Conceiving with Science: A Guide To Fertility Treatments
Watching TV, reading the news, or perhaps even within your own social circle, you’ve likely heard of couples undergoing fertility treatments. Maybe YOU have been trying to have a baby, however, all the unsuccessful attempts have left you thinking it’s time to place science on your side. A quick Google search of “fertility treatments” lands you on a page of fertility clinics advertising what they do, touting that they are the best at it. It can all be a little overwhelming, to say the least. We always hear about assisted reproductive technologies – how expensive they are, how invasive they are, and how emotional the whole process can be. So before committing to any of these treatments or to a clinic for that matter, perhaps a simple explanation of what these fertility treatments are and what they will entail will help guide your decisions! So with that said, here is a quick summary of all your options when it comes to conceiving with science!
Intrauterine Insemination (IUI)
We’ll start off with the least scary of the lot: intrauterine insemination. IUI is a procedure in which sperm is placed directly in the uterus so that there is a higher chance of sperm reaching the fallopian tubes and fertilizing the egg (AKA pregnancy). This procedure is the least invasive in that no eggs have to be retrieved in advance from the woman. Ovulation is confirmed before completing this procedure so that timing is optimal, thereby further increasing chances of pregnancy. So what does this all mean for you? Women, you will be required to undergo monitoring to confirm when you are ovulating (more on that later), you will also have to go in for the procedure at ovulation. The procedure is minimally invasive – some cramping may be experienced and feels similar to period cramps. However, you will be able to return to work the day of or day after. Men will have to provide a sperm sample in advance at the fertility clinic. This whole procedure is really just giving sperm a “head start”. IUI is often used as a first-line treatment before moving on to more invasive treatments. IUI is much more cost effective than IVF and in Ontario, there is no limit on the number of treatment cycles covered by OHIP!
In Vitro Fertilization (IVF)
Let’s get a little more invasive now: in vitro fertilization. IVF is a procedure in which eggs are retrieved from the ovaries, placed in a petri dish with sperm to allow for fertilization and creation of embryos, the embryos are then transferred back into the uterus in the hopes they will successfully implant on the uterine wall leading to pregnancy. Sounds very confusing, and requires some basic high school science to understand. As a refresher, when the sperm successfully fertilizes the egg and that new cell begins to divide, it is then referred to as an embryo. This usually occurs in the fallopian tubes. It takes approximately 5 days for the embryo to travel down to the uterus and implant in the uterine lining (AKA pregnancy). At 5 days, the embryo is referred to as a blastocyst because it contains many more cells and is more likely to successfully implant on the uterine wall. So what does this all mean? Women, this means that around ovulation you will undergo a procedure in which your eggs are retrieved from your ovaries. This has been reported to be quite uncomfortable and painful, but it serves an important purpose. Three to five days after the egg retrieval, and after the eggs have been placed in a petri dish with sperm, the resulting embryos will be transferred back into the uterus in another procedure known as an embryo or blastocyst transfer. This procedure can also be physically uncomfortable- similar to period cramping. This whole process requires you take more time off work in that there are more procedures, and the procedures themselves are more physically invasive with a longer recovery time. As with intrauterine insemination, regular monitoring will be required to ensure procedures are being completed at the right times. Luckily for men, all that is required is providing a sample in advance. This whole process removes the sperm’s job of swimming to the egg; it places the sperm and egg in the exact same environment allowing it to very easily fertilize. It also removes the embryo having to travel and places it right where it needs to be for pregnancy to occur. Sounds pretty fool-proof, but here’s the kicker: this procedure is VERY expensive. In Ontario, OHIP will only cover ONE treatment cycle per patient; so essentially you get one shot. It’s also important to keep in mind that the waiting list for funded IVF is quite long. Out of pocket expenses will vary but range anywhere from $10,000-15,000. Typically, this procedure is advised for couples that have had failed IUI attempts, or sadly have more stubborn causes of infertility. Success rates do vary depending on why you are experiencing infertility, but anywhere from 26-30% is to be expected.
IVF With Intracytoplasmic Sperm Injection (ICSI)
Finally, we have arrived at IVF with intracytoplasmic sperm injection, better known as ICSI. ICSI is a procedure in which INSTEAD of leaving the eggs and sperm in a petri dish together to fertilize (as described above), a single sperm is chosen and injected into an egg to ensure fertilization occurs. This procedure does have higher success rates than conventional IVF which is why many couples will opt to go with ICSI if getting IVF done anyway. Medically, this procedure is mostly reserved for severe male factor infertility. This means the sperm are having trouble in all parameters: concentration (sperm count per mL of semen), motility (ability to swim), and morphology (shape). When all semen parameters are low, the chances of pregnancy become near impossible to achieve naturally, with IUI, and sometimes even with IVF. With this procedure, women can expect to go through the same motions as they would with IVF alone. For men, sometimes donating a sample is not enough if parameters are sub-optimal. In some cases, sperm retrieval will be required in order to get healthy, good quality sperm. There are many methods for sperm retrieval, however, the most common include inserting a needle to collect a small amount of sperm. ICSI can cost anywhere from $10,000-17,000, however, it does have a higher pregnancy success rate of approximately 35%.
While undergoing the treatments described above, most women will be placed on a host of fertility drugs. There are MANY fertility drugs and protocols, and every clinic will have their own method. All methods aim to stimulate the development and maturation of many eggs, as opposed to just one, in order to retrieve a good number of them for transfer. Women’s cycles are also completely controlled with fertility drugs in order to ensure a perfect environment and the highest possible success rates. At mid-cycle, clinics will then “trigger” ovulation by injecting a “trigger shot”, which is usually an injection of the hormone hCG. Once the trigger shot has been injected, IUI or IVF procedures are completed the day after. Throughout this process, regular injections into the abdomen can be expected to ensure hormones are at appropriate levels, which is required for a successful pregnancy. Fertility drugs and their many protocols can be very confusing and scary in itself. Remember that different protocols are used for different causes of infertility, so be sure to ask your doctor which protocol is best for you! If you are concerned about fertility drugs and would like to learn more, stay tuned for our blog post on Fertility Drugs: Things to Look Out For and Ask About!
Now before undergoing ANY of these treatments outlined above, women will be required to undergo cycle monitoring at their chosen fertility clinic the month before and month of their procedure. Cycle monitoring on its own can be quite invasive and time-consuming. It entails getting blood work and transvaginal ultrasounds completed on a regular basis throughout the month to see how your cycle and your eggs are progressing. It is SO essential to complete cycle monitoring to ensure you have the best chances of successfully conceiving with assisted reproductive technologies. Cycle monitoring allows the clinic to know exactly when and if you’re ovulating, how many viable eggs are available that month, and that you are producing the proper amounts of hormones required for successful pregnancy. Cycle monitoring will also help determine if you are a good candidate for treatment and which type of assisted reproductive technology is best suited for you. Be sure to stay tuned for our blog post on Cycle Monitoring: What to Expect to learn more!
Need Help with your Fertility Treatments?
Needless to say, these fertility treatments are VERY involved and can be quite draining. The cost, procedures and success rates may not sound all that great but remember this is the best method at the moment for achieving pregnancy when all else has failed. It’s important to keep in mind that women at a prime reproductive age still only have a 25% chance of natural pregnancy each month, even when timed out properly with ovulation. Assisted reproductive technologies stimulate and in some cases even one up these odds of conceiving. So while you’re going through these treatments, what can you do on your end to ensure you are giving it your all? Go see a Naturopathic Doctor! The research that has come out regarding Naturopathic care as an adjunct to these treatments has had some phenomenal results! In particular, acupuncture has some excellent results when combined with assisted reproductive technologies. For more info on acupuncture and assisted reproductive technologies, click here. Fertility doctors are excellent at working on your reproductive system to improve chances of pregnancy, but no matter how many drugs and procedures you undergo, nothing can erase stress, diet, physical activity, personal history and emotional components to health. See a Naturopathic Doctor to ensure all facets of your health are being optimized so that you are at your best both physically and mentally when undergoing these procedures! If you would like to know more about assisted reproductive technologies and naturopathic adjunctive care, Awaken Life is here and happy to help! It doesn’t have to be scary and you don’t have to go through it alone!
With love and in health,
Dr. Priya Prakash, ND
I want to help you get there. The key to your fertility lies within you.
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