IVF: Your Journey to Parenthood

Infertility rates around the world continue to rise, leaving assisted reproductive technology like IVF (in vitro fertilization) the best chance at starting a family for many Canadian households. 

Being such an expensive and involved – both physically and emotionally – procedure, prospective parents should know what to expect from the process. Parents-to-be may have to go through multiple rounds of IVF before a successful birth.

Infertility can be heartbreaking and physically demanding for the prospective mother. Sometimes, it helps to talk to others experiencing the same problems as you are. Find an infertility support group here.

Step One: Hormones

Fertilization can be tricky, as you already know. Doctors want to retrieve more than the single egg that is normal for ovulation, so they’ll give you a mix of drugs to make it happen. 

Instead, to increase your egg release and the chance of the procedure working, your doctor will try to retrieve 10-12 mature eggs. This gives women about a 65 per cent chance of getting pregnant.

Not all eggs will be mature. In fact, your doctor may be able to retrieve up to 40 eggs, but only a per cent of them will be viable. 

If you’re squeamish around needles, this may be a good place to get your partner involved. To stimulate egg production and release, you’ll be put on hormones, some of which are administered as a shot. 

Possible hormones:

• Follicle stimulating hormones (FSH). Stimulates the development of multiple eggs in the ovaries which will be released during ovulation.
• Gonadotropin-releasing hormone (GnRH) agonists, GnRH antagonists, or Progestins. These drugs prevent premature ovulation to ensure that the mature eggs are not released before your doctor can collect them.
• Human chorionic gonadotrophin (hCG) and/or GnRH agonists. Once the eggs are mature and you’ve gotten the all-clear from your doctor, you’ll take this drug to trigger ovulation.
• Estrogen supplements. It can help thicken the lining of the uterine wall, which increases your chances of a fertilized egg attaching.

Side effects may be mild or severe and can even cause health risks to the mother-to-be.

This process usually takes between eight days to two weeks from starting medication to retrieving an egg.

To ensure you stay on track, you’ll have appointments for blood work and ultrasounds. Your doctor may change up your routine to try and maximize the potential yield. 

Your doctor will not go through with the procedure if they don’t think they can retrieve more than two mature eggs. 

Step Two: Egg retrieval

Egg retrieval is an invasive procedure, but knowing what to expect from the process can help dispel some of the anxiety you may be experiencing.

Done either in your doctor’s office or a clinic depending on the plan you made with your doctor beforehand, you’ll stop taking your fertility medication 34-36 hours prior to retrieval. 

First, you’ll be given medicine to help you relax and to keep you from feeling pain associated with the procedure. 

Transvaginal ultrasound aspiration is the most common method of egg retrieval. An ultrasound device is placed in the vagina to find the eggs, which may also be referred to as follicles (the sac containing an egg). Then, a thin needle is inserted into the ultrasound device (which is acting as a guide) to collect the eggs.

The needle is connected to a small suction device which can collect multiple eggs in about 20 minutes. 

If entry through the vagina isn’t possible or practical, your doctor may ultrasound your stomach to find the eggs and guide the needle through the stomach to the eggs.

It’s common for women to feel pressure, cramping, and/or a sensation of fullness after the procedure. Take it easy for at least 24 hours afterwards, even if you feel fine. 

Part Two: Sperm retrieval 

Sperm can either be collected on the morning of the egg retrieval or can be frozen in advance.

Usually, sperm is collected through masturbation, but can also be retrieved from the testicles using a needle or surgery if ejaculation is a problem. Donor sperm can also be used.

There is not much difference in success rate between frozen and fresh eggs/sperm. Talk to your doctor about the pros and cons of each to decide what works best for you and your budding family.

Step Three: Fertilization

There are a couple of ways your fertility team may choose to fertilize the collected samples. 

Conventional insemination is the most common. Your doctor mixes healthy sperm and mature eggs in an incubator. The controlled environment makes it the optimal conditions for fertilization.

Intracytoplasmic sperm injection (ICSI) often comes with an extra cost and is usually when there is an issue with semen or when previous IVF cycles haven’t panned out. With ICSI, a single sperm is injected into each mature egg. 

If you’ve experienced trouble with IVF rounds before or if you’re using frozen embryos, ask your doctor about assisted hatching. It can help eggs attach to the uterine wall more successfully.

Genetic Testing

You may also be able to gain additional insight into your embryo with preimplantation genetic testing. While in the incubator, a sample is taken from the embryo and is tested for genetic diseases and/or proper chromosomes. 

While preimplantation genetic testing can lower the chance of passing on a genetic disorder, it doesn’t erase the possibility. Genetic testing comes with an extra cost.

In Canada, you can even obtain an accurate 3-generation family genetic and ethnic history to identify possible genetic conditions or malformations you could pass on to a child before starting IVF. The more severe the issue, the more detailed a history is needed (i.e. cystic fibrosis or congenital heart disease).

“A history of previous birth of a low birthweight infant, previous cesarean sections, multiple previous spontaneous abortions, prior stillbirth, or uterine anomaly identifies women at increased risk for recurrent [miscarriage], preterm birth, or stillbirth,” according to a study.

Certain populations will require specific screenings for issues that disproportionately affect them.

• Ashkenazi Jewish, who have an elevated risk of multiple genetic conditions, including Tay–Sachs;
• African, who have an elevated risk of sickle cell anemia and thalassemia;
• Mediterranean and Asian, who have an elevated risk of thalassemia.

Step Four: Embryo transfer

About two to six days after your eggs have been collected, it’s time for the embryo to be transferred from incubation into the uterus. 

Though the procedure is often painless, your doctor may offer you a mild sedative to help you relax and reduce post-procedure cramping.

To implant the embryo, your doctor will feed a catheter through your vagina, cervix, and into your uterus. Then, a syringe with your embryos and a small amount of liquid is attached to the other end of the catheter so they can be placed in the uterus.

If the process is successful, an embryo should attach to the uterine wall within 6-10 days after the transfer. Even though the egg may attach, you’ll have to wait at least two weeks after the transfer to take a pregnancy test.

Mayo Clinic lists possible side effects as:

• Passing a small amount of clear or bloody fluid shortly after the procedure. This is due to the swabbing of the cervix before the embryo transfer.
• Breast tenderness due to high estrogen levels.
• Mild bloating.
• Mild cramping.
• Constipation.

Though you can return to your daily life, take it easy after the procedure and keep in mind that exercise and sex may cause discomfort. Ask your doctor when you can restart activities. 

Do you have unanswered questions about IVF and/or infertility? Tell us at info@thehealthinsider.ca and we can write content that you want to read.

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The information provided on TheHealthInsider.ca is for educational purposes only and does not substitute for professional medical advice. TheHealthInsider.ca advises consulting a medical professional or healthcare provider when seeking medical advice, diagnoses, or treatment.