IVF and Fertility Treatments

Below is a simple explanation of the various fertility treatments, from the simplest, to the most complex and invasive.

Hormone or Vitamin treatment
     Sometimes just a hormonal imbalance of vitamin deficiency is the culprit for a couple not getting pregnant. Perhaps the woman is not ovulating on time, or not at all, and hormones to correct that so the couple can time intercourse accordingly is all that needs to be done to assist in achieving pregnancy. High TSH (Thyriod Stimulating Hormone) has been linked to low fertility (some clinics want to see it under 3) as well as some vitamin deficiencies such as Vitamin D.

IUI or Intrauterine Insemination or the old fashioned term "Artificial Insemination"
     Sperm is collected from the male via ejaculation and introduced into the female while she is ovulating. She may be ovulating naturally or her ovaries may be hormonally stimulated to ovulate more than one egg, possibly resulting in a multiple pregnancy. IUI is usually the first step when a couple has unexplained infertility, due to the lower cost and less invasion compared to IVF. It is also the method most commonly used when a couple is using donor sperm.

IVF
     In Vitro Fertilization means 'fertilization outside of the body'. The woman's ovaries are hormonally stimulated to develop multiple eggs. This is done by her injecting usually two hormones into her belly or thighs. The ovaries are monitored using ultrasound. Once the follicles holding the eggs are an optimal size (usually 18mm) the woman gives herself a trigger injection. The woman will ovulate exactly 36 hours following the trigger, so the egg retrieval procedure is scheduled exactly 35 hours after the trigger shot. This is to prevent losing the eggs due to ovulation, but the follicles being ripe enough to collect the eggs. During the procedure, the woman is either under general anaesthetic or mildly sedated, depending on the clinic. The ovaries are accessed through the vaginal wall, using a needle type instrument to get through the wall, with suction on it to obtain the eggs. The procedure takes a few minutes, depending on how many follicles need to be penetrated and how easily accessible the ovaries are. Once the eggs are out, they are fertilised by means of introducing them to the partner's semen/sperm in a fluid medium in the laboratory. Once an egg is fertilised, it is called an embryo on day 3 or a blastocyst (blast for short) on day 5. Not all fertilised eggs make it to day 3, and even less make it to day 5. The reason to push them to day 5, is because if there are a good number of them, it helps to wean out the weaker ones. This assists in selection of which blastocyst to transfer back into the uterus, especially in clinics that do not perform any form of genetic testing to assess which blastocyst are viable. The reason not to push them to day 5 is the risk of losing too many due to the fact that some may have survived in the uterus, had they been put there on day 3. There are pros and cons to each method and it truly depends on the age of the woman (hence the strength and quality of eggs), the number of eggs retrieved and the decision between the couple and their doctor. Pushing past day 5 is not done, as blastocysts need the uterus at that time to survive further.
     "Putting back" a day 3 embryo or a day 5 blastocyst into the uterus is called a "Transfer". Day 3 or day 5 transfers can be done with fresh or frozen embryos/blasts. Fresh embryos are transferred 3 or 5 days following the egg retrieval, and frozen transfers are with embryos or blasts that have been frozen for some time. There are several reasons for freezing. A couple may have left over embryos/blasts and will transfer them if their first transfer did not result in full term pregnancy, or if it did, they may provide siblings. Also, a fresh transfer can be a lot going on at once (since it's only days following a procedure), putting undue stress on the woman and may not provide the best environment for her embryos/blasts. Our blast in Denver was frozen to wait out the genetic testing that was done on one of its cells, and to provide some time for my body to completely recover from the hormones and egg retrieval. Other couples may chose to freeze embryos/blasts because their cycle produced a low number and they wish to consolidate their embryos/blasts with another egg retrieval down the road.
     The transfer involves the embryos/blasts be put inside a catheter type instrument which is fished into the uterus. The doctor pulls a trigger on the catheter to place them in the optimal spot in the uterus. It is not a painful procedure and can be simple or involved, depending on the clinic. In Calgary AB, the doctor transferred three day 3 fresh embryos and called it a day. In Denver, CO, there was a 45 minute acupuncture treatment prior to transfer, a dose of valium to calm the uterus, followed by the transfer of one, genetically normal (frozen now thawed) blast, followed by another acupuncture treatment, followed by rest, followed by rest for 48 hours in the hotel. The transfer in Denver was successful.

ICSI
     Intracytoplasmic sperm injection is the name for a fertilisation process performed under microscope with special instruments where the sperm head (the tail is removed) is manually injected directly into the egg. It is the fertilisation procedure used during an IVF treatment where there is severe male infertility (sperm blocked, low number or poor morphology) or because of other reasons, such as poor egg penetration during an IVF fertilisation.