Paths to Parenthood
Understanding Fertility
01
The Hormonal System
Step 01
Hypothalamus
The control center
GnRH
Gonadotropin-Releasing Hormone; released by the hypothalamus to signal the pituitary gland to produce FSH and LH.
Step 02
Pituitary gland
The messenger
FSH
Follicle-Stimulating Hormone; produced by the pituitary gland to stimulate the growth and development of ovarian follicles.
LHG
Luteinizing Hormone; produced by the pituitary gland to trigger ovulation (the release of an egg).
Step 03
Ovaries
The responder
E2
Estradiol; the primary form of estrogen, produced by growing ovarian follicles and commonly measured to monitor follicle development during a treatment cycle.
P4
Progesterone; produced after ovulation by the corpus luteum to prepare and maintain the uterine lining for implantation and early pregnancy.
The Menstrual Cycle
Most people think of the menstrual cycle as just a period. It's a precisely coordinated
hormonal sequence that happens every single month - and it tells us a huge amount.
hormonal sequence that happens every single month - and it tells us a huge amount.
Embryo Implantation
Chances of conceiving
1/5
individuals need help to conceive
85%
of individuals conceive without help, within 12 months of trying
20%
chance per month for the first 12 months
Fertility changes over time
Finding the
Cause
02
What we look for
There are several well-understood factors that can impact chances of conception.
Endometriosis
Endometriosis is a condition where tissue similar to the uterine lining grows in places it shouldn't. Over time it can cause inflammation, scarring, and the formation of cysts on the ovaries known as endometriomas.
Polyendocrine Metabolic Ovarian Syndrome (PMOS)
Formerly known as PCOS
PMOS is one of the most common hormonal disorders where the normal cycle of follicle development and ovulation is disrupted. If ovulation isn't happening regularly, the window for conception is significantly reduced.
Irregular ovulation
Weight gain
Hair thinning or growth
Acne
Sperm factors
Up to 40% of fertility challenges involve sperm in some way. It's easy to assess the key measures of sperm health, but beneath those numbers there's often a cause: a varicocele quietly affecting production, a hormonal imbalance, or a physical obstruction preventing sperm from reaching where they need to go. Finding the cause is the first step to addressing it.
Uterine factors
The uterus is where an embryo implants and grows, so its structure and environment matter enormously. Uterine factors are a less common cause of fertility challenges than ovulatory or sperm factors, but they're important to identify early because many are straightforward to treat, and some can affect the outcome of treatment if left unaddressed
Unexplained infertility
Unexplained infertility is diagnosed when all standard investigations return normal results but conception hasn't happened after a defined period of trying. There may be subtle factors in egg quality, fertilization, or implantation that standard testing doesn't capture. We have strong evidence-based protocols that work well even when no single cause is identified.
Diagnostic testing
Diagnostic testing is all about building the clearest possible picture so we can recommend the right support and design a tailored treatment plan. Well guide you through what's relevant for your situation.
Antral follicle count (AFC)
We can count the number of antral follicles using a transvaginal ultrasound scan. The number of visible follicles gives us a strong indication of how many eggs are likely to be available in any given month. This helps us to tailor your treatment plan - but similarly to the AMH blood test, it doesn't tell us anything about egg quality.
Anti-Müllerian Hormone & Day-3 FSH
AMH is produced by the small follicles in your ovaries. The more follicles present, the more AMH is released into the bloodstream - so a simple blood test gives us a reliable indication of the remaining egg supply. AMH is indicative of egg quantity only, not quality. Two people with the same AMH level can have very different outcomes. We pair it with a baseline (day-3) FSH - shown as the dashed line on the chart - for a more reliable picture of ovarian reserve.
HSG — checking the tubes & uterine cavity
An HSG is a dye test that shows whether the pathway through the fallopian tube is clear. If the tubes are clear, the dye should flow freely. If the dye is obstructed, there may be a blockage or narrowing that's worth investigating further.
The shape of the uterine cavity is also visible, which can flag structural factors at the same time.
The shape of the uterine cavity is also visible, which can flag structural factors at the same time.
SIS — Saline infused ultrasound
An SIS is a simple, minimally invasive scan where a small amount of sterile saline solution is gently introduced into the uterine cavity. The fluid fills the uterus and separates the uterine walls, allowing us to see the shape of the cavity, texture of the lining and whether anything is present that may impact the recommended course of treatment.
Semen analysis
A semen sample is analyzed across three key areas: count (how many sperm are present), morphology (whether the shape and structure are normal), and motility (how many are moving, and how well). Sperm quality naturally varies from sample to sample.
Genetic Carrier Screening
A one-time blood test that's relevant for everyone, regardless of how you're building your family.
Genetic carrier screening looks at whether you carry variants in genes associated with certain inherited conditions. Carriers are usually completely healthy and have no idea they carry a variant - it's only when egg and sperm that both carry the same variant meet that leads to a chance of passing the condition onto a child.
Genetic carrier screening looks at whether you carry variants in genes associated with certain inherited conditions. Carriers are usually completely healthy and have no idea they carry a variant - it's only when egg and sperm that both carry the same variant meet that leads to a chance of passing the condition onto a child.
(Finding The Cause Summary)
01
What we look for
02
Endometriosis
03
Polycystic ovarian syndrome (PCOS)
04
Sperm factors
05
Uterine factors
06
Unexplained infertility
07
Diagnostic testing
08
Anti-Müllerian Hormone (AMH)
09
Antral follicle count (AFC)
10
HSG - tubes & uterine cavity
11
SIS — saline infused ultrasound
12
Semen analysis
13
Genetic carrier screening
Trying to
Conceive
03
What matters
Before we look at options, it helps to know what matters most to you.
There are no right answers here. But these questions are worth sitting with.
There are no right answers here. But these questions are worth sitting with.
Treatment Pathways
The most advanced treatment option isn't always the right one. Every person who sits here has a different story. These options cover the full spectrum of support - from the simplest approaches to IVF and beyond. If you're here to talk about preserving fertility for the future, skip to module 04.
Also Available
Donor sperm
Donor eggs
Gestational carrier
Timed Intercourse & Ovulation Induction
Everything here happens naturally, no laboratory procedures are involved. Ultrasound scans give us a precise picture of when ovulation is most likely to occur, and where the cycle needs a helping hand, medication can be used to encourage follicular development and make ovulation more reliable.
IUI - intrauterine insemination
IUl is a straightforward, minimally invasive procedure that gives sperm a head start. Prepared sperm is placed directly into the uterus, much closer to where fertilization takes place. Cycles can be medicated or non-medicated, and we build the approach around what makes most sense for you.
In conjunction with medications
Natural Cycle IUI
IVF - The full journey
In an unassisted cycle, fertilization happens inside the fallopian tube. IVF moves that step to a laboratory setting where we can observe it, support it, and give the resulting embryo the best possible conditions to develop and result in a healthy pregnancy.
OVULATION STIMULATION & MONITORING
EGG RETRIEVAL
FERTILIZATION
EMBRYO DEVELOPMENT
EMBRYO BIOPSY AND PGT (OPTIONAL)
EMBRYO TRANSFER (FROZEN IF PGT)
PREGNANCY TEST
STEP 01 OF 07
Ovarian Stimulation
The goal is to retrieve several eggs within a cycle. Injectable medication is taken daily to promote follicular growth, and regular monitoring visits are required to monitor your ovarian response.
STEP 02 OF 07
Egg retrieval
A short procedure under sedation to retrieve as many mature eggs as possible. Most people are home within a few hours.
STEP 03 OF 07
Fertilization
Mature eggs are fertilized in the lab under carefully controlled conditions. As with any biological process, not every egg will fertilize, and not every fertilized egg will develop into a blastocyst. This is a normal part of the process.
STEP 04 OF 07
Embryo Development
Over the next five to seven days, embryologists closely monitor their development, watching for the signs of healthy, continued growth.
STEP 05 OF 07
Preimplantation genetic testing for aneuploidy (PGT-A)
During IVF, embryos are often tested using PGT-A - a genetic test that counts chromosomes. Having the right number of chromosomes (46) gives an embryo the best chance of becoming a healthy pregnancy.
A small biopsy is taken from each embryo and sent for analysis, and results typically come back within 2-3 weeks, during which the embryos remain safely in storage.
STEP 05 OF 07
Understanding PGT-A Results
PGT-A can yield three possible results.
STEP 05 OF 07
Preimplantation genetic testing for monogenetIC conditions (PGT-M)
PGT-M is used for people who carry a known genetic condition and want to identify if it is passed onto their embryos.
STEP 06 OF 07
Embryo transfer
The final step of the process. The embryo is placed into a carefully prepared uterus. Around 10 days after the embryo transfer procedure, a pregnancy test will confirm if the embryo has successfully implanted.
Chances of success
Just like unassisted conception, pregnancy can be attempted once per month, either through IUl or a single embryo transfer via IVF.
Family Planning
How many children you hope to have shapes the plan you put in place today. These are a few questions worth sitting with.
01
A Starting Question
What is your desired family size?
02
THE ARITHMETIC OF EMBRYOS
Depending on your age and the quality of your embryos, you may need 2 - 3 embryos for each child you want to have.
03
WORRIED ABOUT THE TIMING?
If you're thinking about your age and future fertility, embryo banking might be an option to consider now.
04
LOOKING FURTHER AHEAD
Freezing embryos today can help make sure you have the family you want - when you're ready for it.
Your care team will walk through how many retrieval cycles and embryos may be realistic for your situation — there are no right answers, only what feels right for you
What If the First Cycle Isn't Successful?
70% of families need more than one attempt to achieve a healthy live birth, so it's important to consider what options are available.
Donor & Gestational Carrier Pathways
We support all family building pathways that include the use of donor sperm, donor eggs or a gestational carrier.
Same-sex couples
Unpartnered individuals
Severe male or female factor
Recurrent unsuccessful IVF cycles
Presence of genetic conditions
Fertility Preservation
04
Fertility Preservation Overview
Fertility preservation is about keeping options open. Whether it's timing, a medical diagnosis, or simply wanting to plan ahead.
Egg freezing
The biological age of the egg is fixed at the moment of freezing, preserving the quality irrespective of how long the material is kept safe in storage.
How many eggs do I need?
The number of eggs retrieved depends on ovarian reserve. Testing AMH and antral follicle count gives us a strong indication of what to expect. Generally, around 10 to 15 mature eggs gives a reasonable chance of one future live birth, though this varies significantly by age and individual factors. Individuals may undergo multiple cycles of egg freezing to store as many eggs as possible.
10-15 mature eggs
a reasonable chance of one future live birth
10 eggs frozen
8-9 eggs survive thaw process
2-4 embryos once fertilized
Blastocyst
Embryo Freezing
Similar to egg freezing but with an extra step. The eggs are fertilized in the lab under carefully controlled conditions. Over the next five days, embryologists closely monitor their development, watching for the signs of healthy, continued growth. As with any biological process, not every egg will fertilize, and not every fertilized egg will develop into a blastocyst. This is a normal part of the process. Once developed, the embryos will be frozen for when you're ready to use them.
Sperm Freezing
New sperm is produced continuously throughout adulthood - but quality declines with age, with more significant risks emerging from 45 onwards. Sperm freezing is recommended in a number of situations: before cancer treatment or gender-affirming hormone therapy where sperm production may be permanently affected, ahead of a vasectomy or high-risk reproductive surgery, or as a practical backup before IUl or IVF if production may be difficult on the day.
Obtaining the semen sample
Addition of cryoprotectants
Storage in liquid nitrogen at - 196C
Moving Forward with Confidence
05
Your Next Steps
It's important to understand we're here for you every step of the way.
You can contact your dedicated financial counselor for any assistance with next steps.
You can contact your dedicated financial counselor for any assistance with next steps.
01
Schedule appointments for testing
Book the diagnostic tests that will shape your personalized plan.
02
Confirm treatment plan with your care team
Walk through options together and choose the approach that fits your story.
03
Check your detailed insurance coverage
Confirm benefits with your insurance carrier.
04
Review your payment & protection options
Understand what cover and financial protection is available to you.
Treatment with Financial Protection
For families without insurance coverage, IVIRMA has partnered with Gaia to offer a simpler, more protected way to pay for treatment. Gaia exists to give you clarity on costs, more chances to succeed, and human support throughout the journey.
We're a team - clinical expertise from IVI RMA, financial protection from Gaia Family, and care that meets you wherever you are in your journey.
