In Vitro Fertilization (IVF) Patients’ Guide

Considering undergoing IVF treatment?

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Table of contents:

1. In Vitro Fertilization (IVF)
2. IVF Legislation
3. Who Is Eligible for IVF?
4. The IVF Process
5. Factors Affecting the IVF Success
6. Success Rates of IVF: Single vs. Multiple Transfers
7. Live Birth Rate
8. Cost of IVF
9. Tailoring IVF to Your Needs
10. Intracytoplasmic Sperm Injection (ICSI)
11. Mini–IVF
12. Natural Cycle IVF
13. Egg Donation IVF
14. Egg Donation Law
15. Sperm Donation IVF
16. Tandem IVF Cycle
17. Egg and Sperm Donation IVF
18. Embryo Adoption IVF
19. Genetic Testing IVF
20. ROPA IVF: Shared Motherhood
21. Frozen Embryo Transfer
22. Exploring Your Options
23. Conclusive Words

There are many reasons why parents–to–be opt for medically assisted reproduction treatment when starting or expanding a family, including fertility issues, risk of passing genetic conditions, genetic and hereditary diseases, a history of pregnancy loss, being in a same–sex relationship, or simply wanting to have a baby of the desired sex.

Many couples experiencing infertility choose In Vitro Fertilization (IVF) as a way to achieve pregnancy.

In Vitro Fertilization (IVF)

In vitro fertilization (abbr. IVF) is the most efficient way for couples to achieve pregnancy when they are experiencing issues with conception.

Generally, it is a common infertility treatment where an oocyte (egg) is fertilized by sperm in the laboratory. The resulting embryo is cultivated until day 3 (cleavage stage) or day 5 (blastocyst stage), and then an embryo is transferred back into a woman’s uterus to achieve a successful pregnancy.

According to the American Society for Reproductive Medicine and the Society for Maternal-Fetal Medicine Guidelines, it is recommended to receive a single–embryo transfer, regardless of the embryo stage (if the woman is <35 years of age) and single or double–embryo transfer (if the woman is between 35 and 37 years of age) to avoid multiple pregnancies. But in exceptional cases, the fertility specialist may introduce into the womb up to three embryos per single procedure.

IVF Legislation 

Many countries have established laws or guidelines for Assisted Reproductive Technology (ART). These regulations often address issues such as the number of embryos transferred and age limits for women seeking treatment. In some countries, there are no legal restrictions on IVF, and it is neither prohibited nor forbidden.

Variations in Access

There are significant variations in how different countries approach access to ART. Some countries limit access to heterosexual couples only, while others embrace inclusivity and allow single women and same–sex couples to pursue fertility treatments.

Options for Gametes

Some countries permit IVF procedures only using the intended parents’ gametes (eggs and sperm). In contrast, countries with more liberal legislation allow cycles using donor eggs, sperm, or embryos. This broader range of options allows individuals to find solutions even when they cannot provide their own genetic material.

Who Is Eligible for IVF? 

Eligibility criteria for IVF can vary depending on several factors. This includes the specific regulations of the country, the policies of the fertility clinic the single individuals or couples choose, and their unique situation. Having a clear understanding of these factors is important.

Here is a breakdown of some common scenarios where In Vitro Fertilization could be an effective treatment for you:

• Individuals and couples facing advanced maternal age.
• Women with blocked, tied, extremely damaged or surgically removed Fallopian tubes.
• Women with issues related to ovulation, including diminished ovarian reserve, premature ovarian failure, or perimenopause.
• Women experiencing uterine factor infertility.
• Couples with a history of ectopic pregnancy.
• Couples struggling with male factor infertility, such as low sperm count or motility.
• Couples experiencing unexplained infertility.
• Couples who have completed multiple rounds of Intrauterine Insemination (IUI) without success.
• Women with recurrent pregnancy loss (multiple miscarriages).
• Women diagnosed with severe endometriosis.
• Individuals and couples who carry a genetic condition they wish to avoid passing on to their child.
• Individuals and couples facing a combination of the conditions listed above.
• LGBTQ+ couples who plan to use donor eggs and/or sperm.

Depending on your specific situation, IVF can be tailored to utilize:

• Your own eggs and your partner’s sperm (standard IVF).
• Your own eggs with donor sperm.
• Donor eggs with your partner’s sperm.
• Donor eggs and donor sperm.
• A combination of your eggs and donor eggs, fertilized with either your partner’s sperm or donor sperm (Tandem cycle).
• Your partner’s eggs (oocytes) with donor sperm (reciprocal IVF).
• Donated embryos.

Depending on your specific situation, IVF can be tailored to utilize a variety of options. To determine if IVF is the right treatment for you, consult with a healthcare professional to discuss your individual needs and options.

The IVF Process 

In vitro fertilization (IVF) is a multistep process initiated to increase the chances of pregnancy. It involves initial and follow–consultations, pre–cycle fertility testing, egg retrieval procedure, sperm collection, and embryo transfer. 

During the first step (ovarian stimulation), fertility drugs (injectable hormones — Gonadotropins, Oral contraceptives, GnRH analogs, Antagonists, Progesterone, and Estrogens) are used to stimulate the ovaries to produce multiple mature eggs. Stimulation may continue for a few days until there are sufficient follicles of an appropriate size, as confirmed during ultrasound scans (in a Single cycle). In some cases, a second round of stimulation might be needed within the same cycle (DuoStim) to collect more oocytes, especially in poor responders.

When the size of most follicles reaches 18 to 20 mm, egg retrieval is done. Once retrieved, these eggs are then fertilized with sperm via conventional or various micromanipulation methods (zona dissection, sub–zonal insemination, and direct injection of a spermatozoon into the cytoplasm (ICSI) of the oocyte) in a laboratory. Fertilized eggs are cultured for 3 to 5 days before the best embryos are chosen for transfer into the uterus.

Following embryo transfer, pregnancy tests and ultrasound scans are done to confirm the pregnancy. If the first scan done at the end of week 5 or early in week 6 doesn’t visualize the embryonic sac and heart activity but the pregnancy tests are positive, a series of ultrasound scans and blood tests will be scheduled at the end of week 6, during week 7, and during week 8.

Factors Affecting the IVF Success

Many factors may influence a couple’s chance for success, including the woman’s age, the couple’s diagnosis, the response of the woman’s ovaries to medication, and the sperm quality. However, each step in the IVF cycle can have hurdles. For example, suppose the ovaries have a poor response to medication. In that case, few or no eggs may develop, resulting in the cancellation of the cycle. In the best–case scenario, a SingleStim protocol will be modified to DuoStim with two egg retrieval procedures so as not to stop the current cycle.

There is also a small chance that fertilization may not occur due to either sperm and/or egg defects, such as sperm DNA fragmentation, oocyte maturation abnormalities, or severe cytoplasmic deviations of the oocyte. Furthermore, eggs may be retrieved and embryos obtained, but the embryos may be of poor quality and may have a low potential for implantation. Finally, embryonic arrest may happen, the embryo transfer may be delayed, or technically difficult, or, in extremely rare cases, just impossible. The most common reason for failure in an in vitro fertilization cycle is failure of the embryo(s) to implant within the uterus, resulting in miscarriage, usually associated with embryo quality issues.

Success Rates of IVF: Single vs. Multiple Transfers

Live Birth Rate 

A woman’s age is the most significant factor influencing IVF success rates. The chances of pregnancy using her own eggs are highest in younger women and decline as she reaches 42.

The day the embryo is transferred also affects the outcome. Studies have shown that transferring a blastocyst (developed embryo, day 5) generally leads to slightly higher live birth rates compared to transferring an embryo on day 3 (cleavage stage). This difference is most pronounced for younger women (under 35).

Impact of Age on Cumulative Live Birth Rates

Live Birth Rates with Egg Donation

It is important to note that while we have focused on IVF using a woman’s own eggs, there is a different success rate for cycles that use donated eggs (egg donation IVF). Studies suggest that for women between 41–42 years old, the cumulative live birth rate using donor eggs can be over 60% after four cycles.

While age and the day of transfer are significant factors, success rates can vary depending on individual circumstances. Consulting with a healthcare professional experienced in IVF can provide a more personalized assessment and guide you through the process.

Cost of IVF 

IVF may cost as low as €2,960 to figures like €13,700 in Europe and $8,000 to $23,000 in the United States; cycles with traveling egg donors are around $30,000 to $66,000, but an average is $25,000, influenced by a variety of factors. The specific genetic materials utilized in the procedure, the involvement of egg or sperm donors, the number of cycles initiated and embryo transfers completed, as well as additional services used such as preimplantation genetic testing (PGT) and egg or sperm vitrification — are all affecting the total price tag. Moreover, logistical aspects like the transportation of gametes or embryos can further shape the financial investment required for IVF.

The diversity in IVF cost is echoed throughout various European countries, each with its own pricing structure and available services. With such a broad spectrum of expenses, it is essential for prospective parents to explore, understand, and carefully plan for the financial aspects of IVF, ensuring alignment with both their dreams and their budget.

Compare the cost of single IVF cycle vs. multi–cycle rounds and learn all about your spending:

Check out our fertility guides for Fertility Treatment Costs in Eastern, Western, Southeastern, and Northern Baltic Europe in 2024!

Tailoring IVF to Your Needs

In Vitro Fertilization (IVF) is a versatile treatment that can be adapted to any unique case, including the most diverse ones, when hiring a gestational carrier or surrogate is necessary to carry the baby. Not all couples can use their own eggs and sperm to create an embryo. Some may require donor sperm or eggs, while others might prefer a less–medicated natural cycle approach. There are even options for using donor embryos or own eggs and the donor’s eggs in one cycle.

This IVF guide will explore the different types of IVF treatments available, including:

• Intracytoplasmic Sperm Injection (ICSI)
• Minimal Stimulation IVF (Mini–IVF)
• Natural Cycle IVF
• Egg Donation IVF
• Sperm Donation IVF
• Tandem IVF Cycle
• Egg and Sperm Donation IVF
• Embryo Adoption IVF
• Genetic Testing IVF (PGT)
• ROPA IVF
• Frozen Embryo Transfer (FET)

We will begin by delving into ICSI, a technique used for specific fertility challenges.

Intracytoplasmic Sperm Injection (ICSI)

ICSI is a type of IVF. With traditional IVF, an embryologist places thousands of sperm next to each egg on a Petri dish. There is no guarantee that the oocyte, surrounded by sperm, will be penetrated and fertilized. If none of the sperm penetrate and fertilize the egg, conception (fertilization) doesn’t occur.

Intracytoplasmic sperm injection enhances this process by directly injecting a single healthy sperm into a single egg. While ICSI doesn’t guarantee fertilization, it significantly increases the chances compared to traditional IVF.

This technique is typically used in cases where the number of sperm available is extremely low, in cycles with vitrified oocytes, or when surgically–retrieved sperm is used, or there is a past history of failed or poor fertilization.

Following fertilization, whether through traditional IVF or ICSI, the fertilized oocyte (an embryo) is monitored and cultivated in a laboratory for 3 to 5 days before being transferred back to the mother’s uterus for a potential pregnancy.

Check out OVU.com's blog article about Understanding the Risks of ICSI in In Vitro Fertilization and IVF vs ICSI: What Technique to Choose?

Mini–IVF

Minimal Stimulation IVF (Mini–IVF), sometimes referred to as “modified cycle with minimal stimulation,” is a cycle with a unique protocol that concentrates on egg quality rather than quantity.

Unlike traditional IVF, where different fertility drugs and injectable hormones are used to stimulate the ovary to produce multiple eggs, mini–IVF gently stimulates the ovaries to produce between three and eight high–quality eggs in a single cycle.

The Minimal Stimulation IVF protocol differs from Natural IVF as it uses a minimal amount of oral medication and injections (antiestrogens and/or adding the minimum doses of gonadotropins). Thus, women can expect a less invasive cycle with less medication and fewer side effects. It is worth saying that the success rates with mini–IVF are similar to those of Conventional IVF.

Mini–IVF is a good option for women with: 

• Low AMH (anti–Mullerian hormone) level.
• High FSH (follicle–stimulating hormone) levels.
• PCOS (polycystic ovary syndrome).
• Blocked or damaged fallopian tubes.
• Poor IVF responder to high doses of stimulating drugs.
• Multiple failed conventional IVF cycles.

Additionally, a minimal stimulation cycle might be a suitable choice for those who:

• Wish to minimize hormonal medications.
• Are LGBTQ+ individuals or couples (potentially due to cost or a preference for a less demanding process).

It is essential to add that while Mini–IVF can be an ideal option, some cases won’t be resolved and will need more sophisticated solutions. If you are a couple or a single woman seeking fertility help — consult with an experienced reproductive endocrinologist to understand if this approach aligns with your unique fertility profile and family goals.

Natural Cycle IVF

Like Mini–IVF, Natural Cycle IVF is a gentle alternative form of IVF that lowers health risks associated with conventional IVF, allowing the women to avoid the discomfort of daily self–administered fertility drug injections and reduce the high costs associated with treatment.

The clinicians focus on tracking the natural ovulation cycle and the one egg produced by the ovary each month. This oocyte is harvested for fertilization procedure and transferred to the woman’s uterus for implantation.

The candidates for Natural Cycle IVF are women who:

• Are at an advanced maternal age for fertility (over 35).
• Have high follicle–stimulating hormone (FSH) levels.
• Have a normal ovarian reserve and are able to ovulate.
• Don’t want to use or don’t respond well to fertility medication.
• Are unable to produce a large number of eggs during a single cycle.
• Who are at high risk for developing ovarian hyperstimulation syndrome (OHSS).
• Do not want to produce multiple embryos for ethical or religious reasons. 

If you are considering a Natural cycle IVF or need help choosing between Native vs. Minimal stimulation, book your free initial consultation to discuss your options with a leading fertility expert. 

Egg Donation IVF

In Egg Donor IVF the donor’s eggs (either fresh or vitrified) are fertilized with the male partner’s or donor’s sperm. After that, the resulting embryos are transferred to the woman’s (recipient’s) uterus to carry and deliver the baby.

IVF with egg donation is one of the most effective strategies offered to infertile women who are unable to conceive with their own oocytes due to:

• Bilateral absence of the ovaries. 
• Congenital absence of fallopian tube and ovary.
• Bilateral absence of Fallopian tubes and ovaries. 
• Premature ovarian failure.
• Oocyte factor (diminished ovarian reserve, low quantity and quality of the oocytes, repeated fertilization or implantation failure). 
• Ovarian endometriosis or genetic conditions. 

Using the donated eggs in such situations may reduce the risk of miscarriage compared to using eggs with diminished ovarian reserve, and increase the chances of having a healthy baby.

Check out OVU.com's blog article - "IVF with Donor Eggs"

Egg Donation Law 

Legislation on egg donation varies from country to country. Some countries have liberal legislation, while others prohibit using the donor’s oocytes in IVF. European countries such as Bosnia and Herzegovina, Germany, Norway, and Switzerland banned donations. Turkey, Saudi Arabia, Kuwait, Qatar, Oman, and other Muslim Middle Eastern countries also prohibit using the donor’s oocytes in IVF.

Few countries where the egg donation process is regulated and legitimate limit its accessibility to heterosexual couples only. However, same–sex female couples opting for egg donation may undergo the procedure in Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, Georgia, Greece, Latvia, Portugal, Spain, the Netherlands, Ukraine, the United Kingdom, the United States, Mexico, Colombia, and Argentina.

Single women seeking such treatment in countries like Austria, Croatia, Czech Republic, France, Georgia, Germany, Italy, Montenegro, Norway, Poland, and some other countries, should consider the other destinations as the current legal framework in these countries doesn’t allow them to be eligible.

Like any treatment, egg donation is a complex process with emotional and legal considerations. Consulting with a fertility specialist and counselor can help you understand the process, navigate the legalities, and make informed decisions about this path to parenthood.

Sperm Donation IVF 

IVF with donor sperm is used when there is a lack of healthy sperm in a male partner’s semen (heterosexual couples) for single women who want to have a child, and for female couples wishing to conceive. The process is similar to traditional IVF: the mother will still receive fertility drugs stimulating her ovaries to produce multiple eggs for retrieval. Once retrieved, the eggs will be combined with the donor sperm, and any resulting embryos will be transferred back to the woman’s uterus for implantation.

Common reasons for using donor sperm include: 

• The sperm quality test shows too many abnormalities.
• Absence of sperm in the semen.
• Spermatogenic failure (inability to produce sperm). 
• Genetic disease carried by the sperm.
• Testes have been removed, or their function has been compromised by a chemotherapy.
• High percentage of sperm DNA fragmentation index (DFI).

Legal Framework on Sperm Donation

Legislation on sperm donation is generally more liberal and inclusive than for egg donation. Sperm donation is legal and regulated in many countries worldwide. Most European countries, along with the United States, Canada, and the United Kingdom, allow heterosexual couples to receive treatment using donor sperm. Muslim Middle Eastern countries typically prohibit sperm donation outside of marriage.

Lesbian couples can also access sperm donation IVF in most European countries, including Switzerland, which legalized it for married same–sex couples in June 2022. The United States, Mexico, Colombia, Argentina, and some other countries also have liberal legislation on providing assisted reproduction with donor sperm to female couples and single women, making sperm donation IVF a more accessible option for lesbian couples and single women to build families, enabling an equal access to fertility treatments to all types of families.

Check out OVU.com's blog article - Sperm Donor IVF: 
How Much Does It Cost & Success Rates

Tandem IVF Cycle

A tandem IVF cycle is an IVF treatment that uses two sets of oocytes to create embryos for implantation. One set of oocytes comes from the mother (recipient), and the other comes from an egg donor.

In this cycle, both the recipient and the donor take fertility medications to synchronize their menstrual cycles, continue visiting the clinic during ovarian stimulation, and undergo egg retrieval procedure. Once the oocytes are retrieved, they are fertilized with either father–to–be or donor sperm. The resulting embryonic cohorts will contain either the maternal DNA or the donor’s DNA. During the embryo transfer, fertility specialists can choose to implant either an embryo created with the recipient’s eggs, a donor embryo, or even both, depending on the specific situation.

Legislation on Tandem IVF Cycle

It is important to note that tandem IVF is only legal and available in countries where egg donation is legal and regulated. This is because the process involves using eggs from a donor, and regulations around egg donation vary significantly from country to country.

Tandem IVF is an option for women with diminished ovarian reserves, those who have experienced prior IVF failure, and women of advanced maternal age. It offers a backup option by using both the mother’s eggs and donor eggs, potentially increasing the chances of a successful pregnancy.

Check out OVU.com's blog article Tandem IVF Cycle

Egg and Sperm Donation IVF

Double Donation IVF is a type of fertility treatment that involves both egg and sperm donation, either fresh cycle or using vitrified oocytes and cryopreserved sperm to create the embryos. Then, the resulting embryos are transferred into the uterus of a mother.

Unlike Egg Donation IVF, where the father–to–be provides sperm or undergoes an invasive surgical/non–surgical sperm retrieval, or Sperm Donation IVF, where the mother has to follow an ovarian stimulation protocol using fertility drugs and undergo an invasive egg retrieval procedure routinely requiring anesthesia, this cycle of IVF makes it possible to eliminate these steps and have a healthy embryo.

Single women and couples who undergo IVF with egg and sperm donation should expect routine screening and blood tests followed by the specific protocol to prepare the uterine lining for embryo transfer and implantation.

Single women and couples who undergo IVF with egg and sperm donation should expect the routine screening and blood tests followed by the specific protocol to prepare the uterine lining for the embryo transfer and implantation.

Who Is Eligible For Egg and Sperm Donation?

• Couples with severe dual–factor infertility, when neither partner can produce healthy eggs or sperm on their own.
• When both partners carry the risk of transmitting genetic or hereditary conditions.
• Single women with diminished ovarian reserve, polycystic ovarian syndrome (PCOS), primary ovarian insufficiency (POI), advanced maternal age, empty follicle syndrome (EFS), poor egg quality, or other fertility issues.
• Female couples where neither partner can provide their own eggs to be used in IVF/ICSI.

Legal Regulations on Double Donation Treatment

It is worth considering that double donation IVF is only legal in countries that also permit and regulate egg and sperm donation. Even in these countries, access to Double Gamete Donation may be restricted by law for single women and female couples.

Unfortunately, some countries with established legal frameworks for egg and sperm donation still prohibit double–donor IVF. In such cases, infertile individuals and couples seeking this treatment might consider fertility tourism.

Why Singles and Couples Choose Double Donation?

One of the main reasons why Double Donation is wanted is its high success rates. 75% of all embryos created within one cycle are reach the blastocyst stage. The accumulative positive pregnancy rate per Single IVF cycle with egg and sperm donation is around 82%, two cycles is around 88%, and over three cycles is around 94% respectively. 

The positive pregnancy rate (including cryotransfers) starts at 90% and goes up. Fresh cycles have 94% of successful implantation.

Embryo Adoption IVF

Embryo adoption is a medically assisted reproduction technique that consists of transferring to a woman’s uterus the embryo donated by the other couple.

Basically, embryo donation is an alternative to the double gamete donation cycle but less expensive, as it doesn’t require egg donation or procedures like ICSI in all cases. Still, a devitrification procedure is required. Furthermore, most clinics offer genetically tested (PGT–A) embryos, thus allowing recipients to choose embryos screened for genetic abnormalities, potentially leading to a healthier pregnancy.

In such cases, IVF involves the preparation of the endometrium for embryo implantation, a series of ultrasound assessments to detect endometrial thickness, and a few serum tests to measure hormonal levels and identify the optimal transfer window. Most IVF clinics limit the number of embryos to transfer per cycle to two for safety reasons.

Who Can Benefit from Embryo Adoption?

• Individuals or couples facing infertility challenges.
• Those with a genetic disease history in the family.

Legality of Embryo Adoption

Similar to other treatments involving egg or sperm donation, embryo adoption has varying legal and regulatory frameworks around the world. Some Western and Northern European countries, along with most Asian and Middle Eastern countries, prohibit embryo adoption. In other countries, it might be restricted to heterosexual couples only.

However, there are countries where embryo adoption is legal for single women and female couples. These include Belgium, Denmark, Estonia, Ireland, Portugal, Spain, the Netherlands, and the United Kingdom. Additionally, single women can undergo embryo adoption in Croatia, Cyprus, Georgia, and Greece, while Latvia and Malta allow embryo adoption for lesbian couples.

Check out OVU.com's article about Embryo Adoption: 

How Long Does it Take & What Are the Success Rates?

Genetic Testing IVF

Preimplantation Genetic Testing (PGT) is a sophisticated technique used in vitro fertilization (IVF) to analyze embryos for genetic abnormalities. This early form of prenatal genetic diagnosis screening helps identify potential issues that could lead to implantation failure, miscarriage, genetic conditions, or congenital disabilities before transferring an embryo to the uterus.

There are three main categories of PGT:

• Preimplantation Genetic Testing for Aneuploidy (PGT–A): This test checks embryos for the correct number of chromosomes, which can impact a healthy pregnancy.
• Preimplantation Genetic Testing for Monogenic Disorders (PGT–M): This test screens embryos for specific genetic conditions caused by mutations in a single gene. This helps prevent passing on these conditions to the child.
• Preimplantation Genetic Testing for Structural Chromosomal Rearrangements (PGT–SR): This test identifies structural abnormalities in chromosomes, such as duplications, insertions, inversions, translocations, or deletions that could lead to health problems.

Who Should Consider Genetic Testing IVF?

• Individuals or couples facing infertility challenges.
• Women with a history of pregnancy loss.
• Couples/Individuals with a genetic disease risk.

Genetic testing IVF process includes an IVF cycle to retrieve eggs and create embryos. In all forms of preimplantation genetic testing, the biopsy is performed at the blastocyst (day 5 or 6 after fertilization) stage of development. 

At the blastocyst stage, each embryo is subject to a small biopsy. This biopsy involves removing a small number of cells (usually 3–10) from the trophectoderm, the outer layer that will form the placenta, not the cells that will become the baby.

These biopsied cells are then sent to a specialized laboratory for DNA genetic testing. The analysis takes about 7–10 days. During this time, the biopsied blastocyst is frozen. Once the test results are available, a healthy embryo free from the identified genetic condition can be thawed and transferred to the woman’s uterus in a subsequent cycle.

Preimplantation genetic testing legislation and accessibility

The legal status of genetic testing in the countries varies around the world, impacting its accessibility.

Many European countries have at least some form of regulation or restriction on PGD. Few of them have adopted a relatively liberal regulatory framework, and a few allow fertility clinics to self–regulate the process.

While in most destinations, genetic testing is permitted, especially for medical reasons—to identify chromosomal abnormalities (PGS) in addition to PGD for serious heritable conditions—some countries like Germany and Switzerland impose a more restrictive approach by prohibiting genetic testing, especially for selecting the gender of fertilized embryos for implantation (sex selection for family balancing). Surprisingly, the United Arab Emirates legislation allows family balancing, making this country an emerging hub for Muslim couples looking for a baby of a desired gender. 

Unlike many European countries, the United States has no regulations concerning the use of preimplantation genetic diagnosis. As such, PGD can and is used for a variety of controversial purposes, including sex selection, which raises ethical concerns.

Check out OVU.com's article about "Preimplantation Genetic Testing (PGT): When to Consider it & What Are the Success Rates?"

ROPA IVF: Shared Motherhood

For lesbian couples who dream of sharing the motherhood experience, procedure called reciprocal IVF (ROPA) offers a unique fertility treatment option. ROPA, which stands for “Reception of Oocytes from Partner,” allows both partners to be actively involved in creating their family.

ROPA is an adaptation of traditional IVF where both women select a sperm donor; one partner donates her eggs to be fertilized with donor sperm and becomes the genetic mother, while the other partner embraces the role of carrying the baby in her uterus and becoming the gestational mother.

After Reciprocal IVF has been introduced to assisted reproduction techniques, it unlocked new possibilities for female couples seeking fertility services. Compared to using intrauterine insemination (IUI) or standard IVF with donor sperm, ROPA fosters a shared bond by allowing one partner to contribute genetically and the other to experience pregnancy.

ROPA Legislation

Currently, female same–sex couples hoping to conceive via reciprocal IVF have access to such services. The list of countries that do not discriminate between heterosexual and same–sex couples when it comes to reproductive rights, thus striving for inclusivity and adding the ROPA to the list of available services, is extensive and includes almost every country in the European Union (Austria, Bulgaria, Cyprus, Denmark, Estonia, Finland, France, Germany, Latvia, Portugal, Spain, the Netherlands, Sweden, and Switzerland), Northern and Southern America (Canada, the United States, Mexico, Argentina, Brazil), Israel, Australia, and the United Kingdom. This positive approach to changing some of Western Europe’s strictest rules governing medically assisted pregnancies highlights the evolving legal landscape surrounding assisted reproduction.

However, it must be noted that ROPA IVF remains prohibited in many other countries.

Frozen Embryo Transfer

For singles and couples who already have vitrified embryos (through IVF or another program) stored at their local clinic or abroad, fertility clinics routinely offer a program known as “Frozen embryo transfer” (FET) or “Cryotransfer.”

Cryotransfer cycles typically involve:

• Transporting the embryos to the clinic.
• Thawing them (devitrification).
• Transferring them to the uterus.

If genetic testing is desired before implantation, the geneticists will include it in the protocol. After thawing the embryo, a small sample of cells (blastocyst biopsy) may be taken, followed by re–vitrification while waiting for the results. Once the results are available, embryo transfer will be scheduled and performed.

FET cycles offer several advantages. They have a shorter timeline (if no shipping is required), involve fewer medications and doctor’s visits, and can be less stressful than IVF cycles because there is no invasive egg retrieval. Some cycles may even be needle–free, using medications that don’t require injections.

The transfer procedure itself is non–invasive. It may consist of a mock transfer to create a “map” of the uterus, followed by the actual transfer using a flexible catheter loaded with the embryo. A pregnancy test is typically taken 10–14 days after the transfer.

Who Can Consider a Cryotransfer?

• Singles and couples who already have frozen embryos and don’t want to undergo a whole new IVF cycle.
• Couples and single individuals who want to have a backup option in the ongoing fresh IVF cycle.

Frozen Embryo Transfer Laws

While most countries allow using frozen–thawed embryos for in vitro fertilization (IVF), there are some exceptions with stricter regulations.

Italy, for example, limits the creation and use of embryos to a maximum of three for a single implantation procedure. Additionally, cryopreservation of embryos is generally prohibited. The only exception is freezing embryos if a temporary health condition prevents immediate implantation in the mother. As a result, Italian clinics typically perform IVF with immediate transfer of fresh embryos and only vitrify (freeze) embryos in exceptional cases.

In contrast, countries like Turkey and the United Arab Emirates (UAE) permit cryotransfers (transfers of frozen embryos). The UAE even allows the transport of frozen gametes (eggs and sperm) and embryos to clinics abroad. Under their New IVF Law, frozen unfertilized eggs, fertilized embryos, or sperm can be imported to or exported outside the UAE, following specific regulations and procedures.

Since legal frameworks surrounding IVF and embryo transfer are constantly evolving, it is advisable to consult with an attorney specializing in these matters before making any decisions.

Exploring Your Options

As a prospective parent, regardless of your marital status or sexual orientation, you can research your options. Numerous resources are available to help you find the program that best suits your unique situation and preferences. You may use a Filter to select the best option suitable for your unique case and preferences, get a Free Quote from one or several fertility clinics, and book an initial consultation to learn more about the policies, pricing, and payment options.

It is also important to check the current laws in your country or the country where you are considering treatment.

Check out OVU.com's blog article about FET

Conclusive Words

“Blueprinting and fueling your journey to parenthood, no matter which infertility barrier you have.” — OVU Surrogacy and Fertility Network.

At OVU Surrogacy and Fertility Network, we understand the deeply personal and emotional nature of the journey to parenthood. With our values of empathy and inclusivity at the core of everything we do, we are here to listen and hear you, and to transform your hope into your IUI, IVF, or surrogacy journey, no matter what infertility barriers you may face.

Our mission is to connect you with top–notch IVF clinics and surrogacy agencies all around the world and provide you with personalized solutions tailored to your unique needs, preferences, and budget.

With our extensive network of clinics and proven track record, we offer you the highest chance of success. Let us help you turn your dream of parenthood into a beautiful reality.

Footnotes:

1. American Society for Reproductive Medicine (ASRM). (2007, April). Number of embryos for transfer in ART. Fertility and Sterility, 87(4), Supplement 1, S19-S22. 

2. American Society for Reproductive Medicine (ASRM). (2021). Guidance on the limits to the number of embryos to transfer: A committee opinion. 

3. American College of Obstetricians and Gynecologists (ACOG). (2016, September). Perinatal risks associated with assisted reproductive technology: Committee Opinion. Number 671. 

4. Calhaz-Jorge, C., De Geyter, C. H., Kupka, M. S., Wyns, C., Mocanu, E., Motrenko, T., ... & Goossens, V. (2020). Survey on ART and IUI: Legislation, regulation, funding and registries in European countries: The European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Human Reproduction Open, 1(1), hoz044. 

5. Corveleyn, A., Zika, E., Morris, M., Dequeker, E., Davies, J. L., Sermon, K., ... & Ibarreta, D. (2008). Preimplantation Genetic Diagnosis in Europe. Publications Office of the European Union. 

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