Timed intercourse involves “cycle monitoring”, which means having blood tests and ultrasounds on certain key days during the menstrual cycle. The testing starts 2-5 days after the period begins. After these tests, the patient is seen by the nurse and/or a physician and is told when to return to the clinic for further monitoring. When a patient is approaching ovulation, she will return to the office more frequently so that the timing for ovulation can be identified. She will be told on which days she is to have intercourse with her partner to maximize her chances of conception. Timed intercourse can be used in a natural cycle (no medications) or in combination with oral or injected medications. Once ovulation is confirmed, she may return to the clinic in two weeks for a pregnancy test.
Intrauterine Insemination (IUI)
Intrauterine Insemination (also called IUI and sperm washes) involves placing specially treated or “washed” sperm directly into a woman’s uterus. This treatment is helpful for both male and female infertility. Since the sperm is placed beyond the cervix, the sperm avoids the cervical mucus. This is important for a woman who has an abnormal post coital test (PCT), Low sperm count or motility, Unexplained infertility or anti-sperm antibodies.
The woman’s partner may produce their sperm sample in the comfort of their own home, as long as the sample is given to the laboratory within 60 minutes, or they can provide it in one of our private collection rooms.
Donor sperm can also be used for males with no sperm, or in the case of single women or same sex couples.
This procedure can be done in a natural cycle in which the patient does not use any medications, or in combination with oral or injected medications. The patient will undergo cycle monitoring (blood work and ultrasound on certain key days during her cycle) and when she is showing signs of ovulation, the she will be informed of the best time for the insemination to be done. In some cases, the physician will “trigger” ovulation with a medication called HCG in order to ensure the proper timing.
Two inseminations are performed, on two consecutive days, ideally one before and one after ovulation. This procedure is not painful and takes only a few minutes to perform. Afterwards, the patient is asked to lie down for 10 minutes and she can resume normal activity right away. Twelve days later she can return to the clinic for a pregnancy test.
In Vitro Fertilization (IVF)
In Vitro Fertilization, more commonly referred to as IVF, is a process by which a woman’s eggs are removed from her ovaries and fertilized in the laboratory with her partner’s sperm. The resulting embryos are incubated in the laboratory and transferred back into her uterus three to five days later.
Women undergoing IVF will receive subcutaneous injections for approximately ten to twelve days during which time she will have cycle monitoring to track her progress. The medications will stimulate the growth of a good number of eggs. Once her eggs are mature, she is given an injection called “Ovidrel” (or HCG) and 35 hours later, the eggs will be retrieved under intravenous sedation using a needle in our office. The eggs are immediately passed to the embryologist, the sperm is collected the same day and the eggs are fertilized.
Many couples can benefit from IVF treatment including;
- Male factor infertility (including low sperm count or previous vasectomy)
- Fallopian Tube Problems (including tubal blockage, damage, or previous ligation)
- Pelvic Adhesions
- Advanced Female Age (over 38 years old)
- Severe Endometriosis
- Reduced ovarian reserve (low quality or quantity of eggs)
- Two to six failed cycles with ovulation induction and insemination
- Unexplained Infertility
- Polycystic Ovarian Syndrome (PCOS) who have failed conventional treatment
The first IVF baby, Louise Brown, was born in England in 1978 and since there has been approximately four million children born from this procedure.
ASSOCIATED IVF PROCEDURES
After transfer to the uterus, the embryo must implant in the uterine lining and continue its development. In order to do this it must break out of its “shell”. This shell is called the zona pellucida. Embryos may have a harder than normal shell or they may lack the energy needed to break out and complete the “hatching” process. Embryologists can assist this hatching by make a small hole in the zona pellucida of the embryo on the third or fifth day of the embryo’s growth. This is done through a specially fitted laser microscope. The cells of the embryo can then escape from this hole and implant at an earlier time of development when the uterine lining may be more favourable.
Some embryos grown in the laboratory may have a harder shell than normal or may lack the energy requirements needed to complete the hatching process. The embryologists can help these embryos achieve successful implantation through a technique called assisted hatching.
On the third or fifth day of laboratory growth and shortly prior to uterine transfer, a small hole is made in the zona pellucida of the embryo with a specially fitted laser microscope. Through this opening, the cells of the embryo can escape from the shell and implant.
Patients who are most likely to benefit from assisted hatching are:
- over 38 years of age
- mildly elevated Day 3 FSH
- multiple ART failures
- identified abnormalities with the zona pellucida.
Patients are often able to collect a large number of eggs which result in many viable embryos. Any remaining embryos that are not transferred into the woman's uterus after a fresh IVF transfer may be frozen or"cryopreserved" in small tubes and kept and stored in the laboratory for future use. Cryopreservation allows the patient to limit the number of embryos transferred "fresh" without discarding the unused embryos that could lead to a future pregnancy. The embryos can be kept in storage for many years. Patients are often able to achieve several pregnancies from just one egg retrieval procedure. These frozen embryos can be transferred back with minimal preparation of the uterine lining. The correct transfer time is calculated based on the stage the embryo was frozen. Newlife Fertility Centre has tremendous success with this procedure and currently has the highest success rate in the country for achieving pregnancy from frozen embryo transfer.
Egg freezing or “oocyte cryopreservation” is a method used to preserve eggs to be used at a later time. The eggs are protected and frozen in liquid nitrogen; they are placed in a state of suspended animation so that they may be frozen for long periods of time then thawed and used when the patient is ready to become pregnant. The preferred method of freezing is called “vitrification”, which is a special method of freezing that is done very quickly as opposed to the older method of slow freezing. Vitrification, unlike slow cooling which has been used for freezing over the past 20 years, avoids the damage to the cell invoked by ice crystal formation, as well as the “chilling” effects seen with slow cooling. With vitrification, embryos are taken from room temperature to -196º C in a fraction of a second using high concentrations of cryoprotectants.
The patient will undergo IVF with injected medications so that the maximum number of eggs are retrieved. NewLife Fertility Centre will store eggs for as long as the patient desires with an annual renewal of the cryopreservation agreement. The types of patients who may want to access this technology include young women who want to preserve their fertility due to career or lifestyle choices. The choice to freeze their oocytes at a young age will give them the opportunity to conceive at a later time which may be more appropriate for them. The second group of patients who are candidates for egg freezing are those young women recently diagnosed with cancer. Since most cancer treatments involve radiation, chemotherapy, or a combination of both, ovarian function is often compromised causing infertility. If the patient is not in a relationship, the option to freeze just her eggs as opposed to freezing an embryo with partner’s sperm is an option. Once her treatment is completed and she is in a relationship, the frozen eggs can be used with her partner’s sperm.
The option of egg freezing should be discussed with the patient as soon as possible after the cancer diagnosis, so there is time to proceed with the egg collection and freezing prior to any cancer treatments. This many also be an option for those patients who have chronic illnesses whose medication may have a detrimental effect on oocyte function.
Donor Egg Program
One of the assisted reproductive technologies available at NewLife Fertility Centre is in vitro fertilization (IVF) with egg donation. This treatment option allows women who do not have viable eggs to become pregnant and give birth.
Donor eggs are useful for:
- Women with premature ovarian failure
- Women who have had radiation or chemotherapy
- Women who have had their ovaries surgically removed
- Women who have poor quality eggs
- Women with genetic diseases or chromosomal translocations that they wish to avoid passing on to their offspring.
- Advanced age
Egg donors may be a member of the patient’s family, a friend, or an anonymous volunteer screened by our staff. The egg donor must use fertility drugs to stimulate the development of multiple mature eggs, whereas the recipient takes estrogen and progesterone to prepare the uterus for embryos derived through egg donation. The sperm of the husband, partner, or sperm donor is used to fertilize the eggs. All egg donors are screened before they are accepted into the program.
Anonymous egg donors are healthy women between the ages of 19-33 who go through the following testing procedures before being accepted:
- medical history and physical examination
- testing for infectious diseases
- screening for inheritable diseases through family health questionnaire
Members of our nursing staff can discuss with you the egg donor option.
INTERESTED IN BECOMING AN EGG DONOR?
Altruistic egg donation can help create families for those who suffer infertility. Please call us to discuss this gift of life.
Male Factor Infertility
There are many factors which can lead to sperm problems and male infertility, including childhood diseases (like the mumps), previous surgery or injury, diseases like diabetes, drug or alcohol abuse, sexually transmitted infections, environmental factors, congenital or genetic problems, and hormonal factors.
The semen analysis is one of the most important tests conducted during the infertility evaluation and it can identify many sperm disorders that can lead to male factor infertility. As part of the initial assessment, all male patients at NewLife Fertility Centre are asked to provide a sperm sample for semen analysis. The sample will be evaluated for the quantity of sperm, the viscosity of the ejaculate, the shape of the sperm (morphology), an evaluation of how the sperm swim (motility), and many other characteristics. The sperm sample can be provided at home and driven to the laboratory within 45 minutes, or it can be provided in one of our private, comfortable collection rooms. This test should be done after three to five days of abstinence to yield the most accurate results.
According to the semen analysis results, further testing may be requested. This may require another sperm sample to be provided a few weeks later, for either a repeat analysis or specialized sperm tests like DNA fragmentation, antibody tests, or strict morphology. A scrotal or testicular ultrasound or hormonal blood tests may also be advised.
Some couples with infertility caused by disorders of sperm number or function may achieve success with intrauterine insemination (IUI). This is often performed during cycles in which the woman is taking fertility drugs to stimulate multiple egg development. Surgical repair of a man's varicocele may also increase the chance of pregnancy. However, IVF is the best treatment option for couples when there is severe impairment of sperm count, motility, or shape, or when sperm antibodies are present. The laboratory technique of Intracytoplasmic Sperm Injection (ICSI) has revolutionized the way we can treat male infertility. Even men with no sperm in their semen can father a pregnancy if the urologist extracts sperm from the man's epididymis or testicle for use in IVF..
Preimplantation Genetic Diagnosis:
Newlife Fertility Centre offers Preimplantation Genetic Diagnosis (PGD). This is genetic testing on embryos for chromosomal or genetic disorders thus allowing patients at risk for these disorders to have their embryos tested before transfer during am in vitro fertilization (IVF) cycle.
PGD requires embryo biopsy and genetic analysis. Only the embryos that have the correct number of number of chromosomes and are free from abnormalities are considered for transfer in the IVF cycle. The genetic material of the embryo is not altered or harmed in any way during PGD Testing.
Who should consider PGD?
Newlife Fertility Centre does not recommend PGD for all its patients. Those who may be considered are:
- Women with recurrent miscarriage
- Chromosomal abnormality in a previous pregnancy
- Multiple IVF failures
- Patients who are carriers of a specific genetic condition (such as cystic fibrosis)
- Women over the age of 35
- Chromosomal aneuploidy (a variation in the number of chromosomes, ie an extra chromosome 21 in Down syndrome)
- Chromosomal rearrangements (inversions, translocations, deletions)
- Single gene disorders (ie cystic fibrosis, Huntington disease)
Preimplantation Genetic Diagnosis may not be available in all circumstances or for all genetic disorders.
What If I've already tried without Success?
Microsurgical Tubal Ligation Reversal is the procedure through which previously interrupted fallopian tubes are reconnected using the required magnification and technique to achieve a smooth continuous tubal conduit in order for fertilization and normal pregnancy to occur.
Our results have been consistent over the years with success rate of 100% for tubal patency and 90% for pregnancy rate. The most important factors are the female age, the method of initial sterilization, semen parameters and the presence of other female factors. This stresses the importance of initial evaluation before surgery.
At NewLife Fertility Centre, our physicians are specially trained and have experience in Tubal Reconstructive Surgery to correct tubal abnormalities caused by reasons other than tubal ligation (e.g. endometriosis, infection...). Laparoscopic Surgery is offered to treat endometriosis, hydrosalpinx, and peritubal adhesions.
Hysteroscopic Surgery is very rewarding in fertility treatment when uterine factors are corrected (e.g.. septa, fibroids, adhesions...). Hysteroscopic Tubal Cannulation can also be done to overcome proximal tubal obstruction.
Newlife Fertility Centre’s team of specialists produces one of the highest success rates in Canada. Newlife has helped thousands of couples achieve their dream of having a child. Many of our patients have undergone unsuccessful IVF cycles in other centres.
Newlife Fertility Centre incorporates innovative procedures in its treatment plans for the more "complex" patients including:
- Highly individualized medication schedules for ovarian stimulation of women over 40, patients with slightly elevated FSH, and patients who are poor responders to fertility drugs.
- Intracytoplasmic sperm injection (ICSI) for patients with significant male factor infertility or those who previously had low fertilization rates or fertilization failure. Assisted hatching is offered in IVF procedures to assist with uterine implantation issues.
- Donor egg IVF program. Altruistic donation may be from a family member or friend of the woman desiring a pregnancy or an anonymous donor to the clinic.
- Assisting with gestational carrier IVF, when the woman desiring children has a uterine abnormality or a history of an inability to carry a developing fetus to term.
There are many interventions that can increase your chances of conceiving and delivering a baby. You are encouraged to see the doctor for consultation to discuss your options.
Being diagnosed with cancer is one of the most devastating life events a person can face. Recently, advances in cancer treatment can lead to very high survival rates but treatments such as radiation, chemotherapy and surgery may have life-altering implications. For women of reproductive age, cancer treatment may often lead to ovarian damage and premature menopause which can reduce or even eliminate the chance of having a baby.
The decision to preserve fertility in the face of cancer is difficult. Decisions regarding the timing of cancer treatment and disposition of the eggs or embryos are never easy and require the support and expertise of a wide range of health care specialists. Often doctors are focused on saving a patient's life and are not used to thinking about preserving a patient's fertility and the option is not discussed
Thanks to significant advances in reproductive medicine, there are technologies now available that can help to preserve fertility prior to undergoing cancer treatment.
At NewLife Fertility Centre, we offer both sperm and egg freezing prior to cancer treatment, to preserve fertility. If you have recently been diagnosed with cancer and are interested in pursuing this option, please make an appointment with one of our physicians right away. Polycystic
Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) affects between eight and ten percent of women of reproductive age. It is a common cause of anovulation and female infertility. This disease is characterized by excess body hair, acne and/or oily skin, hair loss or thinning hair, and a tendency to be overweight. Some PCOS patients will never ovulate and some will ovulate occasionally, because of this women with PCOS will usually have difficulty conceiving and will need medication to induce ovulation.
Treatment options for PCOS patients include clomiphene citrate (Clomid) for ovulation induction and Metformin, an insulin sensitizer. If this treatment is not successful within three to six cycles, the next step is using FSH (follicle stimulating hormone) injections to induce ovulation. PCOS patients are more likely to have exaggerated responses to fertility drugs that can lead to side effects like ovarian hyper stimulation syndrome (OHSS) and to cancelled cycles to avoid multiple birth. Because of these side effects, it is very important for woman to have proper cycle monitoring and to follow the advice of their physician.
Weight loss can lead to resumption of ovulation in obese PCOS patients and it may be suggested that these patients attempt to lose weight, however hormone imbalances can make this very difficult and frustrating for patients. NewLife Fertility Centre encourages women with PCOS to see a nutritionist. At Newlife, we use innovative stimulations protocols to achieve ovulation in PCOS patients who have failed treatment before.
Counselling and Wellness
Acupuncture is becoming recognized as a valid form of treatment by Western doctors. Acupuncture dates back thousands of years in China and has been found to be helpful in treating a variety of conditions, like pain management and cessation of smoking. Recent studies have shown that it can also be beneficial to those experiencing infertility. Acupuncture is has been shown to calm the nervous system, increase blood flow throughout the pelvic region and reduce stress.
Used as a complementary form of therapy for women undergoing other fertility treatments, acupuncture has been proven to be especially beneficial. In particular, studies have shown that acupuncture definitely increases the rate of pregnancy in women undergoing in vitro fertilization (IVF).
Newlife Fertility Centre has a certified acupuncturist on site to offer this service to our patients as part of our holistic approach to treatment.
Research has long shown a connection between obesity and infertility in women. And it's not just women that need to watch the scale. Recent research has shown that obesity can negatively impact male fertility as well, leading to lower sperm counts.
Watching your carbohydrate and junk food intake is also advisable. Research on women dealing with PCOS (polycystic ovarian syndrome) has shown that may improve their symptoms, even without weight loss. The lower-carb diet led to more regular menses and increased fertility potential.
Studies have also shown that being underweight could cause you have difficulty becoming pregnant. The main reason is women who are underweight may not ovulate or have a regular menstrual cycle because they do no have enough fat for proper hormonal balance. For some people who are underweight it can seem difficult to put on weight and keep it on.
Newlife Fertility Centre offers a certified dietician is available to offer assessment and advice to maximize your chances of success whether your issue you is being over or underweight.
There is no doubt that fertility treatment is stressful, it has an impact on all areas of the patient’s life. It is also known that stress reduction improves your chances of success. At NewLife Fertility Centre, we have specialized counsellors who are experienced in the area of infertility counselling to help you through your journey. Counselling sessions may focus on issues such as managing stress, coping with depression and anxiety, enhancing relationships, making treatment decisions, fear surrounding injections or treatment, and embryo management. Their services are recommended for all couples. Patients entering our IVF, donor egg, and donor embryo programs are required to attend one session of counselling prior to starting treatment.
Yoga techniques allow you to direct your full attention and focus on your body, your movement and your breathing. All of these combine to facilitate stress reduction and a feeling of being more aware of your body. This helps to realign and balance out your body’s systems. This is particularly beneficial for couples coping with infertility.
It may seem unusual that the performance of yoga postures can help you conceive, but many would agree it is true. Each yoga exercise focuses on a different area of your body. Some help to rebalance your hormones or glandular system while others increase the amount of blood flow to your organs, thereby stimulating and strengthening them. Meditation which is also a large part of Yoga aims to bring tranquility to your life and can be a great stress management technique. It is proven that stress can be a huge impediment when you are trying to conceive.
NewLife Fertility Centre offers individual, couple, and group yoga sessions to complement your fertility treatment by reducing stress and thus assisting you to achieve your goal of a pregnancy. Information about Yoga can be obtained from any of our staff members.