

AFC, Hormone Testing, and IVF Planning 

Most clinics don’t rely on AFC alone. It is commonly paired with: 

• AMH (Anti-Müllerian Hormone) 

• Day-3 FSH 

• Estradiol 

• Clinical history and age 

Together, these labs help create the most accurate prognosis and allow providers to tailor the safest, most effective IVF medication plan. 

If you’re interested in learning more about female fertility testing or anything else about what a fertility journey can mean for you, schedule a consultation with our team today!  

Key Takeaways 

• Antral follicle count ultrasound is one of the most accurate ways to measure ovarian reserve. 

• Normal antral follicle count by age declines gradually, especially after 35. 

• How many follicles is good for IVF? Most women fall somewhere between 5–20, but there is no single “right” number. 

• A very low AFC may mean a weaker response to stimulation, while a very high AFC requires careful monitoring to avoid overstimulation. 

• AFC is most helpful when evaluated in conjunction with AMH, FSH, age, medical history, and overall fertility goals. 

Antral Follicle Count FAQ 

Can an antral follicle count improve? 

AFC usually reflects the underlying ovarian reserve, which naturally declines with age. Because of that, AFC doesn’t typically increase in a long-term or permanent way. 

However, short-term variations can happen from cycle to cycle, and some patients see slightly higher counts after lifestyle changes, treatment for hormone imbalances, or when inflammation or cysts have been remedied. But for most women, AFC remains relatively stable and is determined mainly by age and genetics. 

Does AFC predict egg quality? 

Not directly. AFC tells us how many follicles are likely to respond to stimulation, but it doesn’t measure the genetic health or maturity of the eggs. Age is still the strongest predictor of egg quality. 

For example, a 42-year-old with 20 antral follicles may produce many eggs, but those eggs are more likely to have age-related chromosomal abnormalities than those from a younger patient.  

Is antral follicle count more accurate than AMH or FSH? 

AFC and AMH are widely considered the best measures of ovarian reserve. Both can be strong predictors of IVF response. 

FSH and estradiol are still used, but they can fluctuate more from cycle to cycle, and depending on where you are in your menstrual cycle when the labs are drawn. Fertility specialists often use AFC + AMH + age together to get the clearest picture. 

What is a good antral follicle count for IVF at age 35? 

There is no perfect number, but many women in their mid-30s have around 8–15 antral follicles. 

Even women with lower counts may still respond well to medication. The number of eggs retrieved is only part of the equation; fertilization, embryo development, and embryo genetics all play major roles in determining success. 

What is a good antral follicle count at age 40? 

By age 40, it’s common for AFC to be lower, often in the 4–10 range. 

IVF success at this age depends more heavily on egg quality than egg quantity, which is why many clinics discuss options like mild-stimulation IVF, embryo genetic testing (PGT-A), or donor eggs, depending on individual goals. 

How many follicles do you need for IVF to work? 

There is no strict cutoff, but many clinics prefer to see at least 3 mature follicles growing before proceeding to retrieval. That said, successful pregnancies have been achieved with even a small number of eggs. 

A higher number of eggs increases the chances of creating healthy embryos, but quality matters more than quantity. 

Does a high antral follicle count always mean better IVF results? 

Not always. Very high AFC, especially counts above 30, can be associated with PCOS and a higher sensitivity to stimulation medications. 

These patients often respond very well, but they also require careful monitoring to avoid ovarian hyperstimulation syndrome (OHSS). With proper medication adjustment and a trigger shot designed to reduce risk, many patients still have excellent outcomes. 

Can AFC be wrong? 

AFC is considered one of the most accurate ovarian reserve tests, but it’s not perfect. 

Ultrasound interpretation can vary slightly between clinicians; ovarian cysts can obscure follicles, and the timing of the scan matters. This is why most providers repeat AFCs when needed and always interpret results alongside AMH, FSH, age, and treatment history. 

The post Antral Follicle Count: How Many Follicles Are Good for IVF? appeared first on CNY Fertility.

Good news, there is! But first . . .

Why Affordable IVF is so Important:

There are a number of factors that combine to form the perfect storm regarding the importance of affordable IVF in today’s medical landscape:

The Average Cost of IVF is Really Expensive

• The average cost of IVF is often quoted at $12,000, but that is just the price quoted by a fertility clinic for their base IVF package. Many other necessary expenses bring the true average to around $20,000 .
• IVF doesn’t work the first time for many people. The unfortunate truth is that success rates top off around 50% in the best of circumstances. In fact, some studies have found that the average person/couple seeking IVF will need more than two-cycles (with a median of two) and spend $50-60,000 on treatment .

Insurance Doesn’t Often Cover IVF 

• Despite infertility being a medical diagnosis and IVF being the best medical treatment for the diagnosis of infertility, a 2018 analysis of the IVF Insurance market by Mercer, found that 74% of Americans do not have insurance coverage for IVF .
• Even states with laws mandating IVF coverage don’t have coverage for nearly everyone. The 2020 New York State IVF insurance mandate is a good example. While it is a great leap forward, there is so much wiggle room and exceptions, that the law leaves behind nearly 50% of the population by the simple fact that many Americans don’t work for companies with over 100 employees .
• The Mercer report also confirmed a long-held assumption those with coverage were those of higher economic status. Those covered have an average salary of over $20,000 more than those without coverage.

The Average American Simply Doesn’t Make Enough to Afford IVF Priced Like a Luxury Good.

The median annual household income in the USA is roughly $63,000 with around $14,000 of discretionary income. 

The Perfect Storm for Affordable IVF

This lack of IVF insurance coverage combined with the fact that a single IVF treatment often costs more than the average American’s discretionary income causes finances to be the number one barrier to seeking fertility care. 

Fortunately, some options combine both affordable IVF pricing and financing to allow a vast majority of people the ability to pursue IVF.

CNY Fertility: One of The Cheapest IVF Clinics

Quite simply, CNY Fertility is one most affordable fertility clinics out there offering IVF for 1/3 the National Average.  We encourage you to explore our price calculator below, which conveniently calculates our pricing along with national averages.

How is affordable IVF possible?

How do we do it? This is quite possibly the most common question we get. The answer is quite simple, but not very satisfying. We do it because we can. The simple fact of the matter is IVF doesn’t need to be so expensive. Due to increases in technology, the cost to run a fertility clinic has gone down dramatically since the early days of IVF.  While doctors have benefited from this in a reduction of expenses, those cost savings have not been passed along to patients in most cases. At CNY, we BELIEVE that reproduction is a human right and will do anything we can to make it as accessible as possible.

You can learn more about our founding story, how, and why we chose to provide a more affordable option here.

Are There Hidden Costs of Affordable IVF

There are certainly some additional costs on top of our base $4,500 IVF, but our (along with nearly all fertility clinic) pricing is broken up for a good reason. Many of the other costs are either variable (like medications that depend on the protocol) or are not needed by many (like genetic testing). If a fertility clinic were to make a package inclusive of all these variables, it’s likely that many would pay a great deal for things they never needed or used.

As you can see above, our $4,500 IVF includes what is normally around $12,000. As you add more things, our price, along with the national average continues to climb.

That said, it’s important to understand what’s included in our base cost (or that of any clinic’s base cost) and all the additional costs you might encounter.

What’s Included in our $4,500 IVF

• The Egg Retrieval: This removes the eggs from the female’s ovaries.
• Anesthesia for the retrieval:  This ensures a comfortable egg retrieval surgery. It is often not included in a clinic’s base price but is included in the $12,000 national average.
• Sperm preparation: This prepares the sperm for fertilization.
• Conventional or ICSI fertilization: ICIS is an extra cost at most fertility clinics and is not included in the $12,000 national average. It has an average price of $1,500, but can be as much as $3,000.
• Assisted Hatching: Assisted Hatching is often needed to help the embryo shed its outer shell, which is needed for implantation. It is rarely included in a clinic’s base price and is not included in the $12,000 national average.
• Cryopreservation – Remember, in an IVF cycle, there are often more embryos made than can be transferred back into the woman’s uterus.
• 1 Fresh Embryo Transfer: The process of putting the embryo back into the woman’s uterus.

What’s Not Included in our $4,500 IVF – and needed by everyone (or almost everyone)

• Monitoring: Monitoring includes the ultrasounds and bloodwork needed for an IVF treatment to be timed properly and conducted safely. While it is included in the $12,000 national average, it is not included in our base price for two reasons. Many people who
• Medications: Medications are used in just about every IVF cycle, but the protocol and cost of each varies incredibly.  Medications are billed for by pharmacies.

What’s Not Included in our $4,500 IVF- and needed by only some people

• Frozen Transfer: Frozen transfers are only needed by some people, usually as a second transfer with remaining embryos, in order to do genetic testing, or in other circumstances when a fresh transfer is not medically advised.
• Preimplantation Genetic Testing (AKA Embryo Genetic Testing): It can be useful to lower the odds of miscarriage, especially for women in their late thirties and beyond, to choose the sex of the child, and to avoid known genetic disorders.
• Reciprocal IVF: Is done by lesbian (or trans male) couples and enables both partners to be biologically involved in the child creation process.
• Donor Sperm: This is used for significant male factor infertility, single or lesbian women.
• Donor Eggs: Donor eggs may be added to their cycle for those who wish to improve their odds of a live birth but would still like to try to use their own eggs if possible.
• Surrogacy: Surrogacy is used for those who, for some reason, can not carry a child.

Options for IVF Financing: Because Affordable IVF Isn’t Really Cheap at All

When considering fertility clinics and looking for affordable IVF options, one of the options many people turn to is financing. Even as one of the most affordable fertility clinics, $4,500 plus all the other costs truly is not cheap.  Even with our pricing, a majority of those paying out of pocket set up some sort of payment plan. While there are many other third-party financing options available, most find that our minimal monthly account management fee of $40/month beats any interest rate available to them for IVF financing. Additionally, CNY does not check credit scores, has a 100% approval rate, and allows you to start treatment with about $200 down.

Does the Cost of Travel Wipe out any Savings:

Many people travel to CNY from out of state and even out of the country. In fact, over 50% of our clients come from states that we don’t have offices in and over 5% from out of the country. While many low-cost IVF programs abroad require you be out of the country and away from your home and job for the entirety of the IVF treatment (roughly 3-7 weeks) our unique user-friendly travel program is guided by our team of travel nurse concierges, who help coordinate and manage most of your treatment remotely, so you only need to travel to us for the actual egg retrieval and embryo transfer.

Due to the unpredictability of retrieval and transfer days, we generally recommend buying flexible/refundable flights or even drive.

The range of travel costs varies greatly when traveling to CNY due to the significant amount of variables, including the distance being traveled and personal preferences that go into the actual travel (driving vs. flying) and local accommodation.  While it’s hard to gauge the exact cost of traveling, we recommend you take a look at our partner hotels (that you can find by going to our location pages), Airbnb, and the price of flights/gas to and from where you live. 

“Give the incredible price difference between CNY and most fertility clinics, we find that even including travel expenses most people are still able to save around $10,000 per IVF cycle”

Guarantee Programs: 

While guarantee programs are usually not inexpensive, they do offer the promise of a hefty refund should you walk away without a child at the end of some predetermined number of IVF cycles.

Our guarantee packages, the Fertile Guarantee, range from $16,000-26,000 for 6 IVF cycles, of course not including the cost of medications or genetic testing.

Odds of Walking Home With A Baby: Is an Affordable IVF Clinic Worth It?

One of the first things you probably think of when looking into cheaper IVF options is the good old saying of you get what you pay for. While it is an often true statement, we’ll show you why and how it doesn’t apply to IVF.

It’s something that’s just plain smart to look into and something we happily invite you to investigate.  You can find the success rates for the national average here and CNY Fertility here.  You will see that year after year, we are in line with the national average in every category.  Sure, some years, we may be slightly ahead in some categories and some others slightly below, but we are always near the national average.

AND as SART (the organization that collects and reports the data) explicitly warns: “Clinics may have differences in patient selection, treatment approaches, and cycle reporting practices which may inflate or lower pregnancy rates relative to another clinic.” In essence, they mean that it is common practice in reproductive medicine to have different patient qualifications or who they allow to have treatment.  At CNY, we believe true success is only achieved in helping EVERYONE achieve the family of their dreams. That means we treat a large population of people who were turned away from other clinics for their Age, AMH or FSH levels, BMI, or the number of failed cycles. While this certainly affects our success rates, it is something we are proud of and thoroughly embrace, as we believe it’s a basic human right to have access to the reproductive resources needed to start or expand one’s family.

The Largest Benefit of Affordable IVF: The Realistic Ability to Pursue Multiple Cycles

What’s the biggest benefit of pursuing IVF with a fertility clinic like CNY that offers affordable options and the ability to finance? The ability to pursue multiple cycles. Even with our great success rates, if you remember what was said above, the average person/couple needs to go through multiple IVF cycles to get pregnant or carry that pregnancy to term.  This, the ability to have two cycles for the price of one, even when factoring in all outside costs, is perhaps the single greatest thing about finding and an affordable IVF clinic.

The post Affordable IVF In USA appeared first on CNY Fertility.

Intracytoplasmic sperm injection (ICSI) is a laboratory technique used during in vitro fertilization (IVF) in which a single sperm is injected directly into a mature egg to achieve fertilization. The procedure is commonly used for male factor infertility or when fertilization may be difficult with conventional IVF.

Quick facts About ICSI IVF 

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Intracytoplasmic sperm injection (ICSI) is an advanced lab technique used during IVF to help with fertilization. 

In ICSI, a single sperm is injected directly into a mature egg, bypassing the steps the sperm normally completes to penetrate and fertilize an egg on its own.  

ICSI was originally developed to help overcome male factor infertility (such as very low sperm count or low motility), but over time, it has also become widely used in many IVF cycles, including some without clear male factor infertility.  

What is ICSI in IVF? 

ICSI is one of two main fertilization methods used in IVF: 

• Conventional IVF insemination: many sperm are placed with each egg in a dish in hopes that fertilization happens “on its own” if the sperm successfully penetrates the egg. 

• ICSI: a single sperm is injected directly into the egg to achieve fertilization.  

A helpful way to think about it is that IVF bypasses the fallopian tubes, while ICSI bypasses several of the final sperm-to-egg steps that can fail in male factor infertility.  

The ICSI procedure: step-by-step (what happens in the lab) 

ICSI is performed by an embryologist using micromanipulation tools under a specialized microscope. While exact lab workflows vary, the core steps are consistent: 

1. Egg assessment and preparation (denudation) 

Eggs are surrounded by cumulus/granulosa cells. For ICSI, labs typically remove these cells so the embryologist can confirm egg maturity and safely perform injection.  

2. Only mature eggs are injected 

ICSI is typically performed only on fully mature eggs. In the lab, embryologists often look for a small “polar body” on the egg as a sign that the egg is ready for injection. 

3. Sperm selection 

The embryologist selects sperm with the best available movement and shape from the processed specimen (or surgically retrieved sperm, depending on the case).  

4. Microinjection 

Each egg is held steady with a holding pipette while a thin injection needle passes through the zona pellucida and deposits a single sperm into the egg cytoplasm. cytoplasm.  

5. Fertilization check (the next morning) 

Eggs are assessed for normal fertilization (typically, evidence of two pronuclei), and normally fertilized eggs are cultured into embryos for transfer or freezing.  

What happens before and after ICSI? 

ICSI is not a separate treatment from IVF. It is one of the fertilization methods used in the lab during an IVF cycle. 

Most ICSI IVF cycles include: 

• Ovarian stimulation with injectable gonadotropins 

• Monitoring with ultrasound and bloodwork 

• Trigger injection 

• Egg retrieval 

• Fertilization via ICSI (or conventional insemination) 

• Embryo culture 

• Embryo transfer or embryo freezing for a later frozen embryo transfer 

When is ICSI recommended? 

ICSI is most strongly indicated when fertilization is less likely to occur with conventional insemination, especially in male factor infertility.  

CNY Fertility clinical perspective: 
 
In addition to these traditional indications, CNY Fertility uses ICSI as the standard fertilization method in the vast majority of IVF cycles. This approach reflects a clinical priority to minimize the risk of failed fertilization, which can occur even in cycles without obvious male factor infertility.

Because the procedural risks of ICSI are small and fertilization failure can be emotionally and financially devastating, CNY’s default approach favors consistency and fertilization reliability. 

At-a-glance: common indications for ICSI 

Why CNY Fertility uses ICSI as the standard of care 

Large studies show that routine ICSI does not consistently improve clinical pregnancy or live birth rates compared with conventional insemination in patients without male factor infertility. However, these same studies also show that ICSI does not reduce pregnancy or live birth rates. 

At CNY Fertility, our clinical philosophy prioritizes minimizing the risk of failed fertilization. Because ICSI significantly reduces the likelihood that otherwise healthy eggs will fail to fertilize, and because the procedure itself does not appear to negatively impact pregnancy or live birth outcomes, it is used as the standard fertilization method in IVF care. 

Unlike many clinics, CNY does not charge an additional fee for ICSI in self-pay IVF cycles. This allows ICSI to be offered as the standard of care based on risk–benefit considerations rather than cost. As a result, over 99% of IVF cycles at CNY Fertility use ICSI for fertilization. 

When conventional IVF insemination may be sufficient  

 In patients without male factor infertility, large studies and randomized trials show that ICSI does not consistently improve clinical pregnancy or live birth rates compared with conventional IVF insemination.  

Importantly, these studies also show that ICSI does not result in lower pregnancy or live birth rates compared with conventional insemination. This means that while ICSI may not improve outcomes in every patient group, it generally does not cause harm when used broadly. 

This balance, similar downstream outcomes with a lower risk of fertilization failure, is why fertilization strategies vary across clinics and why some programs, including CNY Fertility, choose to default to ICSI as a standard laboratory approach. 

Success rates: ICSI fertilization vs pregnancy outcomes 

 A common point of confusion is the difference between: 

• Fertilization rate 
• Clinical pregnancy rate 
• Live birth rate 

ICSI often achieves high fertilization rates. While higher fertilization does not automatically translate into higher live birth rates in all patient populations, evidence shows that ICSI does not reduce pregnancy or live birth outcomes compared with conventional IVF insemination.   

For many clinics, this “no harm” profile, combined with more consistent fertilization, supports the use of ICSI across a wide range of IVF cases. 

Does ICSI guarantee fertilization? 

No. Even with a technically perfect injection, fertilization can fail due to sperm decondensation (“open up inside the egg”) problems or egg quality limitations.  

Risks and limitations of ICSI 

ICSI is widely considered a safe, established IVF laboratory technique, but it has some limitations.   

Key limitations (why fertilization can still fail) 

• Egg activation failure: sometimes the egg does not initiate the intracellular steps needed to fertilize after injection. 
•  
• Oocyte quality limitations: poor egg quality (often related to age or ovarian factors) can limit survival, fertilization, and embryo development even with ICSI. 
•  
• Sperm decondensation problems: in some cases, sperm DNA may not properly decondense inside the egg, contributing to abnormal or failed fertilization. 
•  
• Sperm DNA integrity issues: ICSI can help achieve fertilization when sperm cannot penetrate the egg, but it does not automatically “repair” underlying sperm DNA damage (which can still affect embryo development).  

Safety and child outcomes 

The procedure itself is considered safe, and discussions about child outcomes focus on small absolute risks and the possibility that some risks relate to underlying infertility factors (including genetic contributors to male factor infertility) rather than ICSI alone.  

ICSI is widely considered a safe, established IVF laboratory technique. Safety discussions usually focus on two areas: 

1. Procedure-related risks to eggs and embryos 

Any micromanipulation can stress eggs, and not every injected egg will survive or fertilize, especially when egg quality is poor. 

2. Health outcomes in children conceived with ICSI 

ASRM notes that major birth defects occur in about 1.5% to 3% of naturally conceived pregnancies and that certain rare conditions have been associated with ICSI, though the absolute risks remain low. ASRM also emphasizes that some risks may relate to underlying infertility factors (including genetic contributors to male factor infertility) rather than ICSI alone. 

Cost of ICSI: national ranges vs CNY Fertility 

Many clinics bill ICSI as an add-on to IVF. At CNY Fertility, ICSI is included for self-pay patients as part of their comprehensive IVF packages.  

FAQ: ICSI 

What is ICSI? 

ICSI is a lab fertilization method in IVF where one sperm is injected directly into one mature egg to help fertilization occur.   

What is ICSI IVF? 

“ICSI IVF” usually means an IVF cycle where ICSI (rather than conventional insemination) is used to fertilize the eggs.   

What is the ICSI procedure like? 

An embryologist prepares mature eggs, selects sperm, and injects a single sperm into each mature egg using micromanipulation tools under a microscope.   

Is ICSI better than conventional IVF Fertilization? 

ICSI is not “better” across the board. It is most helpful when fertilization is unlikely with conventional insemination (especially male factor infertility). In non-male factor infertility, routine ICSI has not consistently improved live birth outcomes over conventional IVF, but does not seem to harm them either.  

ICSI: The takeaway 

 ICSI is a powerful IVF laboratory tool that makes fertilization possible when sperm cannot reliably fertilize an egg on its own. While large studies show that ICSI does not universally increase live birth rates in all patient groups, evidence also shows that it does not lower pregnancy or live birth outcomes. 

At CNY Fertility, this balance, high fertilization reliability with no demonstrated harm to downstream outcomes, is why ICSI is used as the standard of care and included in IVF treatment without additional cost. Individualized decision-making with your fertility team remains essential, but for many patients, ICSI offers consistency and reassurance during an already complex process. 

The post Intracytoplasmic Sperm Injection (ICSI) in IVF: How the ICSI Procedure Works, Who It Helps, and What to Expect appeared first on CNY Fertility.

What Causes Adhesions?

Pelvic adhesions result from inflammation, so anything that triggers inflammation can in turn cause adhesions. This includes infections (such as pelvic inflammatory disease), endometriosis, and the food we eat, but they are most often the result of gynecological pelvic surgeries including:

• myomectomy (surgery to remove fibroids)
• tubal surgery (to remove an ectopic pregnancy)
• surgery on the ovary (to remove cysts)
• surgery for endometriosis
• even surgeries to remove adhesions can lead to the formation of new adhesions

Pelvic Adhesion Symptoms:

Many people who have pelvic adhesions do not have any symptoms.  Others may experience:

• Infertility
• Abdominal cramping/pelvic pain
• Nausea
• Bloating
• Bowel obstruction

How Do Adhesions Cause Infertility?

Infertility is caused when the adhesions interrupt gamete (sperm or egg) transport and prevent them from meeting or implanting or distort the reproductive organs. The fimbria (finger-like projections of the fallopian tube) have difficulty receiving the oocyte (egg) after ovulation if adhesions block the entry point or pull the fallopian tube too far away from the ovary. Asherman’s syndrome or uterine adhesions cause infertility by preventing implantation. They are also linked to recurrent miscarriage.

Women who have adhesions are at greater risk for having infertility, recurrent pregnancy loss, and ectopic pregnancy.

How are Pelvic Adhesions Diagnosed?

Pelvic adhesions can be diagnosed via:

• Hysterosalpingogram (HSG): A test in which the uterus is visualized via x-ray as dye is introduced into the uterus through the cervix and passed through the fallopian tubes.
• Hysteroscopy: A miniature camera is inserted into the vagina to examine the cervix and inside of the uterus.
• Laparoscopy: A miniature camera is inserted through a small incision in the abdominal wall to view the abdominal organs.

How are Pelvic Adhesions Treated?

Surgical repair may be possible via an operative Laparoscopy Hysteroscopy depending on the severity and location.  IVF is another successful form of treatment for women suffering from infertility due to pelvic adhesions.

Through out-patient procedures, CNY Fertility‘s skilled surgeons are able to detect and remove adhesions, thus improving fertility and reducing discomfort.

For more information, contact us.

The post Adhesions and Infertility: Understanding the Impact and Treatment Options appeared first on CNY Fertility.

IVIG is made up of human antibodies, derived from washed and processed donor blood. It is not clear exactly how IVIG works, but studies suggest that it may reduce the amount of natural killer (NK) cells in the body, and/or may absorb or block a woman’s antibodies, which are causing the body to attack the pregnancy.

Women who have tested positive for natural killer cells and have experienced multiple miscarriages or implantation failures may opt for the use of IVIG therapy to increase their chance of conceiving and carrying a pregnancy to term.

IVIG Treatment Overview

During a treatment session, IVIG is introduced to the body very slowly through an intravenous drip in the arm, possibly taking several hours. It is recommended that IVIG be administered prior to embryo transfer and then two additional times following a positive pregnancy test.

ASRM Suggestions

Currently, ASRM suggests that IVIG therapy be considered experimental treatment because studies have reported inconclusive results on the positive effects of IVIG therapy for recurrent pregnancy loss patients.

Cost of IVIG Therapy

The primary cost of IVIG therapy is the cost of the medication itself. As of March 2023, we understand IVIG costs roughly $110 per gram, with clients needing an average of 20Gms for a total medication cost of around $2200. The nursing/infusion/administration costs can be submitted to insurance; however, IVIG therapy is seldom covered by insurance.

Please note medications are billed for and paid to medications directly, and that CNY Fertility has no control over the cost of IVIG. We are providing the above information strictly for educational purposes with the hope that some estimate is better than none.

The post IVIG Therapy appeared first on CNY Fertility.

In this article, we’ll explore the role of progesterone in IVF, how it’s administered, what your progesterone levels mean, and what to know about stopping progesterone and estrogen support after IVF.

Fast Facts: IVF and Progesterone Shots

• Why it matters: Progesterone is essential after IVF to support embryo implantation and early pregnancy.
• Progesterone levels and IVF success: Levels below 10 ng/mL may signal a higher risk of implantation failure or early miscarriage.
• Why supplementation is needed: During egg retrieval, cells that typically make progesterone are removed, and medications like Lupron and Ganirelix further suppress natural production.
• Progesterone after IVF: Can be taken as injections (progesterone shots) or vaginal options like Crinone®, Endometrin®, or Prometrium®, all equally effective.
• Estradiol and progesterone after IVF: Both hormones stabilize the uterine lining and are typically continued until 7–9 weeks of gestation.
• Stopping estrogen and progesterone: Always taper under medical supervision; temporary symptoms like mild cramping or spotting are common.
• Safety: Studies show no fetal risk from progesterone use in IVF, only mild injection-site side effects.

What Is Progesterone and Why Is It Important for IVF?

After ovulation, the corpus luteum (the structure that forms from the empty follicle after the egg is released) produces progesterone. This steroid hormone prepares the uterine lining (endometrium) to receive and nourish a fertilized embryo.

In a natural pregnancy, the corpus luteum continues to produce progesterone for approximately 8 weeks after conception, until the placenta takes over progesterone production around weeks 8–9.

If progesterone levels are too low before the placenta takes over, the uterine lining may not support implantation, or an early miscarriage could occur.

Progesterone Levels and IVF: Why Supplementation Is Needed

During IVF, eggs are retrieved from the follicles using a fine needle. This process removes the very cells that would typically produce progesterone, resulting in a luteal phase deficiency.

To make up for this deficit, progesterone supplementation after IVF is necessary. Without it, the uterine lining may not be receptive enough for implantation.

Additionally, most modern IVF protocols include gonadotropin-releasing hormone (GnRH) agonists or antagonists such as Lupron, Antagon, or Ganirelix, which suppress natural LH (luteinizing hormone) production, further reducing the body’s own progesterone levels.

That’s why nearly all IVF cycles today require progesterone support.

Types of Progesterone Used After IVF

There are two main ways progesterone is administered during IVF treatment:

1. Progesterone Shots (Intramuscular Injections)

• Injected into the muscle of the upper outer buttocks.

• Contains progesterone in oil, allowing for slow and steady absorption.

• Long considered the gold standard in the U.S. because early studies suggested better pregnancy rates than vaginal forms.

However, newer research shows no difference in IVF success rates between progesterone injections and vaginal administration.

2. Vaginal Progesterone (Gels, Tablets, or Capsules)

• Absorbed directly through vaginal tissue into the uterus.

• Common options include:

  • Crinone® (gel, once daily)

  • Endometrin® (vaginal tablet)

  • Prometrium® (micronized progesterone capsule)

• Studies confirm these are equally effective as progesterone shots for supporting early pregnancy.

Estradiol and Progesterone After IVF

In most IVF protocols, both estradiol (estrogen) and progesterone are prescribed after embryo transfer to stabilize the uterine lining.

• Estradiol supports the endometrium’s growth and helps balance hormones following ovarian stimulation.

• Progesterone transforms the endometrial tissue into a receptive environment for implantation.

Together, estradiol and progesterone after IVF play a crucial role in maintaining the early stages of pregnancy until the placenta takes over hormone production.

When to Stop Estrogen and Progesterone After IVF

Typically, progesterone and estrogen support is continued until about 7–9 weeks of gestation, when the placenta is producing sufficient hormones on its own.

Some clinics gradually taper the dosage, while others stop abruptly once lab and ultrasound confirmation of a healthy pregnancy is achieved.

Side Effects of Stopping Estrogen and Progesterone After IVF

It’s normal to worry about stopping these medications, but if done under your doctor’s guidance, it won’t harm your pregnancy.

Possible temporary effects include:

• Mild cramping

• Spotting or light bleeding

• Breast tenderness changes

• Mood fluctuations

These symptoms usually resolve quickly as your body adjusts to the placenta taking over hormone production.

What Progesterone Levels Mean After IVF

Progesterone levels and IVF success are closely linked, but levels fluctuate naturally, and a single blood test can be misleading.

Generally:

• Below 10 ng/mL in early pregnancy may suggest an increased risk of poor implantation or early pregnancy loss.

• Stable or rising levels above 10 ng/mL usually indicate healthy corpus luteum or placental support.

Your fertility team may periodically check your levels to ensure adequate supplementation.

Are Progesterone Shots Safe?

Yes. There’s no evidence that progesterone supplementation poses any risk to the fetus.

The main challenges are discomfort at the injection site, bruising, and inflammation, which can usually be minimized with warm compresses and alternating sides.

IVF and Progesterone: The Bottom Line

Progesterone plays a critical role in helping the uterus support and maintain early pregnancy after IVF. Whether administered by injection or vaginal route, supplementation is essential in almost every IVF cycle.

While progesterone shots after IVF can be mildly painful, modern alternatives like vaginal gels or tablets offer equal success rates with less discomfort. Combined with estradiol support, progesterone ensures the best possible environment for implantation and early pregnancy development.

If you’re preparing for IVF, talk with your fertility specialist about your progesterone protocol, including when to start, how long to continue, and which method best suits your needs.

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Procedures Requiring Sperm Washing

Sperm washing is important for patients planning to have an IUI. During natural conception, the vagina and cervix act as automatic ‘sperm washers,’ removing seminal fluids containing prostaglandins, which can cause cramping in the uterus. After sperm washing, the isolated motile sperm are placed directly into the uterus, bypassing the vagina and cervix, bringing the sperm into close proximity to the fallopian tubes, where eggs are fertilized.

Sperm washing is used to prepare semen samples for IVF and IVF with ICSI as well. The separation of motile sperm allows the embryologist to add the motile sperm into a petri dish, containing eggs for IVF. To fertilize eggs for patients using IVF with ICSI, each sperm is individually selected using a micro tool on a powerful microscope, and then directly injected into an egg. Removing unnecessary debris from a semen sample allows the embryologist to pick sperm easily, without clogging the micro tool.

Sperm Washing Process

After a semen sample is collected, the andrologist allows it to liquefy for approximately 20 minutes on a warmer. The sample is then assessed for sperm count, motility, progression, volume, and viscosity. Once all the parameters are determined, the semen is placed in a test tube, on top of two liquids with different densities (called a “gradient”), which will act as a filtering system.

The gradients contain silane-coated silica particles in a specific concentration. The top gradient is less concentrated than the lower gradient. The semen and gradients are then centrifuged, causing the seminal fluid to be trapped in the top layer, non-motile sperm in the middle layer, and motile sperm in a pellet at the bottom. The pellet of motile sperm is re-suspended in another liquid media, and the concentration, motility and progression of the sperm are evaluated. The sample is then ready for IUI, IVF or IVF with ICSI.

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According to multiple sources, males are solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall.   Interestingly, Dr. Magarelli states the current medical consensus is that approximately 60-70% of all cases that enter a fertility clinic are due to male factors. This is due to the fact that infertility is treated heavily at OBGYNs (a doctor for females) before being referred to a fertility clinic. Men on the other hand, are rarely treated prior to entering a fertility clinic.

Because males contribute to such a large portion of infertility cases, we highly recommend that both male and female partners (if applicable) undergo fertility testing before beginning fertility treatment.

Male fertility can easily be evaluated via a semen analysis and further examined if necessary.  Male Fertility testing can save you thousands of dollars in treatment costs and help guide you and your fertility specialist in determining proper fertility treatment.

This article will discuss all aspects of male infertility, including common causes, male fertility testing, fertility treatments, and ways to boost male fertility.  

Fast Facts

• 4-12% of men experience infertility.
• 30 million men worldwide experience infertility.  
• Male fertility can be affected by many lifestyle factors like smoking, alcohol consumption, illicit drug use (like marijuana), diet, and more.
• Fertility medications like Clomid have been shown to improve certain aspects of male fertility.
• Male fertility supplements, eating a fertility diet, and making lifestyle changes like exercise may help to boost male fertility.

What is Male Infertility?

Male infertility is defined as the inability of a male to make a fertile female pregnant after a minimum of one year of unprotected intercourse.   

How Common is Male Infertility?

4-12% of all men experience infertility; that’s roughly 30 million men worldwide.

When a couple experiences infertility, male infertility is equally as likely to be the cause as female infertility.  

Approximately 1/3 of infertility cases can be attributed to male infertility, 1/3 to female infertility, and 1/3 to unknown causes or a combination of male and female infertility.

That said, once a couple reaches a fertility clinic, it is far more common that male factors are an issue.  According to Dr. Magarelli, the current medical consensus is that approximately 60-70% of cases treated inside a fertility clinic are due in part or in full to male factors.

This is due to the fact that female infertility is heavily treated (and often successfully) at the OBGYN level before being referred to a fertility clinic. Men, on the other hand, are rarely treated prior to entering a fertility clinic.

This results in a great deal of easily managed female infertility cases being “cured” and relatively few male cases being “cured” before entering a fertility clinic.

Male Infertility Symptoms

Most men with infertility don’t experience any “symptoms” in the way we typically think of them.  The most typical “symptom” of infertility in men is the inability to conceive.  Inability to conceive is oftentimes tied to other male infertility “symptoms” like inadequate spermatogenesis (sperm production), low sperm count (number of sperm), irregular morphology (sperm shape), and impaired motility (sperm movement).

Some men’s infertility may be caused by or contributed to by an underlying health condition like an inherited disorder, dilated veins near the testicle, or blockages that prevent the passage of sperm may cause observable symptoms like the following:

• Erectile dysfunction or impaired sexual performance
• Pain or swelling in the testicles or testicular area
• Gynecomastia (abnormal breast growth)

The symptoms listed above and others associated with infertility are commonly associated with low testosterone levels or other hormonal imbalances.

What is Required for a Man to Be Fertile?

1.) Production of healthy sperm. – At least one testicle must function properly, and the body must produce hormones like estrogen and testosterone, which are required for sperm production.

2.) Sperm must be present in the semen. – The testicular tubes must function properly so that sperm can be carried from the testicles to mix with semen and be ejaculated.

3.) An adequate amount of sperm in the semen. – The lower the sperm count, the lower the chances for conception.  A minimum amount of sperm must be present in the semen to reach and fertilize the partner’s egg.

4.) Sperm must be functional and able to move. – If sperm have poor motility or morphology, they will not be able to swim correctly and reach the egg.

What Causes Male Infertility?

As mentioned above, male infertility isn’t usually caused by, but it is commonly tied to the following four main “symptoms” or issues:

• Inadequate spermatogenesis (sperm production)
• Low sperm count (number of sperm)
• Irregular morphology (sperm shape)
• Impaired motility (sperm movement)

These issues can have many different causes and contributing factors.  Male fertility issues can be caused or contributed to by all of the following:

Health and Lifestyle Causes – 

• Smoking
• Excessive alcohol consumption
• Marijuana use
• Exercise (over-exercising)
• Diet

Medical Causes – 

• Cancer
• Medication side effects
• Hormonal disorders
• Androgen insensitivity
• Androgen excess State
• Estrogen excess state
• Testicular Failure
• Congenital or developmental testicular disorder (e.g., Klinefelter syndrome)
• Testicular Trauma
• Varicocele
• Obstruction of the reproductive tract

Environmental Causes/Other – 

• Exposure to toxins
• Heat
• Radiation
• Unknown/unexplained reasons

Common Male Infertility Diagnoses

Azoospermia

Azoospermia is the medical term used to describe when there is no sperm present in a man’s ejaculate.  The absence of sperm in the ejaculate affects 15% of infertile men.

An azoospermia diagnosis has two classifications (1) obstructive azoospermia (OA) or (2) non-obstructive azoospermia (NOA).  

Obstructive azoospermia – 

OA is defined as the absence of sperm in the ejaculate despite normal spermatogenesis (sperm production). It results from obstruction at any location between the testis and the ejaculatory ducts.   

OA can be caused by infection, congenital anomalies (body structure or function abnormalities), inflammation, or past medical treatments/surgeries (like a vasectomy).  It is diagnosed through a combination of history/physical examination, laboratory testing, genetics, and imaging studies.

Oftentimes, OA can be treated through corrective surgery or vasectomy reversal.   Couples where the man has OA can get pregnant without corrective surgery by utilizing a sperm retrieval procedure and in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) IVF.  (More information on IVF and ICSI IVF is below.)

Non-obstructive azoospermia – 

NOA is defined as no sperm in the ejaculate due to failure of spermatogenesis.   It is considered the most “extreme” cause of male infertility.  NOA has been estimated to affect 1 in 100 men.

NOA is caused by a hormone abnormality that doesn’t stimulate the testis to produce sperm, or because of an intrinsic defect in the testicles.   It is identified through clinical assessment (testis consistency/volume), laboratory testing (FSH), and genetic testing (karyotype, Y chromosome microdeletion, or specific genetic testing for hypogonadotropic hypogonadism).   

Patients with NOA can also conceive using their own gametes by undergoing a sperm retrieval procedure and ICSI IVF.  Research indicates that testicular sperm retrieval is successful in up to 50% of men with NOA.

Oligospermia

Oligospermia is defined as a low or reduced count of sperm in the semen (low sperm concentration).  men with oligospermia have less than 20 million sperm per milliliter of semen.   Low sperm concentration affects 25% of infertile men.

Men with oligospermia often experience poor sperm motility and morphology, indicating poor spermatogenesis.   The vast majority of oligospermia cases are unexplained.  Still, it can be caused by endocrine dysfunction, anatomic abnormalities, medications, inflammation, or environmental exposures (toxins, heat, etc.).

Oligospermia is identifiable through a basic semen analysis, but a full work-up is required to identify the underlying cause.  First, fertility specialists will administer a physical examination, hormonal evaluation, and imaging to eliminate possible reversible factors such as hormonal deficiencies, medication effects, and retrograde ejaculation.  Then, after ruling out reversible causes, they will attempt to identify any underlying genetic syndrome through genetic testing or medical reasons through additional evaluation.  

Even after a comprehensive work-up, 60% to 75% of cases remain unexplained.

Depending on testing results, different treatments may be indicated.  Possible oligospermia treatments include:

• Medication withdrawal
• Gonadotropic therapy
• Clomiphene citrate (Clomid) treatment
• Vitamins and supplements 

For men with untreatable oligospermia, fertility treatments like intrauterine insemination (IUI), IVF, and ICSI IVF can be used to achieve conception. 

It has been reported that men with oligospermia can achieve 50-75% fertilization rates and clinical pregnancy rates of 20% per cycle when utilizing IVF with ICSI treatment.  Research indicates that after three cycles, men with oligospermia have achieved an overall cumulative live birth rate of 50%.

Asthenospermia

Asthenospermia is defined as reduced sperm motility.  Men with asthenospermia have less than 40% sperm motility or less than 32% progressive motility.   Severe asthenospermia is called teratozoospermia, which is characterized by at least 85% of sperm having abnormal morphology.   

Asthenospermia and teratozoospermia affect approximately 20% of men with infertility.  

Astheospermia is tested for by utilizing a basic semen analysis.  Asthenospermia is caused and contributed to by many different factors, including lifestyle choices, environmental factors (like toxins), sperm structural abnormalities, energy deficiencies, inflammation, oxidative stress, and other factors.

Specific supplements like carnitine, ashwagandha, vitamin C, CoQ10, and omega 3 fatty acids have been shown to support healthy sperm motility and may be used to increase sperm motility.

In one study, mean sperm motility increased by 92% from baseline after men received 2 months of vitamin C treatment.

Other natural treatments have also shown promise for improving sperm motility, like acupuncture.  Research has indicated that acupuncture can effectively improve sperm motility.

Improving sleep, reducing alcohol consumption, stopping smoking, and avoiding intense exercise have also been shown to improve sperm motility.

If asthenospermia or teratozoospermia are caused by structural abnormalities that can not be improved through natural remedies, fertility treatments like ICSI IVF may help achieve conception.

Varicocele

Varicocele is an enlargement of the veins within the scrotum that holds the testicles.   Varicocele is present in 40% of infertile men and 15-20% of all men.

Varicoceles can cause abnormal semen analysis, low sperm count, decreased sperm motility, and abnormal sperm morphology.   Men with varicocele commonly experience oxidative stress and inflammation, both of which have been associated with infertility.   

The precise cause of varicocele is unknown, but it is considered the most common correctable cause of male infertility.   Varicocele can not be treated through medicine or other natural remedies.  If the varicocele is impairing fertility or causing pain, it can be treated through outpatient surgery.  Following surgery, approximately 70% of men experience improved semen parameters, and 40% to 60% have improved conception rates.

IVF with ICSI can help men with varicocele and sperm conditions like azoospermia conceive.

Primary Testicular Failure (Hypogonadism)

Primary testicular failure (PTF), also known as hypogonadism, occurs when the testes fail to produce sperm despite adequate hormonal support.  It is a major cause of non-obstructive azoospermia and oligospermia.

Approximately 12% of male infertility cases are caused by primary testicular failure.   Primary testicular failure can be caused by testicular injury, radiation, varicocele, gene mutations, and other congenital or acquired disorders.  Kleinfelter syndrome (when a male is born with an extra copy of the x chromosome) is the most common cause of primary testicular failure.

Primary testicular failure is usually tested for after other more common causes of infertility have been ruled out.  If semen analysis results come back and indicate low sperm count or no sperm in the semen, a fertility specialist will usually ask about medical history, lifestyle, environmental exposures and then administer a physical examination, hormonal testing.  If a cause is not identified, then a testis biopsy is utilized to confirm a PTF diagnosis.

Recommended treatment for PFT depends on the underlying cause.  If PFT is caused by varicocele, then surgery may be recommended.  Otherwise, men with azoospermia and oligospermia may be able to conceive through a sperm retrieval procedure and ICSI IVF.

Male Fertility Testing

There are many types of male fertility testing available.  In almost all cases, male fertility testing starts with a semen analysis.

The Semen Analysis

A semen analysis analyzes the health and viability of a man’s sperm.  Semen analyses should be performed during a man or couple’s initial fertility consultation or evaluation. 

Semen analysis results act as a guide for determining the most effective fertility treatment.  By completing a semen analysis, men and couples can save time and thousands of dollars.  For example, if semen analysis results indicate low motility or poor morphology, the fertility specialist may recommend Intracytoplasmic Sperm Injection (ICSI) IVF as the first course of treatment instead of starting with Intrauterine Insemination (IUI) or conventional In Vitro Fertilization treatment.

Semen analyses measure all of the following (and sometimes more) to determine sperm viability :

Male Infertility Treatments

Intrauterine Insemination (IUI)

Interutinary Insemination (IUI) treatment is commonly used as a first-line treatment for cases of mild or moderate male infertility and men with ejaculate disorders.   During an IUI procedure, sperm is collected, concentrated, and deposited into a woman’s uterus. 

IUI procedures may help to overcome unexplained infertility and male factor infertility, especially for men with low sperm motility and low sperm volume.  

In Vitro Fertilization (IVF)

Research indicates that oligospermia, asthenospermia, teratozoospermia, autoimmunity, and other forms of male infertility can be successfully treated by Invitro Fertilization (IVF).   IVF treatment offers the highest success rates and quickest time to pregnancy of any Assisted Reproductive Technology (ART). 

IVF can help increase the chances of pregnancy for nearly all infertile men, but it is especially helpful for men with low sperm count, low sperm concentration, and low sperm motility. 

Intracytoplasmic Sperm Injection (ISCI)

Intracytoplasmic Sperm Injection (ICSI) is an advanced reproductive procedure done in an embryology lab during an IVF treatment.  A single sperm is injected directly into a woman’s egg to create a fertilized embryo.  ICSI procedures can be used as long as viable sperm are present in the ejaculate or retrievable from the reproductive tract. 

Research indicates that ICSI treatment can help to overcome severe male factor infertility and allow pregnancy rates up to 52%, with ongoing pregnancy and live delivery rates as high as 37% per IVF cycle attempt.

Sperm Retrieval Procedures

Sperm retrieval procedures are surgical procedures to retrieve sperm from some part of the male reproductive tract.  Sperm retrieval procedures like PESA, TESA, and TESE are used when there is no sperm present in the ejaculate.  If successful, the sperm retrieved is used with an ICSI IVF procedure.  

Sperm extraction procedures can be used after a vasectomy, if a man lacks a vas deferens, or if there is a reproductive tract blockage or insufficient sperm production.  

In one study, TESA allowed for high sperm retrieval rates for men with severe oligozoospermia (low sperm count).  In the study, sperm was recovered in 90% of men.  The recovered sperm was then used in ICSI procedures and produced results that researchers deemed “acceptable.”  In this study, the overall clinical pregnancy rate per embryo transfer was 46%.

Testicular Platelet Rich Plasma (PRP)

Testicular Platelet-Rich Plasma (PRP) is a concentrated blood product that contains a high percentage of biomolecules with natural healing and regenerative properties.  Testicular PRP is an innovative and experimental technique used on men with azoospermia (zero sperm in the ejaculate) with the goal of achieving even a small number of active sperm in the ejaculate, which can then be used for IVF with ICSI.  Here at CNY, Dr. Mariabelle Vardiales is currently conducting research to determine the efficacy of the treatment; so far, the results look promising. 

Improving Male Fertility

There are many ways to boost male fertility both naturally and with the use of fertility medications. 

Fertility Medications

Male fertility may be improved via oral medications like clomiphene citrate or Letrozole.  In addition to oral medications, male infertility can also be treated via injectable medications like human chorionic gonadotropin (hCG) or human menopausal gonadotropin (hMG).  The following medications are commonly used to improve several aspects of male fertility.  

Clomid (Clomiphene citrate)

Clomid for men is not approved by the FDA so it is prescribed off-label (as clomiphene citrate) to treat male infertility.  Clomid is especially useful for men with low sperm counts, but it can also help to improve overall male fertility by correcting hormonal imbalances and increasing testosterone production.

The American Society for Reproductive Medicine (ASRM) published a study on Clomiphene Citrate treatment’s ability to treat men with idiopathic oligozoospermia (unexplained decrease in sperm concentration or quality) and infertility.  After 6 months of treatment, the clomiphene citrate treatment group experienced a 36.7% pregnancy rate, nearly three times that of the control group (13%).

The clomiphene citrate treatment group also saw a greater increase in sperm count and progressive sperm motility when compared with the control group.  

Alternative Oral Medications

Letrozole or Femara: Letrozole is a relatively new male fertility treatment that has been demonstrated to improve sperm concentration and the testosterone to estradiol ratio for men with oligozoospermia.

Anastrazole or Arimidex: Recent research has demonstrated that Anastrazole may help to reduce testosterone levels, improve the ratio of testosterone to estradiol, and significantly improve sperm parameters for some men.

Low Dose Naltrexone (LDN)

Lod dose naltrexone (LDN) is used to reduce the symptoms of many medical conditions.  LDN is prescribed for male factor infertility due to its anti-inflammatory properties which are believed to encourage better blow flow and nutrient delivery to the developing sperm. 

New research has also indicated that LDN may be an effective treatment for men who have erectile dysfunction.

Human Chorionic Gonadotropin (hCG)

hCG has been shown to help induce testis growth, improve spermatogenesis and increase fertility in gonadotrophin-deficient men.  Men with low sperm counts and low motility may benefit from daily HCG injections.

Human Menopausal Gonadotropin

If men don’t see results after an extended period of time with hCG treatment, hMG injections may be added to their treatment protocol.  In combination, hCG and hMG have been shown to increase sperm count and motility.

Human Growth Hormone (HGH)

Research indicates that HGH may help induce spermatogenesis in men with hypogonadism who are non-respondents to gonadotropin therapy.   Growth hormone treatment has also been shown to restore sperm concentration, morphology, and motilit.

Supplements for Supporting Healthy Sperm and Male Fertility

Many different male fertility supplements have been shown to support sperm motility, count, morphology, concentration, overall sperm health, and other aspects of male fertility.  Check out some of the best vitamins and nutrients and the aspects of male fertility they support below:

• Vitamin C – sperm count, motility, and morphology
• Vitamin D – hormone production, sperm development, sperm motility
• Vitamin E – sperm motility and morphology
• Carnitine (L-carnitine) – sperm maturation and maturity, all sperm parameters but most significantly sperm motility
• Coenzyme Q10 (CoQ10) – sperm count, motility, morphology
• Folate – sperm count and sperm DNA
• Inositol – sperm motility
• Lycopene – sperm count, motility, or morphology
• Omega 3s – sperm count, motility, and morphology
• Selenium – sperm motility and morphology
• Zinc – sperm development, count, and motility

Supplements Highlights

Omega 3s – A study of over 200 men found that after 32 weeks of Omega 3 supplementation those in the treatment group saw an average total sperm count increase from 38.7 million to 61.7 million and a concentration of 15.6 million/ml to 28.7 million/ml.  

Carnitine (L-carnitine) – In a study of infertile men who took carnitine supplements for 6 months, the percentage of total motile sperm improved from 23.17% to 31.11% and the percentage of forward progressive sperm went from 14.83% to 25%.

For more information, check out our comprehensive guide on male fertility supplements!

Male Fertility Diet

At CNY Fertility, we believe that the food we eat impacts our fertility, perhaps more than any other single factor.  Based on decades of clinical experience, we recommend that men consider eating eat a high fat, moderate protein, and low carbohydrate diet (aka the ketogenic diet).  Typical keto foods include fatty meat like ribeyes, pork belly, chicken wings, lamb shoulder, etc. along with butter, heavy cream, coconut oil, and other high-quality fats.

The Ketogenic diet improves male fertility in two main ways, (1) reducing inflammation and (2) improving hormone function.

Acupuncture

Acupuncture is a medical treatment grounded in Traditional Chinese Medicine that involves using sterilized needles to stimulate certain pathways and regulate the flow of energy and blood in the body.  Acupuncture is used to treat many different diseases and symptoms.  Research has shown that acupuncture causes the brain to release opioids, the body’s natural painkillers, and other endorphins that help moderate stress.  Acupuncture is also known to help balance hormone levels.   

Specific to male fertility, acupuncture treatment has been shown to be distinctively efficacious in improving sperm quality, especially motility, when combined with traditional Western Medicine.   As mentioned above,  research indicates that acupuncture may be an effective treatment to improve sperm motility for men with asthenozoospermia.

Stress

Stress and fertility are intimately related.  Research indicates that stress may cause or contribute to male infertility, and inversely an infertility diagnosis has been shown to cause and increase stress levels.  

Stress can impact hormone production, spermatogenesis, and sperm quality.   Men’s stress levels have been demonstrated to significantly increase after diagnosis of male infertility, follow-up appointments, and failed in-vitro fertilization (IVF) treatments.

There are many different proven ways to reduce stress that men can explore. 

Yoga is a highly-touted stress-reduction technique that research indicates may cause significant reductions in stress and improvements in several other psychological health measures.

Acupuncture, as mentioned above, has been shown to reduce physiological stress immediately following treatment and over time.

Massage has been shown to reduce stress levels significantly.   Massage also offers many additional physical and psychological benefits like improving circulation, reducing muscle tension, encouraging blood flow to the reproductive organs, increasing lymphatic flow, and optimizing reproductive physiology.

Lifestyle Changes

While trying to conceive, you can make many different lifestyle changes to naturally improve your fertility.  

 Quit Smoking

Smoking negatively impacts nearly every aspect of health and negatively impacts male fertility.

For men, smoking has been associated with reduced sperm density, total sperm count, and the total number of motile sperm.

Limit Alcohol Consumption

Excessive alcohol consumption impairs men’s sperm quality.  Alcohol abuse can result in impaired testosterone production, shrinkage of the testes, sexual dysfunction, and infertility.   

Alcohol consumption can also significantly decrease sperm quality, as displayed by the figure below.

In a study on 100 alcoholics, only 12% had normal semen parameters.  Non-alcoholic men were three times as likely (37%) to have normal semen parameters.

Fortunately, stopping drinking alcohol has been demonstrated to quickly and drastically improve semen parameters for heavy drinkers.

Consider Limiting or Stopping Marijuana Use

Several studies exist that link marijuana use to poor sperm quality.   In one study conducted in 2015, men who smoked marijuana regularly (more than once per week) had a 28% lower sperm concentration and a 29% lower total sperm count compared to non-marijuana users.

It is worth noting that research is not conclusive, and contradictory studies exist indicating that marijuana does not negatively affect sperm quality.   If you have received sub-optimal semen analysis results, you may consider reducing or refraining from using marijuana while trying to conceive.  If you use marijuana for therapeutic healing or are prescribed marijuana, you should consult with your doctor to make an informed decision.  

Stop Over- Exercising

Moderate exercise is great for fertility.  On the other hand, over-exercising can reduce men’s sperm quality and impair fertiltiy.

Research has shown that exhaustive exercise can decrease thyroid hormones, testosterone levels, and overall sperm quality.

Avoid Saunas, Steam Rooms, and Hot Tubs

Heat, mainly from saunas or hot tubs, has been shown to affect sperm production and overall male fertility.  Heat stress may cause a decrease in sperm motility and increase the percentage of sperm cells with major and minor defects.  

One small study indicates that exposure to hot baths or hot tubs can lead to male infertility.

The Bottom Line about Male Infertility

If you are struggling to conceive or have been diagnosed with male infertility, we hope you know that you are not alone. 

Male fertility can be affected in many ways, including by medical, environmental, and lifestyle factors. 

Fortunately, as you’ve seen in this article, there are many available treatments to boost male fertility and fertility treatments that can help you conceive. 

Be sure to consult with your fertility specialist or if you don’t have one, schedule a virtual consultation with one of our providers to discuss your treatment options.

Now that you’ve read all about male infertility, we highly recommend checking out our comprehensive guide on how to increase sperm count, motility, morphology, and overall male fertility!

The post Male Factor Infertility appeared first on CNY Fertility.

• What it is: A condition in which the end portion of one or both fallopian tubes becomes fluid-filled and swollen, blocking egg pickup and transport
• Where it occurs: Most commonly at the fimbrial end of the tube near the ovary, preventing the ovulated egg from entering the tube
• Common cause of infertility: Tubal factor infertility accounts for about 25–35 percent of female infertility
• Diagnosis tools: Hysterosalpingogram (HSG), transvaginal ultrasound, laparoscopy
• Best treatment before IVF: Salpingectomy or proximal tubal occlusion
• IVF impact: Untreated hydrosalpinx reduces implantation rates by about 50 percent and increases miscarriage and ectopic pregnancy risk

Hydrosalpinx is a form of tubal factor infertility in which fluid becomes trapped inside a fallopian tube after infection, inflammation, or surgery damages the delicate inner lining of the tube. The word hydrosalpinx comes from Greek, where hydro means water and salpinx means tube.

Most cases occur at the fimbrial end of the tube, which is the finger-like portion near the ovary responsible for capturing the egg at ovulation. When this end becomes scarred and sealed, fluid accumulates inside the tube and the egg can no longer enter.

What Is Hydrosalpinx?

Hydrosalpinx occurs when infection, inflammation, or physical injury damages the fallopian tube lining. Scar tissue seals the end of the tube, trapping inflammatory fluid inside.

The condition may affect one tube or both. Bilateral hydrosalpinx results in complete infertility without assisted reproduction.

Even if fertilization were to occur, the swollen tube often blocks the embryo from traveling to the uterus, increasing the risk of ectopic pregnancy, a life-threatening condition in which the embryo implants inside the tube.

What Causes Hydrosalpinx?

The most common causes include

• pelvic inflammatory disease
• untreated sexually transmitted infections such as chlamydia or gonorrhea
• endometriosis
• prior abdominal or pelvic surgery
• ruptured appendix
• adhesions
• pelvic trauma
• congenital tubal abnormalities
• some pelvic tumors

Hydrosalpinx Symptoms

Many patients have no noticeable symptoms. When symptoms occur, they may include :

• pelvic or lower abdominal pain
• abnormal vaginal discharge
• discomfort during intercourse
• difficulty getting pregnant
• In some cases, ectopic pregnancy

Hydrosalpinx does not directly cause weight gain, although bloating or pelvic pressure may create a sensation of fullness.

Can Hydrosalpinx Burst?

True rupture is rare. However, severely distended tubes may leak toxic, inflammatory fluid back into the uterus. This fluid is harmful to embryos and significantly reduces implantation rates.

Can Hydrosalpinx Go Away on Its Own?

Hydrosalpinx does not resolve spontaneously. Antibiotics may treat infection, but cannot reopen a scarred fallopian tube. Once closed, the tube remains blocked unless surgically treated.

How Is Hydrosalpinx Diagnosed?

The most common diagnostic test is a hysterosalpingogram, where dye is injected through the cervix into the uterus and fallopian tubes. If the dye does not spill freely, hydrosalpinx is suspected.

A transvaginal ultrasound may reveal a dilated, fluid-filled tube, but it often misses milder cases.

Laparoscopy allows direct visualization of the fallopian tubes and is considered the gold standard diagnostic method.

Hydrosalpinx Treatment Options

Salpingectomy

Complete surgical removal of the affected tube. This is the most effective treatment prior to IVF and eliminates toxic fluid exposure.

Salpingostomy

A minimally invasive procedure that attempts to reopen the sealed end of the tube. This can restore natural fertility in select cases but carries a higher recurrence risk.

Proximal tubal occlusion

The tube is clipped or cauterized near the uterus to prevent toxic fluid from leaking backward.

Sclerotherapy

Ultrasound-guided drainage with chemical collapse of the tube. Long-term success data is limited.

Hydrosalpinx and IVF Success

Hydrosalpinx decreases IVF implantation rates by approximately 50 percent and increases miscarriage and ectopic pregnancy risk because inflammatory fluid refluxes into the uterus and interferes with embryo development and endometrial receptivity.

Removal or occlusion of the affected tube prior to IVF restores pregnancy rates to levels comparable to women without tubal disease.

Hydrosalpinx Fertility Outlook

With proper surgical management, IVF success rates in patients with hydrosalpinx become similar to those without tubal disease. Early diagnosis and treatment preserve fertility potential and dramatically improve outcomes.

FAQ

Does hydrosalpinx always cause infertility?

Often yes when both tubes are affected. Even unilateral disease reduces fertility and IVF success.

Is surgery always needed before IVF?

Most specialists strongly recommend tube removal or occlusion prior to IVF to improve implantation and live birth rates.

Can hydrosalpinx cause ectopic pregnancy?

Yes. A blocked tube increases the risk of dangerous ectopic implantation.

Will repairing the tube restore fertility?

Tubal repair may work in select cases, but IVF after salpingectomy consistently yields the best results.

Hydrosalpinx: The Bottom Line

Hydrosalpinx is a serious but highly treatable cause of infertility. Treating the condition before IVF dramatically improves pregnancy outcomes and protects long-term fertility potential.

The post Hydrosalpinx Symptoms, Causes, Treatment, and IVF Success Rates appeared first on CNY Fertility.

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The testicles are located outside of the man’s body because they need to be at a lower temperature for proper sperm production. Varicoceles cause an increase in the temperature of the testicle, which often results in lower sperm concentration and motility, and an increase in abnormal sperm shape. All of these parameters, which are observed in a routine semen analysis, contribute to a man’s infertility.

A varicocele is diagnosed by ultrasound or a Valsalva maneuver, in which the patient stands in a warm room and bears down as if having a bowel movement. As more blood is forced to the testicles, the physician is able to palpate the testicles to locate the bulging vein.

Varicoceles are treated with surgery. A urologist makes a small incision in the abdomen and locates the varicocele. The vein is then closed off, stopping its blood flow. An alternative approach is to inject alcohol or coils into the vein to stop blood flow. Both procedures are out-patient, and have a three to four day recovery period.

Results from varicocele repair vary, however studies report that 33% of men’s semen parameters improved following surgery. Approximately 30-60% of these men were able to naturally conceive within one year of their surgery. Improvements in semen parameters are visible after four months; however, if improvements are not seen within six months, additional fertility treatments may be necessary to attain a pregnancy.
Lifestyle changes also help to improve success rates before and after varicocele surgery. Eliminating smoking, recreational drugs, anabolic steroids, and alcohol improves semen parameters. Exercising and taking vitamins that have antioxidants improve sperm production as well. Lubricants should be avoided when trying to conceive.

For more information about varicoceles, ask your physician at CNY Fertility Center.

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Vitrification uses a flash-freezing methodology in which the eggs and embryos are cooled at an approximate rate of -12,000°C/min. This rapid freezing prevents the formation of ice crystals (that would cut and destroy said egg or embryo) and instead instantaneously turns the molecules making up the embryo into a glass-like lattice structure. Vitrification, as it so turns outcomes from the Latin vitreum, which means “glass”.

Slow Freezing:

Before we dive deeper into vitrification, let’s take a step back and examine the previously used slow freezing technique.

Slow freezing was successfully used to preserve human embryos for nearly 30 years, beginning in Australia in 1984.  But slow freeze technology faced a major challenge:  the need to avoid the formation of intracellular ice crystals in the fluids in the cells as the water in them turned to ice. These razor-sharp ice crystals can be deadly to cells for two reasons: (1) they can kill cells by shredding the cell membranes, and (2) as water turns to ice, expanding its volume beyond the capacity of the membrane, it can rupture the cell walls.

To solve this problem, embryos were run through different solutions of media to dehydrate the cells of water and replace it with cryoprotectants such as ethylene glycol and glycerol. Then the cryoprotected embryos were individually labeled and stored in cryopreservation straws, which were put in special freezers.

These freezers slowly (at a rate of -0.3° Celsius per minute) cooled the embryos to -35° Celsius using liquid nitrogen. Embryos were then stored in liquid nitrogen (-196° Celsius). At that extremely cold temperature, cellular activity is brought to a halt, allowing the embryos to remain viable indefinitely. By replacing the water in the cell with cryoprotectant, this “swap out” avoids or limits much of the formation of ice crystals in a cell.

Slow freezing works reasonably well for embryos and sperm, but was not as successful for eggs.  Eggs have a much larger volume of water than embryos. The large water component of an egg increases the formation of intracellular ice crystals during the freezing process, which causes degeneration.

Vitrifying eggs reduces the occurrence of intracellular ice crystals, which improves freeze, thaw, and pregnancy outcomes.

Vitrification (aka Fast Freezing):

Vitrification is a relatively new process for cryopreserving embryos, eggs, and sperm. Through vitrification, the water molecules are removed and replaced with a higher concentration of cryoprotectant than in the slow freeze method. The embryos are then plunged directly into liquid nitrogen. This drastic (-12,000° Celsius per minute) freezing changes the egg or embryo into chemical glass in milliseconds, so quickly that there is no chance for any significant ice crystals to form, thus decreasing the degeneration of cells upon thawing for embryo transfer.

Embryo Vitrification:

Patients who undergo IVF generally have several eggs collected. The eggs are then fertilized with a sperm and checked for fertilization. Fertilized eggs are called embryos. A patient may have multiple high-quality embryos available for transfer back to the uterus. A certain number of embryos can be chosen for fresh embryo transfer (usually one and not more than two), and the surplus of high-quality embryos are able to be cryopreserved for future use.

Before freezing, vitrified embryos are exposed to 5-10 times more cryoprotectant than embryos that are slow frozen.  Cryoprotectants cause hardening of the shell surrounding an embryo or egg. Once thawed and placed in the uterus, an embryo will have to escape from the shell. Assisted hatching is a procedure in which a fine laser is used to make a hole in the shell prior to transferring the embryo. This procedure helps avoid complications associated with hardening of the shell. Since the shell is a non-living part of the embryo, assisted hatching does not damage the embryo.

Many studies show survival rates of vitrified embryos to be far higher than survival rates of slow freeze embryos. According to 2019 research, pregnancy and live birth rates are better with eggs, sperm, and embryos that were frozen with vitrification .

While embryo freezing is still the preferred technique for fertility preservation (as opposed to freezing unfertilized eggs), women who don’t want to use a sperm donor may want to preserve their healthy eggs in preparation for motherhood at a later time giving them the opportunity to pursue education or careers until they’re ready to start a family.

Oocyte Vitrification:

Oocytes (unfertilized eggs) are exposed to high concentrations of cryoprotectant in a somewhat slower, multi-step approach designed so oocytes can survive freezing as well as human embryos do. The eggs are bathed in a series of cryoprotectant solutions with increasing concentrations, and when the eggs are placed in the last cryoprotectant solution, they are instantaneously frozen.

Using Frozen Embryos & Eggs

When patients decide to use their cryopreserved embryos to try for a pregnancy, the embryos are removed from the liquid nitrogen, warmed and run through solutions of media to remove the cryoprotectant and rehydrate the cells with water.

This same process is used for eggs.  Once thawed, the eggs must be fertilized using ICSI, where a single sperm is injected directly into the egg.  Regular IVF is not possible because the freezing process hardens the eggs outer membrane making it impenetrable to sperm.

Fresh vs. Frozen:

While couples once faced difficult a decision about transferring multiple fresh embryos and risking the chance of twins, triplets, or more or freezing extra embryos and risking them not surviving the freeze/thaw process, vitrification has eliminated this quandary.  With the advent of vitrification, survival rates similar to fresh oocytes and embryos can now be obtained. This has resulted in two major developments in fertility treatment:

Freezing Unfertilized Eggs:

• Clinics now have a reliable way of freezing unfertilized eggs so women can bank their eggs and thaw them for future use when they decide to have a family. This allows women to effectively stop their biological clocks, giving them time to pursue education, careers, and have a family when the time is right. It also allows women with low ovarian reserve or a cancer diagnosis to preserve eggs for future treatment as well.

IVF with Delayed Frozen Embryo Transfer:

• Pregnancy rates from frozen embryo transfers are now at the point where the success rate of frozen cycles exceeds the success rate of fresh transfers when a woman is stimulated and supplies eggs for her own IVF cycle.  The downside of stimulation in an IVF cycle is that medications used to optimize egg development can often cause a hormone imbalance that interferes with endometrial receptiveness which may make successful implantation unlikely. Doctors have found that freezing the embryos and switching to a frozen embryo transfer (FET) gives the woman’s body the chance to recover from any negative effects of the stimulation drugs, upping the odds of successful implantation and pregnancy.

What are the Risks of Egg, Embryo, and Sperm Freezing with Vitrification?

Even though vitrification is a more reliable freezing method than slow freezing with much higher survival rates, it’s still important to remember that not every frozen egg or embryo survives the warming process. Not every thawed egg will fertilize, nor will every embryo continue to develop. Just as every fresh egg or embryo does not always develop as expected, frozen eggs and embryos face the same natural limitations.

There has been some concern about the level of cryoprotectants used in vitrification and that they may have some effect on frozen cells. Researchers are always searching from ways to decrease this risk, but frozen embryos come with the advantage of being able to screen for certain genetic mutations and chromosomal abnormalities, such as trisomy 21, which causes Down’s Syndrome, and others. The ability to de-select abnormal embryos has the potential to improve live birth rates even more.

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Supta Baddha Konasana (Reclining Bound Angle Pose, also called Goddess Pose):

Viparita Karani (Legs up the wall pose):
I think this is one of the most powerful restorative poses in yoga.  It helps to calm the nervous system, while drawing life-force energy (prana) to your sexual organs as well as your heart center and brain.  This pose stimulates your ovaries, as well as your pituitary, hypothalamus, and pineal glands –  all incredibly important for proper hormone balance in the body.
Place a folded blanket two inches or so from a wall.  Sit on the blanket, lower your back to the floor,  and walk your legs up the wall until your hips are as close to the wall as you can get them.   Flex your feet and extend your arms out to the side, opening your heart center.  (If you are menstruating, do not use a blanket.)  Now breathe.  Deeply breathe and imagine the energy cascading down from your feet into your uterus and ovaries nourishing them with every breath.  Then the energy flows to your heart center and continues on to your third eye center (the space in between your eyebrows).  Imagine  the energy as a golden white light cascading down your legs, nourishing your womb, heart and third eye.  Try to hold the pose for 15 to 20 breaths.

Supta Hasta Padangusthasana variation (Also called Reclining Half Pigeon pose):
I love this pose because it helps release tight hips, and we tend to hold negative emotion and past trauma in that tightness.  This pose helps bring energy flow and circulation to the sexual organs, nourishing and healing them.
Lay on your back with your knees bent, feet on the floor hip distance apart.  Cross your right ankle on your left knee.  Now lift your bottom leg off the floor drawing your knee toward your torso. Reach through the center hole made my your legs and interlace your fingers on the back of your leg.  (If this hurts your right knee, place your foot back on the floor and breathe from here.)  Breathe deeply for 10 to 20 breaths.  Release your leg and do the opposite side.  Notice if you are holding any tension in your jaw or neck during this pose.  Breathe and relax into any tight places in the body.  Do not raise your head off the floor during this stretch.
There are also very powerful breathing techniques called Pranayama that can bring deep peace and healing to the practitioner when practiced regularly.  Find a qualified yoga instructor who can show you the proper way to do these breathing exercises before attempting them at home.

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your face wondering, “What in the world are vaginal steams and how could this possibly support my fertility?”

What is a Vaginal Steam Bath?

Vaginal steam baths, or “Bajos” (ba-hoes), as they are known in Spanish, are used to assist in the cleansing of the uterus in conjunction with the Arvigo Techniques of Maya Abdominal Therapy for the treatment of numerous female symptoms. The formulation of a vaginal steam bath consists of aromatic, cleansing herbs such as basil, calendula, lavender, oregano, yarrow or lemon balm that will penetrate into the uterine wall. The therapeutic effects of thermotherapy and aromatherapy contribute to the effectiveness of this treatment. Overall the bath aids as a uterine lavage or internal cleanse of the membranes that often accumulate incompletely flushed debris/fluids from cycle to cycle. In addition, the bath introduces healing warmth and softens and nourishes internal membranes.

When to do a vaginal steam bath?

The baths can safely be combined with either natural cycles or any cycle involving assisted reproductive technology such as IUI or IVF. Consider adding vaginal steam baths to your self-care routine if you experience painful periods, dark blood at the beginning or end of your menstrual cycle, irregular periods, fibroids, cysts, endometriosis, cervical stenosis, vaginal dryness or painful intercourse.

During a Natural Cycle:

If you are in a natural cycle, steam once within a few days after your period, and then once just before ovulation but before intercourse (we don’t want to heat up the sperm).

During a medicated ovulation induction cycle with timed intercourse or IUI:

If you are taking Clomid, steam once when you first start your Clomid medication, and then once just before ovulation but before intercourse/IUI. A side effect of Clomid may be a decrease in cervical mucous. The steam will help increase this mucous.

If you are doing an injectable IUI cycle, steam once when you first begin your stimulation drugs, and then once in the morning before your IUI procedure. Steaming before your IUI procedure helps to liquefy the cervical mucous and creates a lubricated path for the insertion of the catheter through the cervix.

During IVF:

If you are doing an In Vitro Fertilization (IVF) cycle, steam once when you first begin your stimulation drugs, and then once in the morning before your transfer. Steaming before your transfer procedure helps to create a lubricated path for the insertion of the catheter through the cervix.

During Donor Egg IVF:

If you are doing a donor egg cycle, steam once while your donor is stimulating and then once in the morning before your transfer.

How to do a vaginal steam bath – Directions:

• Obtain vaginal steam bath, available from all of our CNY Healing Arts locations. The contents of one bag of herbs is enough for 2-3 vaginal steam baths.
• In a large pot containing about a gallon of water, place the herbs. Bring to a soft boil for 5 minutes then steep for 10 minutes with the lid on. Offer prayer.
• Place the pot of water/herbs under a slatted chair, lawn chair, or even in your toilet. Sit over the pot without underwear. Be careful to make sure the water/herbs have cooled enough so that you do not burn yourself!!
• Drape yourself with a blanket from your waist down to the floor so that no cold air is introduced.
• Sit over your pot of herbal steam for approximately 20 minutes.
• The side effects of a steam may include a temporary increase in menstrual flow (more dark fluids, debris) and/or menses may start earlier that usual due to a cleansing effect.

*Vaginal steam baths are contraindicated during pregnancy!
If you have any questions, please contact Erin at emccollough@cnyhealingarts.com

By Erin McCollough, LMT RYT
CNY Fertility & Healing Arts Center, Rochester, NY
2244 East AVe, Rochester
585.244.1280

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When Does It Make Sense to See a Genetic Counselor?

If you’re pregnant or planning a pregnancy, you may want to consider genetic counseling in the following situations:

• You want to learn more about available genetic or carrier testing

• You are 35 or older and planning to conceive or are already pregnant

• You or a family member has a history of genetic disease, birth defects, intellectual disability, or learning delays

• You have a history of fertility issues, multiple miscarriages, stillbirths, or infant losses

• You and your partner are biologically related (for example, cousins)

• You belong to an ethnic group with a higher prevalence of certain genetic conditions, such as:

  • Cystic Fibrosis (Caucasian ancestry)

  • Sickle Cell Anemia (African American ancestry)

  • Tay-Sachs Disease (Ashkenazi Jewish ancestry)

• You’re considering adopting a child who may have a genetic condition

• You’re concerned about prenatal exposure to medications, drugs, chemicals, radiation, or infection

Why Timing Matters

Genetic testing can be complex and may take several weeks or months to complete. If you have concerns, don’t wait—the best time to address genetic issues is before pregnancy, when you have the most options for planning and prevention.

How to Find a Genetic Counselor Near You

You can:

• Ask your OB/GYN, fertility specialist, or primary care doctor for a referral

• Use the National Society of Genetic Counselors (NSGC) online directory to search for a certified counselor in your area: www.nsgc.org

The Bottom Line

Genetic counseling offers valuable insight into your reproductive health and can provide peace of mind when planning for a healthy pregnancy. Whether you’re beginning fertility treatment, already pregnant, or simply exploring your family’s health history, meeting with a genetic counselor can help you make informed, empowered decisions for your future family.

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Antibiotics are sometimes prescribed before or during IVF to help protect against infection and create the healthiest possible environment for embryo implantation. While not every patient will need them, in some cases, they can make a meaningful difference in preparing your body for treatment and pregnancy.

In this article, we’ll explore why antibiotics may be used during IVF, which medications are most common, and what current research says about their role in supporting a successful cycle.

Prevent Infection During IVF:

So, why are antibiotics sometimes used during in vitro fertilization (IVF)?

While IVF is generally very safe, it does carry a small risk of infection for both partners.

• For men, infection can occur at the site of sperm retrieval and may complicate healing.
• For women, procedures like egg retrieval and embryo transfer can occasionally introduce bacteria into the reproductive tract, leading to pelvic infection.

Women with a history of pelvic inflammatory disease (PID) or adnexal adhesions are at slightly higher risk of infection after egg retrieval.

However, the step that carries the most potential for infection is the embryo transfer itself. This is because the process involves gently passing a catheter through the cervix into the uterus, temporarily breaching the natural cervical mucus barrier and allowing bacteria from the lower genital tract a rare opportunity to travel upward.

Antibiotic therapy helps reduce these risks, protecting both your reproductive health and your chances of a successful implantation.

Research on Antibiotic Treatment with IVF:

Between January 2002 and April 2004, fertility specialist Dr. Attila Toth studied 52 couples who had previously experienced one or more failed IVF cycles.

His research examined the outcomes of new IVF cycles following antibiotic therapy. The results were compelling. In his conclusion, Dr. Toth noted that “a certain number of failures during IVF cycles are due to intrauterine infection that could affect the course of the pregnancy and/or the mode of delivery.”

At CNY Fertility, our goal is always to give you the best possible chance of conception and a successful cycle. For this reason, we may recommend antibiotic therapy as part of your treatment plan when it’s appropriate for your unique situation.

If you have questions about how antibiotic therapy might fit into your IVF care, please reach out to your nurse or physician during your next appointment, or call our office anytime. We’re always here to help guide and support you on your journey to parenthood.

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• Endometriomas – cysts that form in women with endometriosis, a condition in which the tissue that normally lines a woman’s uterus grows outside the uterus. These cysts can cause pain during menstruation and sexual intercourse. Endometriomas as often called “chocolate cysts” due to the color of the fluid within many of them (old dark blood).
• Ovarian cysts resulting from polycystic ovaries – sometimes the follicle that is meant to burst open and release the egg for fertilization does not and it turns into a cyst. More and more cysts can then begin to form, eventually building up all over the ovaries and possibly affecting the woman’s fertility. This is a symptom of a condition known as Polycycstic Ovary Syndrome (PCOS).

Ovarian cysts that do not affect fertility:

• Functional cysts – these are the most common type of ovarian cyst and do not cause or contribute to infertility. In fact, functional cysts indicate that all necessary, healthy processes leading to fertility are taking place. They occur during ovulation and often disappear painlessly through menstruation. However, some may rupture, twist, or bleed, possibly causing severe pelvic pain. These cannot occur during menopause.
• Cystadenomas – a cyst that develops from cells from the outer part of the ovary. They are normally not cancerous, but may need to be surgically removed. Cystadenomas can become very large and may measure 12 inches or more in diameter.
• Dermoid cysts – these contain tissue from a person’s skin, hair, teeth, or other abnormal structure, rather than fluid or blood.

If you are concerned or have questions about any of the above, please don’t hesitate to contact us. You can call us at 1.800.539.9870 or send us your questions through our message form here.

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My friends and I sat around our non-air conditioned apartment one hot summer evening in 2003.  I was just out of college, and my friends were in their last year or two of their undergraduate work.  We had the radio on and cold drinks in hand as we tried to remain as still as possible in the brutal summer heat. An ad on the radio suddenly caught our attention.  The ad was asking for women our age who were healthy to donate their eggs in order to help couples with fertility problems have families.  This ad sparked a long conversation. None of us had ever heard of this before.  We were aware of “test-tube babies” and had heard of sperm donation, but egg donation?  This was a new concept.

We, of course, immediately went online and checked out CNY Fertility’s website.  It seemed to us that we could potentially all be eligible.  All we had to do was call the fertility center, and we’d get a packet in the mail to fill out and send back.  Easy enough.  Now the question became, do we really want to do this?

From what we could understand, the process did involve shots of hormones, and the egg retrieval seemed to be a “surgery. ” And there were, of course, some other questions that we explored.  Would it be too weird to know that there is a child out there somewhere that has half of our DNA? Biologically, it would be a product of our bodies, but it wouldn’t be our child.  What if the child wanted to get in touch with us later on?  These were serious things we had to consider. 

After much deliberation, we all decided that whether or not we, as individuals, ever wanted our own families or not, it seemed silly to have the ability to help a couple have a baby and not do anything to help. Personally, I was pretty sure I never wanted children of my own, so I felt especially compelled to let another woman use my eggs if having a baby was important to her.  Hey, if I wasn’t going to use them, someone else sure should!

Of the four of us friends, three of us ended up sending in for the egg donor application. One of my friends and I filled out the application right away and sent it back.  She was immediately called to be an egg donor and ended up donating a total of five times over the next couple of years.  I never did get called during that first year, but in talking with her, I could tell that it was a great thing to do and that I was going to keep at it.  My friend loved the experience, and her enthusiasm was contagious.

Over the following years, I would reapply to be an egg donor several times.  Still nothing.  I decided to try applying one last time this past winter.  Things got busy, and I actually kind of forgot that I had applied until this week.  I received an email saying that I had been chosen by a recipient!  I was elated!  I felt like I had just won an Oscar.  Someone had picked me! I cannot wait to start the process of helping a couple become a family.  I know my role is small.  It only requires one month of my time, but in another sense, my role is huge!  I feel overwhelmed with excitement and humbled all at the same time.

Sincerely,
Diane

Diane (not her real name) has embarked on the journey of becoming an egg donor at CNY Fertility and will share her thoughts during the process in her blog here. If Diane’s journey and the stories she shares compel you to look into becoming an egg donor, we would love to get you started. The first step is to fill out our Donor Eligibility Questionnaire – click here to begin.

The First Visit:

Ok, the morning of the first visit to CNY Fertility Center to officially become an Egg Donor. Here we go!  I’m really excited about doing this, but as I pull into the parking lot of the office I start to feel nervous.  I wonder why, but then I realize that I don’t know anyone who actually likes going to a doctor’s appointment and being examined. 

The nerves continue to flutter in my stomach as I enter the office.  Then they all disappeared.  The office isn’t anything like a “normal” doctor’s office.  The waiting room is full of warm, cozy furniture, soft, relaxing music is playing, there are inspirational books lining one wall, and complimentary coffee on the other side.  I’m greeted by smiling faces who also help to put my nerves at ease.  I check in with the smiling ladies at the front desk and then take a seat on a comfortable couch near the fireplace.

Only moments later, I’m called back to an exam room.  First things first: the standard “pee in a cup” routine.  No problem there.  Painless and I’d had plenty of coffee that morning which made this part of the exam the easy part!   Next, I returned to the exam room, answered a few questions, and signed a few more pieces of paper.  My blood pressure was taken next.  Then they had to draw several vials of blood.  Blood tests were needed prior to becoming an egg donor in order to test for certain diseases, genetic and otherwise. 

The young woman explained that these tests would take about a week to ten days to process and that we’d go from there.  She said it was highly unlikely I was a carrier of any of the diseases but it was mandatory to check.  After drawing blood, it was time for the ultrasound.  A different young woman came in to do this part of the exam.  She had me lay back while she got the ultrasound ready and in less than five minutes that was done.  I was able to look at the screen while she did the ultrasound.  It was really interesting and exciting to see!   She kindly took the time to explain what we were looking at and to point out my ovaries, uterus, and even some follicles.

Everything looked good and the paperwork and blood work are all in order.  I’m anxious to get the blood test results back and excited to proceed with becoming an egg donor!

Sincerely,
Diane

The Next Step:

So I’ve received word that my blood test results all came back normal. Now I’m excitedly awaiting the next step in the process of becoming an egg donor.  I was told the recipient is completing one more test, and upon completion of that, I can begin my part of the process.  And (more exciting news), I’ve also been informed that another recipient is considering my application.  Wow! Maybe I’ll get to donate eggs twice!  But first things first, onto the next step!

After reading through the various emails I received about becoming an egg donor I really started thinking about everything that goes into this whole process.  The entire process is really making me appreciate the expression, “The miracle of birth”.  I’ve never had children so I never felt that I could fully understand the miraculous part of it until now.  Just being an egg donor and seeing the full staff of doctors, nurses, lab technicians, embryologists, people working around the clock to coordinate the timing of things with precision, and a facility wholly dedicated to this miracle of birth it makes me wonder how on earth anyone has a baby without all of this! It really is a miracle.

Until next time, I humbly await my part in the miracle of birth!

Sincerely,
Diane

The Recipient is Ready:

Today I took another step forward in the process of becoming an egg donor.  Upon arrival today, the visit began much like my last visit.  I first had to once again provide a urine sample and they also had to draw blood again.  We also had to do another ultrasound.  This time the ultrasound was done to determine if my follicles were ready to start the medications that I would be on for the next couple of weeks.  Happily, my follicles looked ready to go, and my ovaries were symmetrical in size, which meant there were no cysts present.  The presence of a cyst would, evidently, complicate the process a bit.  Luckily, everything looked great, and the nurses stepped out to determine the exact treatment plan.

A couple of minutes later, the nurse returned with a typed-up plan and a bag with the medication enclosed.  The nurses decided that I would be starting the follicle-stimulating hormones on Saturday and that my next appointment would be Monday.  Monday’s appointment would consist of another blood draw and an ultrasound.

The process of starting the medication was simple.  Once a day I would give myself a small injection in my abdomen about one inch away from my belly button.  The nurse had the “pen” (which is basically an apparatus that already contains the medication, a system for dosing it appropriately for each day, and a place for a fresh needle to attach each day).  We went over how to put a clean needle on each day (which was very easy, each needle is in its own small package and just twists into place onto the pen), then how to set the dosage (again, this was very easy; all you have to do is click the appropriate number so it lines up with the big arrow), then she explained where the injection goes, and how to put it in (at a 90-degree angle).  I will be giving myself this particular medicine at this particular dosage for one week.  This medicine will stimulate my body to produce eggs, then I will switch to taking a medicine that will tell my body not to ovulate (as this needs to be timed perfectly with the recipient), and finally, I will take a medicine that will tell my body to ovulate at the ideal time.

I came away from today’s appointment armed with new information and a bag of follicle-stimulating hormones.  The process, although made easy and as straightforward as possible by the fertility team, is a complex one.  I have to say, I give a lot of credit to couples who endure this process.  I am only getting a tiny glimpse into this as an egg donor.  I can now begin to appreciate the tenacity it takes for couples to go through fertility treatments.  And I also have to give the entire staff at the fertility center a lot of credit as well.  Their jobs are not only to deal with the technical side of hormone levels and lab tests but also the emotional side of this very personal journey.  Bravo to both the families that have gone through fertility treatments and to the fertility teams for making this difficult process as effortless as possible for the couples.

Sincerely,
Diane

Stimulating!

Since my last appointment, I have started taking the Follicle Stimulating Hormones (FSH).  I am currently on Day 3 and had another appointment today.  Let me first tell you about taking the FSH.

The nurse explained how to give myself an injection at my last appointment.  I don’t think of myself as a squeamish person so I thought this would be no problem.   But I have to admit, giving myself that first injection was more challenging (mentally!) than I had anticipated.  When a nurse gives you a shot, they chat with you, and usually, I look away so I don’t see what she’s doing.   They can distract you and it’s usually over before you even realize they’ve done it.  It’s impossible, I quickly realized, to distract yourself when you are the one giving the injection, to yourself.  The anticipation was worse than anything.  I had to psyche myself up way more than I thought.  After a deep breath and a big ONE, TWO, THREE! I realized the injection itself was painless.  As I said, the mental anguish and anticipation was way worse than the actual shot.  I felt sort of foolish afterwards for making such a big deal out of, what turned out to be, nothing!  The area of the injection (right around my belly button) was just a tad tender for a few minutes afterwards, but as of yet, I am not experiencing any side effects.  So, now that I’m on Day 3, I fancy myself the injection expert and no longer torture myself with anticipation beforehand.

I felt quite proud of that as I walked into my checkup today.  The nurse drew blood again.  But just one vial today instead of 4, which was what they drew the previous two visits.  She told me that, depending on the results of the blood test today, they may increase or decrease the dosage of FSH that I’m currently taking.  Then the second nurse came in to do the ultrasound.  The ultrasound showed that there were indeed follicles and she said they looked good.  Then we set up appointments for two days out, four days out, and seven days out.

The nurse did end up calling me a couple of hours later to tell me that we did need to increase the dosage of FSH by 75 units.  Although the follicles did look good, my estrogen levels were still a bit low.  I would take the new increased dosage and see how things looked at my next check-up in two days.

This entire experience is so educational.  I feel as if I’m taking an advanced biology course; learning about estrogen levels, follicles, injections, dosages of hormones, etc. and all within my own body!  Each day is a new fun experience and I eagerly await each new part of becoming an egg donor!

Sincerely,
Diane

Days 5-7:

Wednesday was Day 5 of being on the FSH.  I had a check-up at CNY Fertility Center.  We started out the regular way, with a blood draw to check my estrogen levels and then an ultrasound.  The ultrasound was far more interesting on this visit.  The follicles were significantly larger and actually a measurable size.  They measured about 8mm, and the nurse explained that once they were about 18-20mm the egg inside would be mature.  She said the size of mine was right on track with where they should be.  I would continue by taking the recently increased dose of FSH unless they called to tell me otherwise.  She asked how I was feeling and if I was experiencing any side effects yet.  I am happy to report that so far so good.  I do not feel that my abdomen is swollen at all and I have yet to experience any PMS symptoms (physical or emotional).  My next appointment is set for Friday, which will be day seven of taking the FSH.
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I just returned from my Day 7 check-up.  I had another blood draw and ultrasound.  The ultrasound showed a thickening of the uterine lining, which is normal and expected.  The follicles were measured and had now increased to 12mm.  Because they are getting close to maturing I was now going to also have a second shot.  This other injection, called Cetrotide, would prevent my body from prematurely ovulating.  The nurse gave me my first injection of the Cetrotide while I was there.  This is also given around the belly button area.  I have to admit, this injection did sting more than the shot for the FSH.  For the next two days, I have to administer both the FSH and the Cetrotide to myself, then I have another appointment on Monday.   I am happy to report that I am still side effect-free, although the nurse said that as my estrogen increases, the PMS-type side effects may still kick in.

This continues to be such an amazing experience.  I am learning so much and gaining a lot of perspective on what it means to couples creating families.  Just being an egg donor is an involved process and a big commitment; I can only imagine what the recipient must also go through.  Again,  I am humbled by the dedication and perseverance of couples experiencing infertility and of the fertility staff guiding them on this journey.

Sincerely,
Diane

The Home Stretch:

On Wednesday, I returned for another check-up.  The follicles were now about 16-18mm.  The doctor and nurse decided Friday would be too early for the retrieval and instead to plan on Saturday morning.  On Wednesday, I would administer the FSH and Cetrotide again. Thursday morning I was instructed to only take the FSH, and in the evening take the hormone that would now tell my body to ovulate.  Then on Friday, I don’t have to take anything, but Saturday morning I am scheduled to be in the office first thing in the morning for the surgery.  I can’t believe I’m almost done!   What a process this has been, I can’t believe I’m in the final stretch already.  I hope over the next few days I continue to feel as good as I do now, to be side effect free and that they successfully retrieve lots of eggs for the recipient!
Sincerely,
Diane

The Retrieval:

Follow Up:

Round Two:

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