My suspicion is that this comes down to two reasons. Financial, yes, but importantly, emotional: For all of us, the plan was to achieve pregnancy naturally. It is a difficult step to move the act of fertilization into the laboratory.

But, if it has been more than six months of trying naturally together, there are three situations in which IVF may make the most sense:

1. Sperm

Whenever male factor is present, couples may choose to try to maximize sperm quality. This could be done through lifestyle management, through vitamins to maximize sperm quality, through medication such as Clomid to maximize the stimulation of the testes, and through intrauterine insemination to deliver more sperm to the ends of the fallopian tubes.

But none of the above is as effective as doing IVF. This is because with IVF, we can bypass all concerns associated with count, motility, morphology, or obstructions related to previous vasectomy or a congenital absence of the vas. All are treated with a single procedure, by doing intracytoplasmic sperm injection, or ICSI. ICSI places the sperm into the eggs.

It is an extraordinarily effective treatment, as long as the sperm’s DNA can support a healthy embryo.

And so before doing IVF, you might consider getting a karyotype done to confirm normal genetics, and a DNA fragmentation assay of the sperm, if available, to ensure that the DNA being delivered is well packaged and likely to be easily handled by the eggs.

For these reasons, male factor subfertility may often be a serious frustration, but if sperm’s DNA quality can be confirmed, then your expectations for successful IVF can be very high.

2. Tubes

It’s rare that compromised fallopian tubes will be able to be reopened through a cannulation procedure, very rare. The reality is that IVF is a far more successful approach, because it simply bypasses the fallopian tubes. Pregnancy rates can often be superb for a couple facing a situation where eggs and sperm are of good quality, the uterine structure is healthy, and the maternal health is excellent. If it is just a mechanical issue – sperm could not reach the eggs – IVF is a bypass.

As noted, we can try cannulation, or sometimes, if tubes are only partially compromised, we will look to inseminations.

“Partial compromise” can be very difficult to diagnose. Imaging, such as sonohystogram and HSG (hysterosalpingogram) will routinely miss compromised tubes, and the gold standard of investigation – laparoscopy – is highly interventional and invasive. For that reason, we miss fallopian tube compromise with great frequency, and arguably the number one cause for unexplained infertility will prove to be tubal dysfunction. It is for that reason that unexplained infertility is often also well treated through IVF.

A major risk for tubal compromise is low-grade endometriosis, but any source of pelvic scarring, including pelvic inflammatory disease from a previous STD like Chlamydia, a ruptured appendix, or other bowel surgery, all are risk factors for tubal compromise.

3. High quantity of low quality eggs

This situation is more complex. Many couples, particularly when women are over thirty-five years, increasingly worry about egg quality.

On the face of it, IVF would not seem to be all that beneficial; simply placing a sperm inside the egg does not increase its quality. Ninety-three percent of first trimester losses are related to embryo quality, 90% of which come back to egg. So, egg quality is a serious concern in any fertility setting.

The advantage that IVF can provide is this: Numbers. With high-dose fertility drugs, instead of the two to four eggs we will often encourage people to have intercourse or inseminations with, we would be aiming for ten, fifteen or twenty eggs with IVF.

And so it is a numbers game: If egg quality is a concern, and egg quantity is high, then IVF has a superb chance of being more beneficial than any other therapy for the shear advantages that come when ten to twenty eggs are fertilized at a time. It is like one to two years of trying naturally all focused into a single cycle.

And so when is IVF less successful?

Arguably, IVF is less successful when none of the elements above are present: If egg quality is a potential concern, but egg quantity is low, with all other parameters being normal, then IVF is unlikely to be of great benefit. When the issue is related only to uterine structure or implantation, IVF is unlikely to be successful, and if the issue is related to the couple’s overall health, IVF is unlikely to be successful.

IVF, therefore, may be our gold standard of therapy, but it is not for everybody. Still, if any of the three diagnoses above apply to your situation, and it has been a number of months of trying with other means, then IVF may well be considered as a reasonable option.

The post 3 situations where you’ll want to consider IVF appeared first on Fertility.ca.

Women who are not yet ready to start a family may choose to freeze their eggs to keep the option on the table for longer.

There has been significant promise, but also significant disappointment, with egg freezing to date. The disappointment stems from the relative lack of success rate data. Many more women are freezing eggs than thawing them. And until they are thawed, how do we know how successful the treatment really was?

At first, the data was generally only coming from egg donors, women pre-selected to have eggs that would be expected to succeed. Significantly less data was available for “social” egg freezing, that is, women who are choosing to delay their reproduction and hope to be able to freeze their eggs in time. The majority of our patients were waiting for the latter data sets to come through, as we tried to keep expectations firmly in check.

We are now finally seeing the numbers, and it appears that for most patients egg freezing works as well as embryo freezing, with success rates often in the range of 60% (see this article for more). This published data fit our internal data suggesting clinical pregnancy rates 55-60% per set of eggs for women under 38.

Egg freezing is promising when we have enough good eggs to freeze. If you are under 38 years old (age being a marker for egg quality) and have been told you should be able to freeze 12-20 mature eggs (ie. you have a good ovarian reserve), and are working with a good lab able to offer vitrification, you may anticipate having three or more fertilized egg develop to blastocysts and a reasonable expectation for pregnancy in the future. No, it isn’t perfect – all things being equal frozen eggs do not work as well as fresh eggs – but with good counselling egg freezing may provide some measure of reassurance that had been missing until now.

For a good video that walks you through the process check out this video, or a more detailed scientific review, see this article.

The post New data on non-donor egg freezing success rates! appeared first on Fertility.ca.

There’s been an increase in talk about the role vitamin D plays in our health. Vitamin D has been linked to a variety of autoimmune diseases and cancers (breast and colorectal).

Recent studies suggest that vitamin D may play a role in fertility. It may be important for egg quality or play a role in embryo implantation. Right now, we just don’t know how it impacts fertility and further studies are needed.

Infertility is a common problem affecting 10-15% of Canadian couples. In our study of 173 Canadian IVF patients, we found that women with higher vitamin D levels were more likely to achieve pregnancy following in vitro fertilization.

Vitamin D is a fat-soluble prohormone that your body gets from exposure to sunlight, from foods rich in vitamin D or by taking supplements. People living in countries at higher latitudes, such as the US and Canada, are more prone to vitamin D insufficiency.

Women with higher body mass indexes (BMI), especially a BMI of 40 or higher, were more likely to have deficient levels of vitamin D.

We found a 55% prevalence of vitamin D insufficiency in their reproductive age infertility population. Clearly, women are not getting enough vitamin D from their diet, sunlight exposure or supplementation.

What we do know is that women with sufficient vitamin D levels had significantly higher pregnancy rates per cycle start (52.5%) compared with insufficient or deficient women (35%).

More studies are needed to find out whether vitamin D supplementation can improve pregnancy rates. Women experiencing infertility should speak with their healthcare provider for more information regarding the possible link between vitamin D and infertility.

Making sure you have all the vitamins and nutrients your body needs to function properly is an important part of taking care of your overall health!

The post Is there a connection between vitamin D levels and IVF success? appeared first on Fertility.ca.

The best predictor for egg quality is being under 35 years of age. Yes! Age is on your side.

Anti Mullerian Hormone is released by cells involved with the growth of antral follicles and correlated to the number of active antral follicles you have.

Usually with IVF, we hope to retrieve 12-20 eggs. We like 12-20 eggs because then you are most likely to end up with good quality embryos. We find our best pregnancy rates occur when we generate 3-5 high quality embryos. With a very low AMH, you may retrieve as few as one. But you can have an excellent quality embryo from only one egg too.

Of course, you will only get good quality embryos from a low number of eggs when you have good quality eggs.

The post I am 28 and I have just been diagnosed with the lowest AMH possible. I’m starting aggressive IVF. Is age on my side with good quality eggs? appeared first on Fertility.ca.

1. Your age. Nearly all women under 35 will have good eggs. The vast majority will have good eggs until they’re 38. Over age 38, everyone is different. The average age beyond which women will not have a healthy ongoing pregnancy is 42.
2. Your ovarian reserve. We measure that by AMH, antral follicle count, and FSH.
3. Your cycle. Cycle length, premenstrual spotting, ovulation day, peak estradiol and peak progesterone can all help us determine the quality of your eggs.
4. Outcome of any recent pregnancies. Early losses followed by longer and longer waits before pregnancy may mean decreasing egg quality.
5. Lab results from any IVF cycle. It’s through IVF that we finally can see the eggs. The most accurate way of testing eggs is IVF with Preimplantation Genetic Screening (PGS). You can do PGS of the eggs themselves (”polar body biopsy”) but it’s probably safer to do PGS on day 5 or 6 of embryo development (”trophectoderm biopsy of blastocysts”). Over 90% of chromosomal abnormalities (“aneuploidy”) is thought to be of maternal (egg) origin, so PGS becomes the most accurate test of egg quality that we have.

Egg quality is complicated!

The post “How do you measure egg quality?” appeared first on Fertility.ca.