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Do you know a friend or family member who has previously struggled with infertility? Some individuals and couples dream of starting their family, but are limited by infertility or gender. We have patients at NRM who need your help!

Fill out the Donor Questionnaire to get started!

What is egg donation?

Egg (or oocyte) donation refers to the process of selecting and retrieving eggs from an egg donor. The egg donor agrees to anonymously donate her eggs to a woman who cannot use her own eggs to become pregnant. To do this, the donor takes fertility medications to produce multiple eggs prior that are surgically retrieved for use in an IVF cycle. These eggs will be combined with the recipient partner’s sperm to create embryos that will be transferred into the recipient’s uterus.

Why donate?

• The majority of donors state that the primary benefit to them is the knowledge that they’ve helped someone have a baby.
• Often, donors have had personal experience with friends or family members who have struggled with infertility and have seen how devastating it can be — and they want to help.
• Financial compensation (see below).

Who should consider egg donation?

Healthy young women between the ages of 21 and 32 who have regular menstrual periods and don’t smoke are eligible for anonymous egg donor screening. Women who smoke or have risks of infectious disease will not be eligible for egg donation.

Does donating your eggs affect your fertility?

No. There is no evidence that donating your eggs will impact your fertility if you are young, healthy, and have excellent ovarian reserve.

Does donating your eggs hurt?

• The majority of donors find that they have no problems with the injectable medications.
• Some people experience mild discomfort when getting their blood drawn.
• Some egg donors experience bloating or discomfort as their follicles grow. While this is normal, we will closely monitor you for any signs of moderate to severe hyperstimulation, or “OHSS” (ovarian hyperstimulation syndrome), leading to abdominal distention, pain, or other medical concerns.
• The surgical egg retrieval is done under anesthesia with pain medication going through your IV. You may have some cramping similar to a menstrual period for 2-3 days after the procedure; part of your medication packet includes pain medication that you can take if you need it.

Do you find out who receives your eggs? Do recipients find out who their donor is?

No. While there are some situations where donors and recipients either know each other or are related, our egg donor bank is anonymous. Neither the donor nor the recipients know who the other party is in their process.

How long does the process take?

• The process of screening to be accepted into the anonymous egg donor pool can take about 2-3 months.
• Once your profile has been chosen by a recipient and your cycles have been synchronized, the actual IVF process takes about 3 weeks.

What is the compensation?

• As a NRM donor, you will earn $4,000 for your donation.
• At any point after you’ve taken the injectable medications and before you go through the egg retrieval, if your cycle is cancelled for any reason other than second thoughts on your part, you will be paid $500 for the time and effort you have already given. If you choose to cancel the cycle after you’ve started the injectable medications, you will not be compensated.

What are the steps in the process?

1. The first step is to submit your information below to our Donor Coordinator. You will then be contacted for a telephone interview and can complete a donor questionnaire online.
2. Following your initial eligibility determination, we will schedule a physician appointment, ultrasound and lab testing, and mental health screening.
3. You will then undergo the Matching Process to match you to the recipient(s). Once you are matched, we will coordinate your cycle with the recipients, and prepare you for ovarian stimulation and egg retrieval!

Why choose to become an egg donor with NRM?

• Our providers and staff have 15 years experience with donor egg IVF, and are skilled in matching donors and recipients and juggling the multiple aspects of third-party reproduction.
• NRM boasts a brand-new, state-of-the-art office space and lab in Colchester, Vermont, with convenient access and free parking. You won’t have to travel out of the state to complete an IVF cycle for a recipient many miles away.
• NRM staff is caring, sensitive, and understands the delicate nature of an anonymous egg donor/recipient relationship. We are committed to ensuring your anonymity and privacy throughout your experience, from your initial contact through your egg retrieval.

Why choose NRM?

• The NRM team consists of three board-certified Reproductive Endocrinologists and Infertility Specialists with extensive experience in treating infertility and reproductive disorders. Doctors’ backgrounds and expertise.
• Your NRM physicians wanted to create an environment where they could offer affordable, expert care to patients in an easily-accessible, friendly environment — thus the birth of Northeastern Reproductive Medicine!
• We offer state-of-the-art technology and an experienced team of nurses, embryologists, and staff, to maximize your chances at reproductive success.

I don’t have regular periods/I know the problem is me. Does my husband really need a semen analysis?

What comprises a basic infertility evaluation?

• A consult with your physician to review your History and have a Physical Examination.
• Semen analysis
• Hormonal evaluation of the female partner
• Hysterosalpingogram or HyCoSy to evaluate the patency of the fallopian tubes
• Further testing, such as a “baseline” ultrasound of your uterus and ovaries or further blood tests, may be performed if indicated in your particular situation. For more information about the diagnostic evaluation of infertility, click here.

Do you offer artificial insemination?

Do you offer treatment to lesbian or gay couples?

Do you work with single males or females?

Are fertility treatments covered by insurance? Are financing packages available?

• Some insurance plans will cover diagnostic testing only, some cover diagnostic evaluation and fertility therapy, and some do not offer any coverage for fertility evaluation or treatment. We understand that financial issues can add anxiety to an already stressful process, so we have a financial counselor available to help you understand your coverage. More information »
• Financial assistance is available through Springstone.

How do I know if I need genetic testing (PGD) or screening (PGS)? Can I utilize acupuncture or other stress-reduction techniques during my fertility therapy?

• Patients who have known genetic disease in themselves or their family
• Patients with previous failed treatments such as failed IVF
• Female patients of advanced reproductive age
• Patients with a history of recurrent miscarriage

Why should I have carrier screening or GoodStart? Aren’t these diseases rare? No one in my family has any genetic diseases.

• Most carriers don’t have a family history OR any symptoms of disease therefore most people don’t know they are carriers until they undergo screening.
• Being a carrier is not the same as having the disease. We all have two copies of each gene. Carriers have one gene with a mutation and one gene that works correctly.
• Carriers for some diseases are fairly common in the general population. For example, in a room of 30 people, chances are at least one person would be a carrier for Cystic Fibrosis.
• Finding out if you or your partner are carriers of a disease is important information to help you plan your fertility therapy.
  1. You may consider undergoing Pre-Implantation Genetic Diagnosis to test for embryos that are not affected by the disease.
  2. Even if you wouldn’t manage your fertility care differently, some individuals find it helpful to know about their risks so they have time to prepare in case they have a child with a genetic disease.

Do you offer the option of Surrogacy?

Do you provide care to patients who do not speak English as a first language?

At Northeastern Reproductive Medicine, we understand that insurance coverage for the diagnostic evaluation and treatment of infertility is complex. All NRM patients will have access to our financial counselor to help them understand their particular coverage, and answer insurance-related questions.

Participating Insurances for NRM

Participating Insurances for Ovation Fertility

Please note: if you have Aetna, Tricare, or MVP insurance, laboratory services may not be covered because Ovation Fertility does not partner with these insurances

Prior to your first appointment, you may desire to get a head start in determining whether you have coverage. To help you with this, we have summarized key points about insurance coverage below. The majority of insurance plans fall into one of three categories when it comes to infertility coverage.

Insurance Categories

1. The plan provides no coverage whatsoever for infertility services.
   Unfortunately this is sometimes the case and means that you will be expected to pay at the time of service for any non-covered services.
2. The plan provides coverage for the diagnostic phase of infertility testing only. In this scenario, the insurance plan will usually offer some coverage for a new patient consultation and some coverage for fertility testing. The treatment phase, however, is not covered.
3. The plan provides coverage for the diagnostic testing phase and coverage for infertility treatment. In these circumstances, coverage is provided for diagnostic testing and for some methods of infertility treatment. Understanding your individual coverage will help you anticipate whether or not a particular service is covered.

 Financial Assistance

For more information about financing options visit https://www.lendingclub.com/patientsolutions/.

Medications

Who should consider fertility medications?

• Women who do not have regular menstrual cycles (such as women with PCOS or amenorrhea)
• Couples diagnosed with unexplained infertility.
• Couples with mild male factor or those utilizing donor sperm, who have been unsuccessful with IUI alone (below).

What medications may be used?

Timed Intercourse Cycles

The combined use of ultrasound imaging and bloodwork monitoring to optimize each individual's ovulation window. Timed intercourse can be coupled with ovulation induction: using hormone therapy to stimulate egg development and release (ovulation). Having a guided timing of intercourse coinciding with ovulation improves conception rates tremendously, and is one of the more "basic" and cost effective fertility treatments.

Who should consider Intercourse Cycles?

• Individuals who have unobstructed fallopian tubes
• Individuals who have a normal uterine cavity
• Individuals whose partner does not have unexplained male factor infertility

Intrauterine Insemination (IUI)

What is IUI?

• The IUI procedure is a basic reproductive technique that deposits washed sperm into the uterus at the time of ovulation. The sperm source can be fresh or frozen, from a male partner or a donor. The goal is for the sperm to swim into the fallopian tube and fertilize a waiting egg, resulting in a pregnancy.
• IUI can be coordinated with your normal cycle or with the fertility medications above.

Who should consider IUI?

• Women using donor sperm to achieve a pregnancy
  • Same sex female couples
  • Single females
  • Couples in which the male partner has low sperm counts or azoospermia (no sperm).
• Women who have been diagnosed with unexplained infertility or infertility related to endometriosis.
• Couples with mild male factor infertility: semen analysis showing below-average sperm concentration, weak movement of sperm or abnormalities in sperm size and shape.

Why chose NRM?

Located in Colchester, Vermont, we provide a convenient, confidential and comfortable setting with an experienced team of doctors and nurses dedicated to meeting your needs. Click to learn more about our Physicians and Patient Care Team.

When you are ready, the next step is to schedule a consultation where we can meet with you to develop a personalized fertility plan designed to deliver the family of your dreams.

Schedule A Consultation

What is Donor Egg IVF?

Who should consider Donor Egg IVF?

What are the steps in the Donor Egg IVF process?

• Infectious disease testing for you and your partner
• Confirmation of Rubella and Varicella immunity
• Thyroid function testing
• Genetic testing if indicated
• Women over 40: mammogram
• Women over 45: ECG, cholesterol testing, diabetes screening
  • Maternal Fetal Medicine consult
• Semen analysis for your partner
• Psychological consultation
• Saline-infusion sonogram

• At Northeastern Reproductive Medicine, we screen healthy young women age 21-32 to identify appropriate egg donors with the best chances of success.
• You then work with the nursing team to identify a donor who is a good match for you.
• Occasionally, individuals or a couple will have a known egg donor they wish to utilize. That donor will be screened by NRM’s fertility doctors to determine if this donor offers you the best chances at conception.

• Birth control pills
• Lupron for cycle down-regulation
• Baseline ultrasound with blood draw to confirm cycle readiness; trial embryo transfer
• Estrogen for uterine lining preparation
• Ultrasound to monitor the uterine response to estrogen

Why Choose NRM?

• Our brand-new, state of the art facility serves patients in need of fertility services extending throughout Vermont, Massachusetts, New Hampshire, New York, and Quebec. Our wide geographic range, yet central location, allows us access to a larger pool of egg donors.
• Treatment by an experienced team of board-certified physicians and a qualified and compassionate nursing staff.
• Therapy occurs in a peaceful and comfortable environment with convenient parking and easy access to appointments and facilities.

What is fertility preservation?

Who should consider fertility preservation?

• Individuals diagnosed with cancer in their reproductive years should consider fertility preservation prior to starting treatment. Chemotherapeutic agents can be toxic to reproductive organs, specifically ovaries and testicles where the reproductive cells are produced and stored. Preserving gametes prior to treatment can give patients peace of mind that they can still start or expand their family in the future.
• Women who choose to delay becoming pregnant for social reasons—career choices, continuing education, lack of partner, or other personal reasons—and who want to give themselves access to “younger” eggs allowing for higher chances at pregnancy.
• Individuals with autoimmune disorders who must be on medications that may destroy reproductive function.
• Women who have been advised to have their ovaries removed (for example, due to severe endometriosis.)
• Transgender individuals who wish to preserve genetic material prior to transition.

What is involved in freezing eggs?

• Egg freezing should be done prior to undergoing any cancer treatment.
• The first step is a consult with one our specialty physicians to discuss the procedure and the risks and benefits. While egg freezing is not a guarantee of future pregnancy, our goal is to maximize your chances of success by using the latest cryopreservation technique.
• An egg freezing cycle is similar to undergoing the firsts steps of IVF, and is customized by the physician with the timing of a patient’s treatment in mind.
• You will undergo:
  • Ovarian stimulation with injectable medications
  • Monitoring via ultrasound and blood work
  • Egg retrieval

• All mature eggs that are retrieved will be vitrified the same day utilizing the latest cryopreservation techniques to most efficiently and effectively store your eggs for future use.
• Future use of stored eggs involves: warming the eggs, fertilizing the eggs via ICSI, and creating embryos in the laboratory for future embryo transfer.

What is involved in freezing sperm?

• It is preferable to collect and store sperm prior to the initiation of any cancer treatment; however, samples collected after starting certain forms of treatment have been shown to be viable.
• The first step is to consult with one of our specialists to discuss risks and benefits to sperm freezing. Bloodwork for infectious disease testing is required prior to sperm banking.
• Prior to collection, patients should abstain from ejaculation for 2-5 days.
• Patients can choose to collect several times in order to bank more samples (it may take more than one sample for a future cycle).
• Depending on how many samples you freeze, options for future conception may include IUI or IVF.

Who should consider freezing embryos (eggs fertilized by sperm)?

• Any female described above who has a partner—and together, you wish to preserve your fertility as a couple.
• The decision of freezing eggs versus freezing embryos can be complex and depends on your particular situation—schedule an appointment with one of NRM’s physicians to discuss how your needs will best be met.

Why choose NRM?

Who should consider fertility testing?

• Any woman under the age of 35 following 12 months of regular, unprotected intercourse
• Any woman over the age of 35 following 6 months of regular, unprotected intercourse
• Couples who have experienced two or more pregnancy losses

Earlier evaluation is appropriate for the following:

• History of irregular menstrual cycles, or no cycles at all
• Known or suspected problems in the uterus, fallopian tubes, or abdominal cavity (like endometriosis)
• Known or suspected male infertility problems
• Women over age 40

What does fertility testing include?

At Northeastern Reproductive Medicine, your physician will focus an evaluation in a cost-effective way, while following established guidelines and investigating both the male and female partner.

A basic evaluation may include:

• Semen analysis
• Hormonal evaluation of the female partner
• Ultrasound evaluation of the uterus and ovaries
• Hysterosalpingogram or HyCoSy (below) to evaluate the patency of the fallopian tubes

Factors that influence the speed and extent of evaluation:

• Patient preference
• Age of the woman
• Duration of infertility
• Medical history and physical examination

Additional Information and Terminology:

Hormone testing: This can help predict whether a woman can produce an egg or eggs of good quality, as well as how well her ovaries are responding to hormones released by the brain.

• The most common blood test is follicle-stimulating hormone (FSH), drawn on day 2-3 of a woman’s cycle, in conjunction with Estradiol (E2) and luteinizing hormone (LH). Additional hormonal testing may include anti-mullerian hormone (AMH), drawn at anytime in the cycle.
• Thyroid function is evaluated using a blood test for thyroid stimulating hormone (TSH), since poor thyroid function has been shown to contribute to fertility problems.

Transvaginal ultrasound: This allows the physician to evaluate for any abnormalities in the uterus or ovaries (such as fibroids or cysts). This also allows the physician to count the “resting” or antral follicles present in the ovaries, which helps determine a woman’s ovarian reserve.

Sonohysterography, or saline-infusion sonography (SIS): This is a special ultrasound-guided procedure in which the physician fills the uterus with saline solution. This expands the cavity of the uterus and makes it easier to see problems like polyps or fibroids that can affect fertility. The physician can also instill air bubbles in the solution to see if the fallopian tubes are open (called HyCoSy).

Hysterosalpingogram (HSG): This is an X-Ray procedure to see if the fallopian tubes are open and the shape of the uterus is normal. A catheter is inserted into the opening of the cervix through the vagina. A liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open.

Hysteroscopy: A surgical procedure in which a small fiberoptic scope is passed through the cervix to see the inside of the uterus. This procedure can help diagnose and treat abnormalities in the uterus, such as polyps, fibroids, and scar tissue (adhesions).

Laparoscopy: A surgical procedure in which a lighted scope is inserted through the abdominal wall into the pelvic cavity. This is a useful tool for evaluation of the pelvic cavity for endometriosis, scar tissue (adhesions), and other abnormalities. This is not a first-line option for evaluation of infertility, but it can be recommended based on results of other testing or medical history significant for pelvic pain or previous abdominal surgeries.

Semen analysis: This essential piece of the infertility workup provides information about the number, movement, and shape of the sperm, all of which can affect the sperm’s ability to travel and fertilize an egg. All men should have a semen analysis regardless of whether they have fathered children in the past.

Other testing can be considered based on the results of the semen analysis and may include hormonal or genetic testing.

Even if no one in your family has any known genetic diseases, you may carry a gene that increases your risk of genetic disease in your offspring. Carrier screening of genetic disorders common in all populations can provide important information to you and your doctor before pregnancy. NRM has partnered with GoodStart Genetics to offer our patients the most advanced technology available to screen for genetic disease.

The American College of Obstetrics and Gynecology (ACOG) recommends all women undergo routine prenatal screening for Cystic Fibrosis; the American College of Medical Genetics recommends both Cystic Fibrosis and Spinal Muscular Atrophy. Further tests may be recommended by your physician based on your ethnicity; alternatively, pan-ethnic screening may be performed for the most commonly-carried disorders.

Carrier screening is often covered by insurance, even if other aspects of reproductive healthcare, such as IVF, are not covered.

Cystic Fibrosis

• CF is characterized by chronic respiratory and digestive problems; symptoms range from mild to severe.
• CF is the most common fatal genetic disease in Caucasians-- yet with treatment today, individuals with severe CF can live into their 30’s.
• Most carriers have no symptoms or family history of CF.
• The incidence of CF in the US is about 1 in 3,600, but the carrier frequency for individuals maybe as low as 1 in 23 (Ashkenazi Jewish), 1 in 25 (Caucasian), or 1 in 58 (Hispanic).
• If both parents are carriers, the risk of having an affected child is 1 in 4 (25%).

Spinal Muscular Atrophy (SMA)

• SMA is characterized by severe muscle weakness and progressive loss of voluntary muscle control.
• In severe cases, SMA results in death before two years of age.
• Most carriers have no symptoms or family history of SMA.
• The incidence of SMA is about 1 in 10,000 in the US. Carrier frequency depends on ethnicity but may be as low as 1 in 47 (Caucasian) or 1 in 59 (Asian American).
• If both parents are carriers, the risk of having an affected child is 1 in 4 (25%).

For more information, click here.

Who should consider gender selection?

What is the process of gender selection?

Why choose NRM?

• A thorough discussion of your particular history, your options, and the pros and cons of each option.
• Education regarding the process of IVF with PGD for gender selection and the medical, financial and psychological risks of the process.
• Counseling regarding expectations of the process and success rates.

What is third-party reproduction?

• Third-party reproduction refers to the involvement of a third person (outside of the Intended Parent or Parents) to create a baby.
• This blanket term encompasses the use of sperm donors for IUI or IVF, egg donors, and gestational carriers.
• A gestational surrogate (GS) agrees to carry the child for another individual or couple. The GS provides the uterus without contributing genetic material.

Who should consider gestational surrogate IVF?

• Gay male couples or single men who wish to become parents.
• Women who have a contraindication to carrying a pregnancy, such as:
  • Uterine abnormalities, such as a T-shaped uterus or Mullerian anomaly, or hypoplastic uterus with history of infertility or repetitive pregnancy loss
  • Women with untreatable intrauterine scar tissue
  • Absence of the uterus, whether surgical (hysterectomy) or from birth (Mullerian agenesis)
  • Medical conditions in which risks of pregnancy would outweigh any benefits, such as:
    • Severe heart disease
    • Systemic lupus erythematosus
    • History of breast cancer
    • Severe renal disease
    • Cystic fibrosis
    • Prior poor obstetric history, like history of severe pre-eclampsia with HELLP syndrome

  Who should consider becoming a gestational surrogate?

  • NRM requires that intended parents be acquainted with gestational surrogate before undergoing a third-party IVF cycle. Many gestational surrogates are family members or close friends of the intended parents. You can also choose from gestational surrogate agencies that help coordinate intended parents with a healthy GS candidate.
  • Gestational surrogates should be at least 21 years old and have delivered a live-born child at term.
    • The older the GS, the higher the risk of age-related obstetric complications, especially pregnancy-induced hypertension or gestational diabetes. Evaluation of overall health and screening for underlying conditions, as well as counseling regarding risks, should be performed if an older GC is being considered.

  What is the screening process for Intended Parents?

  • NRM follows American Society for Reproductive Medicine (ASRM) and FDA guidelines for all processes.
  • Intended parents undergo complete medical history and physical examination by their physician. Semen analysis is performed for the male partner, and ovarian reserve assessment performed for a female partner that is using her own eggs.
  • Infectious disease testing is performed on intended parents, as well as any genetic testing if indicated in the family history.
  • NRM strongly recommends that intended parents undergo mental health counseling regarding their ability to maintain a respectful relationship with the GS, as well as what emotional issues may arise with children born of gestational surrogate IVF.

  What screening will be performed on gestational surrogates?

  • The GS should undergo a complete medical history including the following:
    • Detailed obstetric history
    • Lifestyle history
    • Physical examination
    • Evaluation of uterine cavity (most commonly by saline-infusion ultrasound)
  • Lab testing
    • Infectious disease testing
    • Screening for immunity to rubella and varicella
    • Blood type and antibody screen
  • Mental health evaluation: the goal of GS counseling is to provide the carrier (and her partner if present) with a clear understanding of the psychological issues related to pregnancy. Other issues to be discussed include managing a relationship with the intended parents; coping with attachment issues to the fetus; and the impact of a GC pregnancy on her children and her relationships with partner, friends, and employers.

  What other components are needed prior to undergoing a gestational surrogate IVF cycle?

  • The GS (and her partner) and intended parents meet together with a mental health professional to discuss expectations regarding a potential pregnancy. This includes a discussion of the type of relationship all parties desire; the number of embryos for transfer; prenatal diagnostic interventions; fetal reduction and therapeutic abortion; and respecting the GS’s right to privacy.
  • Consultation with an attorney familiar with third-party reproductive law is required. With GS arrangements, a legal contract should cover the following:
    • Financial obligations on the part of the intended parents and the GS
    • Expected behavior of the GC to ensure a healthy pregnancy
    • Prenatal diagnostic tests
    • Agreements regarding fetal reduction or therapeutic abortion if indicated
    • Declaration of parentage according to state laws

  NRM partners with the Vermont Surrogacy Network to help Intended Parents match with a Gestational Surrogate. Click here to learn more.

  When you are ready, the next step is to schedule an initial consultation so that we can meet with you and develop a personalized plan designed to deliver the family of your dreams. Schedule A Consultation

Who should consider IVF?

For some situations IVF may be the first-line treatment:

• Women with bilateral tubal ligation.
• Women with irreversible tubal disease or hydrosalpinx (swollen, fluid-filled tubes).
• Male partner with vasectomy.
• Male with severe male factor (very low or no sperm “azoospermia,” or low sperm motility or morphology “oligospermia“ or “asthenospermia”).  In these cases ICSI may be necessary for successful fertilization of the egg.
• Gay males utilizing a Gestational Carrier.
• Any individual or couple using donor eggs.
• Any individual or couple using previously frozen or vitrified eggs.

In other cases, IVF is recommended only if basic treatment options fail. Indications for IVF may include:

• Unexplained infertility
• Diminished ovarian reserve
• Endometriosis
• Anovulation
• Male factors

What is involved in the IVF process?

Talk to us! IVF may initially seem overwhelming. The NRM team is here to answer your questions and guide you through the process.

1. IVF Consult. Your first step is to schedule a consult. Our team of board-certified Reproductive Endocrinology and Infertility physicians will talk with you to determine if IVF is the best therapy for you.
2. After reviewing your history and any previous fertility treatments or testing, we will determine what type of testing you need prior to your IVF.
3. IVF plan. Once testing is complete, we develop an IVF plan specifically for you—based on your test results and history. Your IVF coordinator will provide you with a calendar that will give you day- by- day instructions of medication use and initial appointment dates.
4. Medication instruction. A member of our nursing team will provide one-on-one instruction regarding how to mix and administer your IVF medications and injections.
5. IVF Stimulation. IVF is designed to stimulate multiple follicles on your ovaries (inside each follicle is one egg). In order to maximize your success while minimizing any risks, you will be monitored closely during stimulation with frequent ultrasound and lab work. We will be in constant communication during this time. Based on your response to the medication, we may make adjustments to maximize your chances of success. Your oocyte (egg) retrieval will then be timed based on the size of your follicles in conjunction with your hormone levels.
6. Oocyte Retrieval. Your physician will determine the timing of your final “trigger shot” to begin the process of egg maturation and ovulation—preparing you for egg retrieval. Egg retrieval is a minor surgical procedure that our physicians perform in the surgical suite of our office. You will be given sedation by an anesthesiologist and the retrieval will be performed under ultrasound guidance. Most patients tolerate this procedure very well with minimal discomfort.
7. Laboratory Reports. Egg fertilization and embryo development will occur over the next 2-5 days in our NRM laboratory. During this time, we will keep you updated on the status of your embryos. A normal attrition (decrease) of eggs to embryos is expected—this means that while you may have a high number of eggs retrieved, we expect only a portion of those to be mature and fertilize, and then only a portion of those will develop into good quality embryos. The specific percentage decrease depends on your particular diagnosis, age, and fertility history. The goal is to have 1-2 high quality embryos for transfer into your uterus. We follow ASRM guidelines regarding the number of embryos to transfer based on your age and quality of your embryos. Any remaining embryos may be vitrified (frozen into a “glass-like” state) and stored for future use.
8. Embryo transfer. Embryo transfer will take place 2-5 days after the retrieval. The day will be determined by your particular number and quality of embryos. You will not need any sedation for the embryo transfer and you will be able to watch the transfer occur on ultrasound with your partner (or any support person you would like to be present). You will then be given a date to return for your pregnancy test!

Why choose NRM?

We strive to provide you the highest quality care available and to maximize your individual chances of success, while doing our best to make your treatment as smooth and comfortable as possible.

• Treatment by an experienced team of board-certified physicians and qualified and compassionate nursing staff.
• Brand-new facility offering state-of-the-art equipment.
• Therapy occurs in a peaceful and comfortable environment with convenient parking and easy access to appointments and facilities.
• Multiple options available to create the plan that is best for you.

We realize there is a lot of information to digest. We're here to help. Your next step is to schedule a consultation so that we can meet with you in person, conduct a complete examination, and work with you develop a personalized treatment plan designed to provide you the most cost effective path to a successful outcome.

Schedule A Consultation

How is ICSI performed?

Who should consider ICSI?

• Individuals with male factor infertility and/or previously failed IUI
• Individuals utilizing donor eggs
• Individuals utilizing eggs previously preserved via vitrification (flash- frozen)
• Individuals utilizing donor sperm for IVF
• Individuals utilizing surgically-collected and/or previously frozen sperm
• Individuals with previous failed standard fertilization during an IVF cycle
• Individuals with unexplained infertility

Why come to NRM for ICSI?

Women having babies

IUI with donor sperm

• Intrauterine insemination is a minimally invasive procedure where sperm is placed directly in a woman’s uterus. Many single females and lesbian couples choose sperm from an anonymous donor; there are a number of sperm banks across the country where patients can choose a donor based on physical characteristics, family history, academic achievements, and many other criteria.
  • Preparing for donor sperm IUI is the same as for any woman choosing IUI. Infectious disease testing and mental health consultation is recommended.
  • Individuals and their providers work together to choose the best plan of treatment for their cycle. If the individual undergoing IUI has regular menstrual cycles and can track her ovulation, a natural cycle IUI may be the best and least expensive choice. In other patients, medication can be used to induce ovulation and time the IUI.

IVF with donor sperm

• IVF involves using medication to stimulate the ovaries to develop multiple eggs. The goal is to develop a large number of eggs, then retrieve them and inseminate them with donor sperm to produce embryos, which can then be implanted into the uterus.
  • For any IVF cycle, patients must undergo ovarian reserve evaluation and infectious disease testing, as well as evaluation of the uterine cavity. Mental health consultation is recommended.

Reciprocal IVF with donor sperm

• Reciprocal IVF is another option for lesbian couples where both partners can participate in the process of building their family.
• One partner goes through medicated stimulation of the ovaries, and undergoes egg retrieval.
• The other partner goes on medication to prepare her uterus for embryo implantation, and will carry the pregnancy.

Men Having Babies

 Donor egg IVF with gestational surrogate

• One option for individual males or male couples who want to build their family is the use of donor eggs, which are then fertilized with one partner’s sperm. Embryos are then implanted into the prepared uterus of a gestational surrogate.
• The partner donating his sperm would undergo semen analysis and infectious disease testing. We have a team of professionals including assistance from Vermont Surrogacy, attorneys, and counselors to help you navigate this process.

Transgender individuals

Pre-transition fertility preservation

• Fertility preservation should be discussed with any transgender individual prior to undergoing any medical or surgical transition therapies. The decision to preserve fertility should ideally be made before the age of 30, in order to optimize future fertility.
• Options differ depending on the direction of transition, the gender of the current/future partner, and stage in the transition process.
• Male to female:
  • Banking a frozen sperm sample prior to starting treatment is ideal.
  • If hormonal treatment has already begun, it is possible to temporarily stop treatment in order to allow sperm production to resume. Sperm can then be collected and frozen for banking.
  • If hormonal treatment has already begun, it is possible to temporarily stop treatment in order to allow sperm production to resume. Sperm can then be collected and frozen for banking.
• Female to male:
  • Freezing eggs to be stored and used in a future IVF procedure is an option for pre-transition preservation of fertility.
  • Alternately, the transsexual man can undergo egg retrieval and have the eggs fertilized, either by a male partner’s sperm or by donor sperm. Embryos can then be cryopreserved, or implanted into the uterus of a female partner or a gestational carrier.
  • Transsexual males who have not undergone surgical transition and still have a uterus can also choose to carry a pregnancy prior to transition if they are willing to undergo reversal of masculinizing hormone effects during that period.

What are the types of PGS/PGD and who should consider?

• Women with infertility related to recurrent miscarriage
• Women with previously unsuccessful IVF cycles
• Women of advanced reproductive age

• Individuals who carry known chromosomal rearrangements such as translocations or inversions

• Individuals or couples who carry a gene(s) for a specific genetic disorder (such as cystic fibrosis, spinal muscular atrophy, Tay-Sachs disease, fragile X syndrome, etc)
• Not sure if you’re a carrier of a single gene disorder? NRM is the only clinic in Vermont offering pan-ethnic carrier screening with GoodStart technology called next-generation DNA sequencing (NGS).

What is a “normal” embryo?

What you need to know about PGS for chromosomal screening:

• Normally, there are 23 pairs of chromosomes in each human cell, for a total of 46 chromosomes. This is referred to as euploidy.
• One pair of each (23 chromosomes) comes from the mother the father.
• Although you and your spouse are likely to be genetically normal, when the egg matures or the embryo develops, errors may occur in the chromosome number of your embryo. This is called aneuploidy and is more common as women age.

• Failure of pregnancy to occur despite a normal-appearing embryo
• Biochemical pregnancy loss (an initial pregnancy as seen by +bHCG testing which then fails to develop)
• Miscarriage
• Chromosomally affected infant (such as Trisomy 13,18, and 21 “Down’s Syndrome”)

What is the process of PGS/PGD?

What can we learn from PGS/PGD?

1. Obtain a 24-chromosome assessment in embryos with updated technology.
2. Detect chromosomal rearrangements such as reciprocal/Robertsonian translocations and pericentric and paracentric inversions which are well-recognized forms of genetic abnormality.
3. Detect known genetic disease with an identified mutation—PGD can be combined with your PGS cycle if needed. Preparation for this specific test is necessary prior to starting your IVF cycle (see above.)
4. Determine gender of embryos for family balancing purposes.

What is NOT tested with PGS or PGD?

• Birth defects (all newborns have approximately 3% risk for a congenital abnormality—“birth defect”—unrelated to known genes or disorders.)
• All genetic disorders. This technology does not allow us to screen for all genetic disorders. If you have a known specific genetic disorder, you must plan specifically for PGD, examining embryos to determine if they carry the same genetic disorder that you carry.
• Smaller chromosomal errors.

Why choose NRM for PGS/PGD?

• Minimize your chances of passing along a known genetic disease to your children.
• Potentially improve your chances of IVF success and minimize your chance of miscarriage.
• Improve your ability to select a single embryo to transfer, thus minimizing your risk of twins or higher-order multiple pregnancy.
• Your embryos will be biopsied by experienced embryologists, and testing will be performed using state of the art technology in order to get you accurate results in a timely and cost effective manner.

• There are two oral medications that are most commonly used: clomiphene (Clomid®) and letrozole (Femara®).
• Oral medications are taken at the beginning of the woman’s cycle, starting between day 3 and 5 of the cycle and continued for 5 days.
• A transvaginal ultrasound will be performed, usually around cycle days 10-12, to evaluate follicular response to the medication. Ideally, only one follicle will have responded to the medication. Some women may have two or more follicles, which could result in a multiple pregnancy.
• Your physician may prescribe an injectable medication called human chorionic gonadotropin (HCG) to be given at a specified time to induce ovulation, about 40 hours before the IUI. This medication will cause the egg to leave the follicle and start moving down the fallopian tube.
• For other patients, injectable medications may be prescribed to stimulate the ovaries. Gonadotropins such as Menopur®, Bravelle®, Gonal-F®, or Follistim® will be prescribed by your doctor and you will be closely monitored by ultrasound for follicle development. Some women develop multiple follicles with gonadotropin therapy and risks of this therapy include multiple pregnancy.

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Infertility Unlocked

If you have questions about infertility and are ready to develop a customized, cost-effective fertility treatment plan, the highly trained fertility specialists at Northeastern Reproductive Medicine can help.

We provide a wide range of fertility testing, diagnostic and treatment options in a warm and caring environment. We help couples and individuals throughout Vermont, the northeastern United States, and Canada understand their options and follow their most promising course of action. Talk to us today… we’re here for you every step of the way.

Learn More About Fertility Treatment »

Our on-site laboratory offers world-class technology, time-saving convenience, and peace of mind.

Welcome to Northeastern Reproductive Medicine!

An experienced, compassionate team

Providers

Jennifer Brown, M.D.

Practice Director/Physician

Learn more about Dr. Brown

Peter Casson, M.D.

Physician

Learn more about Dr. Casson

Christine Murray, M.D.

Physician

Learn more about Dr. Murray

Emily Turner, N.P.

Nurse Practitioner

Learn more about Emily

Jen Guglielmi, N.P.

Nurse Practitioner

Learn more about Jen

Clinical Team

Melissa Davis, R.D.M.S

Ultrasonographer

Stephanie Olmstead, R.N.

Lead Nurse

Cassie French, R.N.

Nurse

Logan Smithfields, R.N.

Nurse

Tiffany Stratz, M.A.

Treatment Coordinator

Carly Labrie, M.A.

New Patient Navigator

Chelsea Kuiper, M.A.

Medical Assistant

Melissa Streeter, M.A.

Medical Assistant

Jessica Walston, R.N.

Nurse

Our Fertility Doctors

The physicians at Northeastern Reproductive Medicine look forward to getting to know you. We started NRM because we wanted to create a comfortable, confidential and friendly setting with convenient access to affordable fertility care. Our Vermont NRM team of doctors, nurses, and embryologists specializes in all forms of Assisted Reproductive Technology and reproductive surgery.

Peter Casson M.D., FACOG, FRCS(C)

Dr. Casson is a nationally recognized researcher, with over 60 peer-reviewed publications, multiple chapters, and long stints of NIH funding. His areas of expertise are Infertility, Assisted Reproductive Technologies, laparoscopy and hysteroscopy, and androgens in women. In conjunction with Dr. Murray, Dr. Casson founded Northeastern Reproductive Medicine to focus on providing excellent, personal, compassionate, and affordable care to patients in Vermont and upstate New York. Dr. Casson is Board-Certified in Reproductive Endocrinology and Infertility. He worked at Fletcher Allen Health Care for 15 years and was the REI Division Director for 5 years. As part of a national, multi-center Reproductive Medicine Network, Dr. Casson was instrumental in ground-breaking research including PCOS and primary infertility. To learn more about his recent work in the PPCOS II trial, click here. Dr Casson was recently elected to represent Vermont on the Executive Committee of the New England Fertility Society.

Christine Murray M.D., FACOG, FRCS(C)

Dr. Murray is a Board-Certified Reproductive Endocrinologist and Infertility (REI) Specialist has spent 15 years in Vermont as an Academic Physician involved with the training of medical students, residents and fellows. Dr. Murray has published in multiple peer-reviewed journals including Human Reproduction, Obstetrics and Gynecology and Fertility and Sterility. She underwent OB/GYN residency training at McGill University in Montreal, Quebec, followed by a fellowship in Reproductive Endocrinology and Infertility. From 1999-2014, Dr. Murray worked at Fletcher Allen Health Care and was an Associate Professor in the Division of Reproductive Endocrinology. In addition to a busy clinical practice, Dr. Murray became Residency Program Director in 2004 and held that position for 8 years. Along with Dr. Casson, Dr. Murray decided to open NRM to bring affordable, comfortable care to patients in a warm environment. She specializes in IVF, robotic surgery, PCOS, and provides care to French-speaking patients. Dr. Murray was elected by her peers to serve on the HealthFirst Board Of Directors from 2014-2017, leading the effort to provide Vermonters community-based, accessible, effective, and personalized medical care.

Jennifer Keller Brown M.D., M.B.A, FACOG

Dr. Brown is a Board-Certified REI physician who joined the NRM family in January of 2015. Dr. Brown attended medical school at the University of Colorado and OB/GYN residency at St Joseph’s Hospital in Denver, CO. During her residency, Dr. Brown co-authored research performed at the Colorado Center for Reproductive Medicine (CCRM) in the areas of egg and embryo vitrification. While performing this research, Dr. Brown realized she could invest in her own future fertility, and have some sense of reproductive security by freezing her own eggs for potential future use. Today she works to educate the community about the option of Fertility Preservation for reproductive-age patients diagnosed with cancer and preparing for chemotherapy, or for women delaying conception for personal or social reasons. Dr. Brown completed her fellowship training in Reproductive Endocrinology and Infertility at Fletcher Allen Health Care, where she performed research in PCOS, which was published and presented at national meetings. She then moved with her family to Denver, Colorado, where she worked at CCRM from 2012-2014, expanding her infertility practice and learning a tremendous amount by treating complex patients from all over the world. Dr. Brown specializes in reproductive surgery, Fertility Preservation, PCOS, and IVF with pre-implantation genetic diagnosis. Dr. Brown was elected by reproductive endocrinologists across New England to be the President of the New England Fertility Society in 2019; she currently sits as the president-elect.  Dr Brown was also elected by her peers in 2018 to represent independent practitioners in Vermont as an executive board member of Health First. Health First leads the medical community to provide Vermonters community-based, accessible, effective, and personalized medical care.

Emily Turner N.P.

Emily Turner is a Board Certified Family Nurse Practitioner (FNP) that joined our NRM team in May of 2021. She is a native Vermonter who earned her Bachelors of Science in Nursing from Seton hall University. Emily returned to the green mountain state to work as an operating room nurse at UVMMC. In this role, she had vast expertise working across service lines from neurosurgery to general and GYN surgical procedures. Although she loved her surgical career, she decided to further her education and become a family nurse practitioner so she could establish relationships with patients of all different backgrounds. She obtained her Masters of Science in Nursing from Simmons University in Boston, Massachusetts in 2020. Emily works with all of our patients here at NRM discussing diagnostic testing results, providing education on treatment cycles and coordinating care for patients. She takes great pride in furthering her education within the field to better serve our patients. When Emily is not at NRM you will find her spending time with family or out adventuring with her husband Ben and their two pugs, Charlotte and Meisha. Family is very important to Emily which is why she looks forward to working with you on building yours. 

Jen Guglielmi N.P.

Jen Guglielmi is a certified Family Nurse Practitioner who has been working in fertility/women's health space since 2008. She practiced many years in Philadelphia, PA in various roles and joined the NRM family recently in 2022 with a move to Vermont. Jen attended the University of Scranton in Scranton, PA for undergraduate then went onto Drexel University in Philadelphia, PA for her masters degree in Family Nurse Practitioner. Jen started out her nursing career in the US Army Nurse Corps where she was a medical/surgical nurse & labor and delivery nurse. She left the service honorably as a Captain and then went onto work in Philadelphia, PA at Society Hill Reproductive Medicine and Reproductive Medicine Associates of Philadelphia for numerous years. Jen has been a frequent contributor to the Delaware Valley Association of Neonatal Nurses (DVANN) "Baby Buzz" Podcast, enjoys precepting future nurse practitioner students and loves her volunteer work most recently with B...

Grading of an embryo refers to the appearance of the tissue. Embryologists and physicians use embryo grading during IVF treatment to determine which embryos to transfer as well as the number of embryos transferred.

An embryo's grade is not the only thing taken into consideration when having an embryo transfer. The patients age and fertility history are also taken into account.

Please note: The day of your egg retrieval counts as day 0.

Helpful Definitions:

Fragmentation: process where portions of the embryos cells have broken off and are now separated from the nucleated portion of the cell. fragmentation is common however, embryos with greater fragmentation may be less likely to progress through normal blastocyst development and then implant in the uterine wall to result in pregnancy.

Normal progression of embryo development: the rate at which your viable genetic material (eggs or embryos) taper off once they are in the embryology lab and growing. There are three main stages of this. The first phase is at the egg retrieval. Your doctor will retrieve all the follicles that they can, however, not all of them may contain mature eggs. The second phase happens with fertilization. Not all of the mature eggs will progress to become fertilized embryos. This happens with both conventional insemination and Intracytoplasmic Sperm Injection (ICSI). Phase 3 occurs with embryo growth, from day 3-6, and possibly 7, in some instances. Some embryos will not mature fully into a blastocyst, and stop gradually developing. These steps are all part of the IVF process are to be expected when having an IVF treatment plan.

• Conventional Insemination: the mature egg is surrounded by a deposit of sperm in a petri dish and the sperm naturally find their way to the egg to fertilize. This mimics natural selection in a laboratory setting

• Intracytoplasmic Sperm Injection (ICSI): the embryologist selects a single sperm and manually injects it into the egg to fertilize.

Day 3 Embryo Grading

Embryos are graded A, B, and C on day 3.

• The grading for this stage consists of the number of cells an embryo has, followed by the quality of the embryo
• typically 6-8 cells are inside the embryo on day 3

Blastocyst Grading

Blastocysts are graded on day 5, 6, and possibly day 7 based on progression.

The grading for this stage consists first of how far in development the blastocyst is. In the early blastocysts, a small fluid cavity forms. as the blastocyst develops, this cavity gets larger, and the outside shell of the embryo thins until the cells begin to herniate through the shell. This herniation allows implantation to occur.

• Embryos are first labeled early blastocyst (EB), then, as they progress through time they are called blastocyst (B), late blastocyst (B+), expanded blastocyst (XB), hatching blastocyst (HB) to finally a fully hatched blastocyst (HdB)

Labeled Blastocyst

A quality grade is given for both the inner cell mass and the trophectoderm.

• The first letter denotes the inner cell mass quality, the second letter denotes the trophectoderm quality
  • the inner cell mass is graded based on how many cells there are as well as how tightly packed the cells are spaced
  • the trophectoderm is graded based on the how many cells make up the cell's border as well as their uniformity
• Blastocysts are graded as good (G), fair (F), or poor (P) for each of these factors

Example: a hatching blastocyst (HB) with good inner cell mass and trophectoderm quality would be labeled "HBGG"

Giving couples hope.

As you know, embarking on a new journey of fertility treatment can be a daunting and unnerving process. We invite you to share your success story with families who are struggling with infertility. Your journey can give patients- and individuals struggling to decide what to do next- the hope for which they are searching. Anything you can share, big or small, can play a fundamental role in reassuring their personal journey to success.

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Our on-site laboratory offers world-class technology, time-saving convenience, and peace of mind.

The reproductive laboratory team at NRM makes every effort to create an in-vitro environment for our eggs and embryos as similar as possible to the conditions inside the fallopian tubes and the uterus. Using the most sophisticated media and incubation equipment available, we work to ensure that embryos in our care develop in a quality-controlled, optimal environment.

Embryos growing inside a uterus are protected from potentially toxic compounds in the air by the human body. When an embryo is growing in a culture dish in the laboratory, we must provide that level of protection for the embryo in the best manner possible. In order to achieve this goal, the Laboratory at Northeastern Reproductive Medicine was built with low emission construction materials and installed a large air handling unit to purify the air before it enters the laboratory. We utilize a ‘Life Aire’ filtration system, which passes the air through high-efficiency particulate absorption (HEPA) filtration, volatile organic compound (VOC) filtration, and then ultra violet light. Not only is the air filtered and sterilized, but this system also provides positive pressure in the IVF laboratory which helps prevent dust from entering the laboratory through doorways and other openings to best provide an environment free of dust and chemicals.

Our patient’s embryos are maintained in next generation Planar and Esco benchtop incubators which are designed to maintain consistent culturing environments for optimum temperature and pH control and which are able to return rapidly (within a minute) to this optimum environment after embryo viewing.  NRM embryologists use the precision Saturn V active laser, which enables safe and precise blastomere and trophectoderm biopsies, as well as assisted hatching. This remarkable system reduces error and provides a safe, rapid and precise approach to embryo procedures. Our Research Instruments and Narishige micromanipulation apparatus allows for accurate and atraumatic intracytoplasmic sperm injection (ICSI). All of our equipment is computer-monitored with a Sensaphone system for safety. Staff and patients alike are able to watch their embryos on procedure room monitors which communicate wirelessly with the embryologists work stations.

With this advanced technology, combined with our skilled embryology staff, NRM strives to give you the best possible chances of reproductive success. We’re here for you!

Please contact us with any questions.

About Northeastern Reproductive