Frequently Asked Questions

IVF Quality Monitoring

  • Using a reference standard of expected live birth rate per embryo can help to adjust for day of embryo blastulation and age at oocyte retrieval. The data from “Embryo morphology and live birth in the United States” is available here:

    https://pubmed.ncbi.nlm.nih.gov/35789729/

  • Calculating the number of day 5 blastocyst equivalents per oocyte is a good performance indicator to use.

    1. Embryo quality - This is impacted by age at oocyte retrieval and if the embryo had PGT-A testing or not. Sometimes the embryo appearance after it is thawed is not optimal indicating it my not have tolerated the freeze and thaw process well. Ideally embryos grow a bit (expand) after they are thawed out. However, many embryos that look bad after thaw do implant and become healthy babies.

    2. Frozen embryo transfer protocol - The best frozen embryo transfer protocols are natural FETs, modified natural FETs without letrozole, and Hormone Replacement Therapy (HRT) protocols using daily intramuscular progesterone.

    3. Ease of embryo transfer - Is there cervical stenosis or a curvature at the uterocervical junction making embryo transfer challenging? Is there a notch, crevice, or false passage that the embryo transfer catheter is tracking to? If there is a history of cesarean delivery does the embryo transfer catheter go past the cesarean section scar easily? If embryo transfer is challenging would cervical dilation and/or hysteroscopy be helpful?

    4. Uterine anatomy - Is there a history of polyps, fibroids, septum, or adhesions? Were good views of the uterus obtained on transvaginal ultrasound, saline sonogram, hysterosalpingogram, or hysteroscopy? Is the endometrium a uniform thickness throughout or are there thin or atrophic spots?

Patient Resources

  • There is no specific reason for the variability in price of sperm from different sperm banks. Each sperm bank makes their own pricing.

  • It is easiest to purchase pre washed sperm (sperm that has been washed then frozen. Washing sperm is needed to remove dead sperm and cellular debris. If sperm is frozen unwashed then it will need to be washed after it is thawed.

    If using sperm for intrauterine insemination (IUI) typically purchasing “Washed IUI sperm” is the best option. Typically these vials will have at least 5 million total motile sperm in a volume of about 0.5mL (appropriate volume for intrauterine insemination).

    If using sperm for IVF (with ICSI or conventional insemination) typically purchasing “Washed IVF sperm” is the best option.

    For home insemination ICI (intracervical insemination) is a good option.

  • In the USA going to sart.org and clicking the “IVF Success” dropdown then “Find A Clinic” is a good option.

Research

  • There does not appear to be any instances where embryo hatching is helpful in IVF.

  • Limitations of meta-analysis include study heterogeneity, publication bias, and misclassification bias.

  • In 2015 when embryo biopsy became more widespread, loss of reproductive potential from embryo biopsy may have been as high as 30-50%. Current loss of reproductive potential from embryo biopsy is likely 0-20% but may vary by laboratory and embryologist performing the biopsy.