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MicroSort/PGD Flowchart

This chart shows the steps in a MicroSort and/or PGD cycle using IUI or IVF. Click each box for a description of the step.

Start

Welcome to your high-tech gender selection journey! Or as it is otherwise known, the emotional roller coaster, because at each step of the way you'll feel like your dream is almost within your grasp, only to have an unexpected turn dash your hopes. As you set out on your adventure, be prepared for the ups and downs that are part of the ride!

Apply and Get Accepted

If you are using MicroSort, start by filling out the clinical trial application form at MicroSort.net. You must meet MicroSort's basic qualifying criteria.

If you are planning to use PGD only (no MicroSort) you may also need to be accepted by the fertility clinic performing PGD.

See: What are the conditions to qualify for MicroSort?

MicroSort Consultation

After completing a medical history form, you'll have a consultation with a MicroSort clinician, either in person or by phone. This is your chance to ask questions about any part of the process.

You'll pay a non-refundable fee for the consultation.

Infectious Disease Testing

Both husband and wife must be negative for HIV and Hepatitis B and C.

Prices can vary widely for the same tests, so call your local labs to check prices.

You will probably need infectious disease screening before your first cycle only, not for repeat cycles, depending on how much time has passed.

Semen Analysis

A semen analysis is performed to check the amount and quality of sperm. Some of the test results you'll receive are:

  • Sperm count: The number of sperm per mL (milliliter).
  • Sperm morphology: Percentage of sperm with a normal shape.
  • Sperm motility: Percentage of sperm with normal forward movement.

Low sperm quality may affect the choices you have available. For example, if sperm count or motility are poor, IUI is very unlikely to be successful, and it will be necessary to use IVF.

A poor semen analysis isn't the end of the road. First of all, you can often drastically improve semen quality with changes in lifestyle (such as quitting smoking, reducing stress, and taking fertility enhancing vitamins). Secondly, many fertility treatments have been developed to overcome the obstacle of poor sperm quality, such as ICSI.

Decide: IUI or IVF?

After deciding which gender selection method to use, one of the biggest decisions you'll face is whether to get pregnant by IUI or IVF.

IVF Consultation

Before beginning your IVF cycle, you'll have a consultation with the IVF clinic to explain each step of the process.

(Even if you are doing IVF at MicroSort in Virginia or California, you may need to schedule an IVF consultation as well as a MicroSort consultation.)

FET (Frozen Embryo Transfer)

If you have leftover frozen embryos from a previous IVF cycle, you can perform a FET (Frozen Embryo Transfer) cycle.

The advantage of a FET cycle is that since the embryo has already been created, most of the expensive and invasive steps in the IVF process can be skipped. Dad, in fact, has no job at all in a FET cycle. Mom needs only to go through some monitoring to detect ovulation (to determine the best time to perform the embryo transfer), and perhaps use fertility drugs to regulate the cycle.

The disadvantage of a FET cycle is that the pregnancy rate is somewhat lower than a fresh IVF cycle, around 20% to 30%. Your success rate will vary depending on your age, the number and quantity of embryos transferred, and other factors.

Freeze/Store Embryos

After choosing the embryos for your embryo transfer, if you have leftover embryos of good quality, you may choose to freeze them for a future cycle. A cycle using frozen embryos is called a FET, for Frozen Embryo Transfer, cycle (click the FET circle for more information).

Embryos are cryopreserved (frozen) in special controlled cooling equipment, and stored in liquid nitrogen. Embryos can be stored in this way for many years, and studies have shown that babies born from frozen embryos are perfectly healthy.

You will, however, have to pay a fee for cryopreservation as well as a monthly storage fee. Unfortunately, about 30% of embryos will not survive the freeze/thaw process. Only embryos that seem healthy and are growing well are usually selected for freezing, because they are most likely to survive.

Thaw Embryos for FET

Previously cryopreserved embryos are thawed in preparation for embryo transfer. Only at this point will you find out how many embryos have successfully survived the freeze/thaw process. Embryos are thawed one by one, and checked to see how many cells in each embryo have survived, until the desired number of embryos is reached.

Frozen Sperm

If you had a previous unsuccessful MicroSort cycle, and were able to sort an extra vial of sperm during that cycle, you can skip the entire MicroSort phase of this cycle and use the thawed, previously sorted sperm. (Click on "Extra Vial" for more information.)

MicroSort and/or PGD?

With IVF, your options for gender selection are:

  • MicroSort sperm sorting, increasing your odds to about 70% for a boy or 90% for a girl
  • PGD, choosing the desired gender by checking embryos, and only transferring male or female embryos
  • PGD combined with MicroSort

If you are using PGD alone, follow the down arrow. If you're using MicroSort (either alone or combined with PGD), follow the up arrow.

See: Why would I want to combine MicroSort with PGD?

Using a MicroSort Collaborator

A MicroSort collaborator is a fertility clinic who works with MicroSort.

If you are not using a collaborator, you must travel to one of the two MicroSort locations (Virginia or California).

If you are using a collaborator, then you can choose to either provide the semen sample at a MicroSort location, or with your collaborator.

See: What is a MicroSort collaborator?

Travel to Collaborator

The husband travels to the collaborator to provide a semen sample. Depending on your location, travel may be local, or farther.

Semen Sample

Usually, you will be instructed for the husband to come to the clinic, and produce a semen sample, um, alone in a private room.

However, you can also usually produce the sample at home or at your hotel, if you can deliver the sample quickly. You can also get a special condom for collecting semen (not a regular condom). This is a much better option, in my opinion, but often this will not be suggested to you and you will have to ask about it.

Travel to MicroSort (Husband)

The husband travels to one of the two MicroSort locations, in Fairfax, Virginia, or Laguna Hills, California.

Husband and wife do not necessarily have to travel together. The husband must be present only on one day:

  • For IUI, the day of the IUI
  • For IVF, the day of egg retrieval

However, it can be difficult to know in advance exactly which day that's going to be.

Freeze Semen

Semen is frozen, or cryopreserved, for storage. Although fresh semen is considered to have slightly better chances for pregnancy, freezing semen is considered safe, and has been in use since the 1970s.

You will usually pay a fee to have semen frozen (each time), and a monthly fee for frozen semen storage.

Enough semen?

If you are providing semen at a collaborator, it will need to be frozen/thawed twice: for shipping to MicroSort, and again for shipping back to the collaborator. Because each freeze/thaw will result in the loss of some sperm, you may need to provide more than one sample in order to have enough healthy sperm.

Shipping Semen

Frozen semen is shipped between the collaborator and MicroSort. It may seem weird to think about your potential baby being shipped across the country, or even around the world, but the practice of shipping frozen semen isn't uncommon.

You may pay an additional fee for shipping semen.

Thaw Semen

Frozen semen is thawed, and usually evaluated to determine sperm quality.

Freeze/Store Extra Vial

The extra sorted vial of sperm is cryopreserved, and stored at MicroSort.

PGD (Preimplantation Genetic Diagnosis)

PGD is an extra step in an IVF cycle, used to select male or female embryos and/or to screen out embryos with a chromosomal or genetic disorder.

See: PGD

MicroSort

The semen sample is placed in the MicroSort machine, and sorted. An XSort results in mostly X sperm, favoring conception of a girl, or a YSort results in mostly Y sperm, favoring conception of a boy.

See: How does MicroSort sperm sorting work?

Extra Vial

When your semen sample is MicroSorted during either an IUI or IVF cycle, you may be able to save an extra vial of sorted sperm. Whether this is possible depends on the quality of the semen sample. You will pay an extra fee to sort the extra sample, and to freeze and store it.

If the current cycle does not result in pregnancy, the extra vial can be used in a future IVF cycle, avoiding the cost of MicroSorting again.

Rushing Purity Results

After your sample has been MicroSorted, a small amount is set aside to be tested later, to determine the actual purity of the sort. This is called the sort percentage, and reflects the actual proportion of X and Y sperm in the sample. This number varies, even for the same man in multiple cycles.

Usually, the results of this analysis are not available until several days later -- meaning that you find out your odds of having a boy or a girl after the IUI has already been performed.

You can, however, pay an additional fee to find out your sort percentage immediately, so that you can decide whether to go ahead with the IUI based on the results.

Purity Okay?

If you paid to get your sort percentage immediately, it's now time for a decision. If the purity is lower than you hoped for, do you go ahead with the IUI anyway, even though your odds of having the desired gender are not as high as you'd like? Or do you cancel and walk away empty handed, after spending so much money and effort to reach this point?

This can be a difficult decision if your sort is low. For an XSort, many women consider their sort low if it is in the low 80%'s. However, this is still much better than your natural odds, and most women with "low" sorts do go on to conceive a girl.

If your sort percentage is very low, you may get a second sort performed for free. However, it will be too late to do another sort in the current cycle. You'll have to start another complete cycle, and only the sort fee will be free, none of the other costs.

IUI, Intra-Uterine Insemination

At last, it is time for the insemination with MicroSorted sperm. The procedure only takes a few minutes, and is painless (discomfort-wise, it's about the same as having your yearly pelvic exam).

Using ultrasound for guidance, a slender, flexible tube (catheter) is inserted in the vagina, through the cervix and into the uterus. Your sorted sample is squirted into the tube using a syringe, and you will actually be able to see the white cloud of sperm entering the uterus on ultrasound.

Fertility Drugs for IUI

With an IUI, you have several options for using fertility drugs.

  • None. You can opt for a natural cycle, although this is not done very often because pregnancy rates are lower.
  • Clomid. Using Clomid will make sure that you ovulate, that it happens at the expected time, and you will probably have multiple follicles.
  • Injectibles. Using more powerful fertility drugs is much more expensive and has some risks, but increases pregnancy rates.

Ovulation Monitoring for IUI

It's crucial to time your IUI on the day you ovulate. You can choose which method to use to determine ovulation:

  • Self-monitoring. Using OPKs (or any method), you determine on your own which day you are ovulation. This is the cheapest option, but a lot is riding on getting this right.
  • Self-monitoring plus confirmation. You determine your day of ovulation, which is confirmed by one day of full monitoring.
  • Full monitoring at MicroSort. Blood tests to check hormone levels, and vaginal ultrasound to check the ovaries for the number and size of follicles, as needed.
  • Full outside monitoring. Monitoring tests performed by a local physician, coordinated with MicroSort. (This allows you to delay travel to MicroSort, rather than arriving early for monitoring.)

Travel to MicroSort (Wife)

The wife travels to one of the two MicroSort locations, in Fairfax, Virginia, or Laguna Hills, California.

For full monitoring, you will need to plan to stay about a week. Your husband only needs to be present on the day of the IUI.

HCG Shot

When it has been determined that you are on the verge of ovulating, your IUI will be scheduled for the following day. An HCG shot is administered 24 hours before the IUI. Called a "trigger", this hormone sends a message to the ovaries that "now" is the time to release the egg, to make sure the egg is ready and waiting for the IUI the following day.

2WW

The dreaded 2-week-wait while you wait to learn if you're pregnant.

Quote from Maureen's (otherwise decent) husband during the 2WW: "What's the big deal? Either you are or you aren't. Why waste the tests, just wait and see." Men.

Prep Cycle

During the cycle before your IVF cycle, you may take birth control pills to regulate your cycle. You may also undergo some tests to prepare for IVF, such as a mock transfer or a sonohystogram.

Ovulation Induction

Injectible fertility drugs will be used to cause your ovaries to release more eggs than normal -- hopefully, many more eggs.

Ovulation Monitoring for IVF

While you are using fertility drugs, you will be closely monitored to see how well you are responding (how many follicles are developing on your ovaries, and how large the follicles have grown), how close you are to ovulation, and for any adverse side effects. Monitoring is done through blood tests to check hormone levels, and vaginal ultrasound to view the follicles on your ovaries.

Monitoring is crucial to make sure your egg retrieval is timed correctly. If egg retrieval happens too early, eggs will be immature and won't fertilize. If it happens too late and ovulation has already occurred, the follicles have already released the eggs and the eggs can't be retrieved.

Egg Retrieval (ER)

In egg retrieval, eggs are removed from the mother under anesthesia. Using ultrasound for guidance, a long needle is inserted through the vaginal wall, and into a follicle on the ovary. The fluid in the follicle, along with the egg it contains, is aspirated. Each follicle is aspirated, and the eggs are then located in the follicular fluid using a microscope.

Creating embryos

At last, it's time to bring egg and sperm together. One option, GIFT, is available if you do not want to create embryos in the lab. Follow the down arrow for GIFT, or the right arrow for IVF.

GIFT/ZIFT/TET Laparoscopic Surgery

These options all involve laparoscopic surgery to access the fallopian tubes. In GIFT, eggs and sperm are placed in the tubes. In ZIFT, a 1-day embryo, or in TET, a 3-day embryo is placed in the fallopian tubes.

See: ART Overview

Stanard IVF Fertilization

In IVF fertilization, a droplet of sperm is placed with the egg, and sperm are allowed to penetrate and fertilize the egg.

If sperm have been frozen, MicroSorted, or there is a poor sperm count, you will need to use ICSI instead.

ICSI Fertilization

In ICSI (Intra-Cytoplasmic Sperm Injection), a single sperm is selected under the microscope, and injected directly into the egg.

Incubate Embryos 3 Days

Embryos are incubated for 3 days, and then evaluated.

For a blastocyst transfer, embryos may be incubated a total of 5 days (with or without PGD).

Incubate Embryos 1 Day

For ZIFT, embryos are incubated only one day.

Incubate Embryos 2 More Days (5 Total)

An embryo incubated for 5 days is called a blastocyst. Some clinics claim better pregnancy rates with "blast transfers", because only the best embryos survive to this point. Others argue that viable embryos are lost, because an embryo that may have survived if it had been implanted on day 3 may not survive 5 days in the lab.

Choose Embryos

Hopefully, you have arrived at this step with enough embryos to proceed to embryo transfer. Unfortunately, due to embryo attrition, sometimes there are no embryos that survive to this point.

If, however, you have extra embryos, at this point it is time to decide two things: 1) how many embryos to transfer, and 2) which ones to transfer. Deciding how many embryos to transfer can be a difficult decision, because transferring more than one increases your chance of pregnancy, but also your chance of having multiples.

Embryo Transfer (ET)

At last, the moment has arrived to transfer the precious embryos to the mother's uterus. This is a quick and painless procedure, as the embryos are transferred through a thin, flexible tube through the vagina and into the uterus.

Freeze, Donate, or Destroy Unneeded Embryos

After a successful IVF cycle, you may be faced with the decision of what to do with unneeded, frozen embryos -- called "snowflakes". You can continue to freeze them indefinitely, donate them to scientific research, or destroy them. Another option is to place them for "adoption" by an infertile couple.

See: Snowflakes.org

I know there's a lot of boxes here! This chart isn't meant to show a broad overview, but rather to give you an idea of all the steps involved, and the many decisions you'll have to make. I hope it helps you to get a better picture of what's really involved in a MicroSort/PGD cycle.

(You can also view a printable flowchart.)