With as many as 15% of Canadians turning to fertility treatments, there are several options available when trying to conceive. One of the most prevalent fertility treatments is in vitro fertilization (i.e. IVF), which you have likely heard of before but may not know much about.
If you are trying to grow your family, this guide will help you to understand the basics of in vitro fertilization (IVF) and whether it may be a fit for you.
IN THIS ARTICLE
All Your IVF Questions Answered
What is IVF?
IVF stands for in vitro fertilization. It’s one of the more widely known types of fertility treatment. This assisted reproductive technology uses a combination of surgical procedures and medicines to help sperm fertilize an egg outside of the human body.
Previously referred to as a “test-tube baby,” an embryo will begin to form. Once a healthy embryo forms, doctors will carefully place this embryo into the uterus, where hopefully it’ll implant and a fetus will grow to term.
How the IVF treatment process works
In order to have a successful round of IVF, you’ll have to go through five steps. This includes ovarian stimulation, egg retrieval, sperm retrieval, fertilization, and embryo transfer. This entire process will take 1-2 months to complete.
1. Ovarian Stimulation and Injections
The beginning of the IVF journey will involve taking multiple injections of hormones to prep for the egg retrieval.
At the beginning of her menstrual cycle, the patient will take daily injections of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) for 8 -14 days. This ensures that your body will mature more than one egg during the cycle, so the doctor has multiple eggs to collect at the egg retrieval appointment, improving your chances of conceiving.
After the 8 -14 days of regular shots, the patient will take another injectable medication to help the final step in the egg maturation process and prep the eggs for retrieval and fertilization.
2. Egg Retrieval
Approximately thirty-six hours after taking the final day of medications, the patient will undergo egg retrieval. Some clinics offer awake sedation and others give full anesthesia for this procedure.
The doctor will locate the follicles in the ovary by inserting the ultrasound probe into the vagina. Once the ovary is located, a hollow needle is inserted through the vaginal wall to retrieve the eggs. The procedure takes approximately 20 to 30 minutes.
If you are having a fresh embryo transfer (in the same cycle), progesterone supplements will be started after your egg retrieval to ensure that the lining of your uterus is receptive for the embryo transfer.
3. Sperm Retrieval
Your partner will be instructed to provide a semen sample by masturbation on the day of your egg retrieval. Alternatively, some patients may use a sperm donor instead. In some cases, sperm can only be obtained by a surgical procedure to remove the sperm directly from the testis or epididymis. After the semen is collected, there is a sperm-washing process which separates the sperm from the seminal fluid.
This has to be done on the same day as the egg retrieval. There are two methods that the doctor can use:
- Conventional fertilization: each egg is placed in a dish with many sperm and fertilization occurs without any manipulation. The fertilized eggs are then incubated.
- Intracytoplasmic sperm injection (ICSI): one sperm is injected into each egg. This method will be used typically if there is male factor infertility or previous IVF attempts have failed.
Once the embryo develops in the lab, it will be ready to be transferred into the patient’s uterus, sometimes after three days but most commonly, five days after retrieval. Any extra embryos can be frozen for future use.
5. Embryo Transfer
The transfer of the embryo takes place at three or five days following the egg retrieval.
The procedure is done with a full bladder so that ultrasound can be used to guide the transfer. A catheter is inserted into the cervix as an introducer. A second catheter containing the fertilized embryo(s) suspended in fluid is passed through the introducer into the uterus. The doctor then uses a syringe to release the embryo(s) into the uterus before removing the catheter and the introducer.
The procedure is relatively painless, similar to a pap smear and takes about five minutes.
If the procedure is successful, there should be an active pregnancy within 6-10 days following the egg retrieval. The doctors will order a pregnancy test about twelve to fourteen days following your embryo transfer.
Fertility Success Story: Meet Kristin & Greyson
After a long fertility journey, Kristin’s family grows with her beautiful son Greyson.
Who is IVF for?
IVF can be a fertility treatment option for a wide range of women and couples trying to conceive, including:
- Those who have been unsuccessful with intrauterine insemination (IUI),
- The egg quality/quantity is reduced,
- The sperm quantity/quality is reduced,
- The Fallopian tubes are blocked,
- Those wishing to avoid passing on a specific genetic mutation,
- Those with recurrent pregnancy loss (miscarriage)
- Cancer survivors
- Those using an egg donor or gestational carrier
- If using one’s previously frozen eggs
Some common causes of infertility that IVF can be used to treat include:
- Fallopian tube damage
- Polycystic ovary syndrome (PCOS)
- Premature ovarian failure
- Uterine fibroids
- Male factor infertility
IVF is also a great option for those who are single or part of the LGBTIQ community, and are planning to start a family using a surrogate.
What are the success rates of IVF?
The success rates of IVF will depend largely on various factors, including the cause of infertility, age of the parents trying to conceive, and the clinic leading the procedure. However, according to the Canadian Fertility and Andrology Society, in 2016, there were 16,852 IVF cycles and out of these, 2,438 pregnancies were achieved.
The clinical pregnancy rates per embryo transfer women can expect are:
- 41% for women under 35 years old.
- 34% for women aged 35-37 years.
- 24% for women aged 38-40
- 11% for women aged 41-42
- 6% for women 40 years old and over.
How many IVF cycles are recommended?
Whether you are planning to undergo IVF for the first time or have already experienced an unsuccessful IVF cycle, it’s recommended to try at least three IVF cycles.
Studies found that women who conceived with IVF treatment went through an average of 2.7 cycles. After three IVF cycles, the pregnancy rates for women of all ages were between 34 and 42 percent.
How much does IVF cost in Ontario?
In Canada, IVF treatments cost about $10,000 to $15,000 per cycle on average. In some cases, the cost of fertility drugs and other tests and consultations can push that cost up to around $20,000.
The Province of Ontario provides financial assistance for IVF through the Ontario Fertility Program. It provides funding to help eligible patients build their families. Access to funded fertility services is available for all forms of infertility (including medical and non-medical infertility), regardless of gender, sexual orientation, or family status.
The Ontario government offers 1 cycle of IVF per lifetime for every woman in Ontario if you have a valid Ontario Health card and are under 43 years of age. This includes cycle monitoring, egg retrieval, ICSI, assisted hatching and embryo freezing. It also covers the transfer of any frozen embryos in a subsequent cycle, as long as they were created from the original funded IVF cycle.
- Your initial fertility consultation
- Most investigative tests
- Most blood tests
- Ultrasound examinations
- Cycle monitoring for diagnosis and treatment
- Intrauterine insemination (IUI)
What's not covered
- Any medications you are required to take during the course of an IUI, IVF, or frozen embryo transfer cycle
- Sperm washing prior to an intrauterine insemination procedure
- The cost of any sperm required to do a donor insemination for IUI or IVF
- The storage of any fertilized eggs (embryos)
- Any adjunctive procedures associated with the IVF cycle, e.g. pre-implantation genetic testing
- The cost of donor eggs
- The cost of using a gestational carrier
What are the side effects of IVF?
Different stages of the IVF process may be associated with side effects, as with any medical procedure. The most common side effects are associated with IVF injections at the early stages, such as:
- Soreness and/or bruising at the injection site
- Breast soreness
- Mood swings
- Abdominal pain
- Ovarian hyperstimulation syndrome (OHSS)
The risks of the egg retrieval procedure include:
- Injury to surrounding structures e.g. bladder and rectum
Your fertility specialist can answer any questions or concerns you have about IVF risks and walk you through the side effects.
Learn More about IVF at Dr Tanya Williams Fertility Centre
At Dr Tanya Williams Fertility Centre, we’re here to help you explore the available options for fertility treatments and support you on the journey to grow your family. Book a consultation with our IVF clinic in Toronto today to learn more.