Selecting the right treatment
As is true for virtually all problems we face in life, there is more than one way to approach their solution. At Gen 5 Fertility, we believe that you should fully understand all of the approaches that are available to you before you decide. We respect the choice that you make and we work with you to maximize the chance that your choice will be successful.
Our OVULATION INDUCTION AND intrauterine insemination (IUI) programs
Sometimes called “artificial insemination,” IUI involves the placement of specially prepared sperm from the male partner (or donor) into the woman’s womb.
This usually is preceded by ovulation induction, which means taking fertility medications to ovulate or to ovulate better. When the plan is to do an IUI, almost always only an oral pill, either clomiphene citrate (Clomid) or letrozole (Femara), are used. Generally, only 1-3 follicles that can contain mature eggs are produced with these medications. For women who don’t normally ovulate, sometimes only the medication is needed, especially if her partner’s sperm is normal.
Ultrasounds are used to follow the growth of the follicles. When they get to the right size, they will either ovulate (release the egg) on their own or you will take an injection to cause ovulation. At a time or times based on the expected time of ovulation, the sperm sample is produced and prepared in a laboratory to select the best sperm, and then these are put into the uterus (through the cervix) using a special catheter.
We care very much about these types of cycles and have learned over the years that outstanding pregnancy rates can be obtained if everything is done as it should be done. We do not pass these off to nurses. Instead a fertility specialist monitors each cycle to ensure that pregnancy rates are as high as possible.
Our Assisted Reproductive Technology (ART) Program
Terms of Reference
IVF is perhaps the best known fertility treatment under the larger umbrella called “ART”. But what does ART mean anyway? The U.S. Centers for Disease Control & Prevention defines “Assisted Reproductive Technology” as all fertility treatments in which both eggs and sperm are therapeutically processed (or “medically handled”).
This means that for something to be classified as an ART procedure, it must involve surgically removing eggs from a woman, combining these eggs with sperm in a laboratory, and then placing the resulting embryo into the woman’s body—or donating the embryos to someone else. So, strictly speaking, ART does not include treatments where just sperm alone is processed/handled (i.e., intrauterine—or artificial—insemination), or procedures in which a woman takes medicine only to stimulate her egg production without the intention of having eggs surgically retrieved.
At G5F, the full range of fertility treatment options are available—from the simple to most complex.
In Vitro FertiliZation (IVF)
The world’s first IVF baby, Louise Brown, was born in 1978. Since then more than five million IVF babies have been born worldwide.
IVF is actually a sequence of treatments, involving a number of important steps. These include ovarian stimulation where a woman takes fertility drugs, usually in the form of daily injections, to stimulate her ovaries to produce multiple eggs. The woman is then sedated and the eggs are retrieved using ultrasound guidance. The goal is to collect a safe number of eggs, usually between 8 and 10. Once the eggs are collected, they are mixed with sperm in the lab and left to incubate. Usually, high percentages of the eggs will fertilize and form embryos.
Hopefully, many eggs will fertilize properly and then go on to develop into embryos—this laboratory culture process usually takes about five days. Once an embryo has become mature (the “blastocyst” stage), each embryo is tested to see if it appears to be genetically normal. This is done by removing a few cells from each embryo and sending them to a reproductive genetics laboratory for preimplantation genetic screening (PGS). The embryos are then frozen until the results are back and the process of preparing the uterus to receive one of these normal embryos has been completed.
To prepare the uterus, the woman takes other fertility medications to build up the lining of her womb so it is ready to receive and accommodate the resulting embryos.
The embryo is then “transferred” to the woman’s womb. While it is up to individual clinics to decide how many embryos are transferred it is usually just one to two. The best practice is to limit the number transferred in order to avoid multiple pregnancies (twins and triplets) which are high-risk pregnancies. Any additional genetically normal embryos remain frozen so that they can be used later if that needs to be done.
At Gen 5 Fertility we almost always transfer only one embryo, because after genetically testing using PGS and then only transferring normal embryos, pregnancy rates are very high. Thus we almost always only do single embryo transfers (SET) because it is much safer to carry one rather than two (or more) fetuses and because there is a minimal increase in pregnancy rate rate by transferring a second embryo.
In very exceptional cases (usually in older women), up to two embryos may be transferred.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a method of assisted fertilization which was originally used in cases where a man has a very low sperm count or poor sperm motility (movement). With standard IVF, approximately 100,000 sperm are put in with each egg and placed overnight in an incubator where the hope is that one sperm will fertilize each egg. With ICSI, a single sperm is injected directly into the egg. As time has passed, the use of ICSI has greatly increased so that now the majority of IVF cycles involve ICSI even if no sperm problems appear to be present.
Donor egg IVF
Success rates for IVF drop considerably after a woman reaches age 40, so some couples turn to eggs donated from a younger woman. In IVF with donor eggs, the process is exactly the same as described above except that the donor undergoes ovarian stimulation and egg collection. The donor eggs are then mixed with the male partner’s sperm and the embryo transferred into the woman’s womb.
Because the young donors will produce young eggs, the success rate for IVF with donor eggs is far higher.
The main issue confronting many who are considering any type of ART as a way to start (or grow) their family is safety. Is IVF really safe? What are the health concerns—both for mom and for baby?
G5F takes these matters seriously and writes about this topic whenever possible. Although our team has personally been involved in thousands of IVF cases worldwide, we agree that this treatment should only be undertaken after careful thought.
Does IVF increase the risk of cancer? This question actually has two parts—cancer risk for moms, and cancer risk for babies. Let’s look at the data on mothers (the IVF patients) first.
One of the largest & best known studies on this topic was produced by the Lund Institute (Sweden). They focused mainly on ovarian cancer and recognized that the same pathology causing any ovarian disease might also be associated with female infertility later. Thus, cancer itself (or cancer treatment) may increase the risk for infertility, which can lead to IVF. But these researchers found that after IVF, where most patients had treatment that included fertility drugs, a significantly low cancer risk was measured. Ovarian cancer showed some risk, although lower than before IVF. One possible reason for this is that the same ovarian pathology causing infertility also brings an increased ovarian cancer risk. Basically, being infertile seems to increase the risk of ovarian cancer.
What about babies conceived from IVF? To address the next part of the question, University College London sponsored research based on the comprehensive national registry of all IVF clinics in the U.K. and linked that with the British cancer registries. That way, they could tell if the babies born after IVF were later showing up with serious medical problems. The study revealed no overall increased risk of cancer among children born from IVF compared with the general population.
What about other factors? Recently, researchers led by New Zealand’s Liggins Institute (Univ Aukland) reported IVF children were a bit taller than expected and had better cholesterol profiles. This was reassuring considering that some authors had previously wondered if the lower birth weight sometimes observed in IVF babies might be associated with poorer health long term.
But the details were intriguing: children conceived when estrogen levels were elevated (i.e., IVF + fresh embryo transfer) were taller, while children conceived with typical amounts of estrogen (i.e., thawed embryo transfer, “FET”) were average height.
So, rather than the culture milieu associated with IVF embryos resulting in some apparent change in offspring height, it now seems plausible that the prevailing hormone situation near the time of conception is really what matters. Such findings appear to show that the fertility “stimulation protocol” chosen for IVF matters a lot, and there is more to assisted reproduction than just what happens in our laboratories.