In-vitro Fertilization (IVF)
In-vitro fertilization (IVF) is the process where the egg is fertilized by sperm outside of the body, with the hopes of achieving a successful pregnancy. The entire procedure can take anywhere from 2-5 weeks and involves the following steps:
1. Ovarian Stimulation
In a natural cycle, the ovaries normally produce one egg every month. For the purposes of IVF, multiple eggs are usually required to increase the chances of success. Ovarian stimulation involves administering medication which stimulates the ovaries to produce more than one egg. Each egg develops within a sac of fluid called a follicle. As the follicle gets larger, the egg matures. Follicle growth is tracked through a process called cycle monitoring, during which, they are measured by ultrasound. Hormone levels are also tracked by a regular blood test.
2. Transvaginal Oocyte Retrieval
Once the follicles (egg sacs) inside the ovaries grow to the right size, the eggs inside the follicles will be collected by a process called egg or ovum retrieval. During this procedure, the doctor uses an ultrasound guided needle to go through the vaginal wall and into the ovaries to collect the eggs. During this procedure, medication will be administered intravenously to prevent pain and to keep you relaxed throughout.
3. Sperm Preparation
Before the eggs can be fertilized with sperm, the sperm must first be isolated from the seminal fluid. Laboratory sperm preparation methods involve the removal of immotile (sperm that are not moving correctly) and dead sperm from the seminal fluid.
The prepared sperm can fertilize the egg by means of traditional IVF, where sperm are allowed to naturally penetrate the egg in a controlled environment, or by means of ICSI, where individual sperm are manually injected into the egg. Your doctor will recommend the most appropriate method for your particular situation.
5. Embryo Culture
In majority of cases, the fertilized embryo (or zygote) will be allowed to develop in the IVF laboratory for 5 to 6 days. During this time, your doctor may suggest additional screening services, such as the EmbryoScope, or Preimplantation Genetic Testing (PGT) to increase the odds of a successful pregnancy.
6. Embryo Transfer
Embryos can be transferred either as fresh embryos or after thawing of frozen embryos. The transfer is carried out under ultrasound guidance. During this procedure, a thin tube called a catheter is inserted into the woman’s uterus to deliver the embryo(s). Following transfer, the woman is generally prescribed medication(s), like progesterone, to help the embryo(s) implant into the uterus. Occasionally, your doctor may suggest additional treatments such as Embryoglue® and insertion of a natural substance called hCG to enhance implantation.
Approximately two weeks after the embryo transfer, a blood pregnancy test will be done to determine if the embryo successfully implanted. This can be performed at CReATe or your local laboratory if you live far from the clinic.
If the test is positive, an ultrasound will be performed at about 6½ weeks into the pregnancy (about 4½ weeks after the transfer) to determine if one or more heart beats are present and if the fetus(es) is/are developing normally.
If the test is negative, patients are instructed by their doctor as to their next steps. We understand that failed cycles can be extremely stressful for all involved, but it is important to try to remain optimistic, proactive, and persistent.
Additional testing for fetal abnormalities can be performed at CReATe by a blood test from as early as 10 weeks of pregnancy called ‘non-invasive prenatal testing’ (NIPT). Some Ontario residents qualify for government funding for NIPT testing based on age and other factors, and others will need to pay a fee for this test. In addition, ultrasound testing can also be performed at CReATe to check for abnormalities during the first 3-4 months of the pregnancy.
At CReATe, we usually monitor our patients for the first 3-4 months to ensure your pregnancy gets off to a healthy start. For patients who live remotely, we can help find a local doctor or health care worker to follow the rest of the pregnancy. In the unfortunate case of a miscarriage, we have the necessary resources to allow for a quick recovery so you can start trying again as soon as possible.
If everything goes well for the first 3-4 months, we refer patients to an Obstetrician, Family Physician or Midwife for prenatal care and delivery of the baby. We can suggest someone, or you may request a referral to one of your own choosing. If your pregnancy is felt to be high risk (such as a twin pregnancy) we can recommend an Obstetrician who specializes in those types of pregnancies. These secondary care providers will continue to follow the rest of your pregnancy after you ‘graduate’ from CReATe.
Additional IVF Services
Intra-cytoplasmic sperm injection (ICSI, pronounced IK-see), is an egg fertilizing method where the sperm is placed directly into the egg, using a very thin needle. This procedure is often used when sperm count is very low, or the sperm quality is poor. Other reasons for using ICSI include a very thick zona pellucida (protective shell around the egg), previous IVF failure, or unexplained infertility.
The EmbryoScope is an incubator with a built-in camera, that takes images of the growing embryos every few minutes, creating a time-lapse video. This allows embryologists to see how the embryos are growing for the entire duration of culture, without having to remove the embryos from the incubator. It also provides valuable information about how fast or slow embryos are growing.
Learn more about the advantages of Embryoscope.
Preimplantation Genetic Testing (PGT)
Preimplantation genetic testing can dramatically improve the chances of implantation and pregnancy. Learn about the different types of genetic testing your doctor may recommend:
Preimplantation genetic testing for aneuploidy, or PGT-A for short, is a method that assesses the number of chromosomes in each embryo. Incorrect chromosome number is the primary reason for IVF failure.
PGT-A is beneficial for all individuals undergoing IVF treatment, especially women over 35 years of age.
Preimplantation genetic testing for monogenic or single gene defects, or PGT-M for short, is used for patients that know they have an increased risk of passing down a specific genetic condition. Performing PGT-M on IVF embryos allows us to identify and avoid affected embryos from being transferred to the uterus.
Preimplantation genetic testing for chromosomal structural rearrangements, or PGT-SR for short is used for patients that know they have a structural rearrangement and are at increased risk of passing down that rearrangement to their embryos. Performing PGT-SR testing on IVF embryos allows us to identify and avoid affected embryos from being transferred to the uterus.