IVF Related Treatments / Treatment

Intracytoplasmic Sperm Injection (ICSI) is a specialized procedure to achieve fertilization by directly injecting the sperm into the egg (rather than putting enough sperm around the egg to let the sperm do the job itself). The expected fertilization rate from ICSI should be around 70% or higher.

Who will require ICSI?
ICSI is typically reserved for couples with severe male factor infertility and significant sperm issues. Previously, therapeutic donor insemination (TDI) or adoption was the only option for these couples. Thankfully, ICSI now provides couples with severe male factor infertility with the opportunity to conceive their own biological offspring.

Overtime, ICSI has become a routine procedure done as a part of the IVF protocol for patients in most fertility centres.

Failed fertilization with ICSI:
This is an uncommon scenario. However, for cases with low or failed fertilization with ICSI, special techniques like oocyte activation with calcium ionophore or puromycin are implemented at our center to remedy this challenging clinical problem.

Many patients undergoing IVF and ICSI treatment have more embryos available than are required for transfer. In order to select the best embryos for transfer and thus improve the outcome of treatment, it has become routine practice to grow the embryos to day 5 after fertilization.

This extended culture allows embryos to develop into blastocysts and gives the embryologist the opportunity to identify and select those embryo(s) that are more likely to implant.

The selection of embryo(s) for transfer on day 5 allows the transfer of fewer embryos, which will reduce the risk of multiple pregnancies, while still maintaining the overall chance of a pregnancy for the individual patient.

Assisted Hatching is a technique where the shell surrounding the developing embryo (zona pellucida), is opened or made much thinner prior to embryo transfer. This aids in the natural process of hatching which is necessary before a blastocyst (day 5 embryo) can implant.

It is still controversial whether Laser Assisted Hatching (LAH) should be performed for all patients’ embryos. There is some evidence that Laser Assisted Hatching (LAH) improves implantation rates and subsequently pregnancy rates in patients younger than 36 years old. There is also some evidence that LAH may also improve the implantation rates of frozen embryos that are allowed to cleave (grow) in the lab after thawing.

How many embryos should I transfer?
Elective single embryo transfer (eSET) is currently recommended for patients under 35 years of age with sufficient, good quality embryos. Ontario Fertility Program patients (those covered by government funding) are restricted to a single embryo transfer if the egg retrieval was done before age 38. It is important to note that eSET achieves almost the same success rates compared to double embryo transfers, with the advantage of avoiding risks associated with multiple pregnancies.

Embryo Transfer Procedure (ET):
On the day of your embryo transfer, you will come to the clinic with a full bladder. In the procedure room, the embryo transfer is performed under direct ultrasound guidance to ensure proper placement of the embryo(s) in the correct part of the uterus. Following the embryo transfer, you will rest in the recovery area for 20-30 minutes. It is important to note that emptying your bladder after the transfer will not cause the expulsion of the embryos! A pregnancy test will be done 10-12 days following the embryo transfer.
The pregnancy rate after ET is expected to around 60%.

Embryo Cryopreservation (Freezing)
Excess remaining embryos after an embryo transfer are frozen for future needs. There is no set time limit regarding how long embryos can be stored. Embryos have been transferred after 15 years of storage with no compromise to survival rates, pregnancy rates and live healthy birth rates.

Sperm freezing in conjunction with IVF can be done with ejaculated sperm or sperm that is retrieved via surgical means from the testicle or the epididymis.

Sperm freezing is done in cases where sperm numbers are very low and/or exhibit marked fluctuations from sample to sample to avoid the risk of having a poor sample on the day of the egg retrieval, which would significantly compromise the results. Sperm freezing before IVF can also be done when the male partner may find it difficult or too stressful to provide a sperm sample on the same day of the egg retrieval.

Sperm collected by surgical procedures are all frozen and banked before cycle starts to ensure that we have satisfactory sperm to use after the egg collection. We do not want to risk having any sperm on the day of egg retrieval.

The option of sperm freezing should be discussed with our team in the preparatory phase for your IVF treatment. If you or your partner have any concerns or may anticipate difficulty providing a sperm sample, you should discuss the issue with our team before your cycle starts.

Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS) are methods of testing embryos for genetic conditions in order to select the healthiest embryos for implantation. In PGD/PGS, cells from the embryo are removed (embryo biopsy) and sent for genetic testing. This does not harm the embryo.

PGD/PGS can reduce the miscarriage rate and minimize the need for elective termination of pregnancies because of chromosomal abnormalities (trisomies). PGD/PGSD can also eliminate the transfer of embryos affected by single gene defects like cystic fibrosis. These abnormalities are impossible to detect by other means.

When should I consider PGD/PGS?
PGD/PGS is indicated if you or your partner carry, or are affected, with a serious genetic disease that can be passed on to your offspring. The goal of PGD/PGS is to select an embryo that is not affected by the disease.

PGS screens embryos for abnormalities in the chromosome number or structure (called aneuploidy) in order to prevent the transfer of embryos with genetic abnormalities, like Down’s Syndrome. In addition, women with a history of miscarriages or repeated IVF failures may consider PGS to select the healthiest embryos and hopefully prevent additional miscarriages or IVF failure.

Donor egg IVF is a very successful option for achieving pregnancy when egg quality or ovarian response to stimulation repeatedly fails to retrieve enough healthy, mature eggs to produce healthy embryos. This can occur due to advanced age, genetic causes, or premature ovarian failure (can be a result of surgery or chemotherapy).

Often, choosing donor egg IVF can be a very difficult decision for a couple. They may need time and appropriate counselling (both legal and psychological) before proceeding. Finding a suitable donor can be a challenge. You may find a suitable donor from your close circle of friends and relatives or you may prefer to find an anonymous donor with the help of available agencies in Ontario or donated frozen eggs through American egg cryobanks. In Canada, it is currently illegal to buy or sell eggs; however, reasonable compensation for the egg donor is allowed. Regardless of which route you take, our job is to validate and ensure the complete screening process for your donor to ensure that all parties are safe throughout the process.

It is the donor who must receive fertility injections and undergo egg harvesting. After retrieving the donor’s eggs, they are then fertilized by your partner’s sperm. The resulting embryo(s) will be transferred to your uterus after proper preparation. The remaining good quality embryos can be frozen for future need.

This is another excellent option to achieve a pregnancy when there are issues with a couple’s eggs, sperm, or both. Unlike donor egg IVF, the embryo does not have any genetic contribution from the couple. It is like an adoption at the pre-implantation stage. The source of embryos is typically excess embryos frozen from other couples who went through successful IVF treatments and no longer wish to store their embryos or who have already completed their families.

This is a true donation from the couple; they do not ask for any compensation and wish to remain anonymous. Limited information about the couple donating the embryos is available to assist in the matching/selection process. Astra, like most fertility clinics, has a significant surplus of frozen donated embryos waiting for a match.

This is a good option for women with a congenitally or surgically absent uterus, or a uterus rendered non-functional because of extensive disease that is not amenable to surgical correction. Surrogacy is also used if you have a medical condition than can be detrimentally worsened by pregnancy which risks both your health and your baby’s well-being. Lastly, it can be an option in patients with unexplained recurrent pregnancy loss or implantation failure.

The surrogate must be healthy, have no contraindication to pregnancy, and have a good reproductive history. Legal and psychological counselling is mandatory before proceeding with the treatment. It is you who will undergo the ovarian stimulation followed by the egg retrieval. After fertilization with your partner’s or donor sperm, the resulting embryos (1-2) will be transferred to the surrogate after adequate uterine preparation. The remaining embryos can be frozen for future use.

Oocyte cryopreservation (egg freezing) is the process by which a woman’s unfertilized eggs are extracted from her ovaries and frozen at a very low temperature using rapid or flash freezing techniques (vitrification). Vitrification allows for excellent egg survival after thawing. When a woman is ready to attempt pregnancy, our team will thaw her eggs and fertilize them to complete the in vitro fertilization process.

What does the process involve?

Egg freezing involves a woman taking daily hormone injections for approximately 10-12 days. During this time, blood work and ultrasounds are performed to monitor the client’s response to the hormones. Once the follicles (the sacs that the egg grows in) are of mature size, a hormone injection is given and two days later the eggs will be retrieved by the physician under conscious sedation. The same day the eggs are collected, they will be frozen for future use.

Fertility Preservation should be considered:

• If you think you want to have children, but have a medical condition or social circumstances that requires that you delay pregnancy for a significant amount of time
• If you are about to undergo cancer treatment, such as radiation or chemotherapy, that can cause infertility
• If you don’t want children now but hope to defer childbearing to sometime in the distant future

We are seeing a growing trend towards women choosing to postpone childbearing for their careers or other personal reasons. Many women are simply unaware of the impact of age on the number and quality of eggs they will produce. Fertility peaks in most women in their 20’s. Around age 35, fertility starts to decline at a more rapid pace. In fact, at age 40, your chance of getting pregnant in any given month is less than 5%. As women become more aware of their fertility and the impact of age on their ability to have a child using their own eggs, egg freezing is becoming a much more widely considered option.

It is important to be aware that social egg freezing is not meant to encourage women to delay their childbearing age. Having a child later in life has its own risks which are related to pregnancy and potential complications.

We are the first clinic in Canada to offer egg freezing for social and personal reasons, and have been doing so since 2007. Although controversial, many other clinics have started to follow suit.

What does the process involve?

Egg freezing involves a woman taking daily hormone injections for approximately 10-12 days. During this time, blood work and ultrasounds are performed to monitor the client’s response to the hormones. Once the follicles (the sacs that the egg grows in) are of mature size, a hormone injection is given and two days later the eggs will be retrieved by the physician under conscious sedation. The same day the eggs are collected, they will be frozen for future use.