Note: We know it can be hard for people who are undergoing treatment to see materials and resources for people who are or maybe pregnant in a space designed for those in the middle of their journey. However, the goal for every fertility patient is to get pregnant and we want to ensure that everyone is prepared for whatever comes next, whether that is a failed round or (hopefully) that miracle baby you have worked so hard for. Your “due date” is the estimated date of when one is expected to go into spontaneous labor. This date is important to know from the start of your pregnancy, as healthcare providers will use this metric to determine the gestational age of a fetus. This is a key piece of information to be used by healthcare providers for scheduling prenatal tests and evaluating prenatal milestones. Knowing how far along you are will allow for your OB-GYN to monitor your progress and evaluate if the fetus is developing appropriately. Your EDD (estimated due date) is 280 days from the date of your last menstrual period. While 280 days comes out to 40 weeks, the majority of pregnancies range from 37-42 weeks long, also known as “full term”. Do not stress about the exact date. 96% of newborns do not arrive on their estimated time of arrival. In this post we will discuss the number of ways to determine your EDD, whether you conceived naturally or via IVF. Naegele's Rule: One of the most commonly practiced ways to determine your due date is what is known as Naegele’s Rule. It is applicable to women with a 28-day regular cycle and ovulation taking place on day 14. The rule is as follows: Determine the first day of your last menstrual period Subtract 3 months Add 7 days + 1 year For example: Your last menstrual period began on September 9, 2024. Counting back 3 calendar months would be June 9, 2025. Adding 1 year and 7 days would bring you to June 16, 2025, as your estimated due date. This rule is best for women with 28 day cycles. EDD should be adjusted for women with shorter or longer periods. Last Menstrual Period: Another method for calculating your EDD is adding 280 days forward from the first day of your last menstrual period. For example: If you last menstrual period began on January 31, 2024, EDD will be November 07, 2024 Again, this is only accurate for people who have a regular cycle. Conception Date: If you are tracking according to your conception date, you should add 266 days from the date you conceived. This is easier to predict if you have a consistent cycle and it is more difficult to pinpoint for women who’s cycles are irregular. Keep in mind that we cannot confirm the exact moment of ovulation, therefore relying on a due date according to time of conception should be done with caution. Fertility Tip: While the egg released during ovulation is only 24 hours, sperm can live up to 5 days, widening your fertile window. Ultrasound: Today, ultrasound screenings are the most accurate way to determine gestational age and the estimated due date (1). In the first trimester, your provider will order a transvaginal ultrasound. As a pregnancy progresses, they will move on to using an abdominal ultrasound. For women who have irregular cycles, a transvaginal ultrasound is a safe way to estimate one’s due date. It measures the size of the fetus to determine the gestational age. Ultrasound monitoring is more reliable than guesstimating with one's last menstrual period.  If there is a discrepancy between one’s ultrasound and date of their LMP, the physician will likely rely on the ultrasound scan. IVF: If you conceived via In-Vitro Fertilization you calculate your EDD based on the date of your embryo transfer and the ‘age” of the embryo. IVF & Fresh Embryo Transfer: 38 weeks or 266 days from the date of the egg retrieval. Frozen Embryo Transfer: Day 3 embryo; add 263 days Day 5 embryo;  add 261 days Keep in mind, the estimated due date serves as a general guideline and may vary based on individual circumstances. Seeking further guidance? : Our Patient Empowerment Coaches provide 30-minute personalized sessions and weekly check-ins to assist you in navigating every stage of your fertility journey, including determining your due date. At Grain Fertility, Premium Users have the opportunity to work 1:1 with our dedicated Patient Empowerment Coaches. They will help you prepare for your upcoming consultations with your provider and they will provide resources tailored to your individual needs. Our PEC's are committed to supporting you throughout your fertility journey. You can become a Premium member and take advantage of a risk free two-week trial by signing up today at https://app.grainfertility.com/signup. Resources: Naidu K, Fredlund KL. Gestational Age Assessment. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30252256.

National Infertility Awareness Week® (NIAW) is a movement, founded in 1989 by RESOLVE, whose mission is to empower you and change the conversation around infertility. As NIAW 2024 comes to a close, it is important to look back at how we have worked to change the conversation and more importantly, look forward to how we can all work together to “Leave Our Mark,” the theme for this year’s movement. Across the country, infertility patients, professionals, advocates and allies all worked to tell their stories, raise awareness to help educate the public about this disease that affects 1 in 6 individuals, and raise funds to help amazing organizations like RESOLVE achieve their mission of protecting and expanding access to care. There were events across the country organized by volunteers like the walks in Northern Virginia and Baltimore that we attended, webinars and Instagram Lives and social media stories, and buildings across the country lit up in orange on April 24 to help shine light on the impact of infertility. Grain Fertility’s mission is to empower fertility patients, putting them in control of their journey and giving them the tools and resources they need to feel confident in their care and NIAW is a week that highlights the importance of empowerment and the impact it can have on individuals. We hope to Leave Our Mark on the infertility community a number of ways, including: Promoting organizations dedicated to helping fertility patients through expanded access to care, protecting IVF, helping afford treatment, and reaching historically people and communities that have historically been marginalized from care. You can see partners we trust at https://www.grainfertility.com/partners and are always looking to add more. Helping patients better understand their own journey by connecting them with expert Fertility Empowerment Coaches who have years of experience working with patients. If you have not created a Grain Fertility account, go to https://app.grainfertility.com/signup and create your account today and our Patient Empowerment Coach Kim will reach out. If you are already a Grain Fertility user and have not scheduled your complimentary call, reach out to us at info@grainfertility.com. Providing fertility patients with a secure, easy to access location to organize, access, and use the most important information they need through the Grain Fertility application. Connecting patients with the fertility services they use to help reduce the amount of time and stress patients and their care team face when trying to understand everything. We are working on allowing you to seamlessly integrate your fertility information directly into the application so you can get real time access to your most important information easier than ever. Advocating for expanded reproductive healthcare access and using our voice in the community to raise awareness, educate decision makers, and help change how fertility care is delivered. Advocacy, awareness and the work of NIAW 2024 does not end this week and you can play an important role! Some ways you can Leave your Own Mark include: Signing up for the RESOLVE Advocacy Network (RAN) on their website at https://resolve.org/take-action/become-an-advocate/act-now/. You can also sign up for RESOLVE Federal Advocacy Day, taking place virtually on May 14, at https://act.resolve.org/page/61686/event/1?ea.tracking.id=website. Sharing, if you are comfortable, your own story, posting to social media or communicating with friends and family about your journey is a great way to reach those closest to you and help them know how impactful infertility can be. Joining or starting a support group to help others like yourself. Support groups are a great way to help find your voice, support others who are struggling, and directly impact the lives and journey’s of others. https://resolve.org/get-help/find-a-support-group/. Advocating for expanded fertility benefits at your work. RESOLVE has created resources to help you talk to your HR department about expanding benefits to cover the cost of infertility care https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/getting-insurance-coverage-at-work/ Partnering with organizations and companies in the fertility industry. If you own a business or have influence in your workplace, consider corporate partnerships with infertility organizations for sponsorships or employee matching donation programs. The power of storytelling, of telling the truth about what it is like to struggle with infertility, and shining light on the trials and tribulations millions of people face every year, is how we will move from infertility being a fringe issue to getting the attention and funding it deserves. We are proud to play an incredibly small role in this larger movement and pledge to continue to work with those throughout the infertility industry to help make fertility treatment easier and empower patients.

National Infertility Awareness Week (NIAW), observed annually in April, serves as a crucial reminder of the millions of individuals and couples facing the challenges of infertility. As it stands, 1 in 6 people struggle with fertility, meaning millions of people struggle to have the family they desire every single year. Founded in 1989 by RESOLVE, NIAW aims to: Enhance public understanding that infertility needs and deserves attention. Ensure that people trying to build a family know the guidelines forseeing a specialist. Educate lawmakers about how infertility impacts people in their state. This year, NIAW’s theme is “Empowering YOU to change the conversation,” a theme we are especially proud of as Grain Fertility was built to help empower fertility patients through their data. We invite you to join us, RESOLVE, and others as we work to raise awareness, promote understanding, and offer support to those on the journey to build their families. Understanding Infertility Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse (or six months if the woman is over age 35) or the inability to carry a pregnancy to term. It's a complex medical condition that affects approximately millions of individuals and couples in the United States, yet it unfortunately remains shrouded in stigma and misconceptions. Unfortunately, infertility treatment is often not covered by insurance, meaning patients often have to spend tens of thousands of dollars to attempt to have a child, placing additional burdens on people who have gone through so much. Breaking the Silence One of the most significant barriers individuals face when dealing with infertility is the silence that surrounds it. Due to societal pressures, shame, and lack of understanding, many people suffer in silence, feeling isolated and alone in their struggles. NIAW aims to break this silence by encouraging open conversations about infertility. By sharing stories, experiences, and information, we can challenge stigma, dispel myths, and foster a supportive community where individuals and couples feel heard, understood, and validated. After founder Joe Cody and his wife started to talk about their own infertility journey, they were surprised how many friends and family came forward to tell them about their own experiences. Whether or not their voices helped others feel more comfortable talking about their experiences publicly or not, they all now had individuals and a community to talk to. Building Support Support is a vital component of navigating the emotional, physical, and financial challenges of infertility. Whether it's through family, friends, support groups, or professional counseling, having a strong support system can make a world of difference. During NIAW, there are a number of webinars, in person events and social media campaigns to provide resources, share information, and connect individuals with support networks. You can find events through RESOLVE’s NIAW calendar at https://www.infertilityawareness.org/niaw-calendar. Taking Action As we recognize National Infertility Awareness Week, let's commit to taking action to gain a better understanding of Infertility: Educate Yourself: Take the time to learn about infertility, its causes, treatments, and emotional impact. Knowledge is power, and understanding can help break down barriers and foster empathy and compassion. Grain Fertility Premium Users gain access to exclusive webinars, 1:1 private consultations with our Patient Empowerment Coach Kim, a fertility nurse and educator of 5+ years. Listen and Validate: If someone shares their infertility journey with you, listen with an open heart, offer validation, and avoid making assumptions or offering unsolicited advice. Sometimes, a listening ear and empathetic response can make all the difference. If you need help or advice on listening and validating someone’s journey, you can check out RESOLVE’S resource at https://resolve.org/get-help/helpful-resources-and-advice/infertility-and-relationships/for-friends-and-family/. Connect: At Grain Fertility we are proud to connect people with organizations that are working to help, including support groups. You can find organizations we work with and support at https://www.grainfertility.com/partners. Speak Up: Use your voice to raise awareness, challenge stigma, and advocate for policies and practices that support individuals and couples struggling with infertility. You can offer your support and share your stories by attending RESOLVE Advocacy Day, held virtually on Tuesday, May 14, 2024. If you cannot attend Advocacy Day, you can send a letter to your Member of Congress, share your story on social media with #NIAW2024, or join RESOLVE’s Advocacy Network to stay up to date on the ways to help the community. Offer Support: Reach out to friends, family, or colleagues who may be dealing with infertility. Offer your support, lend a listening ear, and let them know they're not alone in their journey. National Infertility Awareness Week serves as a powerful reminder of the resilience, strength, and courage of those facing the challenges of infertility. By breaking the silence, building support, and taking action, we can create a more understanding, compassionate, and inclusive society where everyone feels valued, supported, and empowered on their fertility journey. If you are looking to learn more about infertility; whether for yourself or a loved one, our patient empowerment coaches are here to help you and navigate your journey. They will help you prepare for your upcoming consultations with your provider and they will provide resources tailored to your individual needs. Our PEC's are committed to supporting you throughout your fertility journey. You can become a Premium member and take advantage of a risk free two-week trial by signing up today at https://app.grainfertility.com/signup.

By Megan Kukic Note: Administering fertility injections is one of the most stressful components of the fertility journey. The pain aside, the constant pressure of thinking you are going to “mess up” adds so much to the injection experience that it can become one of the most dreaded parts of fertility treatment. To help, registered nurse, fertility patient, and founder of 412 Fertility, Megan Kukic, provides patients with some tips, tricks, and techniques designed to help make the process a little easier and allow you to be more confident when you administer your next shots. The first night I needed a fertility injection, I told my husband I wanted him to do it so he could be “a part of the experience”. While that was true, I was also not looking forward to stabbing myself with a needle. I had him watch the video on how to administer a subcutaneous injection. We set our alarm in case we got sidetracked. He was ready and confident, and I was confident in him. All was well. When the alarm went off, I went to the refrigerator and pulled out the medication. I started wiping my stomach with an alcohol prep pad when he asked, “Can’t you just do it?!” The truth is that I could do it. I had been a registered nurse for years prior to this moment. I had administered more injections throughout my career than I could ever recall. Not to mention that I was working as an RN in a fertility clinic at the time. Although I had the background, training, and skill, the thought of having to inject myself was a totally different experience. If you find yourself not looking forward to starting fertility injections, I can assure you that you are not alone. Many patients experience the same fears related to injections: What if I do it wrong? It’s going to hurt. How am I supposed to know what I’m doing? I can assure you that knowing how to prepare, what to expect, and how to make it less painful is all going to help you feel more confident when you get to this stage of your fertility journey. Understanding Fertility Medications While there are numerous medications your reproductive endocrinologist could place in your protocol, they will most likely fall under two categories: subcutaneous (SubQ) or intramuscular (IM) injection. Injections for IVF stimulation, ovulation induction, and most triggers are given subcutaneously. IM injections are typically used for medications like Lupron for suppression, Progesterone in oil (PIO) for embryo transfer, or occasionally HcG trigger for egg retrieval. Getting Started The basics for fertility injections remain the same: wash your hands, clean the site with an alcohol wipe, let the alcohol dry, inject slowly, remember to breathe, and rotate left and right sides daily. A personal favorite is to listen to your favorite music as you prepare and administer your medications. You could also repeat affirmations, do a meditation, or whatever else might make you feel relaxed and ready to begin. Give yourself time to prepare so that you don’t feel rushed through the preparation process. I also recommend having a treat waiting for you as a reward to yourself – you deserve it. There are some tips, tricks, and techniques that are specific to SubQ vs IM injections. Subcutaneous (SubQ) Injections SubQ refers to the layer of fat beneath the skin. Most fertility injections will be given in this fatty layer of the abdomen. When choosing the injection site, it is recommended to inject ~1-2 inches away from the belly button. My favorite tip is to think of your belly button as a nose and then inject where dimples would be when smiling. Avoid injecting directly above or below the “nose”, but rather a smidge below and to the side. Once you find your intended injection site, ice the area as you prepare your medications. This will not only help with comfort, especially if injecting Menopur. Icing also constricts small blood vessels/capillaries beneath the skin, which can help prevent bleeding and bruising. Using your non-dominant hand, “pinch an inch” of the skin you want to inject. This allows the fatty layer to be pulled away from the abdominal muscle, ensuring appropriate injection technique. Intramuscular (IM) Injections Intramuscular is exactly what it sounds like: into the muscle. Most clinics will recommend using your glute due to how large of a muscle it is. Because the needle needs to reach the muscle, you will notice these needles are a bit scarier. It is easier to have someone administer these to you, but it is possible to do them on your own! If you divide one buttock into fours, always use the upper, outer quadrant. Think of where the top, outer corner of a pant pocket would be. Pro tip: locate iliac crest (where back dimples are on lower back), then locate greater trochanter (golf ball-size bone on the side of upper thigh – press hard to find this). Draw an imaginary line from iliac crest and greater trochanter. Inject where this point meets. Although an IM injection can technically be injected anywhere in the glute muscle, these techniques help to avoid the sciatic nerve and prevent additional discomfort. You want your glute to be as relaxed as possible when injecting. If you prefer to stand, place all your weight on the side you are not using for injection. You can also lie down if that’s more comfortable. Instead of pinching the skin like we would for SubQ injections, we want to use our non-injecting hand to hold the skin taut between the thumb and pointer finger. Progesterone in Oil (PIO) Injection Tips PIO injections are the most common fertility injections that are given intramuscularly. Some tips specific to these injections include: If using lidocaine or numbing cream, place a quarter-size amount on the intended site, do not rub in, and cover with Tegaderm or saran wrap up to an hour before your injection time. Simply wipe with a paper towel and clean the area with alcohol prior to injecting. Some people prefer using a heating pad prior to injection, others prefer an ice pack, some prefer nothing at all. It truly depends on the person. Try each and see which feels best. If icing prior, I do not recommend icing for more than five minutes. Once the medication is drawn into the syringe, place the prepared syringe in your bra or underneath your arm. Using body heat warms the oil for easier injection. Heating and massaging the area after injection are key. Whether it’s a warm shower, a warm washcloth, or a heating pad, heat will be so helpful. A massage gun is also recommended. If you’re able, perform some squats/lunges after the injection. I know, exercising after an injection is probably the last thing you want to do, but people swear by this to help prevent lumping! Lumps in the injection area are common but are avoidable by proper heat, massage, and movement after each injection. Be sure to avoid re-injecting into major bruising/lumping. Common Side Effects and What to Look Out For With any injection - SubQ or IM - redness, bruising, and mild irritation can be normal. However, if you become concerned about any reactions, please do not hesitate to contact your medical team. If you have any questions related to your medications, you can not only reach out to your medical team, but you can also reach out to the pharmacy you ordered your medication from. Pharmacists are great resources for any medication question and are typically easy to get ahold of. This is a gentle reminder that you are your greatest advocate and that it is better to ask for clarity than wonder with uncertainty. About Megan Megan Kukic is a registered nurse and fertility patient. She worked in the operating room of a fertility clinic before launching her own business, 412 Fertility Services, in March of 2023. 412 Fertility is an injection administration and medication teaching service specific to fertility patients. Her goal is to use her education and training as a nurse and her compassion and understanding as a fertility patient to guide patients through the injection process of their journeys. More about Megan and her business can be found at 412fertility.com and on Instagram.

As Endometriosis Awareness Month comes to end, it's crucial to continue to shine a spotlight on this often misunderstood and under-diagnosed condition that affects millions of individuals worldwide. As a fertility nurse, I've witnessed firsthand the impact of endometriosis on individuals' lives, its impact on their fertility journeys and their quality of life. In this blog post, I aim to raise awareness about endometriosis, share insights on its effects on fertility, and offer support to those affected by this condition. What is Endometriosis? Endometriosis (“Endo” for short) is a chronic and often painful condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus, commonly on the ovaries, fallopian tubes, and even up to the  pelvic organs. Despite affecting an estimated 1 in 10 individuals of reproductive age, endometriosis remains widely misunderstood. What Endometriosis Is Not? “Just painful periods”. Unfortunately, because the most common symptom of endometriosis is pelvic pain, it is often dismissed as anything more than a painful period. This misconception often leads to women going months to years without a diagnosis and potentially continue to experience unnecessary pain without proper treatment and guidance. How Does Endometriosis Affect My Cycle? Each month the endometrium, or the inner lining of your uterus, grows in response to hormonal fluctuations between the brain and the reproductive organs. The endometrium will begin to thicken in the middle of a cycle around the time of ovulation and peak during the luteal phase (post ovulation). The endometrium thickens to create a nice cozy hospitable environment for an embryo to grow & develop in. If a pregnancy does not take place, the brain signals the uterus to shed the endometrium lining. Women often experience cramps due to uterine contractions and the endometrium can safely exit the body through the vaginal canal. This becomes problematic for women with endometriosis. With endometriosis, endo-like tissue will begin to grow in neighboring organs outside of the uterus and it will act just how it does within the uterine cavity. If a pregnancy does not take place, the endo tissue in the pelvic and/or abdominal cavity will shed as well. The problem is it will have nowhere to go and the endometriosis tissue will shed into the pelvic/abdominal cavity causing pain, inflammation & scar tissue. Impact on Quality of Life: Endometriosis may cause debilitating pain that may prevent a woman from going about her day to day activities. Women often talk about sudden, sharp pain that is crippling, taking breath away and making them nauseous. Signs & Symptoms to look out for: Pelvic pain Excruciatingly painful menses Dyspareunia (painful intercourse) Pain with bowel movements or urination Excessive bleeding Infertility Unfortunately, a number of these signs & symptoms may be overlooked by a healthcare provider and be mistaken for menstrual cramps. This may lead to a misdiagnosis and a delay in treatment. Endometriosis & Fertility: One of the most significant concerns for individuals with endometriosis is its impact on fertility. The presence of endometriosis can lead to a number of fertility challenges, including: Pelvic Adhesions: Endometrial tissue can form adhesions or scar tissue, causing organs in the pelvis to stick together. This can impair fertility by affecting ovulation, fertilization, and implantation of the embryo. Ovulatory Dysfunction: Endometriosis can disrupt the hormonal balance necessary for ovulation, leading to irregular menstrual cycles and difficulty conceiving. Reduced Egg Quality: Research suggests that endometriosis may be associated with decreased egg quality, potentially affecting embryo development and pregnancy outcomes. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508680/) Increased Risk of Miscarriage: Individuals with endometriosis may have a higher risk of miscarriage due to factors such as inflammation, hormonal imbalances, and uterine abnormalities. As a fertility nurse, my role extends beyond providing medical care; it also involves offering support, education, and advocacy for individuals facing fertility challenges, including those with endometriosis or who think they may have endometriosis. During Endometriosis Awareness Month and throughout the year, it's essential to: Raise Awareness: Educate individuals about the signs, symptoms, and impact of endometriosis on fertility to promote early detection and treatment. Provide Support: Offer resources to individuals with endometriosis as they navigate their fertility journeys. Support groups, online forums, and counseling services can provide invaluable support and encouragement. You may be wondering when is a good time to talk to your OBGYN if you think you have endometriosis? Here at Grain Fertility we are all about patient advocacy and encouraging you to be your number one advocate. It may be nerve-racking to face the reality that you may have endometriosis, but the sooner you work through it with your doctor, the sooner you may be on the path to greater quality in life. If you are in your 20’s-40s’ and you are experiencing pain, painful menstrual cramps, chronic lower back pain and pain during sex, it may be time to talk to your healthcare provider. At Grain Fertility, Premium Users have the opportunity to work 1:1 with our dedicated Patient Empowerment Coaches. They will help you prepare for your upcoming consultations with your provider and they will provide resources tailored to your individual needs. Our PEC's are committed to supporting you throughout your fertility journey. You can become a Premium member and take advantage of a risk free two-week trial by signing up today at https://app.grainfertility.com/signup. Endometriosis is a complex and challenging condition that can significantly impact fertility and quality of life. As we commemorate Endometriosis Awareness Month, we want to reassure all of our users here at Grain Fertility that we are here to support you and your battle with endometriosis. By fostering understanding, empathy, and empowerment, we can make a meaningful difference in the lives of those living with this condition and help them on their journey towards building their families and achieving their reproductive goals. About Kimberly Kimberly Shamroth, RN has worked as a fertility nurse at a top clinic for 5+ years, helping patients through some of the most difficult parts of the fertility journey. She provides guidance and detailed explanations to encourage self-awareness, confidence and continued motivation. You can learn more about Kimberly at https://thefertilityrn.net/

Making the first steps at the path to parenthood through third-party reproduction comes with its own set of challenges and decisions. This guide aims to illuminate the crucial steps for intended parents, ensuring a smoother and more informed journey ahead. Note: The following post is courtesy of our friends at Expecting. Grain Fertility is proud to feature resources and information from trusted sources of information on the different aspects of the fertility treatment process, including third-party reproduction. The journey to parenthood through surrogacy and egg donation, often starts with a vision but is fraught with uncertainties and myriad questions. Feeling overwhelmed is common among intended parents. Where do you begin your search? How do you select your providers, and how can you be certain you've found the perfect match? To effectively refine your options, it's essential to start with a broad perspective. Expecting.ai, the pioneering global platform for surrogacy, egg, and sperm donation, consolidates a wealth of information and service providers in one accessible location. This consolidation allows you to tailor your search, compare services and costs, and assimilate comprehensive information effortlessly. Understanding the Emotional Journey The path to parenthood, especially through third-party reproduction, is as much an emotional journey as it is a practical one. Expecting.ai recognizes the emotional nuances of this journey and offers support resources to help you navigate the ups and downs. Selecting Your Fertility Partners The choice of partners in this journey significantly influences the overall experience. It's vital to explore a wide range of options to identify the partners who genuinely align with your needs.Your choice of surrogacy agency is crucial, as they will guide you through every step. Ensure transparency regarding the services offered and associated costs. Demand comprehensive, straightforward information to assist in your decision-making. The agency should be a reliable pillar of support throughout your journey, offering clinical, legal, logistical, and emotional guidance. Find Your Fertility Agency here - Expecting.ai Agencies Finding Your Ideal Egg Donor The process of choosing an egg donor, a person who will contribute genetically to your family, is profound. Various criteria, from appearance to religious background, proven egg donation experience, and genetic tests, can influence your decision. Expecting.ai offers an intuitive platform with various filters to aid in this decision-making process. Understanding the donor's medical and family history is paramount. Expecting's tip: Aim to gather comprehensive information, including details on physical and mental health. Even with complex medical histories, it's crucial to uncover as much as possible about hereditary conditions. If doubts arise or if something seems too good to be true, don't hesitate to probe further, requesting additional information or photos from different life stages of the donor and her family members. Beyond physical and genetic traits, consider other attributes like intelligence, athleticism, personality, and interests, seeking a connection that resonates with you personally. Find Your Egg Donor here - Expecting.ai Egg Donors Finding your ideal Surrogate With the rising demand for surrogates post-2020, intended parents often face long waiting periods. Before committing to a surrogacy agency, ensure you understand their matching and rematch policies, should the initial match not proceed as expected. Confirm the surrogate's medical and psychological evaluations are comprehensive and up-to-date. While there are standard guidelines for selecting a surrogate, focusing solely on physical and medical criteria is not enough. The relationship with your surrogate is pivotal, so factors like communication preferences, dietary habits, health routines, and involvement in medical procedures should be considered to ensure a harmonious journey. Consider practicalities such as proximity for attending medical appointments and aligning on significant issues like selective reduction, delivery methods, and personal beliefs, which can all influence your relationship and the process. Find Your Surrogate here - Expecting.ai Surrogates Navigating Legal and Ethical Considerations Third-party reproduction comes with its own set of legal and ethical considerations. From understanding the legal status of egg donation and surrogacy in different jurisdictions to navigating contracts with donors and surrogates, Expecting.ai provides access to legal experts specializing in reproductive law. Our platform ensures you have the necessary information to make informed decisions that protect your family's future. Find Your Legal Consultant here - https://expecting.ai/legal-consultants Personalized Matches with AI Technology At the heart of Expecting.ai is our innovative use of AI technology to provide personalized matches for intended parents. Our platform analyzes your preferences, needs, and criteria to match you with egg donors and surrogates who meet your specific requirements. This technology streamlines the search process, making it easier for you to find the right match without the overwhelm of sifting through countless profiles. Comprehensive Educational Resources Knowledge is power. Expecting.ai offers educational resources, including articles, videos, and interactive tools, to help you understand every aspect of the process. Utilize our blog for guidance on pertinent questions to ask at various stages of your journey, such as: The Top 10 Questions Intended Parents Should Inquire with a Surrogacy Agency Key Questions to Ask Your Egg Donor Provider Before Choosing an Egg Donor Agency 3 Essential Tips for Intended Parents on How to Choose Your Ideal Surrogate At Expecting.ai, we are dedicated to helping you find your ideal match, offering digital tools and AI-enhanced services combined with compassionate care to guide you through your parenthood journey, whether through a donor or surrogate. Our mission is to support and accompany you every step of the way, to streamline your journey and help you gain better control over the process.

The Hadwin Family Foundation's Grant via the Arizona Center for Fertility Studies is accepting applicants until March 31st Grain Fertility is dedicated to helping connect patients to resources they can use to help make their fertility journey easier, including promoting IVF grants or other ways to help families afford essential family building treatments. If you know of other organizations that we can highlight, let us know at info@grainfertility.com. Maddy’s Miracle Grant was developed to directly assist individuals and families with the financial barriers associated with infertility treatment. In addition to the social stigma that still surrounds infertility diagnosis and treatment, families are far too often further burdened by the cost of treatment options, specifically in vitro fertilization (IVF). Unfortunately, IVF is frequently the only option left for people to grow their family, and they are left with the difficult dilemma of wanting children but not being able to afford the chance to have them. This dilemma led to the birth of The Hadwin Family Foundation (The Foundation) and the creation of Maddy’s Miracle Grant. Maddy’s Miracle Grant is named after the daughter of the foundation's founders, who were fortunate enough to have the means to undergo a successful IVF treatment at the Arizona Center for Fertility Studies (ACFS). Throughout the IVF process and after the birth of their daughter, the founders felt a sense of frustration and guilt that their personal financial situation afforded them the opportunity to overcome the challenges of infertility through IVF, while others are often not as fortunate. This frustration drove them to create their Foundation, and more specifically Maddy’s Miracle Grant, as a way to support growing families facing the financial hardships that come with costly fertility treatments. Maddy’s Miracle Grant is currently only available to families with financial need who are working with the Arizona Center for Fertility Studies and have been diagnosed with infertility. Additionally, applicants must be legal, permanent residents of Arizona. Grant funds will be paid direct to ACFS and will be restricted to only the standard IVF retrieval and transfer fees for a single cycle as designated by ACFS. Funds cannot be used for treatments already received and will be awarded only for treatment and fees not yet received or incurred. Applicants with stored eggs and/or embryos will be excluded. Funds available for grants depend on the success of fundraising throughout the year by the Foundation. The Foundation hopes in the future to be able to increase the number of recipients selected and/or services covered. They also hope to be able to expand coverage in the future to include services such as medications, labs, genetic testing and procedural anesthesia, but currently the Foundation do not cover any such services. While the grant funds will go to the standard IVF retrieval and transfer fee all ACFS patients incur, the grant funds are available not only to patients using their own eggs, but also to those using donor eggs, donor embryos, or gestational carriers. Please note, however, that no ancillary or extra fees associated with such cycles will be covered by a grant award. Applications may be submitted from March 1st to March 31st via The Hadwin Family Foundation website, www.thehadwinfamilyfoundation.org. The foundation's goal is to have a recipient selected and notified by April 7th, which will be dependent, however, on applicant interest and response. In order to undergo the IVF process you must meet certain medical criteria as determined and required by ACFS. Each applicant must submit a medical criteria verification form singed by an ACFS representative. You may discuss these medical criteria in more detail with your current physician at ACFS. The Foundation does not discriminate based on race, religion, ethnicity or national origin, age, gender, or sexual orientation, and all timely, complete applications will be considered. If you submit an application and are not selected as a grant recipient, you may apply for the grant in another grant cycle, however you will be required to submit a full application each time, including the medical criteria verification form from ACFS. Please read the application carefully, fill it out truthfully and as completely as possible, and be sure to attach all required documents. If you are couple, please fill out all sections of the application for both the applicant receiving IVF treatment as well as the applicant’s spouse/partner. Incomplete or untimely applications will not be reviewed and will be considered withdrawn from the grant cycle. You may be asked to provide proof of employment and income to verify your financial need, so please have your W-2s and personal income tax documents ready and available. If you have application specific questions, please email The Hadwin Family Foundation at info@thehadwinfamilyfoundation.org. For any medical questions regarding your infertility diagnosis and medical criteria for IVF, please contact your physician or representative at ACFS. Other than the medical criteria verification form, please do not provide medical records to the Hadwin Family Foundation. Lastly, and most importantly, thank you for applying for Maddy’s Miracle Grant and trusting us to review your application. The founders know firsthand the toll that infertility takes on a family. Every member on the selection committee has personally dealt with infertility and been through the IVF process. Although all members of the committee have had difficult journeys, we have all been fortunate enough to have had successful IVF treatments with children to show for it. It is our absolute greatest hope that Maddy’s Miracle Grant helps families in their fight against infertility and contributes to the birth of even just one miracle child in the process.

This week is big for Grain Fertility. Our application is finally live and available for download to the public. You can sign up for the app here, where you can get started with a free two-week trial to our Premium Subscription (only $12.99/month after that). It has been said that it takes years to be an overnight success and while Grain Fertility is far from successful at this point, it is important to acknowledge how long it has taken to get here. From my wife's infertility diagnosis in 2016 to the public launch of the Grain Fertility application in February 2024, there are a million inflection points that impacted what we are seeking to do. But throughout this journey, there have been a few constants. First, is the absolute support of my wife. Without her, none of this would exist. Second, is the support from the infertility community. I have had countless conversations with patients from all walks of life in different parts of their journey and I have gotten nothing but honest feedback and encouragement to keep moving forward. And this, the encouragement from the community and the stories I have heard, guides every decision we make at Grain Fertility. Our north star is the development of tools, resources, and technology that helps empower fertility patients, ensure they have the support and strength they need to make more informed decisions about their care, and give them the best chance they can have at having a child. I know this is going to be hard a journey and success is far from guaranteed. The cards are stacked against us and it is going to take continued hard work to deliver an application that delivers on the incredibly lofty goals we have set. But as I look back on where I started and where I am now, I am reminded of another quote that is often said, "good things come to those that wait..."

An often overlooked component of the fertility process is nutrition. It is our mission at Grain Fertility to empower patients and give them the tools and resources they need to make more informed decisions about their own fertility journey. I will admit, this is an area I know very little about, so I thought it was important to connect with an expert in the field to help demystify the impact nutrition can have on fertility and provide you with some IVF and Fertility Nutrition Tips. To help with this, I reached out to Becca Romero, a functional nutritionist specializing in fertility, and founder of Little Life Nutrition, to answer some important questions to help you better understand how nutrition and fertility intersect. Joe: There are a lot of misconceptions out there, so let's start with understanding what impact your nutrition can have on a person's fertility. How much of an impact can your diet have on someone's fertility? Becca: Your diet can have such a profound impact on fertility. Having optimal nutrient levels, balanced blood sugar, low levels of inflammation and so much more are all factors in both male and female fertility. All of these factors are influenced by what you put in your mouth. The nutrients you eat help to fuel both the egg and sperm. Just like the saying "you are what you eat", your egg and sperm are what you eat. Joe: When someone is referred to a reproductive endocrinologist and told they will need assisted reproductive technologies such as IVF to have a kid, are there recommendations you have that can help them as they prepare to undergo a cycle or ways that can help during a cycle? Becca: Absolutely! My suggestions are to audit your diet as well as insure both partners are taking a high quality prenatal vitamin. As we already discussed, diet can have a significant impact on both sperm and egg health. When preparing for an IVF cycle, it is important to get both the eggs and sperm the nutrients they need. Keep in mind it takes about 90 days to impact egg quality and about 60 days for sperm to regenerate. Therefore you want to implement healthy changes for at least that amount of time before an IVF cycle. If you are looking for guidance in this area, seek the health of a fertility nutritionist who can help guide you! For women, I would also suggest taking a high quality prenatal vitamin that contains methylfolate rather than folic acid. 25% of the population worldwide carry a genetic mutation called MTHFR, which affects their ability to utilize folic acid which is vital for fertility and the health of the developing baby. Populations with higher prevalence of this mutation are Hispanics (47%) and Europeans (36%). Lastly, prenatal vitamins are not just for women! I suggest that the male partner also starts taking a prenatal vitamin focusing on sperm quality. One of my favorite brands is FullWell's men's sperm support. Joe: Patients often worry that food or drinks in their diet can harm their chances of success. Is this the case and if so, are there certain foods or drinks that people should stop during fertility treatment and what are the real impacts they can have on an individual's chance of success? Becca: There typically isn't one meal, specific food or drink that was ingested in isolation that will impact the success of fertility treatments. However, it's more about the big picture and what the diet is like a majority of the time. Having good eating habits in general can have a major positive impact on fertility. I do recommend avoiding alcohol altogether as there are no health benefits and it can be highly inflammatory. When it comes to alcohol, act as if you are already pregnant. Especially avoid alcohol after a transfer or in the two-week-wait post fertility treatment. Joe: Are there certain diets that people may be on that you recommend your patients adopt during fertility treatment or others you would recommend they stay away from? Becca: When it comes to diet when trying to conceive and going through fertility treatments, it is all about abundance of nutrients. This is not the time to try to lose weight to restrict food intake. I never recommend skipping meals or engaging in any type of fasting including intermittent fasting. Food restriction can cause stress on the body and the body needs to be as free from stress as possible to create a safe environment for baby. I generally recommend that everyone trying to conceive adopts a blood sugar balancing diet. Keeping blood sugar stable is extremely important to optimize fertility. Learn more about blood sugar and fertility here. Joe: Are there non-medical ways such as diet modifications that can improve egg quality, yield or other important components of a patient's IVF journey? Becca: Absolutely! Keep in mind that everyone is unique and no one approach works for everyone. It is important to consider any conditions you may have such as autoimmune disease, PCOS or endometriosis just to name a few. When it comes to egg quality, diet can either have a positive or negative affect. It is a common misconception that just because a female is born with all the eggs she will ever have means that the quality cannot change. This is not the case. Immature follicles will mature into eggs to eventually be ovulated or extracted for an IVF procedure. Nutrition can impact how the egg matures and of what quality it will be once it matures. It has been shown that diets rich in seafood, poultry, whole grains, fruits and vegetables can improve fertility in women and even sperm quality in men. Specifically omega 3 fatty acids (found in fish) have been shown to improve egg quality. Joe: One third of all cases of infertility are due to male factor infertility. Are there nutrition tips you can give men to help improve sperm count, morphology, motility or other metrics? Becca: This is not talked about enough. As I mentioned above I recommend any man trying to conceive start by taking a men's prenatal. When it comes to improving sperm quality through diet, incorporating antioxidants are key. Antioxidants are the colorful compounds we find in fruits and vegetables. I recommend men try to incorporate at least one color in every single meal. For example, incorporate raspberries as part of breakfast, a side salad with spinach and tomatoes as part of lunch and green beans and sweet potato as part of dinner. Eat the rainbow! Joe: Are there resources you direct your patients to so they can get trusted information as they try to balance living their life and not worrying so much about what they eat while maximizing their chances of success during fertility treatment? Becca: Check out my Fertility Diet Foundations Guide for a good visual of how to put together your plate for fertility. Lastly, it can be extremely helpful to get advice based on your unique situation. It can take a lot of worry off your plate to meet with a fertility dietitian so you can have peace of mind that your diet and lifestyle approach are serving your fertility. About Becca Romero Becca Romero is the founder of Little Life Nutrition, an online fertility nutrition practice. Becca is a Licensed Dietitian Nutritionist and a Certified Nutrition Specialist. With a specialized focus on addressing infertility, she offers personalized dietary and lifestyle solutions for women aiming to enhance their conception potential and ensure the birth of a healthy baby. She is driven by the philosophy that optimal preconception nutrition and lifestyle can shape the well-being of generations to come.

In a previous post, we provided an overview of the IVF treatment process to help ensure patients are more prepared for their journey. However, at Grain Fertility, we not only believe in preparing patients, but also giving patients tips and the tools they need to make IVF easier and empower patients. To help with this, Grain Fertility founder Joe Cody asked IVF fertility coach, fertility nurse, and patient advocate Lauren Haring, RN for some tips, advice, and expert opinion to help IVF patients through different parts of their journey. The IVF process can be overwhelming for anyone, so to help make it a little easier to process, it is best to think about it in phases. At Grain Fertility, we think of it in four distinct phases: Trying to Conceive; The Stimulation Phase; The Retrieval/ Fertilization Phase; and the Transfer Phase. Below, fertility coach and IVF expert Lauren Haring, RN provides some insights and tips to help you during each of these phases. Trying to Conceive: Before the IVF Journey Begins Infertility is defined clinically as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse, or after 6 months if the woman is older than 35 years of age and traditionally doctors and insurers require patients meet this definition before moving to an RE for fertility work. Unfortunately, this often means by the time someone is referred to a reproductive endocrinologist (RE), odds are they have been struggling for months or years before this, many times without anyone knowing. Joe: Often patients are told to wait before seeing a reproductive endocrinologist for a fertility consultation. What are some circumstances when a patient should seek a fertility consultation before they meet the traditional definition of infertility? Lauren: If there is an underlying condition already present that affects fertility, such as PCOS, endometriosis, pelvic inflammatory disease, or a known sperm issue it is not recommended to wait the suggested 6 months if over 35 or 12 months if under 35. Joe: When finding and deciding on a fertility clinic, what advice do you have for patients to help them choose the one that is best for them? Lauren: The most important thing is to find a clinic that you feel truly supports you and is on your team. It is crucial to trust your fertility team and the care you are receiving. I have a blog post where I provide patients nine areas I would consider when evaluating a fertility clinic. Joe: How do you recommend patients best prepare for an IVF cycle? Lauren: It is important to get educated. You are paying for this and deserve to be an active member in your treatment. Learn about your diagnosis and treatment so you can ask questions and ensure your fertility concerns and goals are being addressed. I have written a blog post where I give patients 10 ways to help you mentally and physically prepare for IVF like a pro. Stimulation Phase During the stimulation phase, a person takes injectable hormone medications to encourage the entire group of that cycle’s eggs to mature simultaneously and fully. The goal is to retrieve as many eggs as possible for fertilization. The type, dosage and frequency of medications prescribed will be tailored to the individual based on their medical history, age, AMH (anti-mullerian hormone) level and response to ovarian stimulation during previous IVF cycles (if applicable). Joe: The stimulation phase can be intense for patients. What are tips or tricks that you give to your patients to help make the experience a little easier emotionally and physically? Lauren: It’s important to celebrate all of the milestones throughout IVF, big and small. Getting the go ahead to start stimulation medications is a big deal and accomplishing each injection is a true badge of IVF courage. Recognizing each time you pass a milestone is empowering. It is vital not to run out of medications. Keeping track of your supply and ordering refills before you might run out is crucial. As an IVF coach, my clients have direct access to me anytime throughout their cycle and I strongly encourage them to reach out with any questions, concerns, or simply to vent. I support IVF confidence through extensive information and expert guidance. I review all the personalized details relevant to the IVF cycle prior to starting their first injection. We discuss the medication protocol, cycle plans, what to expect, tips for a better experience, and ways to be a better advocate during treatment. It’s crucial to advocate for yourself by asking questions to ensure you understand what your results show and better manage your expectations for the cycle. Joe: As an IVF coach, how do you help patients keep track of changes and updates that clinical staff provide to the patient during monitoring? Lauren: I give my clients a resource to record all of their monitoring results and medication dosages throughout their complete IVF cycle.They can also track the retrieval outcome, embryo progression, and more. At the end they can see the full picture of how the cycle went. The Retrieval/ Fertilization Phase The Retrieval/ Fertilization Phase is a very stressful time for IVF patients, as only about 50% of the fertilized eggs should be expected to become viable blastocysts, but it is not uncommon for results lower than this, especially for people with undiagnosed issues with their eggs or sperm. Joe: As an IVF coach, how do you help prepare patients to deal with the stress of waiting for blastocysts to develop? Lauren: Knowledge combats preventable stress from uncertainty and not understanding what is expected and what is happening. While my clients are waiting for results, they are always encouraged to reach out and talk about their concerns. Each time my clients get an embryo update from their clinic, we review what the details indicate regarding the number of embryos and progression, along with the next steps. Joe: Are there recommendations or tricks to help patients physically and emotionally prepare for an upcoming transfer? Lauren: Physically there is much a woman can do to prepare her body for an embryo transfer, which should ideally begin at least three months in advance. Focusing on the lifestyle areas that can positively affect the fertility foundation, like nutrition, sleep, movement, and more is equally as important as stress management. Acupuncture has become more commonplace as an additional modality for IVF. It is important to find an acupuncturist who specializes in fertility support as there are special protocols they may recommend. It is also important to utilize your personal support network, which will look different for everyone but may include your partner, family, friends, religious affiliation, professional support and beyond. Whether support comes from family and friends or through a trusted reproductive mental health professional, the key is that no one should go through IVF alone. Joe: How do you help patients cope with a failed retrieval that does not result in viable embryos or blastocysts? Lauren: A failed cycle is devastating, regardless of the reason. When there are no viable embryos for transfer, it can be especially difficult after putting in all the effort IVF requires. I review their cycle in detail with them and suggest questions to ask their fertility team so they gain the best understanding of how the cycle went from their view and what recommendations they have to achieve a favorable outcome. No one can decide for you when it’s right to start another IVF cycle, or if there is another step that’s more appropriate. Emotional healing is variable and while some are ready or even feel a strong need to jump back into another IVF cycle, it is also normal to take time to heal mentally before starting again. The Transfer Phase The mental and physical preparation for the Transfer Phase can be incredibly intense and stressful. To help cope with this process, it is important to understand what you should focus on and what can be less of a priority. Joe: What is the most important information clinical staff are looking at to determine if a patient is ready for a transfer? Lauren: Thickness of the uterine lining is the most important factor, but the lining pattern is also important. Ideally there should be three layers (trilaminar) to indicate a mature lining. Typically most doctors like to see the lining at least 8mm and above in thickness before proceeding with an embryo transfer. Studies show higher success rates with thicker linings, but women do get pregnant with thinner linings as well. Joe: Are there any tips or tricks you can offer to patients to prepare for the two week wait? Lauren: It is important to protect yourself. Searching the internet during the TWW can do more harm than good by supporting many of your worst fears. You will likely find conflicting information that can add further confusion. If you have a question or concern, it is fine to reach out to your fertility team for sound advice. It is ok to schedule “worry time.” Set aside 15 minutes once or twice a day to worry, obsess, cry, question, and feel your feelings. Once time is up, change directions and move on with your day. It is also fine to find ways to indulge yourself, you have earned it! I also recommend trying to avoid using home pregnancy tests. Nothing is more reliable than the blood test your fertility clinic will do at the appropriate time. The results won’t just come back positive or negative, but with an actual number for the HCG. You will get more information with supporting hormones (Estrogen and Progesterone) to provide a better picture of what’s going on. It is easy to obsess over the home urine test kits so remove the guesswork and try to avoid them if possible. In our final post of our IVF treatment overview series, we will soon highlight specific ways the upcoming Grain Fertility application can help fertility patients with each step of the IVF journey. If you are interested in continuing to receive amazing resources from experts like Lauren, sign up for our waitlist and join other fertility patients who want to be the first to gain access to your own fertility management platform at https://www.grainfertility.com/sign-up-today.

Over and over, I hear from patients they wish their IVF clinic had given them a better overview of the IVF process and what they are getting into. It can take multiple cycles, meaning months or years of experience and a lot of money before patients gain an understanding of the process and to start to advocate for themselves. Grain Fertility is built to help fertility patients become better advocates for their own care and empower them throughout their journey. However, in order to do this, it is important to know what the IVF process looks like for most patients. Grain Fertility is proud to provide this IVF treatment overview to help make IVF patients more prepared for their journey. Trying To Conceive: Before the IVF Journey Begins By the time someone is referred to a reproductive endocrinologist (RE) and told they will need fertility treatment to try to successfully have a child, odds are they have been struggling for months or years before this, many times without anyone knowing. Infertility is defined clinically as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse, or after 6 months if the woman is older than 35 years of age and traditionally doctors and insurers require patients meet this definition before moving to an RE for fertility work. However, there are exceptions to this, such as someone who has infertility caused by a cancer diagnosis and treatment or other diseases such as sickle cell, same-sex couples, and single parents by choice. Once someone is referred to a fertility clinic, the care team will work to try to identify the cause of the infertility in hopes of best identifying the best form of treatment. Different treatments can include simple lifestyle changes or prescribing medications, surgeries to an underlying cause, or different forms of assisted reproductive technology (ART) such as intrauterine insemination (IUI), In Vitro Fertilization (IVF), or third-party reproduction options like surrogacy. It is important to know that different forms of treatment have different treatment impacts and processes, but every diagnosis and treatment absolutely has some impact on a person’s ability to work and deal with their fertility issues. IVF Overview: The Phases of Infertility Treatment A normal IVF cycle can last four to six weeks, including the time before egg retrieval, when a person takes fertility medication, until they’re tested for pregnancy. There are several major phases someone undergoing IVF goes through and these are the stimulation phase, the retrieval/ fertilization phase, and the transfer phase. Below, you can see a sample schedule and hypothetical process for a 32 year old IVF patient, created by the amazing team over at FertilityIQ, who provide fertility and menopause education for millions of people. As you can see, the IVF process is not guaranteed to work for every patient every time. In fact, there are a number of factors that determine your success including. your age, medical background, and the cause of infertility. The Centers for Disease Control (CDC) created a simple IVF success estimator tool, available at https://www.cdc.gov/art/ivf-success-estimator/index.html to help patients know their chances. There are also commercial tools available through clinics, including an AI based tool developed by the team at Univfy. It is important that before you start any cycles, you have a clear understanding of your chances. Too often patients are told that it will not be a problem getting pregnant, setting patients up for incredible disappointment if the cycle does not lead to a pregnancy. 1) The Stimulation Phase During the stimulation phase, a person takes injectable hormone medications to encourage the entire group of that cycle’s eggs to mature simultaneously and fully. The goal is to retrieve as many eggs as possible for fertilization. The type, dosage and frequency of medications prescribed will be tailored to the individual based on their medical history, age, AMH (anti-mullerian hormone) level and response to ovarian stimulation during previous IVF cycles (if applicable). This process is intense, consisting of medication taken at specific times daily through shots, orally, and/or vaginal application and monitoring appointments every few days that require blood work and/or ultrasounds to monitor progress. Once the care team decides someone is ready and your (two or more) follicles will have grown to a certain size (18 mm or greater), the patient is ready for the trigger shot. The patient is instructed to take a trigger shot that must be given 36 hours before the scheduled egg retrieval time. While there is a little wiggle room, the timing is critical to ensuring your retrieval timing. 2) The Retrieval/ Fertilization Phase 36 hours after the trigger shot is when the eggs are collected and those that are mature or the patient does not want frozen are fertilized using sperm. As the chart above shows, about 70% of eggs fertilized should be expected to fertilize successfully, so to many patients, banking as many mature eggs as possible is very important. Producing a lower number of mature eggs can be very hard on a patient because they know it decreases their chances of success. Over the next 5 to 6 days, the fertilized eggs are monitored by embryologists and trained staff to track development of viable blastocysts. Embryologist Alease Daniel has written up a fantastic overview of what happens during this 6 day window. This is a very stressful time for IVF patients, as only about 50% of the fertilized eggs should be expected to become viable blastocysts, but it is not uncommon for results lower than this, especially for people with undiagnosed issues with their eggs or sperm. Depending on the patient's readiness for IVF, including how well their uterus has responded to stimulation, the remaining blastocysts are kept fresh and prepared for transfer or are frozen and saved for a frozen embryo transfer at a later date. 3) The Transfer Phase For weeks before the targeted transfer date (if there are viable blastocysts available), patients are taking additional medications and attending monitoring appointments to prep the uterus for implantation using IVF. Patients and their care team decide whether they should proceed with a fresh embryo transfer or freeze the blastocysts and try a frozen embryo transfer at a later date when the uterus is better prepared to accept the transfer. The day of a transfer is relatively easy medically, but one of the more stressful days for a patient. The IVF procedure takes less than 10 minutes but it kicks off what is known colloquially as the Two Week Wait (TWW), where the patient nervously waits 10 to 14 days before their doctor administers a blood test to see if they are pregnant. During the TWW, patients continue all assigned medications until they are told to stop. At this point, hopefully the patient is pregnant where their RE clinic will continue to monitor and treat until 12 weeks, when the patient graduates and is referred back to their OB-GYN for prenatal treatment and monitoring. However, it often takes more than 1 cycle for a successful pregnancy and the patient’s medical history and age are major determinants of how many cycles it may take to get pregnant. Data from the Society for Assisted Reproductive Technology (SART) on success rates for IVF stated that for women under 35, the percentage of live births using the patient's own eggs for a singleton (one child) is 51%.For women ages 35-37, the IVF success rate is 38.3% for live births using the patient’s own eggs for a singleton (one child) birth. At ages 38-40, the percentage drops to 25.1%, and for 41-42, it is 12.7%. For women older than 42, the IVF success rate is 4.1% for a singleton birth using the patient's eggs, according to SART. Throughout this four to six week period, someone average multiple appointments per week, be taking multiple medications orally, vaginally and through shots that can cause a tenderness and pain at shot injection sites, mild bloating and cramping, breast tenderness, spotting, constipation, mood swings due to changing hormone levels, anxiety, possible depression, and other symptoms. Hopefully this overview provides some information to newer IVF patients. In a future post, we will provide you will detailed ways Grain Fertility can help you throughout each of these phases of the IVF process, giving you a blueprint for success and making your IVF cycles a little easier.

By now, most people have heard about ChatGPT. According to a UBS study, it recently set the record for the fastest growing consumer application in history. There is no question ChatGPT is taking the world by storm and the applications of such a powerful tool are endless. I had already heard of patient advocates using GPT-4, the large language model that ChatGPT uses to power its chatbot, to help summarize health records, ask for assistance in dealing with doctors, and giving patients insights into their care with a high degree of certainty and empathy. After all, GPT-4 has already passed the Bar and US medical licensing exams and a recent study showed chatbot responses were preferred over physician responses and rated significantly higher for both quality and empathy. My Testing Process With all of this hype, I decided to use ChatGPT to test out its ability to help a patient understand a frozen embryo transfer (FET) treatment plan. To help with this, I used a real treatment plan that a reddit user uploaded to the Reddit r/IVF community a few years ago and ensured that any information that could compromise the user or identity was removed. It was important to use a real document a patient would receive directly from their clinic so make this as realistic as possible. I adopted the persona of a 34 year old woman with unexplained infertility undergoing IVF for the first time. Although my personal experience gives me a better understanding many of the aspects of the IVF process and find resources, I wanted to see how well ChatGPT could help a novice understand their situation, provide additional insights, and see shortcomings of the current version of ChatGPT (March 2023 version). To start, I created a new account with ChatGPT and a new conversation, ensuring I was starting fresh. The first prompt I gave ChatGPT went as followed: In under 1 second, ChatGPT gave me a list of the medications in the treatment plan along with a brief description of each and why they are used. As the adopted persona of a first time IVF patient, I wanted to know if this was a standard FET plan as a way to start to compare what I was going through to someone else. So I asked ChatGPT if these medications were standard. Once again, ChatGPT responded in less than a second. This answer was less detailed, and started to show some deficiencies as a tool for patients. I decided to change my approach slightly and see what ChatGPT could do to help me better communicate with my fertility doctor and act as a patient advocacy tool. I asked it to give me a list of questions I should ask my doctor to help me better understand the treatment plan. Here, ChatGPT really shines and provides me with a list of questions that not only addresses the current FET plan, but also begins to prepare me for next steps. Many fertility patients know it is hard to balance looking one day and one month ahead when you are in the thick of treatment. Finally, even though ChatGPT had already told me I should ask my doctor about the success rate for my specific case, I wanted to know what it would tell me the success rate for me could be. ChatGPT gave the measured response the model tends to give users, giving a very generic range with a number of caveats. I decided to wrap up our conversation by asking ChatGPT for some advice and resources to help me prepare for and understand the FET process. ChatGPT once again showed an empathetic response and gave me some good tips, focusing on myself by telling me to stay informed and practice self care. It even gave me a list of resources from reliable websites on the FET process. However, this is where ChatGPT failed outright for the first time. When I clicked on the URLs, each one gave me a 404 error. Noticing the URLs, I saw that every one ended with frozen-embryo-transfer-fet. While the websites it chose (RESOLVE, FertilityIQ, and ASRM) are amazing organizations that provide amazing resources to patients, ChatGPT clearly just attached the keywords I gave it to the websites and made up a webpage. This is a demonstration of a phenomenon known as hallucination. You can read more about it here. ChatGPT is Pretty Amazing... As I used ChatGPT, I was amazed by a few things right off the bat. First off, the speed of the answers was faster and more personalized than any other search engine I have used. You can see why Microsoft wants to use GPT-4 in the Bing search engine and other Microsoft products. It is hard to imagine that FET plans are widely available on the internet and ChatGPT was trained on a large dataset with a lot of information on this topic. But that did not matter and ChatGPT gave me varying degrees of detail in answers almost instantaneously. Second, the empathy that the tool provided was pretty striking. There were times where you could imagine a nurse or trained professional who deals with fertility patients providing the exact same response. The ability for an algorithm to appear to relate to a profoundly human experience is a pretty amazing concept. It also is slightly unsettling. Finally, the ability for ChatGPT to take a large amount of complex information and quickly digest and summarize is an amazing capability and probably the most beneficial component of the tool available today. There are plug-ins users can download to digest PDFs and other documents (such as unstructured health records) and quickly summarize or find essential information. I know people are already doing this today. ...But ChatGPT Has Limitations for Fertility Patients However, there are some major limitations that patients need to consider when using ChatGPT or any public facing large language model. First, the ability for ChatGPT to hallucinate and just make up information cannot be discounted as a major liability. There is no reason to think ChatGPT would not make up facts and responses to other questions if it so easily just made up resources when prompted. It is really important for patients to try to double check any outputs from ChatGPT from trusted, scientifically validated resources. I know this is very hard to do for most patients, which can limit the utility of this as a tool. When I double checked all of the descriptions and uses of the medications ChatGPT listed, none appeared incorrect. However, some of the claims were not verifiable or settled. Some of the steps have disputed efficacy according to studies I found online. I decided not to go into detail about this, but instead flag it as a caution and point that patients once again need to double check the truth of outputs from ChatGPT. Perhaps a clinician in the fertility community would want to collaborate on future writing to check the clinical efficacy of ChatGPT as a patient advocacy tool in fertility treatment? If so, email me at joe@grainfertility.com. Second, and maybe most importantly, currently the data that you input ChatGPT leaves your protection the second you use it and frankly, we don't know where it could end up. Reproductive health information is amongst the most sensitive information and it is currently being weaponized in states across the US. Most people do not understand the limitations of laws like HIPAA and ChatGPT or many of the other tools you can use right now are not subject to these protections. I used dummy data for a reason for this test. We know this will change as healthcare companies integrate GPT-4 and other large language models into their clinical systems that must comply with HIPAA protections. But for now, it is the wild west when it comes to data protections. The Future of ChatGPT and Fertility Advocacy In the end, ChatGPT and the GPT-4 large language model is a fascinating tool that holds immense promise in helping fertility patients. In the coming years, these models will be used to help reduce administrative burdens clinicians face, streamline paperwork, provide personalized educational resources to patients, and even help the development of personalized protocols that can increase successful pregnancy rates for patients. I know I will use it to help outline, draft, and edit copy (I even used it to help draft this article) and there are times I would consider using it as a tool to help with my own health. I believe it has immediate utility for fertility patients and a few of the use cases I described above really can help people. I would absolutely use a closed version of GPT-4 to help augment the capabilities of my own fertility application, Grain Fertility, that I am developing and will most likely do so at some point in the future. However, it cannot be overstated that displaying incorrect information about a patient’s health information and failing to sufficiently protect it are severe limitations that inhibit the utility of the tool. If ChatGPT gives a patient wrong information and they decide to take it to their doctor, convinced that the AI is correct, it could have a detrimental impact on that relationship. If a person’s fertility information was inadvertently exposed on the internet and data they uploaded into ChatGPT was leaked, the harm can be irreparable. I look forward to the day when AI is a trusted tool that helps reduce the cognitive burdens fertility patients face today and believe this will happen very soon. Until then, we should all have an optimistic, but cautious, approach to using it as a sole resource.