infertility

More and more women are choosing to become single moms later in life. If you're over 40 and thinking about starting or expanding your family without a partner, you're not alone—and you’re not without options. For some, this has always been the plan. For others, it may be a choice shaped by how life played out. Either way, it’s a decision that deserves thoughtful consideration, honest information, and nonjudgmental support.

This article helps walk you through the paths that may be available to you, whether you’re thinking about conceiving using your own eggs, donor eggs, or previously frozen eggs, trying IUI or IVF. There’s no one “right” way to become a parent, and this guide is meant to help you understand your fertility treatment choices and move forward with clarity.

Becoming a single mom by choice

Being a single mom by choice (often shortened to SMBC, or single mother by choice) means choosing to parent alone, without a partner, whether by pregnancy, surrogacy, or adoption. Some people have always known they wanted to raise children on their own. Others may have hoped to co-parent but decided not to wait any longer. Either way, choosing this path after the age of 40 can come with both additional challenges and unique strengths.

You may already be hearing a lot of opinions from well-meaning friends, doctors, or even strangers. It’s important to center your own values, readiness, and resources in this decision. While this path isn't without stress, it can also be filled with joy, autonomy, and support—yes, even as a solo parent.

Here are some paths to parenthood, in no particular order:

Option 1: IUI with donor sperm

Intrauterine insemination (IUI) is often the first fertility treatment that people consider. It’s less invasive and less expensive than IVF, and can sometimes be done without fertility medications, although medications are often recommended to increase the chances of success.

At 40 and beyond, your chances of getting pregnant with IUI using your own eggs do decline. Estimates vary, but one study found that the live birth rate per insemination for women over 40 was 8.5% per insemination. Still, for some people, trying a few IUI cycles before moving to IVF makes sense.

Things to keep in mind:

• You'll need to choose a sperm donor, either from a sperm bank or known donor.
• You’ll typically undergo cycle monitoring with ultrasounds and bloodwork.
• IUI is done in a fertility clinic, with the procedure often taking just a few minutes once your ovulation is timed.

If you’re eager to try a lower-intervention route and your fertility testing looks promising, IUI may be worth considering, even if just as a stepping stone.

Option 2: IVF with your own eggs

In vitro fertilization (IVF) is more intensive than IUI, but it also comes with higher success rates. IVF involves stimulating your ovaries to produce multiple eggs, retrieving them in a short outpatient procedure, and fertilizing them with donor sperm in a lab. Embryos can then be transferred into your uterus or frozen for future use.

Here’s the truth: age does matter when it comes to IVF success. The chances of a live birth after one cycle vary significantly by age*:

Age 41: 16%

Age 42: 11%

Age 43: 8%

Age 44: 5%

Age 45: 3%

Age 46: 2%

Age 47: 1%

Age 48: 1%

Age 49: 0%

*Data calculated using the CDC IVF Success Estimator for a woman 140 lbs, 5’4”, first time doing IVF, no prior pregnancies, using their own eggs, with no specific infertility diagnosis.

For women 40-42 using their own eggs, the live birth rate per IVF cycle is 11-16%, and it drops to single digit chances after age 43. Many clinics may encourage testing your ovarian reserve (like AMH and antral follicle count) to give you a better idea of what to expect. 

Key things to consider:

• IVF is more physically and emotionally demanding than IUI.
• Costs can be significant, especially if you require multiple cycles.
• You’ll have the option to genetically test embryos before transfer, which some people find helpful for decision-making and gender selection.

Some people try one or two IVF cycles with their own eggs before moving to donor eggs.

Option 3: IVF using previously frozen eggs

If you froze your eggs in your 20s or 30s, they may be a valuable option now. Egg freezing essentially pauses your reproductive age at the time of freezing. So if you froze eggs at 35 and are now 42, those eggs are still considered “35” in terms of fertility potential.

Success depends on the age at which you froze your eggs and how many mature eggs were preserved. Most fertility clinics recommend at least 8-15 mature eggs for a reasonable chance at one live birth, though this can vary. Keep in mind that not every egg will fertilize or grow into a viable embryo.

Key things to consider:

• Thawing, fertilizing, and transferring embryos from frozen eggs is done through IVF.
• Your clinic can walk you through storage, thawing logistics, and what to expect.
• Even with frozen eggs, embryo development and transfer outcomes can vary.

If you have frozen eggs, talk with your fertility clinic about next steps. This can be a helpful path that bridges the gap between using your own fresh eggs and moving to donor eggs.

Option 4: IVF with donor eggs

Using donor eggs can significantly increase your chances of pregnancy if your own eggs are no longer an option—or if you've already tried IVF without success. Donor eggs typically come from women in their 20s or early 30s, and IVF success rates with donor eggs remain high regardless of the recipient’s age.

According to CDC data, the live birth rate from donor egg IVF is over 50% per embryo transfer, sometimes even higher depending on embryo quality and clinic. For people over 40, this is often the option with the highest likelihood of success.

As you can see below, the chances of a live birth using donor eggs does not vary as much by your age if you are the one carrying the pregnancy:

Age 41: 55%

Age 42: 55%

Age 43: 54%

Age 44: 54%

Age 45: 54%

Age 46: 53%

Age 47: 53%

Age 48: 52%

Age 49: 52%

*Data calculated using the CDC IVF Success Estimator for a woman 140 lbs, 5’4”, first time doing IVF, no prior pregnancies, using donor eggs, with no specific infertility diagnosis.

​​If you're considering this path, Cofertility’s unique program offers a better approach to egg donation. Through our egg sharing model, donors aren’t doing it for cash—they keep half of the eggs retrieved for their own future use, and donate the other half to your family. This model supports donors who are planning for their own future families, which many intended parents find reassuring. It’s a less transactional, more human-centered approach to donor matching that helps build mutual respect and transparency in the process.

Key things to consider:

• You’ll need to decide between frozen donor eggs (more immediately available) and fresh donor cycles (often yielding more eggs). At Cofertility, we offer both.
• Using donor eggs should involve careful consideration of disclosure options.
• The egg donation process is expensive and often not covered by insurance.

Many people who use donor eggs go on to have healthy pregnancies and strong emotional bonds with their children.

Option 5: Surrogacy

Surrogacy is another path to parenthood, particularly for those who can’t or prefer not to carry a pregnancy themselves. For single moms by choice, it’s done through gestational surrogacy, where the surrogate carries an embryo created through IVF using either your own egg or a donor egg and donor sperm (also called Double Donor IVF).

Surrogacy is legally and logistically complex, and it often comes with a high financial cost. Depending on your location and whether you work with an agency, the total cost can range from $100,000 to $150,000 or more. That includes compensation for the surrogate, legal fees, medical costs, insurance, and agency fees (if applicable).

Key things to consider:

• You'll need legal representation to draft a surrogacy agreement
• Surrogacy laws vary widely by state and country
• Building a respectful, clear relationship with your surrogate is important

If you’re using donor eggs and surrogacy together, you can still be the legal and intended parent from the start, even if you don’t share genetics or carry the pregnancy. For some single moms by choice, this route brings peace of mind and a sense of agency in becoming a parent.

Final thoughts

Becoming a single mom by choice after 40 is absolutely possible, but it’s also okay to admit that it’s not always easy. Medical realities, logistics, finances, and emotions all come into play. What’s right for someone else may not be right for you—and that’s fine.

Whether you pursue IUI, IVF, donor eggs, and/or surrogacy, you deserve clear information, real options, and respect for your decisions. No one else gets to define your family or your timeline. If you feel ready to become a parent, there is a path forward.

You’re not alone—and you’re not out of time.

Read more:

• Am I Too Old to Have a Baby In My 40s?
• What You Need to Know About Getting Pregnant In Your 40s
• Thinking About Becoming a Single Mother by Choice (SMBC)? Here’s What the Research Says
• Celebrities Who Had Babies Over 50
• IVF after 40: Should I Use My Own Eggs or Donor Eggs?

More women than ever are having children in their 40s, with many building successful families through various paths to parenthood. In fact, women in their 40s are the fastest-growing age group of new mothers in the United States. 

While starting or expanding your family later may present unique considerations, advances in reproductive medicine have created new possibilities for those over 40.

In this article, we'll talk about the realities of having a baby in your 40s, from unassisted conception to IVF and donor eggs. We'll look at success rates with different approaches, discuss specific health considerations, and explore how options like egg donation have helped thousands of women become mothers in their 40s and beyond.

Understanding fertility after 40

Age-related fertility decline is a biological fact, but that doesn't mean parenthood is out of reach. At birth, women have about 1 million eggs. By age 40, that number drops to around 25,000, with egg quality also declining significantly. This decline means:

• Pregnancy occurs in about 5% of women per unassisted cycle at age 40
• By age 43, the pregnancy rate per cycle drops to 2%
• At age 45, natural conception rates are below 1% per cycle

These statistics reflect natural conception attempts. However, fertility treatments can significantly improve these odds for many women.

Your biological clock explained

Female fertility involves both egg quantity (ovarian reserve) and egg quality. After 40, both factors affect conception chances:

• Egg quantity: The number of remaining eggs decreases steadily with age. Fewer eggs mean fewer chances for successful conception each month.
• Egg quality: As eggs age, they're more likely to have chromosomal abnormalities. This leads to lower fertilization rates, increased miscarriage risk, and higher rates of chromosomal conditions.

Of course, male fertility also has an impact. Male fertility also starts to decline around age 40, with sperm quality and quantity decreasing as men age. While there’s much less research on male fertility, studies do show that older fathers have a lower chance of conception, increased time to pregnancy, and potentially higher risks of miscarriage. 

Read more in What You Need to Know About Getting Pregnant In Your 40s

Health considerations for pregnancy after 40

While many women have healthy pregnancies in their 40s, certain risks increase with age:

Pregnancy complications:

• Higher rates of gestational diabetes
• Increased risk of high blood pressure
• Greater chance of placental issues
• Higher cesarean section rates

As such, pregnancies after 40 typically involve:

• More frequent prenatal visits
• Additional screening tests
• Closer monitoring throughout pregnancy

That being said, there has been a significant shift in U.S. birth rates for women over 40! In fact, 4.1% of all births in 2023 were to women over 40, surpassing the rate of births to teenagers for the first time. And most women have safe, healthy pregnancies and births. 

Fertility treatment options after 40

There are several fertility treatment options for women in their late 40s, including IVF. 

IVF with your own eggs

In vitro fertilization (IVF) can help some women conceive using their own eggs. The chances of a live birth after one cycle vary significantly by age*:

Age 41: 16%

Age 42: 11%

Age 43: 8%

Age 44: 5%

Age 45: 3%

Age 46: 2%

Age 47: 1%

Age 48: 1%

Age 49: 0%

*Data calculated using the CDC IVF Success Estimator for a woman 140 lbs, 5’4”, first time doing IVF, no prior pregnancies, using their own eggs, with no specific infertility diagnosis.

IVF using donor eggs

Egg donation has become an increasingly popular option for women over 40 as it greatly increases the chances of success. As you can see below, the chances of a live birth using donor eggs does not vary as much by age:

Age 41: 55%

Age 42: 55%

Age 43: 54%

Age 44: 54%

Age 45: 54%

Age 46: 53%

Age 47: 53%

Age 48: 52%

Age 49: 52%

*Data calculated using the CDC IVF Success Estimator for a woman 140 lbs, 5’4”, first time doing IVF, no prior pregnancies, using donor eggs, with no specific infertility diagnosis.

Read more in Fertility Treatment Options as a Single Mom By Choice (SMBC) Over 40

The advantages of donor eggs

For many women in their late 40s, using donor eggs can be the fastest and most effective path to parenthood. This option opens the door to higher chances of success, especially when age-related fertility decline makes conceiving with your own eggs more difficult.

One of the most compelling advantages of donor eggs is the significantly higher success rate. What’s more, these success rates stay relatively consistent regardless of the recipient’s age, since the quality of the egg (rather than the age of the uterus) is the key factor.

Donor eggs also lower the risk of miscarriage, which tends to increase with age due to chromosomal abnormalities in older eggs. Because egg donors are young and thoroughly screened, the chances of chromosomal issues are much lower, which contributes to a healthier pregnancy from the start.

Another benefit of using donor eggs is the ability to match with a donor based on specific criteria that may be important to you—such as physical characteristics, personality traits, education, or a shared cultural background. Some women find comfort and empowerment in being able to play a role in selecting the person who will help them build their family. 

Finally, for women who have experienced multiple failed IVF cycles or recurrent pregnancy loss, donor eggs can offer a renewed sense of hope. It can be a deeply emotional decision, but many families who go this route say the joy of having a child far outweighs any initial hesitations.

Read more in What You Should Know About Getting Pregnant with Donor Eggs in Your 40s and 50s

Learn about egg sharing

If you’re considering using donor eggs, you may come across the term egg sharing—a model that’s growing in popularity for its accessibility and sense of mutual benefit.

Egg sharing is when a donor’s eggs are split between two parties: one portion is used for donation, and the other is preserved for the donor’s own future use. This creates a unique opportunity for both the intended parent and the donor to move forward with their reproductive goals, together.

One of the most meaningful aspects of egg sharing is that it often attracts donors who are freezing their eggs for their own future family planning. These donors are typically highly motivated, thoughtful about their decision, and deeply aware of the significance of their gift. Many intended parents feel a strong sense of connection knowing that their donor is on a similar journey.

Egg sharing can also make egg donation more financially accessible. Because the donor receives free egg freezing in exchange for sharing a portion of her eggs, intended parents often pay less compared to traditional egg donation arrangements. This model can lower costs without compromising on quality, screening, or support.

At its core, egg sharing is a way to build families with empathy, intention, and care. It’s a model that recognizes the dreams of both parties and creates space for shared hope.

Looking ahead

While having a baby in your 40s presents unique challenges, many paths can lead to successful parenthood. Modern reproductive medicine offers options that weren't available to previous generations, making family-building possible for many women over 40.

The key is understanding your options, working with qualified medical professionals, and making informed decisions based on your personal circumstances and goals. If we can help you on your journey to having a baby, please reach out!

Read more:

• What You Need to Know About Getting Pregnant In Your 40s
• Thinking About Becoming a Single Mother by Choice (SMBC)? Here’s What the Research Says
• Celebrities Who Had Babies Over 50
• IVF after 40: Should I Use My Own Eggs or Donor Eggs?

Becoming a parent through egg donation is an extraordinary journey, one filled with hope, love, and often, unexpected emotional complexity. As a licensed clinical psychologist specializing in fertility, I have spent nearly two decades walking alongside individuals and couples as they navigate third-party reproduction. My work focuses on the emotional layers that often go unspoken: grief, identity, and bonding.

In this article, I’ll share five things no one really tells you about using donor eggs, truths I have learned not just through clinical training, but through the voices and stories of the many families I have supported. These insights are here to help you feel more prepared, less alone, and more confident in the deeply personal path you are on.

1. It’s ok to grieve your genetic connection—even if you're excited

It is completely normal to feel a complex mix of emotions when using donor eggs. You may feel immense gratitude and excitement about becoming a parent, yet still grieve the lack of a genetic connection. Remember that these two feelings can coexist. Acknowledging your grief does not diminish your joy. In fact, giving yourself permission to process these emotions is an act of self-care.

Tip: Consider speaking with a therapist who specializes in fertility or joining a support group for people using donor eggs; sharing your experience with others who understand can help you process these feelings so you don’t feel alone in these feelings.

2. You may start seeing your donor in your child

As your child grows, you might notice features, gestures, or ways of thinking that feel... not quite yours. Perhaps it is the shape of their nose, their sense of humor, or how they tilt their head when they think. These traits may resemble something you saw in a photo or read in a profile. This can be deeply moving, but also disorienting.

Rather than trying to “fix” uncomfortable emotions, we can practice willingness by making space for those uncomfortable emotions without judgment. When a moment of recognition arises and brings a pang of unfamiliarity or longing, it can help to pause and notice: What value is this emotion pointing to? Often, these feelings reflect your desire to feel fully connected.

According to the American Society for Reproductive Medicine (ASRM), intended parents should be made aware that genetic contributors may remain “psychologically present” over time, especially in known/direct arrangements. That presence does not need to be feared or avoided. Instead, it can become part of your child’s story.

Tip: Being mentally prepared for the donor’s ongoing presence in subtle ways can help ease unexpected emotions. Try naming what comes up: “I feel a little sad that I don’t see myself in this moment, and I also feel wonder at who they are becoming.”

3. Openness from day one matters more than you think

When it comes to talking to your child about their beginnings, early and honest conversations aren’t just recommended—they are profoundly protective. Research and guidance from ASRM emphasize that children benefit from being told about their donor origins at a young age, using simple, developmentally appropriate language. 

Leaning into these conversations, even when they feel vulnerable or uncertain, is an act of living in alignment with your parenting values: love, openness, and trust. Practicing psychological flexibility means allowing your own discomfort (if it arises) to be present, without letting it dictate your actions. 

Tip: Look for children’s books that explain donor conception in age-appropriate language. These can help make the conversation feel natural.

4. Genetic health information is a lifelong need

Choosing an egg donor doesn’t end with matching profiles. As your child grows, so does their need for ongoing access to genetic health information. Pediatricians and specialists may ask for extended family history if medical concerns arise. That’s why selecting a donor through a program that allows for future medical updates, or even open communication, can be invaluable.

Consider: Ask your egg donation program how they handle long-term updates to the donor’s medical history.

5. You’ll form a bond that transcends genetics

It is a common fear: What if I don’t feel connected to my child? For many intended parents using donor eggs, the absence of a genetic link stirs quiet doubts about bonding. But over and over, families share that the love they experience is not only real, it is often deeper than they could have imagined. Connection isn’t dictated by DNA; it is cultivated in the everyday rhythms of parenting.

Our minds often generate fear-based stories, especially when we’re stepping into the unknown. These thoughts “What if I don’t feel like their real parent?” don’t need to be judged or pushed away. Instead, we can notice them with compassion, then return to the values that led us here: the desire to nurture, protect, and love a child.

Bonding doesn’t happen all at once. It forms in the small, repeated acts of care—midnight feedings, diaper changes, and warm cuddles. And research continues to affirm that the quality of parent-child relationships has little to do with genetic ties and everything to do with presence, attunement, and emotional responsiveness.

Reassurance: Love is built in daily moments, not shared DNA.

Using donor eggs to build your family is both a medical decision and a deeply human one. It’s okay to feel a mix of joy, grief, uncertainty, and love as you move forward. The most important thing is that you’re showing up with intention, care, and an open heart. However your child comes into your life, your love—the kind built in daily, imperfect, beautiful moments—is what truly defines family.

Read more:

• Nine Things To Know About Raising A Donor-Conceived Child
• How to Talk to Your Donor-Conceived Child About Their Conception Story
• I'm a Fertility Psychologist. Here's What I Want You to Know About Growing Your Family Through Egg Donation

Bringing a child into the world through donor eggs can bring about a complicated mix of emotions, especially grief over the loss of a genetic connection. And for many intended parents, this path also comes with a quiet, often unspoken grief, the loss of a genetic connection. If you're feeling this way, you're not alone. And you’re not wrong for having these feelings. As someone who has walked alongside countless families on this journey, I want to offer practical tools to help you navigate this emotional terrain.

Grief over the loss of a genetic connection is valid, even if you are deeply grateful for the opportunity to become a parent. Many intended parents feel shame or confusion around this grief, wondering, “Shouldn’t I just be happy?” It is okay to hold both gratitude and sorrow as both things can be true at once. In my practice, I  invite parents to make space for these emotions instead of pushing them away. When we try to suppress or avoid uncomfortable emotions (like grief, shame, or fear), they tend to get louder, not quieter. And that pain may leak out in other ways, such as resentment, disconnection, or anxiety because it hasn't been acknowledged or processed.

“When we try to suppress or avoid uncomfortable emotions (like grief, shame, or fear), they tend to get louder, not quieter.”

As a fertility psychologist, I’ve worked with many intended parents who feel conflicted: grateful for the chance to build their family, yet quietly mourning the genetic ties they imagined sharing with their child. In this article, I’ll explore the emotional components of using donor eggs, including how grief may show up, how to communicate with your partner and future child, and how to stay grounded in your values as you move forward. You’ll also find practical tools to help you process your emotions, strengthen your sense of identity as a parent, and navigate this experience with compassion and confidence.

Make space for grief

Try this: Notice what grief feels like in your body. Can you name it, breathe into it, and allow it to be there, even for just a moment and without judgment? When we make space for these emotions, by noticing them, naming them, and letting them be, we’re showing compassion to ourselves. We’re also more able to respond with clarity, rather than react out of fear or avoidance.

You are not your genes. And neither is your role as a parent. Parenting is not made in a lab, it is made in everyday moments of care, consistency, and love. We can acknowledge the pain of a genetic loss while recognizing that your identity as a parent transcends biology. The love, attunement, and presence you offer your child is what builds deep, lasting connections.

Reflect on what it means to be a parent

Try this: Reflect on how you define what it means to be a parent. What values guide you, regardless of DNA. When you clarify your parenting values like showing up with love, consistency, and care, you reconnect with the heart of what makes you a parent. 

Words shape our reality. I’ve worked with many intended parents who’ve found healing through small, powerful reframes:

• “Love isn’t limited by biology.”
• “This baby is 100% mine—even if our genes don’t match.”
• “Grief and joy can co-exist.”

Rather than getting entangled in painful thoughts (“I’m not a real parent”),  notice those thoughts, name them, and shift how much power they have over your actions.

Shift your inner dialogue 

Try this: When a painful thought arises, say: “I’m having the thought that…” This simple phrase helps you create distance from the story. Being the observer helps you step back and see the thought as just that—a thought, not a truth or command.

Grief doesn’t vanish the day you bring your baby home. For some, it resurfaces during pregnancy milestones. For others, it lingers quietly during early parenthood. That’s okay. Staying present with what’s arising, without judgment, can help you process your emotions more fully. Emotions are like waves: they rise, crest, and pass.

Ride the emotional waves

Try this: Check in with yourself during key transitions. “What am I feeling right now? Can I ride this wave rather than fight it?” By checking in with yourself you practice staying present and compassionate with your experience. This builds emotional resilience and helps you respond with intention.

Grief doesn’t always look the same between partners. One may feel sadness; the other relief. One may need to talk; the other may withdraw. This mismatch can cause tension, even when both partners are deeply committed to their future family. The key is anchoring in shared values: Why are we doing this? What kind of parents do we want to be? What kind of support do we want to offer each other?

Be open with your partner

Try this: Set aside time to talk about your emotional experiences - not to fix, but to listen. Use value-driven questions like, “How can I show up for you right now?” This helps foster trust, empathy, and deeper connection. It shifts the focus from solving to supporting, helping each person feel seen and cared for.  

Many donor-conceived adults say they felt deeply loved and secure, even when they weren’t genetically connected to one parent, especially when parents were open and loving about their origins. Children thrive when we meet them with truth and trust. Talking early and often about their story helps normalize it, rather than turning it into a secret or shameful topic.

Talk to your child with openness and love

Try this: Practice child-friendly language: “We had help from a kind egg donor to bring you into our family. You are so wanted and so loved.” Practice this during night time feedings, bathing and snuggling. Practice this even before your child can understand, and even when you’re pregnant.  Let your body feel safe when you say them out loud.

Sometimes, the feelings are too heavy to hold alone. If you notice that grief is interfering with your daily functioning, relationships, or ability to connect with your child, it may be time to reach out for professional support. Fertility-specific therapists understand the emotional nuances of third-party reproduction and can help you move forward with greater clarity and peace.

Know when to ask for help

Try this: Ask yourself, “Am I living in a way that aligns with my values? Or am I feeling stuck in pain?” If the answer is the latter, support can help.

Choosing donor eggs is an act of hope. Of courage. Of deep, fierce love. Grief may be part of your story, but it isn’t the whole story. You are allowed to honor your loss and celebrate your path to parenthood. At Cofertility, we’re here to support you every step of the way with resources, compassion, and connection that’s rooted in real-life experience.

Infertility can be a challenging journey, especially when miscarriage happens. For those who have experienced pregnancy loss or failed IVF, your doctor may have brought up the use of donor eggs. Egg donation is when a woman who is medically cleared donates her eggs to be used by another woman (or gestational carrier) who cannot conceive with her own eggs. You may be wondering whether donor eggs can decrease the risk of miscarriage and increase your chances of bringing home a healthy baby. In this article, we’ll lay it all out.

Why do miscarriages happen in the first place?

Miscarriage, also known as pregnancy loss, is a devastating experience. It occurs when a pregnancy ends on its own before the 20th week of gestation. Miscarriage can happen to anyone, and it's estimated that up to 20% of pregnancies end in miscarriage. When a family suffers two or more pregnancy losses, it is called recurrent miscarriage.

There are many reasons why miscarriage can occur, and in most cases, it's difficult to pinpoint a specific cause. Here are some common reasons why miscarriage happens:

• Chromosomal abnormalities: The most common cause of miscarriage is chromosomal abnormalities. This means that the fetus has an abnormal number of chromosomes or a structural problem with a chromosome. These abnormalities are usually random events and not related to anything the parents did or did not do.
• Infections: Infections during pregnancy can cause miscarriage, especially if left untreated. Infections such as rubella, cytomegalovirus (CMV), and toxoplasmosis can be harmful to a developing fetus.
• Structural issues: Structural issues with the uterus or cervix can lead to miscarriage. For example, if the cervix is weak or incompetent, it may not be able to support the weight of the growing fetus, leading to premature delivery or miscarriage. Uterine anomalies, such as a uterine septum, can also increase the risk of miscarriage. 
• Autoimmune problems: An overactive autoimmune system can mistake the fetus as a foreign object and attack it, causing miscarriage.
• Lifestyle factors: Certain lifestyle factors can increase the risk of miscarriage. These include smoking, alcohol use, and drug abuse. 

Unfortunately in most cases, the exact cause of miscarriage is unknown, and it's not always possible to prevent it from happening. Read more about the common causes of miscarriage. 

What is the risk of miscarriage with donor eggs?

The short answer is that using donor eggs decreases the risk of miscarriage for most women. Especially when those miscarriages were due to chromosomal abnormalities. Because egg donors are young (under 33) and medically cleared, outcomes with donor eggs are better than outcomes with a patient’s own eggs. 

Women who use donor eggs tend to be older, and age is a significant factor in miscarriage risk. As women age, the quality of their eggs decreases, and the risk of chromosomal abnormalities increases, which can lead to miscarriage. By using younger, healthier eggs from a donor, the risk of chromosomal abnormalities is significantly reduced.

Furthermore, the donor egg IVF process involves extensive screening of the donor to ensure that she is in good health and has a low risk of genetic disorders. This can further reduce the risk of miscarriage, as genetic disorders can be a significant contributor to pregnancy loss.

What does the research say?

There is a paucity of research on donor eggs. But one 1997 study of 418 embryo transfer cycles among 276 egg donor recipients at one clinic found that:

• 36.2% got pregnant on the first try with donor eggs, and 29.3% had a live birth
• 87.9% got pregnant within four cycles and 86.1% had a live birth

This data did not differ for women of various ages of diagnoses. Another study from 1998 found that the miscarriage rate for donor eggs was 7.2% for women under 45 and 16.1% for women 45-50. 

However, because these studies were 25+ years ago, and each included outcomes data from a single clinic, we can take it with a grain of salt. We’ve had incredible progress in fertility treatments over the last 25 years, including ICSI and PGT testing,  and one would hope for even better outcomes today. 

Why do donor eggs miscarry?

Donor eggs miscarry for some of the same reasons any pregnancy ends in loss. There could be implantation issues, or issues with the lining of the uterus or other factors that make implantation more difficult, increasing the risk of miscarriage. Or there could be other health issues such as hormonal imbalances, autoimmune problems, or structural problems like fibroids. Of course, there’s also just chance / luck which is sometimes not on our side. 

While donor eggs can reduce the risk of certain fertility-related issues, it does not eliminate the risk of miscarriage entirely. Miscarriages are common, and it's important to work with your doctor to understand the potential risks and to receive appropriate care throughout the pregnancy.

How to reduce the risk of miscarriage with donor eggs

We recommend adopting a relaxed lifestyle and moderating physical activity after an embryo transfer. The most important factor in predicting successful implantation is the quality of the embryo and the optimal hormone environment in the uterus. After the transfer, the most important thing you can do is to take your medications as prescribed. You can rest assure that no other external factors will impact the outcome of your cycle (ie. high stress, specific foods, bumping your abdomen against a hard surface). If you have any problems with the injections, let your clinical team know as soon as possible.

Are donor egg pregnancies high risk?

Donor egg pregnancies may be higher risk, but more research is needed. One meta-analysis of 11 studies found: 

• The risk of developing hypertensive disorders is nearly 4X higher for donor egg pregnancies
• The risk of having a cesarean section is 2.71X higher for donor egg pregnancies
• Preterm delivery is 1.34X more likely with donor egg pregnancies

Another study from Columbia University found that age doesn’t impact risk of complications, and that both older and younger women had similar rates of gestational hypertension, diabetes, cesarean delivery, and premature birth. When undergoing IVF, your doctor will give you an idea of your specific health risks and how to help reduce the risk of complications.

What is the success rate of IVF with donor eggs?

Here’s some good news: donor eggs can drastically increase your chances of success! Around 53 percent of all donor egg cycles will result in at least one live birth. This percentage varies depending on the egg donor, recipient body mass index, stage of embryo at transfer, the number of oocytes retrieved, and the quality of the clinic.

At every age, the chances of birth with donor eggs is better, but those who benefit the most from donor eggs are women over 35 and those with low ovarian reserve. In fact, about one-quarter of women over 40 who succeeded with IVF did so through the use of donor eggs.

At Cofertility, for those who match with a donor in our fresh egg donation program, the average number of mature eggs a family receives and fertilizes is 12. The number of eggs retrieved varies by patient and cycle, but can be predicted by a donor’s age, AMH, and antral follicle count, all of which will be known to you after the donor’s initial screening. Qualified candidates have an ample ovarian reserve for both their own needs and sharing. Egg share donors also often work closely with a fertility doctor to determine, based on their own medical history, the optimal number of eggs needed for their own future family-building goals. Should it make sense for the donor, they may choose to pursue a second egg-sharing cycle to maximize the chances of success for everyone.

Matching with a donor in our frozen program can provide the opportunity to move forward with your family-building plans faster, as frozen eggs can be fertilized or shipped to your clinic immediately or as soon as the cycle is complete. Donors undergoing frozen cycles complete equally rigorous ovarian reserve testing. While the total number of frozen eggs available will vary based on the donor’s retrieval outcomes, every frozen match is guaranteed to have a minimum of at least 6 frozen eggs.

To learn more about these programs and the differences between them, click here.

Ready to move forward with donor eggs? We can help!

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account today!

Every National Infertility Awareness Week, we like to reflect upon the true meaning of “infertility awareness”. All year, we take every chance we get to increase awareness of infertility in an effort to provide proactive fertility education and de-stigmatize all paths to parenthood.

This is important because infertility can feel incredibly isolating due to lack of openness and understanding from the general public. While infertility does not discriminate, it often catches its victims off guard. Due to a lack of awareness (or just a lack of acceptance), we’re taught from an early age that getting pregnant is easy. In reality, this isn’t the case for everyone — one in four American couples struggle to conceive — and the additional stigmatization of infertility just kicks those suffering from it while they’re down. 

We’re here to change that. Myself and my co-founders all experienced challenging journeys to build our families, and we know, first-hand, that words matter. So this National Infertility Awareness Week, we’re proposing a vocabulary overhaul when it comes to outdated and straight-up offensive fertility terminology. 

Here are several fertility terms we commonly hear — in doctor’s offices, news articles, and more — that we think need to be replaced:

Fertility

• “Insurance policy” → optionality: when a woman decides to freeze her eggs, she's giving herself optionality should she experience fertility challenges down the line. While Cofertility’s mission with Freeze by Co is to enable more proactive, empowering egg freezing, we are always transparent about the fact that egg freezing is never an insurance policy.
• Poor sperm quality → sperm-related challenges: when a man experiences low sperm count or motility, or irregular morphology that may result in an unsuccessful fertilization or pregnancy. The same can apply to “poor egg quality,” and we support a similar change to reference egg-related challenges.
• Inhospitable uterus → uterine challenges: when uterine conditions, like endometriosis, cause difficulty getting or staying pregnant.
• Poor ovarian reserve → diminished ovarian reserve: when a woman’s egg count is lower than average for her age.
  

Egg donation and surrogacy

• Donor mother/parent → egg donor: the woman who donated her eggs to fertilize an embryo resulting in a child is an egg donor. The intended parents are that child’s parents, full stop.
• Surrogate mother → gestational carrier: Similar to “donor mother,” a gestational carrier, while doing an amazing thing (carrying the pregnancy of a transferred embryo using another woman’s egg) is not that child’s mother. Gestational carriers are incredible, but should not be confused with a child’s actual parents. 
• Anonymous egg donation → non-identified egg donation: we believe anonymous egg donation is a thing of the past — not only can it have negative effects upon donor-conceived children, it’s also unrealistic with the rise of consumer genetic testing. The American Society for Reproductive Medicine (ASRM) recently recommended this lexicon replacement as well. At Cofertility, we discuss the concept of disclosure at length with all donors and intended parents. You can read more about our stance on “anonymous” egg donation here.
• Buying eggs → matching with an egg donor: No one involved in this process should feel like eggs are being bought or sold (that goes for the egg donor, the intended parents, and the donor-conceived person). Rather, working with an egg donor is a beautiful way of growing a family and should feel the opposite of transactional. 
• “Using” an egg donor → working with/matching with an egg donor: An egg donor should feel like a perfect fit with your family and someone who should be respected, not “used”. Our unique model — where women can freeze their eggs for free when they donate half of the eggs retrieved to another family — honors everyone involved. Learn more here! 
  

Pregnancy loss

• Spontaneous abortion → pregnancy loss: Honestly, this term is beyond cruel given what it describes — losing a pregnancy prior to 20 weeks.
• Implantation failure → unsuccessful transfer: When an IVF embryo transfer doesn’t result in a success, that doesn’t mean it — or your body — was a failure. 
• Chemical pregnancy → early pregnancy loss: Calling a pregnancy “chemical” discredits what it actually is — a pregnancy. And losing it should be categorized as such. 

Let’s hold ourselves accountable

During National Infertility Awareness Week, consider this our rally cry for evolved terminology around the #ttc process. We’ll plan to hold ourselves accountable, but beyond talking the talk, we aim to walk the walk. 

Our goal is to make the actual family-building process more positive and accessible for anyone pursuing third party reproduction. With Family by Co, all egg donors give half of their eggs retrieved to intended parents and freeze the other half for themselves for free to preserve some of their own fertility for the future. This way, they’re able to give a life-changing gift, but also consider their own ambitions and lifestyle choices. We feel this is significantly more ethical than other donation options out there, and our intended parents love the transparent nature of our platform. 

Let’s challenge each other to evolve the surrounding verbiage. Because the family-building process should feel as good as possible, in spite of challenges along the way.

‍Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account today!

We all sit through awkward and embarrassing Sex Ed classes in high school, but when it comes down to it, none of us really learned when to actually have sex during your cycle in order to get pregnant. In fact, we didn't really learn much of anything useful about our menstrual cycles. Like, what even happens to us every month? And what does any of it have to do with getting pregnant?

Now that you’re in the phase of life where you might be trying to get knocked up, a little info would go a long way. So imagine we’re your junior-year P.E. teacher, because we’re about to tell you everything you need to know about what your uterus gets up to every month. Spoiler alert: it basically has a life of its own.

I've heard there are different phases of my cycle...is that true?

Yup. Your monthly cycle is divided up into two phases: the follicular and the luteal. The follicular phase starts when your period kicks off and lasts about two weeks, ending when you release a ready-to-be-fertilized egg in ovulation. Once that happens, you move into the luteal phase, which also lasts about two weeks and ends when you get your period. Then the whole process starts alllllll over again.

Most menstrual cycles are about 28 days, on average, but really there’s a range of normal here. According to the Mayo Clinic, a cycle can last anywhere from 21 to 35 days.

What happens during each phase?

Let’s pretend you have a totally textbook 28-day period (yeah, we know—you’re not a robot, but just go with us here).

On the first day of the follicular phase, Aunt Flo shows up for a visit. You’re crampy and bloated and cranky and bleeding. (So. Much. Fun.) But according to Dr. Jane Frederick, reproductive endocrinologist at HRC Fertility in Orange County, California, there’s also hormonal stuff happening, too: your brain is secreting hormones from your pituitary and sending signals to your ovary to stimulate egg production. You’ll bleed for about 3 to 7 days and then have 7 to 10 days where not a whole lot goes on that you can see.

But behind the scenes, explains Frederick, your hormones are communicating like crazy. At some point, the dominant follicle in your ovary will produce estrogen and then send a message back to your brain: Stop sending egg production signals...I’m ready to ovulate! The ovary releases the egg and it moves through your fallopian tubes. (This is the point in your cycle when you could become pregnant, but we’ll circle back to that in a few.)

Once ovulation is complete, you move into the luteal phase. If you have a 28-day cycle, it’s probably about day 14 of your cycle, give or take. Now your hormones are doing a Freaky Friday-style switcharoo: the estrogen that peaked before ovulation is dropping and your progesterone levels are rising instead. According to Dr. Frederick, if you have a fertilized egg, progesterone will help it implant in the lining of the uterus and develop successfully into a pregnancy.

On the other hand, if your egg didn’t get fertilized during ovulation, your progesterone levels drop and your endometrial lining starts to shed in menstruation. Aunt Flo’s back in town again!

Okay, but when am I most fertile?

Despite what your sex ed teacher might have told you, a woman can only get pregnant during a very short window of time every month. And that’s right around the time of ovulation, because once the egg has been released from the ovary it’s only good for 24 hours, which would be considered your fertile window.

So if you’re looking to become pregnant, you either want to have some sperm already swimming around in your reproductive tract ready to pounce (pro tip: those guys can survive in there for up to 5 days), OR make sure you have sex within that magic 24-hour window as this is when a female is most fertile.

To be clear, when exactly is my fertile window?

This part can be tricky as everyone’s fertile window is different. If you don’t have a perfect 28-day cycle, pinpointing ovulation closely enough to get your conception timing right can feel like a guessing game. The good news is that there are ways to figure out when to have sex to get pregnant.

The best way to indicate your fertile window is by monitoring your cycle. Luckily, there are ovulation calculators and easy-to-use tracking apps on your phone that are super simple to implement in your daily life.

But getting back to your fertile window, it all depends on the length of your cycle. Every woman’s cycle length varies, but the commonality is that ovulation occurs about 14 days before your next period with your most fertile days typically being the 3 days leading up to ovulation, including the day of ovulation.

For example, if you have a 28-day cycle, you are expected to ovulate around day 14 with your most fertile days being days 12, 13, and 14. Whereas, if you have a 24-day cycle you’ll be ovulating around day 10 with days 8, 9, and 10 being your fertile window.

But wait...can you get pregnant on non-fertile days?

The honest answer is that you must be fertile to conceive, but this doesn’t necessarily mean that you can only have sex on the days you are fertile to become pregnant. As previously mentioned, those little swimmers known as sperm can survive in a woman’s reproductive tract for up to 5 days. That means if you have unprotected sex on day 7 of your cycle but don’t ovulate until day 12, you may still have a chance of becoming pregnant. While the odds may not be as favorable compared to your ovulating day, it’s still possible.

Does that mean I can get pregnant during my period?

If you have unprotected sex during your period, it is possible to get pregnant depending on the length of your period and when your fertile window occurs. Going back to the example, a 28-day cycle means that you are fertile during days 12, 13, and 14. Therefore, if you have sex on day 7 of your cycle and you still have your period, you may very well end up pregnant since the sperm is able to survive within the reproductive tract for 5 days.

Am I considered fertile after my period, too?

Depending on what days you are talking about, the answer can be yes or no. If you have sex during your fertile window or five days prior to your fertile window, there is a possibility of becoming pregnant. However, after you reach that day of ovulation and the released egg does not become fertilized within that 24-hour window, your egg jumps ship and heads on down to your uterus since it knows it won’t meet its match this time. Your hormone levels then begin to go back to normal, your uterine lining will shed, and cause you to menstruate to start your cycle all over again.

In other words, this means that your chances of becoming pregnant after ovulation continue to go down.

Wondering if you're fertile after having a baby?

Whether you’re looking to add some more limbs to the family tree, or just want a break from pregnancy…no judgment. The chances of becoming pregnant right after giving birth vary for each woman. Depending on a few factors, women may experience their first postpartum period anywhere from four weeks after giving birth to 24 weeks! That’s quite a difference, which is why if you’re trying to plan your next pregnancy, contraception will be your best friend until you have a better sense of your cycle.

Tracking your fertile window

As we mentioned, the best way to determine your fertile window is to monitor your cycle. You can use some of the many mobile apps or online calculators that exist, but you can also do some simple math in your head or predictor kits if you want precise indications.

Ovulation predictor kits

Around day 10 of your cycle, you can start peeing on a stick to see whether or not you're ovulating yet. Dr. Frederick says it’s best to do this in the evenings after you’ve been hydrating all day. If you see a positive indicator for ovulation, she recommends having sex that night and the next night to optimize your pregnancy chances. Cue the Marvin Gaye!

Cycle tracking

You ovulate about 12 to 16 days before you start menstruating, so you can spend a few months keeping track of how many days your cycles usually are and counting back from the first day of your period to figure out which days in your cycle are prime ovulation territory.

To get pregnant, you would want to have sex for several days during that window. A recent Fertility and Sterility study suggests that daily sex during your fertile window will be the most successful—especially if you do it the day before ovulation. However, some doctors still recommend sex every other day to build a good supply of sperm.

Other fertility awareness methods

Are you ready to get down and dirty with your fertility? These methods are not for slackers, but they can be pretty effective in calculating your day of ovulation if you’re willing to commit. There are a few different varieties, but basically you’ll need to take and chart your basal body temperature (BBT) each morning the second you wake up with a super-accurate thermometer and/or keep tabs on your cervical mucus throughout the day by fishing around in your vagina to see what’s up down there.

Why? Because your body goes through several natural changes throughout your cycle, which you can observe if you’re paying enough attention. Around the time of ovulation, for example, your cervical mucus becomes slippery and stretchy, like egg whites—and right after ovulation, your BBT spikes by a few decimal points. If you know when this stuff is happening and chart it, you can become, like, a total fertility detective (which might eliminate all that pesky ovulation guesswork).

One disclaimer: Dr. Frederick says that tracking ovulation works best when you ovulate regularly, so if you only get one period every 45-60 days, tracking ovulation will be much trickier (though not impossible). There are tons of apps out there that make cycle tracking a breeze if you’re not a pen and paper kind of gal.

Summing it up

Here’s the moral of this story: if you’re trying to get pregnant, start tracking your cycle. If you really want to get crazy, grab a basal thermometer, get familiar with your cervical mucus, and start tracking all that stuff, too. Understanding your cycle does not have to be one of life’s great mysteries. Knowledge is power, girl—go get some.

You are minding your own business and just casually scrolling your socials when you see it, another baby announcement. Here comes that oh-so-familiar feeling. It starts from the pit of your stomach, a queasy, sinking feeling, almost like dread or heartbreak. Then the squeezing or choking sensation, sometimes making it hard to take a deep breath. You might notice you are grinding your teeth or holding tension in your face. And the worst is that racing, fluttering heartbeat. Jealousy often lights up the threat circuits in the brain, triggering stress responses similar to fight, flight, or freeze. Those who have struggled with fertility have at some point felt a pang of jealousy at a friend’s pregnancy announcement, or have pulled away from people they love because their joy feels like a painful reminder of their own struggle. 

As a fertility psychiatrist, I’ve supported countless individuals through the emotional rollercoaster of infertility, and I know how painful and isolating it can feel when jealousy or envy shows up. In this piece, I’ll walk you through why these emotions arise, what makes them so intense in the context of infertility, and how you can begin to cope with more compassion and less shame. I’ll also share tools from Acceptance and Commitment Therapy (ACT) that I use in my clinical practice to help people move through these feelings without getting stuck in them.

Envy and resentment are common in infertility

These feelings of envy, jealousy, and resentment are incredibly common among individuals and couples experiencing infertility. And yet, they often come wrapped in shame, “What’s wrong with me? I should be happy for them.” The truth is that there is nothing wrong with you. These emotions are part of being human, especially when navigating one of life’s most painful challenges. 

Infertility is not just a medical issue; it is an emotional one. When faced with repeated cycles of loss, whether in the form of negative pregnancy tests, failed treatments, or miscarriages, one is experiencing grief. But unlike other kinds of grief, infertility grief is often invisible and unrecognized by the world. According to clinical Psychologist Dr. Janet Jaffe: 

“Infertility is a form of disenfranchised grief - grief that is not socially recognized or validated. This makes the pain even harder to bear, because people feel they must grieve in silence.”

Social media can be an emotional landmine

Today’s world makes it nearly impossible to escape reminders of what you are longing for. On social media, you are bombarded with baby announcements, ultrasound photos, bump pictures, and gender reveal videos. These are not just harmless posts for someone struggling with infertility, they can act as emotional landmines, triggering waves of sadness, inadequacy, anger, and jealousy. 

Read about how to make social media work for you: Navigating Social Media with Infertility: A Guide to Customizing Your Feed

The pain of unfairness

Humans have a built-in sense of fairness. Neuroscience research has shown that the brain regions involved in reward processing and social evaluation light up when we perceive fairness or unfairness. When we feel fairly treated, we get a little boost of reward. When we perceive unfairness, the brain activates emotional centers tied to social pain, which is why unfairness can feel personally hurtful, even when it doesn’t directly affect us. 

So, when you have worked so hard, saved and spent money, endured medical treatments, made sacrifices, and you see someone else conceive “accidentally” or effortlessly, it can trigger a deep feeling of unfairness: “Why them and not me? Why is this so easy for others when it’s so hard for us?” This isn’t because you want to take away their happiness. It is because you are yearning for your own chance, and it feels unfair that something so meaningful seems distributed so unevenly.

The difference between envy and jealousy

Though we often use envy and jealousy interchangeably, they are actually different emotional experiences: 

• Envy is when we want something someone else has. It is centered on longing and comparison. For example, one may feel envious seeing a friend’s pregnancy announcement on social media and feeling a pang of “Why not me? I wish I were pregnant too.”  Or watching a relative have a baby after their first try and feeling crushed inside, thinking, “They didn’t have to go through all this treatment, and I’m still waiting.”
• Jealousy is when we fear losing something we already have to someone else. It is centered on fear, protection, and loss. For example, feeling jealous when your best friend starts spending more time with other new parents, leaving you thinking, “I’m being left behind, we used to be close, and now I’m on the outside.” Or feeling jealous when your partner seems excited about someone else’s pregnancy and worrying, “What if they’re disappointed in me or less connected to me because I can’t give them this?”

When you can name whether you’re feeling envy (I want what they have) or jealousy (I’m afraid of losing what I have), you can identify the underlying need (longing vs. fear), respond with self-compassion instead of shame, and then work on different coping strategies. With envy, you might focus on grief processing and honoring your own longing. With jealousy, you might focus on communication and strengthening emotional bonds. It’s not about judging the feeling, it’s about getting curious about what it’s really telling you, so you can care for yourself more effectively.

Emotions are signals, not flaws

You are human. You will get triggered. You will feel emotions. Emotions are not good or bad. Emotions are signals. They are your body and brain’s way of responding to the world around you. At their core, emotions are: 

• Biological reactions — heart racing, muscles tensing
• Cognitive experiences — thoughts, interpretations, labels like “I’m scared”
• Motivators for action — urging you to move toward something, pull away, defend, connect, etc.
  

Emotions help you navigate life, they tell you what matters, alert you to needs, and help you respond to challenges.

When you notice yourself feeling jealous or envious of a friend’s pregnancy, a social media post, or someone’s “easy” path to parenthood, remind yourself: These feelings are normal. They arise because you deeply care about something that you don’t have right now. Feeling envy doesn’t make you selfish or bad. Feeling jealousy doesn’t make you petty or unloving. These emotions are signals of grief, longing, or fear. You are not alone. Countless individuals on the infertility journey feel this way, even if no one openly talks about it.

How therapy can help you hold the pain

In my practice, I use ACT (Acceptance and Commitment Therapy) principles. Within this framework, we focus not on “getting rid of” difficult thoughts and feelings but on making space for them with kindness. You might feel things you wish you didn't, such as jealousy, envy, rage, deep grief, but you do because you are only human. 

Next time something triggers feelings of jealousy or envy, notice and name the feeling “Ah, this is envy showing up” or “I feel jealous right now.” Allow it to be there without judgment. Labeling these emotions as “bad” or “wrong” adds extra layers of shame on top of the pain. Instead of pushing it away, try breathing into the feeling. Notice where it sits in your body, maybe a tight chest, a clenched jaw, a sinking belly. Say to yourself: “This is a moment of pain. I don’t have to like it, but I can let it be here without judging myself for having it. I am allowed to feel all the parts of this human experience — even the messy ones.” Offer yourself kindness by placing a comforting hand over your heart or belly and refocusing on your values. Ask yourself, “Even with this pain, what kind of person do I want to be right now — for myself, my partner, my relationships?”

I wish everyone would see a therapist because therapy offers something rare and precious, which is a judgment-free space where you can explore your feelings fully, without needing to edit or explain them. A therapist can teach you practical tools like ACT, mindfulness, or cognitive strategies to help you carry these feelings, without being crushed by them. I always remind people that therapy isn’t about “fixing” you. It is about helping you sit beside your pain, face it with courage, and stay connected to your life and your hopes, even when things feel unbearably hard.

Finding space for empathy — without denying your pain

Jealousy can feel isolating, and it can make you want to pull away from others or close off. But with mindful attention, you can sometimes shift toward empathy or curiosity. Have you ever stopped to think, “What might someone else have struggled with on their journey?” Can you remind yourself that their joy doesn’t erase your pain — both can exist at once? Instead of “They have what I want,” try: “We are both human, wanting love, connection, and fulfillment.” This doesn’t mean you have to be happy for them right away or deny your own hurt; it just invites a little more space around the pain.

It is possible to offer kindness and presence to others while still honoring your own wounds. So please, set boundaries when you need to. You don’t have to go to every baby shower or comment on every post. You can feel happy for them and sad for yourself at the same time. You can support others’ joys without pretending that you are not hurting. Lean on your support network. Find spaces where you can be held and supported, so you’re not pouring from an empty cup. Therapy, support groups, trusted friends, etc. – these are places where your pain gets to be seen.

You don’t have to deny your feelings or “fix” your jealousy. You can gently turn toward it, listen to what it’s telling you, and choose, moment by moment, to stay connected to yourself, and to others when you are ready.

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Infertility affects millions of people in the U.S., but the experience is not the same across all communities. For Asian Americans, the path to building a family through fertility treatments, including IVF and donor egg IVF, can involve added barriers, both cultural and clinical. And yet, it’s a topic that often goes unspoken, even among those who are directly affected.

This article explores what the research says about infertility in Asian American communities, why many people wait longer to seek care, and what makes fertility treatment, especially with donor eggs, more complicated for some. We’ll also discuss the role of stigma, access issues, and the very real challenge of finding Asian egg donors. Whether you’re early in the process or weighing donor options, this piece is meant to help you feel more informed and less alone.

Infertility is common—but help is often delayed

About one in eight couples in the U.S. experience infertility. That includes people from all racial and ethnic backgrounds, but Asian Americans tend to be underrepresented in fertility clinics, despite facing similar or higher rates of infertility. Studies have suggested that many Asian American women experience delayed childbearing and may face unique reproductive health risks. Yet, they are often less likely to seek fertility evaluation or treatment.

There are many reasons for this, including a lack of awareness about what counts as infertility, skepticism about treatment, or the belief that things will “work out on their own.” For those who do eventually pursue care, it's not uncommon to be older at the time of first consultation, which can affect treatment outcomes and available options.

IVF outcomes may differ by ethnicity

Several studies have shown that Asian American women may have lower IVF success rates compared to white women. This includes lower implantation rates, rates of pregnancy and live birth. Asian women trying IVF also miscarry more than white women. The exact reasons aren't fully understood, but some hypotheses include:

• Differences in ovarian reserve or response to stimulation
• Delayed access to care due to cultural or structural barriers
• Higher prevalence of certain conditions like endometriosis or PCOS in some Asian subgroups

It’s worth noting that “Asian American” is a broad label. People of East Asian, South Asian, and Southeast Asian descent may have very different experiences—but most fertility data doesn’t distinguish between these groups, making it harder to draw nuanced conclusions.

Cultural stigma still shapes decisions

Fertility is a private topic in many cultures, but in some Asian communities, it’s especially sensitive. There can be pressure to avoid openly discussing reproductive health struggles—even with close family members. Some people may fear judgement or feelings of inadequacy, especially in multigenerational family structures where reproductive “success” can carry weight.

This silence can delay diagnosis and treatment, or lead people to avoid asking questions or seeking second opinions. In cases where donor egg IVF becomes part of the conversation, there may be added hesitation about using donor gametes at all.

Having culturally competent care teams—those who understand the nuances of these dynamics—can help bridge the gap. Support from others who’ve been through it can also make a difference.

Asian egg donors are hard to find

One of the most significant hurdles for Asian American intended parents pursuing donor egg IVF is the limited availability of Asian egg donors in the U.S. Most donor databases skew white, and Asian donors—particularly those from specific backgrounds like Korean, Indian, Vietnamese, or Filipino—are underrepresented.

This can lead to longer wait times, higher costs, and tougher decisions, and emotional strainabout whether to move forward with a donor who doesn’t share your cultural background.

Egg sharing programs, like those offered by Cofertility, help broaden access. In our model, donors freeze their eggs for their own future use and share half with a family. Because the incentive is egg preservation, not cash payment, it attracts a different pool of donors—many of whom are thoughtful about long-term impact and open to more transparency in the match.

We have helped many Asian families find egg donors to expand their family. In fact, while other agencies struggle to recruit Asian egg donors, we have dozens of Asian egg donors ready to be matched at any time. Create a free account today to see donor profiles. 

Build your dream family today

Asian American intended parents face many of the same fertility challenges as anyone else—but often with added layers of stigma, underrepresentation, and silence. The medical system hasn’t always made it easy, and cultural norms can still hold people back from seeking care early or asking for support.

But things are changing. Fertility conversations are becoming more open. More people are exploring donor egg IVF as a viable path to parenthood. And while the search for an Asian egg donor may take time and patience, new models—like egg sharing—are starting to reshape what’s possible.

If you’re navigating IVF or donor egg options and feeling overwhelmed, you’re not alone. The path may not be simple, but it is worth exploring—and we can help you get there.

For those struggling with infertility, the holiday season can intensify emotional challenges as celebrations often center around family and children. This guide explores practical strategies for managing holiday-related stress, understanding your emotional responses, and building resilience during this sensitive time.

Holiday-related anxiety and depression can be particularly high for those facing fertility challenges, as the season often emphasizes themes of family, children, and togetherness, potentially creating feelings of inadequacy, sadness, and envy. Holiday cards, pregnancy announcements, or events centered around children may serve as triggers, amplifying feelings of loss or grief. The societal expectation to feel and display happiness and joy during the holidays can exacerbate feelings of isolation and sadness when one is privately struggling.

How stress affects the brain

Social triggers that evoke strong emotional responses can have not only psychological impacts but also significant neurological impacts. One of the first areas of the brain that gets impacted during stress is the limbic system. The limbic system detects and processes emotional stimuli - especially stimuli perceived as threatening. This activation heightens emotional arousal and contributes to feelings of fear, anger, or shame. The prefrontal cortex (PFC), responsible for executive functions like decision-making and emotion regulation, attempts to interpret and manage the emotional response to triggers. It may struggle to regulate the limbic system’s response effectively in stressful or triggering situations, especially if the trigger is deeply personal or recurrent. Because the prefrontal cortex is struggling, the Hypothalamus-Pituitary-Adrenal (HPA) Axis is activated, releasing cortisol, the stress hormone, which prepares the body for a fight-or-flight reaction. Chronic exposure to triggers can dysregulate the HPA axis, leading to prolonged stress and health issues such as fatigue, anxiety, and depression.

Building emotional resilience through reframing

By addressing the psychological dimensions of social triggers, individuals can build emotional resilience, which is the ability to adapt and recover from stress while maintaining psychological well-being. The ability to reframe negative experiences and see challenges as opportunities for growth is central to resilience. Reframing involves identifying negative thought patterns and replacing them with more balanced or constructive perspectives. With fertility challenges, reframing helps shift the focus from loss and longing to aspects of life that can still bring fulfillment, allowing space for gratitude, flexibility, and self-compassion during a difficult time.

An example of how reframing may be used: 

“I can’t enjoy the holidays because they remind me of what I don’t have—a family with children." 

That thought might be reframed as: 

“This year may look different than I hoped, but it gives me the chance to focus on what I can enjoy and appreciate right now, such as spending time with my loved ones and creating traditions for myself. Building a family may take longer than expected, but that doesn’t diminish my worth or my ability to find moments of joy."

Using mindfulness to prevent anxiety spirals

Sometimes it can be difficult to reframe a thought when the mind is racing. Anxiety is such a fast-paced emotion that it can be hard to not jump from thought to thought to thought and end up spiraling. Spiraling can be prevented by using mindfulness to stay present in the moment, to be aware enough of our thoughts that we can catch them, reframe them, and be intentional with our reactions. Neurologically, mindfulness reduces activity in the limbic system, thereby strengthening PFC regulation and reducing cortisol levels. Lower cortisol levels protect the brain from stress-related damage in parts of the brain vital for emotional regulation.

An example of how mindfulness may be used: 

You are at a holiday gathering and someone makes an insensitive comment about when you’ll have kids.

Mindful response may include S.T.O.P:

• Stop
• Take a 4 - 7 - 8 breath
• Observe (your emotions, physical sensations, and thoughts without judgment) and ground yourself
• Proceed by calmly and saying, “That’s a sensitive topic for me right now.”  

The role of self-compassion in emotional healing

Even if we are being mindful and reframing our thoughts, we may still hear that self-critical voice that loves to self-punish. This is where practicing self-compassion comes in. Neurologically, self-compassion has shown to reduce the limbic systems hyperactivity, helping us feel less overwhelmed by negative emotions. It also strengthens the PFC allowing for better regulation of the limbic system’s responses, leading to greater emotional stability.
An example of how self-compassion may be used: 

You feel overwhelmed seeing social media posts of friends celebrating the holidays with their children.
A self-compassionate response may include:

• Recognizing your feelings with kindness: “It’s okay to feel this way. This is really hard, and I’m not alone in this struggle.”
• Reassuring yourself as you would a friend: “I’m doing the best I can, and it’s okay to focus on my healing during this season.”
• Engaging in an act of self-care, like taking a walk, or treating yourself to a comforting activity.

Understanding trauma responses to fertility challenges

Fertility challenges can be deeply traumatic. While the experience varies from person to person, infertility often involves a profound sense of loss, unmet expectations, and challenges to one’s identity and future. During the holiday season, trauma responses to fertility challenges can manifest in emotional, physical, and behavioral reactions. It is not unusual to feel profound sorrow when seeing children, pregnant family members, or holiday traditions centered on family and children. Anger, irritability, shame, guilt, hopelessness and even detaching from feelings altogether are all very common and normal trauma responses. 

It is also not unusual to experience physical symptoms such as a racing heart, shallow breathing, or sweating when confronted with triggers (e.g., a holiday card featuring a family with children). Feeling drained and developing headaches, stomachaches, or other physical discomforts are also typical. On top of the emotional and physical responses, we have cognitive responses such as “I will never have children” or “I don’t belong here” play on a loop and only exacerbate the other symptoms. All of these things combined then create our behavioral responses. Meaning the things we do in response. For example, skipping holiday gatherings to avoid potential triggers. Engaging in perfectionist behaviors to "prove" worth in other areas, such as hosting the perfect holiday event. Using food, alcohol, or other substances as a coping mechanism to regain a sense of control.
Some ways to cope with these types of trauma responses include:

• Grounding techniques, such as 4 - 7 - 8 breathing or naming objects in the room, to stay present during triggering moments.
• Setting boundaries by politely declining invitations 
• Leaning on trusted friends, family or partner
• Reminding yourself that your feelings are valid and that it’s okay to prioritize your needs.

Finding your own path through the holidays

The holidays can be an emotional minefield for individuals with fertility challenges as it often brings heightened emotions, societal pressures, and reminders of what you may feel is missing. The contrast between the joy others seem to experience and the sadness or grief you may be feeling can amplify the sense of loss. Therefore, emotional resilience is crucial during the holiday season. 

Reframing helps shift the focus from loss and longing to aspects of life that can still bring fulfillment. Mindfulness helps you become aware of your emotions, while self-compassion allows you to address those emotions with kindness and care. Together, these tools enhance the brain's capacity to regulate emotions, foster positive self-reflection, and reduce the harmful effects of stress. Over time, these neurological changes make it easier to approach challenges with kindness and emotional strength.

Understand that the magic of the season doesn’t have to look like everyone else’s. It's okay to experience the holidays differently this year or frankly any year. Even though you might be experiencing a difficult journey, it’s possible to find moments of beauty and peace. Whether it's the peaceful quiet of a winter morning, the sound of holiday music, or the taste of a comforting food, small moments of magic exist. Focus on those moments of beauty and allow them to fill your heart, even if just for a brief moment.

When I started my IVF treatments, I felt overwhelmed and alone. My Instagram feed was full of pregnancy announcements and happy families, while I was giving myself daily shots and tracking my follicle count. That changed when I discovered the fertility community on social media. Through hashtags like #TTCCommunity and #IVFWarrior, I found people who understood exactly what I was going through—the hope, the fear, the technical medical terms, and yes, even the dark humor about progesterone side effects.

But I remember how confused I felt at first, trying to decode what seemed like a secret language of hashtags and abbreviations. Infertility itself was new to me, let alone the secret language of #TWW, #PUPO, and countless other acronyms. As a marketer who's now been through several rounds of IVF, I want to help others find their way to this incredible community more easily.

This guide breaks down the most common fertility hashtags, explaining what they mean and how they're used. Whether you're just starting fertility treatments, exploring egg freezing, or supporting someone in your circle, understanding these hashtags can help you find relevant content and connect with others who share the same experiences.

Core fertility terminology on social media

The most widely used hashtag in the fertility community is #TTC, which stands for "trying to conceive." You'll often see this combined with other terms like #TTCCommunity or with numbers indicating how long someone has been trying (#TTC2Years).

The #1in8 hashtag references a significant statistic: infertility affects one in eight couples. This hashtag helps normalize fertility challenges and builds awareness about how common these experiences are.

Other common hashtags include:

• #NIAW - National Infertility Awareness Week
• #TTCCommunity - Trying to Conceive Community
• #TTPCommunity - Trying to Parent Community
• #TTSSupport - Trying to Conceive Support
• #InfertilityCommunity - General infertility support and discussion

IVF hashtags

Medical hashtags help people find information about specific treatments or connect with others going through similar procedures. Common examples include:

• #IVF - In vitro fertilization
• #IVFwarrior - Commonly used during IVF
• #FET - Frozen embryo transfer
• #IUI - Intrauterine insemination
• #ICSI - Intracytoplasmic sperm injection
• #PGT - Preimplantation genetic testing
• #PUPO - Pregnant until proven otherwise
• #Embaby - Cute term for embryo
• #Embabyonboard - Commonly used after a transfer
• #TransferDay - The day an embryo is transferred

For egg freezing and donation, you'll encounter these self-explanatory terms:

• #EggFreezing
• #EggDonation
• #DonorEggs
• #FertilityPreservation

These hashtags often accompany posts about treatment experiences, questions about procedures, or celebrations of milestones.

Tracking and timing hashtags

The fertility community has developed shorthand for discussing cycle timing and test results:

• #TWW refers to the "two-week wait" between ovulation or treatment and when you can take a pregnancy test. This period can be particularly stressful, and many people seek support during this time.
• #DPO means "days post ovulation" and is often followed by a number (#4DPO, #12DPO) to track cycle progress.
• #POAS stands for "pee on a stick"—taking a pregnancy test. Results are often tagged as either #BFP (big fat positive) or #BFN (big fat negative).

Medical condition hashtags

Specific medical conditions related to fertility have their own hashtag communities:

• #PCOS - Polycystic ovary syndrome
• #Endometriosis or #Endo
• #MFI - Male factor infertility
• #LowAMH - Low anti-müllerian hormone
• #RPL - Recurrent pregnancy loss

These hashtags help people find others with similar diagnoses, share treatment experiences, and discuss management strategies.

The emotional aspects of fertility challenges are just as significant as the medical ones. Several hashtags focus on mental health and support:

• #InfertilitySupport connects people seeking or offering emotional support
• #InfertilityAwareness raises visibility of fertility challenges
• #RainbowBaby refers to a baby born after loss
• #SecondaryInfertility discusses fertility challenges after having a child

Family building hashtags

Different paths to parenthood have their own hashtag communities:

• #NonTraditionalFamily
• #LGBTQ+Family
• #SingleMomByChoice
• #SurrogacyJourney
• #DonorConceived

These hashtags help people find others building families in similar ways and access relevant resources and support.

Finding your community

As social media evolves, new hashtags and communities continue to emerge. Staying current with these changes can help you maintain connections and find relevant information. Remember that online communities can provide support and understanding, but they should complement, not replace, professional medical care and in-person support systems.

The infertility community on social media reflects the diversity of experiences and paths to parenthood. By understanding and using these hashtags thoughtfully, you can find your place within this supportive network of people who understand what you're going through.

Whether you're ready to share your own story or simply want to find others who understand what you're going through, I hope these hashtags help you find your people. Use them in ways that feel right for you, and remember—you're not alone.

Diminished Ovarian Reserve (DOR) is a condition that affects many women, often catching them off guard as they embark on their journey to parenthood. While receiving a DOR diagnosis can be challenging, understanding the condition is the first step in navigating your reproductive options. This article aims to demystify DOR, explore its prevalence, discuss the chances of conception, and outline the available options for those diagnosed with this condition.

What is diminished ovarian reserve (DOR?)

Diminished ovarian reserve refers to a reduction in the quantity of your remaining eggs. Every female is born with all the eggs she'll ever have, and this number naturally declines with age. However, some experience a faster decline than expected for their age, leading to a diagnosis of DOR.

DOR is not the same as infertility. While it can make conception more challenging, it doesn't necessarily mean pregnancy is impossible. Instead, think of DOR as a warning sign that your reproductive window may be shorter than anticipated. The sooner you get a DOR diagnosis. The sooner you can begin to explore your reproductive options, including treatments like in vitro fertilization (IVF) or egg freezing, and potentially increase your chances of achieving a successful pregnancy.

How common is diminished ovarian reserve?

The prevalence of DOR increases with age, but it can affect women of all ages. According to one study, approximately 10% of women seeking fertility treatment are diagnosed with DOR. However, this number may not accurately represent the general population, as many women with DOR may not seek fertility treatment or may remain undiagnosed.

Age is the most significant risk factor for DOR. As women approach their late 30s and early 40s, the likelihood of experiencing DOR increases significantly. However, DOR can also occur in younger women too, sometimes due to genetic factors, medical treatments like chemotherapy, or unknown causes.

Some lifestyle factors have also been known to contribute to a diminished ovarian reserve. Smoking is one of the most significant factors, as a history of heavy smoking can accelerate the loss of eggs and may lead to earlier menopause. 

Diagnosing diminished ovarian reserve

Diagnosis of DOR typically involves a combination of blood tests and ultrasound imaging. The most common blood tests measure levels of follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH). High FSH levels or low AMH levels can indicate DOR. Additionally, an ultrasound to count antral follicles (small follicles in the ovaries) can provide further insight into ovarian reserve.

It's worth noting that these tests provide a snapshot of your current ovarian reserve, not a prediction of your ability to conceive. A low ovarian reserve doesn't necessarily mean you can't get pregnant, just as a high reserve doesn't guarantee conception.

Chances of getting pregnant with diminished ovarian reserve

The probability of achieving pregnancy without assistance (meaning “the old fashioned way”) when diagnosed with DOR varies widely depending on individual factors, including age, the severity of the condition, and overall health. A study published in JAMA found that women aged 30-44 with low AMH (an indicator of DOR) did not have a significantly different probability of conceiving after six months of trying.

However, these statistics don't tell the whole story. Some women with DOR do conceive unassisted, while others may require IVF or donor egg IVF. Every woman's fertility journey is unique, and statistics can't predict individual outcomes.

Options for women diagnosed with DOR

If you are facing infertility due to DOR or other reasons, the good news is that there are options. Here are some paths you might consider:

1. Fertility treatments

For women with DOR who wish to conceive using their own eggs, fertility treatments can potentially improve the chances of pregnancy. These may include:

• Ovulation Induction: Medications to stimulate egg production
• Intrauterine Insemination (IUI): A procedure where sperm is placed directly into the uterus
• In Vitro Fertilization (IVF): A process where eggs are fertilized outside the body and then transferred to the uterus

It's worth noting that success rates for these treatments may be lower in women with DOR compared to those with normal ovarian reserve. A fertility doctor can give you a better idea of your chances of success based on your unique health history. 

2. Egg donation

For some women with DOR, using donor eggs may offer the best chance of achieving pregnancy. This option allows for the experience of pregnancy and childbirth, even if the child isn't genetically related to the mother. Success rates with egg donation are generally higher than when using your own eggs

3. Adoption

Adoption is another path to parenthood for those diagnosed with DOR. While it doesn't involve a genetic connection or the experience of pregnancy, it offers the opportunity to provide a loving home to a child in need.

Conclusion

DOR is a challenging diagnosis, but it doesn't have to mean the end of your dreams of parenthood. By understanding your condition, exploring your options, and working closely with healthcare providers, you can make informed decisions about your fertility journey.

Remember, DOR is a medical condition, not a personal failing. It's okay to feel frustrated, sad, or anxious about this diagnosis. Many women find it helpful to seek emotional support, whether through counseling, support groups, or open conversations with loved ones.

Ultimately, the path you choose will depend on your personal circumstances, values, and goals. Whether you decide to pursue fertility treatments, consider egg donation, explore adoption, or take a different route entirely, know that there are multiple ways to build a family and experience the joys of parenthood.

Your fertility journey may not look exactly as you imagined, but with perseverance, support, and the right medical guidance, you can navigate the challenges of DOR and move forward with hope and determination.

Find an amazing egg donor at Cofertility

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing.

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg-sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Human-centered: We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Donor empowerment: Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud of the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Embryo Guarantee: We’re committed to helping your family grow, and proud to offer a generous Embryo Guarantee to every intended parent we work with
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

As a reproductive endocrinologist (aka a fertility doctor), every day I witness firsthand the profound yearning to build a family. For many individuals and couples, the path to parenthood may not be a straightforward one. Fortunately, advancements in assisted reproductive technologies (ART) have opened doors to alternative family-building options. Third-party reproduction (TPR) can offer hope for those facing fertility challenges or seeking alternative means to complete their families. But what is it?

In this article, I'll dive into the world of TPR, exploring its various facets, the science behind it, and the unique considerations involved. Whether you're a couple struggling with infertility, a single parent by choice, or an LGBTQ+ individual seeking to build a family, understanding TPR can empower you to make informed decisions about your fertility journey.

What is third-party reproduction?

When you hear the term third-party reproduction, it’s referring to a range of techniques that involve using genetic material or gestational services from a third party, someone who is not the intended parent, to achieve pregnancy. This broadens the possibilities for those who may not be able to conceive using their own gametes (eggs and sperm) or carry a pregnancy themselves. Here's a breakdown of the types of TPR:

• Sperm donation: Viable sperm from a carefully screened donor is used to fertilize eggs through intrauterine insemination (IUI) or in vitro fertilization (IVF).
• Egg donation: Donor eggs, retrieved from a healthy egg donor who has undergone rigorous medical and psychological evaluation, are fertilized with the intended father's sperm or donor sperm for implantation in the uterus via IVF.
• Embryo donation: Frozen embryos created by another family undergoing IVF are donated to another couple or individual for implantation. 
• Gestational surrogacy: A gestational carrier, also known as a surrogate, carries a pregnancy for the intended parents using an embryo created either through the intended parents' own gametes or donated sperm and eggs. The gestational carrier has no genetic link to the baby.
• Double donor: Both donor sperm and donor egg come together in IVF. 

More and more families are turning to third-party reproduction to build their families. Third-party reproduction is part science and medicine, and part generosity from someone else who wants to help you build your family. There is a lot of coordination and legal work involved to protect all parties, and if you work with a group like Cofertility, we will help you all along the way. 

What types of families use third-party reproduction?

Third-party reproduction (TPR) opens doors for a diverse range of individuals and couples who may not be able to conceive unassisted or carry a pregnancy to term. I have worked with so many different types of families, who come to me for various reasons. Here's a closer look at some of the families who find hope and fulfillment through TPR:

• Couples facing infertility:  Infertility, the inability to conceive after one year of unprotected intercourse, affects millions of couples worldwide. TPR can offer hope for those struggling with infertility due to various factors including low sperm count, blocked fallopian tubes, or hormonal imbalances.  For these couples, TPR, whether through sperm donation, egg donation, or even embryo donation, allows them to experience the joy of parenthood and build their families.
• Single parents by choice:  An increasing number of single intended parents are opting for TPR to build their families. They can utilize sperm donation, egg donation, and/or surrogacy to create their dream families.  
• LGBTQ+ families: TPR plays a significant role in expanding family-building options for LGBTQ+ individuals and couples. Same-sex male couples can utilize egg donation and surrogacy to have a biological child within their family. Lesbian couples have the option of using sperm donation, either from a known or anonymous donor, and either partner can carry the pregnancy or utilize a gestational carrier.  Transgender individuals can also explore TPR options to complete their families.
• Individuals with medical conditions:  Certain medical conditions may render pregnancy unsafe or even impossible. Uterine fibroids, endometriosis, or a history of complex medical procedures or births are just some examples.  TPR, through gestational surrogacy, allows these women to experience parenthood by having a genetically related child (through egg donation and sperm from their partner) or by adopting an embryo.
• People with genetic concerns:  For couples at risk of passing on a known genetic condition to their biological children, TPR offers a path toward a healthy family.  Preimplantation genetic diagnosis (PGD) can be performed on embryos created through IVF, allowing for the selection of embryos free from the identified genetic condition.  This can give couples peace of mind and increase their chances of having a healthy child.

Regardless of the specific route taken through TPR, the common thread is the unwavering desire to build a loving family.  While genetics play a role, the emotional bonds cultivated through love, nurturing, and shared experiences are the true cornerstones of a family. Studies have shown that children born through TPR thrive in loving environments and develop strong attachments to their intended parents.

The emotional journey of TPR

The decision to pursue TPR is rarely made lightly. It's often born out of a deep longing for parenthood and may be accompanied by a spectrum of emotions. Intended parents may experience a mix of hope, excitement, anxiety, and sometimes even a sense of grief if facing infertility or the inability to use their own genetic material. Open communication is absolutely vital – between intended parents, with any known donors or gestational carrier, with your agency, and within oneself.  Exploring personal feelings and expectations throughout the process  is essential for ensuring everyone is emotionally aligned.

Donors and gestational carriers also carry complex emotional feelings throughout the process.  Donors may derive a sense of altruism and fulfillment from helping others build families.  Gestational carriers often express feelings of deep satisfaction from carrying a child for intended parents who cannot do so themselves.  However, feelings of uncertainty, potential vulnerability, and even moments of hesitation are also natural parts of the experience.

Psychological support in the form of counseling provides a safe space to unpack these emotions for everyone involved.  It can help intended parents cope with potential setbacks, foster healthy communication with stakeholders, and build a strong emotional foundation as they navigate their unique path to parenthood.

If you work with Cofertility, we have a fertility psychologist on our team who supports all parties involved. 

Do I need a doctor who specializes in third-party reproduction?

The short answer is yes! Building a family through third-party reproduction involves a mix of medical, legal, and emotional considerations. While seeking guidance from any fertility doctor is a good starting point, partnering with a board-certified reproductive endocrinologist who specializes in TPR will go a long way. These specialists possess in-depth knowledge of the various TPR techniques, from sperm and egg donation to embryo donation and gestational surrogacy. Their expertise allows them to create tailored treatment plans that perfectly align with your unique circumstances – whether that means selecting the right donor, navigating IVF procedures, or understanding complex legal agreements.

A fertility doctor with TPR experience understands the potential risks and necessary medical monitoring throughout the process. They ensure your safety and well-being, always keeping your best interests in mind. Perhaps just as importantly, they offer compassionate support throughout your emotional journey, answering any questions and providing a safe space to process the complex feelings that may arise.  Building a trusting relationship with your doctor is important when making personal decisions that affect your ability to build a family.

Finding the right specialist takes a little research. Look for board-certified reproductive endocrinologists affiliated with reputable fertility clinics that offer comprehensive TPR services. Ask for recommendations from trusted sources or schedule consultations with a few specialists to find a provider whose approach aligns with your needs. Ask them about their experience with TPR, and how they approach treatment differently. Ultimately, a specialist in TPR will be your invaluable guide, increasing your chances of a positive outcome on your path to creating the family you've always dreamed of.

Summing it up

Third-party reproduction (TPR) is a powerful testament to where science and compassion meet. It expands our horizons of possibility, offering alternative paths to parenthood for many individuals and couples. Whether it's sperm donation, egg donation, embryo donation, or working with a gestational carrier – the techniques behind TPR are ever-evolving, giving more people the chance to fulfill their dreams of family.

While the science is complex, the heart of TPR is simple: it's about love, determination, and the generosity of those who offer the incredible gift of helping others build their families. Naturally, navigating the medical, emotional, and legal aspects of TPR necessitates a guiding hand. That's where a specialized reproductive endocrinologist, a team like Cofertility, and a strong support system are invaluable, turning what can seem daunting into a well-supported, empowering journey.

If this is a path calling to you, know that you're not alone. Seek out the knowledge and support that will enable you to make informed choices and feel confident at every step along the way.  The joy of parenthood, experienced through whichever means resonate with you, is a beautiful path of unwavering love.

Find an amazing egg donor at Cofertility

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing.

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use and donate half to your family.

We aim to be the best egg-sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Human-centered. We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Donor empowerment. Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud of the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Embryo guarantee. We’re committed to helping your family grow, and proud to offer a generous Embryo Guarantee to every intended parent we work with.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

Read more:

• Double Donor IVF: Making Embryos with Donor Eggs and Sperm
• Reciprocal IVF: What Should My Partner and I Consider?
• Gay Men Having Babies: Four Genetic Options with Donor Eggs

With advances in reproductive technologies, more and more families are turning to in vitro fertilization (IVF) to build their families. While some may experience smooth IVF journeys, others may face obstacles such as poor ovarian response (POR). POR is a condition that can affect your ability to produce an optimal number of eggs during fertility treatment. 

In this article, we will explore what POR means for patients, its prevalence, diagnostic methods, potential treatments, and available options for those diagnosed with this condition.

What is meant by low response to ovarian stimulation?

Poor ovarian response (POR) refers to a suboptimal response (actual or predicted) of the ovaries to stimulation during fertility treatment. 

During IVF, fertility medications are used to stimulate the ovaries, which culminates in the retrieval of multiple eggs. However, those with POR may produce fewer eggs than expected, which can significantly impact their chances of successful conception or even lead to a canceled cycle. 

POR is often associated with reduced ovarian reserve, which refers to the diminished quantity and eggs remaining in the ovaries.

How common is POR?

The estimated prevalence of POR ranges from 6% to 35%. This wide range is primarily due to researchers and clinicians having varying definitions of POR. In fact, one systematic review of 47 studies focusing on POR patients found a staggering 41 different definitions of POR being utilized. 

The likelihood of encountering POR increases with age, as ovarian reserve naturally diminishes over time. However, it is important to know that POR can occur in women of all age groups, including younger patients.

What is considered a “poor response” to IVF? Diagnosing POR

The European Society of Human Reproduction and Embryology (ESHRE) working group established criteria for defining a poor response in IVF. 

According to their report, having two or more of the following three features is considered having poor ovarian response: 

• Advanced maternal age or any other risk factor for POR 
• A history of previous POR
• An abnormal ovarian reserve test 

Or, if you experience two episodes of POR after IVF, it is considered a poor response, even without advanced maternal age or low ovarian reserve. Since the term POR specifically refers to the ovarian response, at least one egg retrieval is required for diagnosis. 

However, patients of advanced age with an abnormal ovarian reserve may also be classified as poor responders because both factors indicate reduced ovarian reserve and can serve as predictors of the outcome of an ovarian stimulation cycle. If that’s the case, a more accurate term would be "expected poor responders."

How IVF can fail

Each fertility journey is unique, and various factors, including underlying medical conditions, genetic factors, and individual response to medications, can influence the ovarian response to IVF.

Sometimes, IVF isn’t even a viable option due to low ovarian reserve. Ovarian reserve refers to the quantity of eggs remaining in the ovaries. Assessing ovarian reserve through markers such as anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) can provide insights into your potential ovarian response to IVF. A predicted poor response may be indicated by low AMH levels or a reduced number of antral follicles observed during ovarian reserve testing.

Sometimes, even with normal ovarian reserve, you can experience an inadequate ovarian response to stimulation medications, which leads to fewer follicles developing than you would hope. Follicles are fluid-filled sacs within the ovaries that contain developing eggs. During an IVF cycle, hormonal medications support the growth and development of multiple follicles to increase the chances of obtaining viable mature eggs for fertilization. In general, 10–15 follicles is considered to be the optimal response to fertility medications during IVF. In cases of poor ovarian response, the ovaries may not respond adequately to these stimulation medications, resulting in limited follicular development. This poor response may be indicated by a reduced number of developing follicles observed during ultrasound monitoring throughout the stimulation phase of the IVF cycle.

Typically, a good IVF response involves the retrieval of a sufficient number of eggs, allowing for a higher likelihood of successful fertilization and subsequent embryo development. But sometimes, you simply don’t get enough eggs. A poor response can also be characterized by a lower-than-expected number of eggs retrieved, which may fall below the average range for your age group.

Is POR curable?

While POR poses challenges, it does not necessarily mean that you cannot conceive. The severity of POR can vary, and treatment options are available to optimize the chances of successful conception.

Treatment strategies for POR aim to improve ovarian response and enhance the chances of successful egg retrieval. The specific approach will depend on a lot of factors, including the underlying causes of POR and any other reproductive health obstacles you face. Some common treatment options include:

• Adjusting stimulation protocols: Your fertility doctor may modify the medication protocols used during IVF to enhance ovarian response. This may involve altering the dosage or type of fertility medications administered.
• Adding supplements: There is some evidence that DHEA and CoQ10 may improve IVF pregnancy rates for those facing POR. 
• Human growth hormone (GH): Some evidence suggests that treatment with GH for POR patients could lead to a higher number of retrieved eggs. 
• Third-party reproduction: In certain cases, fertility doctors may recommend alternative approaches such as the use of donor eggs or embryo adoption. These options can increase the chances of success.

What comes next after POR

Navigating a poor response to IVF can be challenging, and you’ll want to work closely with a fertility doctor who can evaluate the specific circumstances and develop an individualized treatment plan. The treatment approach may involve adjusting medication protocols, exploring alternative techniques, or considering options such as donor eggs.

While a poor response to IVF can be disheartening, it does not signify the end of the fertility journey. Advances in reproductive medicine continue to offer new possibilities and hope for those facing challenges in conceiving. With the right support, guidance, and perseverance, individuals and couples can explore alternative paths and find the best course of action to achieve their dream of building a family.

Get the emotional support you need

Dealing with a diagnosis of POR can be emotionally challenging. It is crucial to recognize the emotional impact and seek support from loved ones, support groups, or mental health professionals who specialize in fertility-related concerns. The journey to conception can be complex, and emotional well-being is an essential aspect of the process.

We are here to help you find the perfect egg donor

At Cofertility, our program is unique. After meeting with hundreds of intended parents, egg donors, and donor-conceived people, we decided on an egg donation model that we think best serves everyone involved: egg sharing. We didn’t invent the concept of egg sharing, but we are the first to take it national (and even global!).

Here’s how it works: our unique model empowers women to take control of their own reproductive health while giving you the gift of a lifetime. Our donors aren’t doing it for cash – they keep half the eggs retrieved for their own future use, and donate half to your family.

We aim to be the best egg sharing program, providing an experience that honors, respects, and uplifts everyone involved. Here’s what sets us apart:

• Donor empowerment: Our model empowers donors to preserve their own fertility, while lifting you up on your own journey. It’s a win-win.
• Diversity: We’re proud about the fact that the donors on our platform are as diverse as the intended parents seeking to match with them. We work with intended parents to understand their own cultural values — including regional nuances — in hopes of finding them the perfect match.
• Human-centered: We didn’t like the status quo in egg donation. So we’re doing things differently, starting with our human-centered matching platform.
• Lifetime support: Historically, other egg donation options have treated egg donor matching as a one-and-done experience. Beyond matching, beyond a pregnancy, beyond a birth…we believe in supporting the donor-conceived family for life. Our resources and education provide intended parents with the guidance they need to raise happy, healthy kids and celebrate their origin stories.

Additionally, every Cofertility intended parent is backed by our comprehensive Embryo Guarantee. For detailed pricing, visit our pricing page.

We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account to get started today!

First comes love, then comes marriage, then comes… how does that song go again? Our world has so many cultural rules and norms in place that we forget that in reality everyone’s experiences, needs, and realities are very different. We say we are open and tolerant to difference yet, we let society dictate how we live, love, and feel. So when a woman is diagnosed with infertility and told that donor eggs are required to have a baby, instead of being grateful for the opportunity to be a parent, different fears can kick in. One of the fears includes not being supported by family or friends. But what happens when that non-support comes from your partner? And what if despite his not wanting to use donor eggs, you still do? What happens then?

Understanding your options: the pros and cons of using donor eggs

The positives are obvious: you get to be a parent. And for some, another positive can be that  the husband's sperm can be used, thereby keeping some genetic connection. Negatives can include cost and finding the ‘right’ donor may take time. And in this scenario, conflicts with your partner about moving forward with donor eggs. 

Read more: I'm Considering Using Donor Eggs. What are the Pros and Cons?

Communicating with your partner: how to have a productive conversation

When this topic first came up, you both most likely had your own private reactions. You both may have needed time to truly digest and process the situation. But sometimes, one partner moves through the process a lot quicker and immediately decides what to do while the other partner needs more time to figure things out. 

So if you want to move forward with donor eggs and he doesn’t, what comes next? First, he needs the opportunity to spend time really digesting and processing this on his own terms.  He needs to sit and put himself in both situations (using a donor vs. not using a donor) and being honest about how that would look and feel. Has he had time to talk to someone without you? Maybe a friend, the REI, or even a therapist? He needs to talk to someone about his biggest worries, his biggest concerns, and his biggest issues with using a donor and sometimes that person is not you. 

You can’t force anyone to get on board just because that is something you really want. You also can’t let your feelings invalidate his feelings either. But what you can do is both get educated on the process, you can both speak with a therapist, you can both read the literature, and/or attend groups with other couples in your exact same situation. These are things that can help you make informed decisions, decisions that you can feel good about, even 20 years from now. 

Can I pursue donor eggs without my husband knowing? 

Surprisingly, this isn’t a joke. This question has been asked -  a few times. If you have this thought, then you need to work with a couples therapist. Starting a family is a huge endeavor, regardless if you use a third party or not. It is a life changing event that triggers a lot of stress and can be very challenging. If you are not on the same page regarding donor eggs you need to find a therapist who specializes in fertility. This is important so you aren’t spending time explaining the details of infertility, they will already understand and be able to flush out the issues with you.  

A fertility psychologist can help you  explore different parenting options. Options such as adoption, fostering, or maybe even living child free. It gives you the opportunity to create a safe space for you both to voice your feelings but also a safe space to learn more about each other's feelings, needs and wants. It can open space for understanding and a deeper connection. 

Coping strategies and how to manage your emotions during this time.

You can’t change the past and you can’t control the future. But you can learn how to be in the here and now by practicing mindfulness. Mindfulness can help regulate emotions, decrease stress, anxiety and depression. Practice self-care by doing things you enjoy and being with people you love. Talk to someone. Find a therapist, a friend or join a group, don’t bottle it up.

Conclusion

At the end of the day, there is no wrong decision. Navigating the complex world of infertility and exploring options like using donor eggs is a journey filled with challenges and emotions, particularly if you and your partner are not on the same page. It is essential to maintain open, honest, and compassionate communication throughout the process, granting each other the space to process feelings and come to a decision at your own pace. This is not a decision to rush, and sometimes the assistance of a fertility specialist or therapist may be needed to guide you both through this journey.

Remember, your feelings are valid and it is okay to feel a multitude of emotions. You are not alone in this journey and there are many resources available to you – from literature on the subject to support groups for couples facing the same situation. Lastly, self-care is vital during this time. Practice mindfulness, enjoy activities that you love and surround yourself with supportive individuals. Most importantly, no matter the outcome, it can lead to a deeper understanding of each other and potentially a stronger connection as you face these decisions. Together as a couple, you need to make a decision that is right for you and your family.