The Latest 2017 Zika Virus Update

zikaupdate185pxThe scientific community’s understanding of Zika transmission and the impact on pregnancy are constantly evolving. This is our latest Zika virus update.

What we know about Zika virus:
• Zika virus can be passed from a pregnant woman to her fetus.
• Zika infection during pregnancy can cause a birth defect called microcephaly and other severe fetal brain defects.
• Many people who are infected with Zika have no symptoms, or their symptoms are mild. When symptoms are present, they include fever, rash, joint pain, muscle pain and red eyes.
• Zika primarily spreads through infected mosquitoes, but the virus can also be transmitted sexually. This is possible even if the infected person does not have any symptoms.
• There is no vaccine to prevent Zika or medicine to treat it.
• Testing for Zika is not universally available and is not always covered by insurance. Routine testing is not currently recommended for women who are not pregnant. Testing is also not recommended for men who may have been exposed to Zika virus unless they have clinical symptoms of infection (fever, rash, joint pain, muscle pain and red eyes). This is because accuracy of the test in people without symptoms is unknown, and results might be difficult to interpret. False positive tests result in avoidable stress and expense, and false negative tests provide incorrect reassurance, possibly leading to inadvertent fetal exposure to Zika virus.

Zika and Infertility Treatment
There have been no reported cases of Zika virus transmission through assisted reproductive technology (ART), but Zika virus has been detected in semen, and sexual transmission has occurred. Therefore, it may be possible to transmit the virus through the use of donated eggs, sperm or embryos. With this in mind, RHS is following FDA guidelines for both anonymous and directed egg donation

These guidelines state that donors will be considered ineligible if they have any of the following risk factors:
1. Medical diagnosis of Zika infection in the past 6 months
2. Residence in, or travel to, an area with active Zika transmission within the past 6 months
3. Sex within the past 6 months with a male who is known to have either of the risk factors listed in items 1 or 2

Any couple planning to conceive through fertility treatment should follow these guidelines:
• Before planning any travel, check the CDC’s travel website for areas with Zika risk.
• Please consider avoiding nonessential travel to areas with a CDC Zika travel notice. If you must travel, talk to your doctor before your trip.
• If you do travel to a CDC Zika travel notice area, it is important that you take steps to prevent mosquito bites
• If a woman visits a Zika travel notice area, she should wait at least 8 weeks before attempting pregnancy. During this waiting period, the couple should use condoms or should abstain from intercourse.
• If a man visits a Zika travel notice area, he should wait at least 6 months before attempting pregnancy. During this waiting period, the couple should use condoms or should abstain from intercourse.
• If either has had an active Zika infection, wait 6 months after its onset to attempt conception. During this waiting period, use condoms or should abstain from intercourse.

The CDC will continually update guidance as new information becomes available. RHS physicians remain educated about new developments and will relay this information to patients as it becomes available.

CDC Fertility Treatment

CDC Attempting to get pregnant

FDA: Donor Screening Recommendations to Reduce the Risk of Transmission of Zika Virus by Human Cells, Tissues, and Cellular and Tissue-Based Products

ASRM Guidance for Providers

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Tax Time Tips for Deducting Medical Expenses-Updated for the 2016 Tax Year

It’s tax season (collective groan!), but one silver lining may be the possibility of deducting irs_logo_0_1444394444[1]medical expenses, including expenses related to fertility treatment. According to the IRS guidelines for 2016 filing, “You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 10% of your adjusted gross income (AGI).” When you are in fertility treatment, you can reach that 10% quickly. We recommend consulting with your tax accountant and referring to IRS Publication 502 for the most accurate advice and information.

You will have to itemize deductions when you file. Here are some tips for getting the most out of that deduction!

  • Receipts are the key! Save them all and make sure they are itemized. Keep receipts you may think you don’t need; sometimes you can be surprised at what is deductible. Hang onto your receipts for 7 years in the event that the IRS has questions. RHS and some pharmacies can print you an itemized yearly receipt for your records.
  • Keep a detailed log or diary throughout the year instead of trying to reconstruct it a year later. Note each date of service, the reason for that service and your mileage to the physician’s office, pharmacy or clinic. (Mileage reimbursement for 2016 is $0.19 per mile, down from $0.23 per mile in 2015). Don’t forget tolls, parking, and other travel expenses. Log your prescription medication expenses also.
  • You can include some insurance premiums, but “You can’t include in medical expenses insurance premiums that were paid and for which you are claiming a credit or deduction.” (Publication 502, page 8). These are usually employer based premiums, but read Publication 502 for the very detailed instructions on insurance premiums.
  • Remember that expenses paid through your HSA or FSA are NOT deductible. You already received a tax credit by establishing these plans (Publication 502, page 16).
  • Expenses that can be deducted: copays and deductibles, IUI and IVF expenses, sperm and egg temporary storage fees, diagnostic services, lab fees, “surgery, including an operation to reverse prior surgery that prevented the person operated on from having children”, prescription medications for which you were not reimbursed through insurance, travel expenses such as mileage and lodging, acupuncture, counseling and psychologist fees. Pregnancy test kits are also deductible, as are smoking cessation program costs. Don’t forget to track ALL of your medical expenses, not just those fertility related. Don’t forget your dental expenses too. Deductions are listed on Publication 502, pages 5 through 15.
  • Spouse’s and dependents‘ medical expenses may also be deducted, depending on how you are filing.

Don’t forget you can amend last year’s return if you were unaware or forgot to itemize your medical expenses. Link to Form 1040X on the IRS website for more information. Tax filing, just like fertility treatment, is unique to the individual. Consult your tax professional for advice on the best method for you to file.

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What Does Infertility Treatment Cost?


Approximately one in ten couples will experience difficulty conceiving due to infertility, but with appropriate diagnostic evaluation and treatment, many may achieve their dream of having children.  Treating infertility can be an expensive undertaking, but our team at Reproductive Health Specialists can discuss treatment cost and provide financial planning options to meet your specific needs. By providing comprehensive and complete fertility services on site, we are able to maintain very competitive fees. RHS Financial Counselors can assist patients by exploring available insurance coverage, reviewing financial payment options for treatment and costs and helping patients select the best payment options available for their treatment plan.

We participate with several insurance plans. RHS is contracted with most plan products from UPMC, out-of-state and Highmark Blue Cross/Blue Shield, Aetna, United Healthcare, and Cigna. Benefits vary widely and are often employer based. Because these plans are selected by your employer, it is important to call and get specific information about coverage, and in some cases to obtain authorization, before you begin treatment. Our financial counselors will work with you to help determine your covered services. You can use our worksheet to assist you in determining your benefits when you contact your insurance carrier.

Our highly-trained, full-time financial department offers one-on-one financial consulting with patients in order to review all treatment costs. We provide this general estimate to patients (All prices provided are based on current pricing available. Please check with your financial counselor to verify that no pricing changes have occurred.  Medication cost not included.):

  • Initial physician consultation: $125 – $250*
  • Intrauterine Insemination: $295 – $1,200**
  • IVF – Individual cycle: $12,250 – $14,000**

*Depending on time spent.
**Depending on individual treatment plans.

Unfortunately, IVF is a costly procedure that is often excluded from coverage by health insurance plans.  Due to this lack of coverage by insurers, infertility patients are left with the financial burden of infertility treatments with no assurance of conceiving. To help you with this struggle, RHS offers two innovative cost-sharing programs   where we share some of the financial risk of IVF.  These initiatives were the first of their kind in western Pennsylvania.  There are extensive details about these plans on our website. In addition, we offer a discount structure for patients who opt to pay for each cycle individually. All of these plans can help you reduce some of your financial stress related to treatment.  Each program allows you to:

  • Identify a finite cost for treatment
  • Pursue treatment(s) that give you the best chance of success
  • Significantly reduce the out-of-pocket cost if treatments are unsuccessful, allowing you the option of pursuing adoption, if you so desire.

RHS can also provide information for financing through a banking institution that RHS has developed an affiliation. The Hebrew Free Loan Association of Pittsburgh provides interest free loans for permanent residents of Allegheny County.  For more details about HFLA, and the assistance they provide, visit their website.

Allow us to help ease your financial stress. If you have any questions for our financial counselors, please feel free to contact us.  They will return your call or you can make an appointment to come in to the office to discuss your questions.

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Is It OK to Get a Flu Shot While Pregnant or Trying to Conceive?

It’s time for a refresher since our first flu shot blog. People often ask us whether it’s safe to get a flu shot while pregnant or trying to conceive. The answer is a very big Yes! Not only is it ok — it’s important that you do it, and it’s not too lateflu-shot.

In past years, peak flu season has been from December through March, and it sometimes lasts as late as May. If you haven’t received your flu shot yet, you still have time to build immunity.  It only takes about two weeks to make antibodies after receiving the flu vaccine.  These powerful antibodies can then be passed on to your developing baby and protect your newborn baby for up to six months.

Antibodies can also be passed on to your child via breast milk. All of this is important because babies under six months of age are too young to receive the flu shot. Strongly encourage caregivers and family who come into contact with your baby to receive the flu vaccine also.

Pregnant women are considered to be at high risk for developing flu-related complications. “Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness from flu, as well as to hospitalizations and even death. Pregnant women with flu also have a greater chance for serious problems for their developing baby, including premature labor and delivery.” (

The flu shot has been given to millions of women over the years and has not been shown to harm either women or their unborn babies.  It is safe to receive at any time during pregnancy, although the flu mist nasal spray vaccine is not recommended in pregnancy.  In the 2015-2016 flu season, only half of pregnant women received the flu vaccine and this was a significant leap from the 2007-2208 flu season. (

Do your part to protect you and your unborn baby.  Don’t wait until the peak of flu season.


Source: The CDC website.

For more information link here

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Dr. Kubik Lectures on the History of IVF. Watch It Here!

picture1Incredible strides have been made in the brief history of IVF! On October 14, 2016 Dr. Kubik was honored to speak at the 41st Annual Magee Alumni Day of the Department of Obstetrics, Gynecology and Reproductive Sciences.  Dr. Kubik delivered the Dr. David Katz Minimally Invasive Lecture, entitled, “The History of In-Vitro Fertilization-We Have Come a Long Way”.

In her lecture, she discusses the history of IVF from the 1981 birth of Elizabeth Carr, the first IVF baby born from a US IVF program, to the over 5 million IVF babies there are today.  She also addresses the contribution IVF has made to the understanding of follicle development, egg fertilization and embryo development.  Finally she explains the application of lessons learned from IVF to the diagnosis and treatment of couples experiencing infertility.

This is a great lecture for getting some background information on IVF and you certainly don’t need to be a doctor to understand it.  Link here or visit our YouTube channel to see it in its entirety.

Please be aware, most couples experiencing infertility issues will not need IVF.  In 2014, the latest year with data available, 33,866 IVF babies were born, less than 1% of all US births. Contact Us if you want more information about treatment options.


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IUI Basics

Photo courtesy of WebMD

Photo courtesy of WebMD

Many prospective patients are concerned that if they visit RHS this means they will need to commit to IVF to achieve a pregnancy. But, there are less invasive and less expensive therapies available.  One of the most common is intrauterine insemination (IUI).   In this procedure, during your fertile window, a concentrated volume of sperm is placed in the uterus using a thin catheter that fits easily through the cervix.

IUI is a fertility treatment most commonly used to treat male factor infertility, such as low sperm count or low motility.  Donor insemination may also be chosen by single women in the absence of a male partner, same sex female couples seeking to have a child, or heterosexual couples where the male partner is not producing his own healthy sperm for a variety of reasons.  After your initial infertility testing, our physicians can ascertain if IUI is an appropriate option in your situation.

If a fresh sperm sample is used for the procedure, the male partner provides a semen specimen on the day of the insemination. This day may be determined by blood testing and ultrasound or use of an ovulation predictor kit once your LH surge is confirmed.  A laboratory procedure is then used to separate the active sperm from the inactive sperm and fluid. The “washed” sperm cells are then concentrated into a small volume and then placed (inseminated) inside the uterus (intrauterine) painlessly using a tiny hollow tube attached to a small syringe containing the sperm.  The procedure only takes a few minutes. We’ll ask you to continue to lie down for 10-15 minutes and then you can resume your normal activity.

Evaluation and diagnosis are the first steps towards treatment. Our doctors will work closely with you to determine a diagnosis and help you choose the appropriate fertility treatment. A fertility coordinator will then educate you on the chosen treatment while working closely with you throughout the entire process.  Call us at 412-731-8000 or 1-800-318-3144 to set up an initial appointment, and we will outline a path to help you have a baby.

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Meet Dr. Meredith Snook!!

100_0610Dr. Meredith Snook begins seeing patients on Monday, September 11, 2016!!  Let us introduce her to you!

Dr. Snook recognized her passion for women’s health and fertility as an undergraduate student at Pennsylvania State University.   From there, she pursued a medical degree at the University of Pittsburgh School of Medicine, during which time she also earned a Certificate in Clinical Research as part of the Clinical Scientist Training Program and was elected into the prestigious Alpha Omega Alpha Honor Medical Society.

Following medical school, Dr. Snook completed residency in OB/GYN and fellowship in Reproductive Endocrinology and Infertility (REI) at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC), a program consistently ranked among the top residency programs in the nation. During her training, she received numerous teaching awards, selected by medical students out of all UPMC residents and specifically out of OB/GYN residents. Dr. Snook has published several peer-reviewed journal articles and book chapters and her research has been presented and received awards at both regional and national levels.

Dr. Snook is a board-certified member of the American Society of Reproductive Medicine (ASRM) and a fellow of the American College of Obstetrics and Gynecology (ACOG).

As the newest physician member to RHS, Dr. Snook looks forward to providing exceptional care to patients seeking fertility evaluation. She has expertise in diagnosis and treatment of infertility, including polycystic ovary syndrome and ovarian aging, and is skilled in performing laparoscopy and hysteroscopy.  Additionally, her interests include addressing gynecologic concerns in female athletes and fertility preservation.

Dr. Snook is an avid swimmer and enjoys spending time with her son, reading novels, and traveling internationally.

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Hope’s Infertility Story: We Understand You, Because We ARE You

HopeThank you to Hope for sharing her infertility story.

I am a face not many of our female patients get to see.  However, I am familiar with many of the male patients.  My name is Hope, and I am a laboratory technician back in Assay and Andrology.  I run blood tests and prep sperm for IUI and IVF.

My infertility story begins approximately 14 years ago in 2002.  I was diagnosed with Stage 2 Endometriosis after an operative laparoscopy following an ectopic pregnancy.  I was told that I had less than a 5% chance of ever getting pregnant on my own.  Fast forward 10 years . . . divorced . . . remarried . . . and resigned to the fact that I was not going to be able to conceive on my own.  SURPRISE!  One short month after my honeymoon, I took a pregnancy test.  Two blue lines!  We were over the moon!  Due to my history, serial blood pregnancy tests were ordered by my OB.  My hCG was rising, but abnormally.  An ectopic pregnancy was suspected and verified by ultrasound.  Surgery was performed with the hope to preserve my right fallopian tube.  However, when I woke up from surgery, I was told that my fallopian tube was unable to be saved and a right salpingectomy was performed.  I was devastated, but knew that this was a possibility going into the surgery.  So, there I was . . . August 2012 . . . 36 years old . . . left with only one “useless” fallopian tube (2 historical hysterosalpingograms deemed it blocked).  I felt defeated.  My OB recommended IVF.  My husband and I immediately began the steps necessary to prepare for IVF.  We were, however, left with “sticker shock” as my insurance only covered $5000 worth of medication and NOTHING ELSE.  In January 2013, we went through IVF.  Honestly, I do not have a fear of needles, but injecting myself in the abdomen was intimidating to say the least.  I was working full-time and completing clinical rotations for my fourth degree while preparing for my egg retrieval.  I had a lot going on.  At the end of January, I had 27 eggs retrieved.  25 fertilized with conventional IVF.  I had a single fresh embryo transfer as I was showing symptoms of being hyperstimulated.  Two weeks later, brought no good news.  BIG FAT NEGATIVE!  I knew in advance because I cheated.  I took MULTIPLE hpt’s, sometimes more than once a day.  It was becoming a problem for me and it wasn’t doing my relationship with my husband any favors.  I was obsessed!  I discontinued my medications and waited impatiently for Cycle Day 1.  In March 2013, I had two frozen embryos transferred (two embryos were thawed, both survived).  Two weeks later brought the same result.  BIG FAT NEGATIVE!  The wait also brought the same obsession with hpt’s.  The cashier at the drug store must have thought me insane.  To be honest, I felt crazy.  I was anxious and on edge all of the time.  Anything could set me off.   Once again, I discontinued my meds and waited for Cycle Day 1.  After a long discussion with my husband, we determined that this was going to be our last transfer for a while.  I needed a break.  We both needed a break (mostly from me).  In April 2013, I had two embryos transferred yet again.  This time four had to be thawed to get two to survive.  As I laid there waiting for my transfer, I was already predicting a negative pregnancy test.  I was completely defeated and in tears.  All my husband could do was hold my hand.  There was nothing anyone could say to me to change how I felt or even help me.  I was DONE!  This time, I promised not to obsess over hpt’s.  It was easier said than done and seven long days after my transfer, I broke down and peed on that stick (in secret . . . my husband wasn’t home from work yet).  As a lab tech, I know first morning urine is best for urine tests as it is more concentrated.  It was around 4:00pm.  I was definitely NOT using a good urine sample.  I was setting myself up for failure.  I watched as my urine slowly crept over the area where the test line was supposed to be . . . NOTHING! . . . the control line started to turn blue.  I walked out of my bathroom utterly crushed.  About five minutes later, I walked back into my bathroom and took a quick glance at that evil pee stick prepared to toss it in the trash.  Was that a line?  It was so faint.  Was I imagining it?  I wanted this so bad.  I didn’t even trust my own eyes.  I showed it to my husband when he got home from work.  I had to explain to him what I was seeing . . . it was that faint.  A couple days later, I went for my blood test.  POSITIVE!  FINALLY!  In January 2014, I delivered my daughter, Corinne, by emergency c-section.

Today, I am the proud, happy mother of two children.  I know that you feel alone, but YOU ARE NOT ALONE!!!!  We all have a road to travel.  Working at RHS is my way of giving back.  IVF brought my daughter into this world!  I am forever grateful.

Posted in Conception, In-Vitro Fertilization, Infertility, Reproductive Health, Reproductive Health Specialists, Uncategorized | Comments Off on Hope’s Infertility Story: We Understand You, Because We ARE You

We Understand You, Because We ARE You

RjZhV1470929333Infertility can be stressful, nerve wracking, demanding of your time, emotionally challenging, and many times, isolating.  It is a subject that is often not freely discussed.  Friends may not know how to offer support and couples may not know how to ask for it.  At RHS we understand, because, while in the U.S. 1 in 8 couples have trouble conceiving, that percentage is even higher among RHS staff.  Many members of our staff have used reproductive technologies and medications, suffered miscarriages and waited years to conceive.  For some, their experiences with infertility have drawn them to their lives work. We know everyone’s journey is different, but we understand you, because we ARE you.

Some of our staff has agreed to share their stories.  We offer our encouragement and our empathy and we hope that our stories help you realize that you are not alone.

First up, Nina’s Story.

Recently a patient was discussing with a staff member about how we would probably not “understand” their situation. Lady! I understand! Because I did everything WRONG!

I laugh now because the road was long and hard and painful but filled with lessons and gifts I didn’t see coming.

I always had problems with my weight and subsequently my periods. My period was never regular growing up and after packing on the “Freshman 15” in college my period all but disappeared. I ignored it because I was young and stupid! But once in Nursing School I realized that it could be a big issue.

Fast forward, I graduate, get engaged and move away.  And once married, “Sure let’s try to start a family!” By then I’d had 2 periods in 2 years. Now it was inevitable, I had to find out what was going on if we were ever going to have a baby.  This started a 4 year journey that was filled with drama and heart break.

So I see a doctor I don’t even know in a city I’m new to and I get the news that I’m overweight (not a shock) and have features of PCOS (that was a shock). And in a cold but simple manner the doctor told me to lose weight and then call him in a year.


That was the first moment time began to really tick in my head and my age suddenly mattered. And sadly, I didn’t listen.

A year passed and nothing had changed, I didn’t try to lose the weight and I wasn’t getting my period. By now my husband was concerned and in a not so supportive or subtle way suggested “maybe you should lose some weight and we might be able to get pregnant.”  Arguing ensued and my fertility became a background issue for us, always hanging out there as our friends started to get pregnant and have kids.

A turning point became my sister –in-laws pregnancy. Here I was, wanting a baby badly yet not doing much to make it happen. Then my sister-in-law, carefree, irresponsible and wild announces she is having a baby boy. Anger and jealousy were all I could muster up in my heart. How could this be? Why her and not me? She doesn’t even want a baby! I couldn’t believe it. I sneered at their announcement, rolled my eyes in disgust at their shower invitation. I couldn’t stand it. And at the same time I felt like a truly horrible person for feeling this way towards my family member.  I didn’t even want to meet their baby. I felt like a crazy person and in retrospect hurt a relationship with her because of it.

Between my new nephews birth and months and months of no periods and no pregnancy I broke. I lived thousands of miles from home and was unhappy and lost. I told my husband I wanted to move back to Pittsburgh or get divorced. We agreed to try to patch things up and start over back in the burg.

Once home, I met with my old doctor and had a heart to heart about how to get pregnant. I finally owned the fact I had PCOS and needed to take control of it. My doctor suggested signing up with a weight loss program, starting Metformin  and then return after I had lost 50 pounds. I started the medicine and signed up for Weight Watchers. I bought a scale and an elliptical and faced my fears. I got on the scale and weighed 282 pounds. I hadn’t weighed myself in a couple years and was horrified. I started 2000mg of Metformin and thought my stomach was going to explode. The side effects were horrible. But I stuck to it. I wanted to be a mother so badly, I fixated on that goal and knew if I worked hard I could make this happen. Magically, I started getting periods on Metformin! I started seeing things happen!

Weight Watchers was easy, weight started to come off. I would count steps on a pedometer and then slowly built up to short workouts on an elliptical trainer.

At first my husband tried to be supportive and eat healthy with me but slowly stopped participating. He would joke about “rabbit food” and sneak away for beers and wings with coworkers.

I was determined however and after more than 10 months I reached my doctors weight goal. Next step would be semen analysis to rule out male factor. That came back acceptable so the doctor felt we would be good candidates for Clomid and IUI.

That next step marked a critical change for my relationship with my husband. In hindsight, I should have talked to my husband. I should have asked him if this was something he wanted and was really ready to do? I didn’t include him. Instead he became the sample source. And in my shortsightedness, I treated him curtly. I questioned him when he couldn’t move work commitments and couldn’t have intercourse when it was recommended.  I cried when our schedules didn’t match up and yelled when we would miss “OPK” peak windows. I became insane! And I turned my partner into a villain. I littered our bathrooms with ovulation predictor sticks and calendars on the wall like a crazy person. I was rude, angry and mean.

This should have been the point where we talked to a counseling professional not just each other. A counselor would have helped us! I tried to turn to the nurse that was helping me at this time and I’ll never forget her saying “You’re a nurse! Deal with it!” That stuck with me and as I work at RHS today, I’m determined to be there for people when they need answers and help. I never want someone to feel the way I felt in that moment!

After months and months ,more weight loss and more arguing I finally got the call. I was bleeding and ready for more Clomid and my nurse said my pregnancy blood test was positive. I was bleeding heavy and I told her she was wrong! She said she would repeat my bloodwork in two days but I was in fact pregnant. I hung up the phone in shock. You wait all this time for this moment and it is not what you imagine it to be. It’s a Tuesday afternoon on your couch kinda thing!  I was in disbelief. I called my husband and he too was in disbelief. This rocky road finally ended in pregnancy and all at once my journey was over and onto the next – pregnancy!

Today, I am no longer married! And my son is now 6! And when I look back, I made every mistake and I hurt my marriage during my time in fertility treatments. We let our struggles divide us. Many other things contributed to our demise but our behavior in treatment didn’t help!

Remember why your partner is your partner in the first place! Be a team, don’t blame one another for your infertility and let it bring you together. If you are struggling, think about talking to a counselor that can help you work together not against one another.

And remember, we do know how it feels and that is why I am at RHS!

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A Guide to Embryo Development After Retrieval

I just had my egg retrieval, what happens next?? What is going on behind that lab door??? These are questions patients ask all of the time.  Our embryology staff created this helpful guide to embryo development from Retrieval Day to Day 6.

Day 0 – Retrieval day is what the lab refers to as day 0. The ASC nurse will provide you with a final egg count before you leave the recovery area. 4-6 hours following the time of the egg retrieval the embryologist will initiate the fertilization process of the eggs. Fertilization is attempted using one of two methods, standard insemination or ICSI. Standard insemination involves placing a required number of washed, motile sperm into the culture drop containing an egg. ICSI is a more involved process where the embryologist uses a specialized needle and microscope to catch a single sperm to inject directly into the cytoplasm of the mature egg. Once insemination or ICSI occurs the eggs are placed back into the incubator to allow time for fertilization to occur.

Standard Insemination                                        ICSI


standard insem






Occasionally, the method of insemination may change from the original plan based upon the results of the semen analysis of the sperm collected on the day of the retrieval. The lab will perform a thorough sperm analysis on the retrieval day and will make recommendations to the physician as to which insemination method may work best for fertilization based upon the sperm results that day.

Day 1Day 1 is what the lab refers to as fertilization check day. Approximately 16-20 hours after the insemination process takes place the embryologist will check to see if fertilization has occurred. The embryologist is looking for evidence of 2 nuclei (pn) – one from the egg and one from the sperm. This is how the embryologist determines if normal fertilization has occurred. Any more or any less nuclei present and the embryo is considered abnormally fertilized and is not kept in culture. Once normally fertilized, the embryos are placed back into the incubator and are not disturbed until day 3. The embryos are grown in a specially designed culture dish which contains a small drop of culture medium overlaid with oil. This embryo culture medium contains the proteins, amino acids, and enzymes that mimic the fluid found in the fallopian tubes essential for embryo development. One factor (of many) that contributes to successful embryo development is the constant maintenance of temperature and pH level of this embryo culture medium. The temperature and culture medium pH level is dependent upon the CO2 environment and the heat that is provided by the incubators. Since the embryos are grown in a very small drop of culture medium it does not take long for temperature to drop and the pH level to change in that drop containing the embryo once the dish is removed from the incubator’s environment. Severe changes in the temperature and pH level of the culture medium can have potentially detrimental effects on the embryos. The embryologists are very protective of the embryos in the lab and this is the reason why the embryologists do not like to disturb the embryos too much and will not look at the embryos on a daily basis. Once the embryologist releases the fertilization results, an IVF team nurse will provide an update to you on Day 1 regarding your fertilization results.




2pn Embryo (normally fertilized embryo)




Day 2 through Day 3 – Between days 2-3 the embryos should be dividing through the multicellular stages of development.

 Multicellular Stage Embryos:









Day 4 – On day 4 the embryos should be progressing out of the multicellular stage and should start entering the morula stage. Starting at this stage the embryos rapidly start to divide making it difficult to distinguish the number of cells. Once a morula stage is achieved the embryo begins to move to a cavitating morula phase where a fluid filled cavity forms within the embryo triggering the progression to the blastocyst stage.

 Morula Stage                                                                         Cavitating Morula


cav morula








Day 5 through Day 6 – Between day 5 and day 6 the embryo should continue to rapidly divide and expand into the blastocyst stage. The cells begin to differentiate at this stage determining which cells will become the inner cell mass (potential baby) and which cells will become the trophectoderm (placenta). Day 5 is embryo transfer day! The physician will review the embryology data with you at the time of transfer and will make their recommendations along with the embryologist as to which embryo to transfer. If there are embryos remaining in culture following the embryo transfer and you have consented for embryo cryopreservation, the embryologist will cryopreserve any embryos that reach the appropriate blastocyst stage. Only blastocysts reaching this defined development stage by day 6 will be cryopreserved. Embryos at this defined stage are shown to have higher chances of surviving thawing procedures. After day 6 has passed, and the embryology data has been completed, you will receive an update from an IVF team nurse with whether or not embryos were able to be cryopreserved. Good luck and thank you from the embryologists for allowing us to care for your embryos!

For more information about how RHS grades your embryos, link to our blog, Your Baby’s First Report Card-Embryo Grading.




Blastocyst Stage Embryo




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