What is IVF?
IVF is the common acronym for In-Vitro Fertilization, a frequently used conception practice when there are certain issues with the reproductive health of the female, male, or both. IVF is simply the uniting of egg and sperm in vitro (direct translation “in the glass” or in the lab). Subsequently the embryos are transferred into the uterus through the cervix and pregnancy is allowed to begin. The process is usually done in conjunction with ovulation induction through medications, monitoring of hormone levels and ovarian follicle scans with transvaginal ultrasound.
When should I consider IVF?
If you are under 35 and have been trying to conceive for a year or two, or if you are over 35 and have been trying for 6-12 months, you may want to explore the possibility of IVF. You will want to do tests with your doctor to determine that this is the best route for you. Good candidates for IVF include those who have:
- Tubal problems: when a woman’s fallopian tubes are blocked or damaged, which can make it difficult for the egg to be fertilized or for an embryo to travel to the uterus
- Male factor: this may be seen with a low sperm count, problems with sperm function or motility. This can prevent the sperm from fertilizing an egg on its own
- Severe Endometriosis affecting both fertilization of the egg and implantation of the embryo in the uterus
- Ovarian issues which prevent the release or production of eggs
- Fertility preservation: For the patient that would like to have more than one child and is already over the age of 35. IVF could allow for a pregnancy and freezing the extra embryos could allow for a pregnancy several years later when the woman is older but the frozen embryos are not
- Unexplained infertility
What is the process for conceiving through IVF?
IVF consists of numerous steps, they are:
- Ovulation Induction: Injectable medication is used to stimulate development of multiple mature follicles. The eggs develop in structures in the ovaries called follicles. Some women do not develop mature follicles without help from medication. Each follicle contains one egg and can be seen through ultrasound. Sometimes the natural cycle IVF is done and no stimulatory medications are used.
- Retrieval: When the woman’s follicles are mature, the egg aspiration procedure is performed to remove the eggs. Using conscious sedation for patient comfort, a needle is passed through the top of the vagina using ultrasound guidance to aspirate the follicular fluid from the ovaries.
- Fertilization: Sperm is mixed with the eggs about four hours after the egg aspiration, and can be checked the following day to see if fertilization has occurred
- Embryo Culture: The fertilized eggs, now embryos, are cultured in the laboratory for up to five days and then an appropriate number are selected for transfer to the woman’s uterus
- Transferring Embryos to the Uterus: Typically 1-4 embryo(s) (depending on the female age) are painlessly transferred into the uterus. Success for this part of the procedure depends on the delicate placement of the embryos below the top of the endometrial cavity. The embryo transfer catheter is loaded with the embryo(s) and it is put through the cervical opening up through to the upper part of the uterine cavity. The embryos are then gently released out of the catheter into the endometrial lining. There is no restriction on activity after the transfer, there is no scientific evidence that resting increases the chance of pregnancy.
- Test for Pregnancy: About 11 days after the transfer, a blood test is done to see if the cycle was successful.
If I conceive with IVF will my baby have the same odds of being healthy as if I had conceived naturally?
Yes, recent research has shown no increased risk of prematurity, pregnancy hypertension, extended delivery, need for C-section, or other delivery complications, and children resulting from IVF have the same incidence of birth defects as children who are conceived naturally. There are slightly elevated numbers of miscarriages among IVF mothers, but this may be due to the close monitoring of these woman, versus woman in the general population that may not have been aware of their pregnancy prior to (or following) their miscarriage. However, this assumes all critical factors are the same such as age, number of births, exposure to carcinogens, condition of the mother’s body and uterus. This does not take into account if the mother has twins or triplets with IVF, which elevates many risks including increased miscarriage rate, low birth weight, prematurity, abnormal presentations, prolapse of umbilical cord, placental abruption, fetal distress and bleeding after delivery.
Does IVF increase my chance of having twins or triplets?
Successful IVF pregnancies have a higher rate of multiples than the general population. About 67% of IVF pregnancies result in a single baby, that result in a live birth, about 50 percent are singletons, 30% are twins and less than 3% are triplets or more. This is compared to the naturally conceived multiple rate of 1%. In IVF procedures, the step where the sperm penetrates the ovum is achieved in the lab to increase the odds of success of pregnancy. Because many couples have multiple successful embryos implanted, the chance of more than one of them implanting is higher.
One of my ovaries has been removed because of a cyst. Would that reduce my chance of pregnancy?
It will decrease the number of eggs of course, but fortunately there does not appear to be a significant reduction in the chance for pregnancy.
Does ovulation occur from alternate ovaries in alternate months?
No. Which ovary ovulates in a given month is entirely random.
My uterus is tilted backwards. Is this stopping me getting pregnant?
No. One in three fertile women have a uterus that is tilted backwards. A tilted uterus does not impair a woman’s fertility.
How can I determine my fertile period?
The fertile period is the time during which sex can lead to a pregnancy. Most pregnancies can be attributed to sexual intercourse during a 6-day period ending the day of ovulation.
After having sex I note that most of the semen leaks out of my vagina. Could this be the cause of my infertility?
Loss of semen from the vagina is quite normal after intercourse. Although semen leaks out of the vagina, enough remains to swim up to the fallopian tube.
My wife is frigid. Could this be the reason for infertility?
There is no connection between sexual pleasure and fertility.
My doctor advised me to have fertility tablets and I am concerned about the risk of multiple pregnancy.
Most fertility drugs increase the risk of multiple pregnancy. However, the majority of women who conceive after taking fertility drugs have a singleton pregnancy. The risk of multiple pregnancy is reduced by careful monitoring by ultrasound scans and blood tests.
What is endometriosis?
Endometriosis refers to a benign and common disease in which cells similar to the ones that line the inside of the uterus, are growing outside the uterus.
What is PGD?
PGD stands for Pre-implantation Genetic Diagnosis. PGD technique requires the use of the test tube baby technique (IVF) to test embryos for genetic disorders before it is selected for transfer into the uterus. It can be used to screen for some diseases and in other cases it screens for the chromosomal health of the embryo, which could increase the pregnancy probability in select patients.
When do we give up infertility treatment?
There is no easy answer as to who should stop trying and who should continue. Above all this depends on each couple’s deepest desire for a child. If in doubt get a second medical opinion and possible counseling.
Does IUI hurt?
The IUI procedure is painless for the majority of women. Some women may experience a very mild cramp or period like pain. Occasionally it may be difficult to insert the IUI catheter into the cervix and this can be uncomfortable. This does not usually last more than a minute.
What are the main causes of male infertility?
Male infertility is defined as the inability of a man to father a child. Although male infertility may be associated with impotence, many infertile men have perfectly normal and happy sexual relationships.
Male infertility can be classified into four main types:
- No sperm (azoospermia) accounts for 2% of male infertility.
- Poor sperm quantity (oligospermia) or quality e.g. low motility (asthenozoospermia) or a high percentage of abnormal sperm (teratozoospermia). Antisperm antibodies, etc. This subgroup may account for about 50% of male infertility.
- Sperm dysfunction, where there is a normal semen analysis but the sperm lack or have a defective fertilizing capacity, resulting in complete failure of fertilization or poor fertilization of the eggs in IVF. This may account for 45% of male infertility.
- Inability to ejaculate into the vagina. This accounts for 3% of male infertility.
What is embryo donation?
Embryo donation is a well-established and successful form of assisted conception treatment. It offers hope for select groups of couples who previously thought they could never have children. Embryo donation is usually less expensive and has fewer medical complications compared to in-vitro fertilization (IVF). The success of embryo donation compares favorably with egg donation. It is important that both the donor and recipient couples be adequately counseled, screened and made aware of the psychological, moral and legal implications of embryo donation before being accepted onto the program. All infertility clinics offering embryo donation should observe strict rules of confidentiality and anonymity and take account of the welfare of any child who may born as a result of embryo donation as well as the welfare of any other children who may be affected by the birth.
What is surrogacy?
There are two types of surrogacy. The first, Traditional Surrogacy, this involves the insemination of a surrogate with the sperm of the intended father. The surrogate contributes her genes to the make-up of the child, she carries the baby to term, and then gives up the child for adoption to the Intended Parents at birth. Gestational Surrogacy is where the woman who carries the child does not have a genetic link to the child. The eggs are obtained from the genetic mother and the sperm from the genetic father. The resulting embryos are incubated in the uterus of a surrogate who undergoes prior hormonal preparation. At birth, the surrogate releases the child to the Intended Parents. Depending upon the State where the birth takes place, there may be issues of custody and the Intended Parents might have to undertake formal adoption procedures to acquire legal custody of the child. In some states, the name of the Intended Parents rather than the surrogate (the birth mother) will appear on the birth certificate. However, regardless of legalities, in Gestational Surrogacy, given that the eggs are not supplied by the surrogate, there can be no real debate as to who the rightful parents are.
What is an RHA (Reproductive Hormone Assay)?
We use this hormone test to give information about the ability of the ovaries to respond to stimulatory medications in a particular cycle. The result also gives an estimate of overall egg quality and of the likelihood of achieving a live birth. This allows avoiding suboptimal cycles as a start of your treatment. IVF patients, female partners in gestational surrogacy and oocyte donors will have the reproductive hormone assay prior to the beginning of their treatment. The assay involves two blood draws and a tiny injection of Lupron hormone under the skin. Follicle Stimulating Hormone (FSH) and estrogen levels are measured before and after the Lupron injection. FSH is produced by the pituitary gland. It stimulates the ovaries to produce eggs and the hormones estrogen and progesterone. If the ovaries cannot function normally the pituitary gland puts out more FSH. Elevation of this hormone could mean normal quality eggs may not be produced during the upcoming cycle. Estrogen production by the ovaries influences the FSH secretion and is also related to the quality of the eggs.
What is a Sonohysterogram?
Sonohysterogram (“water ultrasound”) is done to assess the endometrial cavity of your uterus. A thin, soft catheter is passed through the cervix inside the uterus and a small amount of sterile saline solution is gently infused. A transvaginal ultrasound is used to visualize the contours of the endometrial cavity and to confirm the absence of polyps, scarring or fibroids inside the uterus. The presence of any of these structures could significantly reduce the probability of embryo implantation.