Fertility treatment can be an emotional rollercoaster. You’re likely to be ask yourself “why is it so hard for me to get pregnant?” and constantly worrying about when or if it will happen. With so many physical and mental challenges to overcome, numerous questions, scenarios, and worries are likely to be running through your head. Your partner is likely to be feeling the pressure too; perhaps you’ll be talking about it constantly, or spending every spare minute researching. This can feel overwhelming – so it is important to have some coping strategies in place. In this article, we discuss some methods for dealing with what’s to come, from IVF meditation to mindfulness techniques.

How to Prioritize Self-Care Practices for IVF: Meditation, Mindfulness, and Connecting

1. Do Something Nice for Yourself Every Week

Make treating yourself part of your routine. This is a key thing to help maintain your well-being in an emotionally challenging time. What you choose to do to treat yourself is entirely up to you – it could be reading, going to the gym, spending time with friends, a long bath, manicure, or something as simple as buying yourself a bouquet  of fresh flowers.

2. Stay Focussed on Things You Can Control

Although we hope you entered the  IVF process feeling empowered, there are many aspects of your fertility treatment that you cannot control. To take the pressure off, focus on things you can control. This could be your exercise schedule, healthy eating habits, or making sure you get enough sleep. However, it’s important to maintain balance – try not to be too restrictive.

3. Limit the Amount of Time Spent Thinking About Your Treatment

Undergoing fertility treatment can feel all-consuming due to the emotional, financial, and physical requirements, but it need not be that way. Set yourself a daily limit for the number of times you think about, discuss, or research infertility and IVF treatment. Although this can be challenging, it is important that you don’t let your fertility treatment consume every moment of your daily life.

4. Practice Mindfulness and Living in the Moment

It may sound like a cliché, but it is important to try and live in the moment. If you’re undergoing IVF, it’s likely that every possible scenario and outcome will be playing out in your head. Try to cross each bridge as it comes. This is one of the most important principles of mindfulness, which can help us stay more focused on the present moment.

5. Meditate

IVF meditation can help train your mind to redirect your thoughts and increase self-awareness. Over the centuries, people have found that meditation can help reduce stress, promote positivity, elevate moods, and encourage a healthy sleep pattern. As we all know, fertility treatment can be stressful, so when undergoing IVF meditation is a great way to manage your emotions.

6. Communication is Key

It is important to share your feelings with your partner. Fertility treatment can put a strain on your relationship, so be sure to make time for each other. Try to inject some fun and excitement into your relationship and rediscover why you fell in love in the first place.

7. Be Kind to Yourself

Remember – fertility treatment is tough. It’s totally normal to feel fine on some days and stressed, angry, orsad on others. Be kind to yourself. On the bad days, take some time for yourself. Just do what’s best for you, whether it means spending time with friends, time alone, or having a cry.

8. Know When to Ask for Help

Your fertility specialist is here to help. If you’re finding the emotional or physical challenges of fertility treatment difficult to manage, do not hesitate to reach out to them for advice or referrals to a therapist or counselor who specializes in fertility.

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If you have to undergo in vitro fertilization (IVF), you want nothing more than for it to be successful. There are so many moving parts, medications, hopes, concerns, and even fears. There’s a saying, “take it one step at a time” and in this article, we hope to take you through the IVF implantation timeline one step at a time to help educate you, empower you and prepare you for what lies ahead. We even hope you can use some of this information to speak to your doctor about potentially taking extra steps in increasing your chances of a successful outcome!

What is IVF?

The National Infertility Association defines IVF as, “a technique where a woman’s eggs and man’s sperm are combined in a special laboratory in order to create an embryo or embryos. Depending on the diagnosis and age of the woman, an embryo or embryos are transferred to the woman’s uterus through her cervix to enhance the chances of pregnancy.” Depending on your IVF protocol, the IVF implantation timeline can range anywhere from 4 to 6 weeks for one in vitro cycle. Since it was first introduced in 1978, IVF has helped conceive approximately 8 million babies around the world.

IVF Implantation Timeline: The Basics

While every cycle is different, and every IVF implantation timeline can vary, below is a basic overview of what an IVF cycle entails:

• Fertility Consultation. Before you begin any fertility treatment, you will meet with a reproductive endocrinologist who will review your medical history, any previous treatment you’ve done (including any previous IVF cycles) and any diagnosis for you or your partner have that could impact your fertility. Depending on which clinic you go to and what is included in the consultation, some initial consultations are just a conversation while some include blood work and an ultrasound.
• IVF Preparation. This will include blood work, fertility testing (both male and female), an ultrasound, infectious testing and in some cases, regulating the woman’s menstrual cycle. Your doctor will review your health and fertility history as well as your test results and put together a personalized fertility treatment plan or IVF protocol for you.
• Fertility Medication and Monitoring. Most IVF cycles are done with injectable hormones that stimulate follicular growth, as each follicle that grows on a woman’s ovary contains an egg. The goal is to produce multiple eggs in a single cycle so that they may be retrieved and fertilized to create multiple embryos. You will be monitored during stimulation as you progress through the IVF implantation timeline. Your doctor will perform regular ultrasounds and blood work to evaluate your follicle and egg development and hormone levels. This part of the timeline is the most time consuming as it involves regular doctor visits.
• The Trigger Shot, Egg Retrieval, and Fertilization. Based on your monitoring appointments, once your doctor feels your follicles have grown to a certain size indicating that the eggs are mature enough to be fertilized, he or she will advise you to take the trigger shot. They will then schedule the egg retrieval for 36 hours later. The eggs will be retrieved under light sedation and the eggs and sperm will be combined in a lab.

PGT-M and PGT-A

Also, if you and your doctor have spoken about whether Pre-implantation Genetic Testing for Monogenic Diseases (PGT-M), formerly known as PGD, and/or Pre-implantation Genetic Testing for Aneuploidy (PGT-A), formerly known as PGS, each embryo will be biopsied and a small sample from each embryo will be utilized for the genetic testing. These tests may be recommended based on your particular situation. Embryos that are tested with PGT-A and found to be chromosomally normal have a higher implantation rate and a lower chance of miscarriage, which can help improve the outcome of your IVF.

What is Implantation?

Implantation is when an embryo successfully attaches itself into the uterus, which is also known as the endometrium lining. “A window of implantation” is the span of time in which your endometrial lining is at its most optimal state to receive an embryo for implantation. An embryo needs to implant to grow and develop, which is necessary for you to sustain a successful pregnancy. According to Dr. Carlos Simon, finding the window of implantation can also be a helpful tool to improve IVF outcomes.

There is a test called Endometrial Receptivity Analysis (ERA) that can determine your personalized window of implantation. The ERA test requires an endometrial biopsy which is performed in a mock embryo transfer cycle. This sample is analyzed to determine your specific window of implantation. That way, your doctor would know the ideal time to transfer the embryo to give it the best chance of implanting in the uterus, thus giving you the best chances of achieving a pregnancy.

Your IVF Implantation Timeline: Taking it One Step at a Time

As you can see, the timeline ahead can range from a month or two to sometimes longer, but you will have a medical team, reproductive technology, and Igenomix resources to support as you throughout your IVF cycle, one step at a time.

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In vitro fertilization (IVF) is an emotionally demanding process for many couples. With so many hopes and dreams, uncertain circumstances, and lots of scientific terminology to understand, many people feel a bit lost. Educating yourself about the process is a good way to make sure you enter into your fertility treatment feeling empowered. In this article, we discuss how fertility specialists assess embryo quality while culturing embryos to blastocyst stage. We will also review how they assess a day 1 embryo, day 2 embryo, and so forth until the embryo reaches the blastocyst stage. 

How Doctors Measure Embryo Quality

As part of the IVF process, fertility specialists will assess the quality of your embryos. Many patients wonder what happens on each day of embryo development. The morphology or the grading of the embryo can help inform your physician of the chances that the embryo will result in a successful transfer.

Egg Retrieval

After your egg retrieval, an embryologist will assess each egg checking for maturity. The embryologist will remove the cumulus cells, the cells surrounding the egg that provides nourishment as it grew. Each mature egg will be fertilized. There are two different fertilization methods used today, though ICSI is used more frequently. 

• Intracytoplasmic sperm injection (ICSI) – ICSI is when one sperm cell is injected into an egg. This is the most common procedure, as it is very effective and is known to improve fertilization rates when the sperm source has poor parameters. 
• Conventional fertilization – A fertility specialist will place the egg into a culture medium containing thousands of sperm to facilitate fertilization.

Day 1 Embryo Assessment

After fertilization, the embryologist will place your eggs into the incubator; this process takes around 15 to 18 hour.. Typically, the day after fertilization (day 1) an embryologist will check to see if fertilization was successful. However, fertilization rates can vary. You may wish to ask your doctor how many eggs they anticipate to fertilize.

Day 2 Embryo Assessment

On the second day after egg retrieval, a developing embryo should consist of 2-4 cells. Most clinics do not grade the day 2 embryo as they are still just beginning to grow. If you’re curious about whether your fertility center assesses the day 2 embryo, you should consider bringing that question up with your doctor or an embryologist at your center.

Day 3 Embryo Assessment

Depending on your treatment plan, embryos may be transferred back to the uterus at day 3 or at the blastocyst stage (typically day 5 or 6). On day 3, a well-developing embryos should have 7-9 cells. Most embryology labs assign a grade to each day 3 embryo, though the grading systems used can vary from clinic to clinic.  

Day 5-6 Embryo Assessment 

A well-developed blastocyst will likely have over 100 cells and two different cell types: the trophectoderm or outer ring of cells and the inner cell mass (ICM), which is made of precursor fetal cells. An embryologist at your center will assign a grade to each blastocyst embryo.  If you are planning to utilize PGT-A or PGT-M, the embryologist will biopsy or remove approximately 2-10 cells from the trophectoderm which will be sent to the genetic testing lab. From here, the fertility specialist will select the embryos deemed the most likely to result in a successful pregnancy. These embryos will be transferred into the uterus, or saved for the future.

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Preimplantation genetic diagnosis (PGD), now referred to as preimplantation genetic testing for monogenic diseases (PGT-M), utilizes in vitro fertilization, embryo biopsy, and genetic testing to mitigate the risk to have a child with a genetic disease. As most couples know, undergoing fertility treatment is a significant investment – and with preimplantation genetic diagnosis cost is an important consideration. However, for couples at risk to have a child with an inherited disease PGD is the only way to significantly reduce the risk of conceiving a child affected by that genetic condition. In this article, we discuss the costs associated with PGD and whether your insurance plan can cover them.

Preimplantation Genetic Diagnosis: Cost and Considerations

All good fertility providers will provide you with an estimate of your preimplantation genetic diagnosis cost. Some might include PGD as part of a package, so make sure to compare breakdowns when choosing your healthcare provider. Moreover, there are lots of variables depending on your individual case. Although all couples seeking PGD will need to undergo IVF, there are other factors that will impact the cost. These include:

• The number of IVF cycles you need. Your fertility specialist will be able to provide an estimate of the price of each IVF cycle. If your doctor recommends more than one cycle, of course, the cost will be more expensive. Before choosing your provider, take a look at their success statistics.
• Embryo biopsy. Another preimplantation genetic diagnosis cost is the biopsy. Some PGD laboratories will charge per embryo, which may increase costs. However, the more viable embryos you have, the higher your chances of having a healthy pregnancy in the first cycle.
• Inheritance patterns. Some genetic conditions are autosomal dominant with a 50% chance that each child of an affected individual will inherit the disease while other conditions are autosomal recessive with a 25% chance that each child will be affected.
• Technology. Each PGD test (probe) is custom-designed for the couple or individual based on their genetic makeup. The cost of the test may depend on the disease doctors are screening for.

With Igenomix, the cost of an IVF cycle including PGD includes pre-cycle screening fees, fertility medication, the IVF procedure, and the PGD fee. In total, this will cost between $20,000 and $40,000.

Will my Insurance Cover PGD?

Within the USA, it is unusual for health insurance to cover PGD. However, some people that work for large corporations may have the procedure included in their plan. Outside of the US, some couples may be able to obtain PGD through their nationalized health care service or insurance. For example, in the UK, the Human Fertilization & Embryology Authority licenses certain conditions as eligible for PGD. Meanwhile, health insurance providers in Europe have specific restrictions and rules. For more information, contact your employer or insurance provider.

The Cost Benefits of PGD

Although PGD is a significant financial commitment, the benefits can outweigh the investment.  For many individuals at risk for children with a genetic disease, IVF with PGD is viewed as a technology that can significantly reduce the risk of having a child affected with the disease. To fully explore your options, arrange a consultation with a fertility specialist.

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Financial IVF Support

• If your insurance is through your job, speak to your Human Resources representative.Ask them about how to get IVF covered by insurance. According to this infographic created by RESOLVE, increasing feelings of company loyalty among employees may be helpful. If employees know that they have fertility benefits, they would have reduced stress and worry, as they wouldn’t have to wonder how they are going to pay for the IVF treatment they need.
• Reach out directly to the insurance company and if you know for certain that IVF isn’t covered, call and request for either an Exemption of Benefits or a formal form that’s the equivalent where you can request how to get IVF covered by insurance.
• You can also request any documentation from your doctor supporting why IVF is medically necessary for you to have a family (including any diagnostic codes, tests, and documentation. explaining why your reproductive endocrinologist is recommending in vitro fertilization).
• Speak to your accountant about whether any money you’ve spent previously can be filed under “medical” when you file your taxes.
• Look into whether or not your Flexible Spending Account (FSA) or your Healthcare Savings Account (HSA) can be used towards IVF.
• Ask your doctor and/or clinic if there are any IVF clinical trials that you qualify for that may cover either the cycle or any of the medication.
• Some clinics offer discounts to veterans or cancer survivors.  Ask you clinical team if you may apply for any discounted services.

Emotional IVF Support

Medical IVF Support

• Pre-implantation Genetic Testing for Aneuploidy formerly known as PGS on your embryos. PGS identifies the number of chromosomes in embryos, so that your doctor can select chromosomally normal embryos for transfer.  Chromosomally normal embryos are much more likely to implant and result in a healthy baby compared to abnormal embryos.
• Pre-implantation Genetic Testing for Monogenic Diseases (PGT-M), formerly known as PGD. PGT-M is available for patients who have been identified as carriers of the same condition as their partner, who have a diagnosis of a genetic condition, or who have a family history of a genetic condition that they were identified to have an increased risk of passing onto offspring.
• Endometrial Receptivity Analysis (ERA). ERA is a genetic test performed on a very small sample of a woman’s endometrium lining to determine which day would be the best day to transfer the embryo during a future frozen embryo transfer. An endometrial biopsy would be taken by your physician and then sent to a lab to be analyzed to find your specific window of implantation. This test bases your receptivity on the expression of 248 genes. The results of ERA may help your reproductive endocrinologist  schedule your frozen embryo transfer (FET) around when your endometrial lining will be at its most optimal for implantation.

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How Many Embryos to Transfer: The IVF Process in General

How Many Embryos to Transfer: Age is a factor

How Many Embryos to Transfer: How to Increase Your Success

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Up to Day 3 After Embryo Transfer

• First Day: On day 1 after the embryo transfer, the blastocyst – the cluster of cells that could become your baby – will continue to divide.
• Second and Third Day: On the second and third day, the cells will continue to divide and begin to attach to the uterus lining – this is perhaps the most crucial stage.

What to Expect After Implantation

How to Improve Chances of Implantation

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When you’re undergoing fertility treatment, you often have a heightened awareness of your body. After embryo transfer, you’ll be looking for all possible signs of good news – however, the symptoms of successful implantation can be quite subtle. After all, implantation happens quite close to when you would usually get your period, so it is easy to mistake the signs with your usual pre-menstrual pattern. In this article, we clarify the symptoms of successful implantation, so you can differentiate them from your regular cycle.

The Key Symptoms of Successful Implantation

The first stage of pregnancy is when a sperm cell fertilizes the egg cell. After this, the cells begin to divide and increase in number. After approximately five days, the embryo will reach the blastocyst stage. The blastocyst then burrows itself into the uterus wall, which is when successful implantation occurs. When implantation occurs, some women will experience symptoms. These are:

• Cramps. When the embryo implants, you might feel some discomfort. Every woman is different, so not everyone feels stomach cramps. Unlike pre-menstrual cramps, the sensation is typically mild and will only last a day or two.
• Spotting. Spotting is also known as implantation bleeding. Some women experience spotting between 10 to 14 days after conception, which is around when you will expect your period.

How to Tell the Difference Between Implantation Bleeding and Your Period

Because implantation bleeding occurs so close to when your period is due, many women think they are having a period as normal. However, there are some key differences between a menstrual bleed and implantation spotting. These include:

• Color. Menstrual blood is usually dark red, whereas spotting is either pale pink or a rusty brown.
• Clotting. Unlike menstrual blood, implantation bleeding does not clot or congeal.
• Length. Spotting is much shorter than regular menstruation, which lasts approximately 3 and 7 days. In contrast, spotting can last anything from just a few hours to about three days.
• Amount. Spotting isn’t as heavy as menstruation. For instance, during spotting it is unlikely you’ll need to wear a tampon or pad – it is more a slight pink or brown discharge that you’ll notice after you go to the toilet.

Further Signs of Successful Implantation

Implantation is the sign that your fertility treatment has been a success and you may become pregnant. However, everyone is different – so there are a few more symptoms that some women may experience. Below, we list some other symptoms of successful implantation

• Sensitive breasts. After implantation, you might find that breasts appear swollen or feel sore. This happens because of changes in your hormone levels.
• Mood swings. You might feel emotional compared to your usual self, which is also due to changes in your hormone levels.
• Bloating. Although feeling bloating usually happens before your period, it can also be a sign of pregnancy.
• Changing tastes. Pregnancy can make you adverse certain tastes or smells.
• Blocked nose. As your hormones level adjust, it can cause mucous membranes to swell. Some women also experience nose bleeds.
• Constipation. Hormonal changes can also change your digestive system, causing constipation or indigestion.

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An overview of the decisions you’ll need to make about your embryos

• If there is more than one viable embryo, how many to transfer to your womb.
• Which embryos are the best quality and most likely to result in pregnancy.

How do doctors decide how many embryos to put back in the womb?

How do specialists decide which blastocyst embryo is the best quality?

Creating the best possible chances of a healthy pregnancy

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At-Home Pregnancy Tests

POC Pregnancy Blood Tests

Which is Right for Me?

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