IVF fertility Services
Infertility Treatments and Services
In vitro fertilization (IVF)
In vitro fertilization (IVF) is a highly effective technique for infertility. In vitro fertilization refers to a procedure in which an egg (or oocyte) is fertilized outside of the body in the lab (test tube) and then transferred into the woman’s uterus. IVF takes the chance out of the fertilization portion of the process. Then the fertilized egg only needs to implant on its own and grow into a healthy, viable pregnancy. Today, IVF is commonly used to improve your chances of pregnancy. It is used in tubal factor infertility, endometriosis, etc. Read More…
IntraCytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is now a common technique used in the process of in vitro fertilization (IVF). It is used when a malefactor affects fertility. Through ICSI, a single sperm is injected directly into the egg. The sperm, therefore, bypasses several steps in the early fertilization process.
Sometimes it can be difficult for the sperm to find its way to an egg. We use Intrauterine Insemination (IUI) to help the sperm get to the egg (oocyte).
Normally, sperm is released into the vagina when a couple has intercourse. Then the sperm have to swim through a tiny hole in the cervix. The sperm continues through the cervical canal and into the uterus. In some cases, help is needed to get the sperm into the uterine cavity. This may be due to:
- Low sperm count
- Thick or “hostile” cervical mucus
- Poor timing interaction between the sperm and egg
Male Fertility Treatment
Some couples with infertility caused by disorders of sperm number or function may be successfully treated with either intrauterine insemination (IUI) or in vitro fertilization (IVF) or INTRACYTOPLASMIC SPERM INJECTION (ICSI). In the case of the IUI cycle, a woman is typically taking fertility drugs to stimulate the development of more than one egg in the same cycle. This can be effective in couples when there is a mild abnormality in sperm counts, unexplained infertility, endometriosis. However, when there is severe impairment of sperm count, motility, or shape, ICSI is usually the best treatment option for infertile couples.
Intracytoplasmic Sperm Injection (ICSI)
ICSI has revolutionized the way we can treat male infertility. Even men with no sperm in their ejaculated sample, pregnancy may be possible with this technique. In this circumstance, a urologist/fertility specialist can extract sperm from the man’s epididymis or testicle for use in ICSI. With ICSI, a specialized glass needle is used to inject a single normal sperm directly into the center (cytoplasm) of the egg under the guidance of a specially fitted microscope. The success rate with this technique varies considerably among IVF programs and is highly dependent upon the skill of the embryologist performing the procedure.
When it comes to fertility, age matters. As you get older, your eggs diminish in numbers and in quality, making it more difficult to conceive or maintain a pregnancy. This change occurs at different rates in different women but does occur in everyone no matter how healthy you may be otherwise.
By the time you reach your late 30s, about half of your eggs will be chromosomally abnormal (too few or too many chromosomes). These chromosomal abnormalities often lead to failed implantation or miscarriage. Unfortunately, by the time you reach your 40s, you only have a 5% chance of becoming pregnant each month.
For women who are not ready to conceive but wish to try to preserve fertility for the future, freezing your eggs in your 20s and 30s allows you to take advantage of your body’s fertility at a time when your eggs are at their healthiest.
What is the egg freezing process?
Step 1: Fertility Assessment
First, you will meet with your doctor to discuss your medical history, as well as your needs and expectations. On the third day of your period, you will have blood work to assess hormonal function which reflects your current fertility status (“ovarian reserve”) and a vaginal ultrasound performed to make sure that there are no structural abnormalities and to let us know how many eggs we may be able to retrieve. The results of these tests will allow your fertility specialist to assess your current fertility potential and to develop your personalized treatment plan.
Step 2: Ovarian Stimulation
Next, you will give yourself hormone injections to stimulate your ovaries to produce as many eggs as possible (the number should be reflected by your initial ultrasound evaluation). During this process, you will need to come to the hospital every few days to receive regular monitoring (ultrasound and blood work) to assess your response to the medications and to see if doses need adjusting. When your eggs have matured, your doctor will inform you that it is time to trigger the final stage of maturation and start the ovulation process (the release of your eggs) using a different injectable medication. Your eggs will be retrieved as described below.
During stimulation, you will need to avoid any exercise that is jarring to your pelvis in order to protect your ovaries, which will increase in size as the follicles (cysts that contain the eggs) also grow, as well as avoid consuming alcohol, caffeine, medications and many herbal supplements. Your doctor or nurse will discuss what medications and levels of activity are safe for you to take during stimulation.
During stimulation, you may experience symptoms similar to what you are accustomed to experiencing during your regular monthly menstruation including fatigue, headaches, bloating, breast tenderness, cramping and mood swings.
Step 3: Egg Retrieval
Thirty-five hours after the “trigger shot,” your doctor will collect your eggs during a minor surgical procedure which is performed while you are under anaesthesia, by placing a needle through the wall of your vagina into the follicles under ultrasound guidance. The day of the procedure, you will need a caregiver to drive you home and stay with you for the rest of the day as the anaesthesia wears off.
For a few days following your retrieval, you may be bloated and experience cramping and mild discomfort. You will be able to return to work within 24-48 hours following your retrieval and you will feel complete “back to normal” following your next period. We ask that you refrain from exercising until after the next period starts.
Step 4: Egg Freezing
Once your eggs have been successfully retrieved, all mature eggs will be vitrified (rapidly frozen) and stored securely until you’re ready to use them. The embryologist will let you know how many mature, healthy eggs have been frozen.
The entire process to prepare for egg freezing and to retrieve the eggs generally takes 2-6 weeks depending on the specifics of your situation.
This procedure will happen three to six days after oocyte retrieval. The timeline is based on what the doctor and embryologist determine will be most successful.
A catheter (tube) will be inserted into your uterine cavity to place the embryos chosen for transfer. In this case, as well, we will use an abdominal ultrasound to watch and guide what is happening inside. This procedure requires a full bladder. That permits our staff to best see your uterus, and allow for the best possible placement of the embryo(s).
Your doctor and embryologist will work with you to decide on the number of embryos to transfer. A number of factors will be looked at in making this decision:
- Quality and number of embryos retrieved.
- Your age.
- Previous pregnancies.
- Whether you have had a previous transfer.
Embryos that are not chosen for transfer and that meet freeze criteria will be frozen and stored for later use if you choose.
On the day of the transfer, we will give you specific instructions. The information involves bed rest, medications and other important directions to follow until the day of your pregnancy test.
PCOS and Infertility
PCOS negatively impacts fertility because women with the condition do not ovulate, or release an egg, each month due to an overproduction of estrogen by the ovaries. Because ovulation does not occur regularly, periods become irregular and increased levels of hormones such as testosterone can affect egg quality, inhibit ovulation, lead to insulin resistance, and increase the risk of disorders such as gestational diabetes.
PCOS and Fertility Treatment
For those women trying to conceive a pregnancy, the first step in the treatment of PCOS is lifestyle modification, including a healthy diet and exercise. The diets shown to be most successful in PCOS patients include those with lower carbohydrates, a reduced glycemic load. Recommended exercise in PCOS patients is at least 30 minutes of moderate exercise three times per week, with daily exercise being the ultimate goal.
Women who still have infrequent ovulation despite lifestyle modifications may require fertility medications to assist with the release of an egg from the ovary.
For some women with PCOS, fertility tablets do not result in ovulation or pregnancy, and they require fertility injections to release an egg.
In some instances, women with PCOS require in vitro fertilization (IVF) to achieve a healthy pregnancy. In this scenario, daily fertility injections are used to stimulate the ovaries to produce multiple eggs, which are harvested in a minor procedure. The eggs are fertilized in the lab and then a resulting embryo (fertilized egg) is transferred into the woman’s uterus. Additional embryos can be frozen (cryopreserved) for future use.
While infertility is often thought of as typically a female issue, about half of all infertility cases stem from male reproductive problems. Since sperm health is vital to conception, it is important to have your sperm evaluated if you are struggling with infertility. Fortunately, many causes of male infertility are treatable.
Assessing male fertility is a simple process that requires complex evaluation. Through a semen analysis, we can assess whether there is a problem present by evaluating the following parameters:
- Concentration – Greater than 15 million sperm per millilitre is considered normal.
- Motility – If more than 32% of your sperm are moving, your motility is considered normal.
- Morphology – Normal results are when 14% or more of the sperm have normal shaped heads, according to the Kruger morphology test. When sperm have a morphology below 9%, the risk of infertility increases by 2.9 times.