ISIS Regional Fertility Centre
2180 Meadowvale Blvd.
ISIS Oakville Fertility Centre and Oakview Ultrasound
408 North Service Road E, Level 2
Frequently Asked Questions
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1.What success rates may be expected from various treatments such as clomiphene citrate alone, clomiphene citrate with intrauterine insemination, FSH alone, FSH with intrauterine insemination or IVF?
2.What is the success rate of fresh versus frozen donor egg cycles?
3.How does the success in terms of pregnancy compare between frozen embryos and fresh embryos?
4.How thick should the endometrium be to increase the chances of implantation?
5.When does the endometrium stop thickening?
6.If the woman has an endometrium that is considered suboptimal for implantation (too thin), what can be done about this?
7.What options are there for obtaining donor eggs?
8.What system does ISIS use to assess egg quality?
9.Does endometriosis affect egg quality?
10.Do the medications used during in vitro fertilization lead to regrowth of the endometriosis?
11.What assistance does Health Canada provide to Canadians for infertility treatment?
12.What can be done to prevent weight gain during infertility treatment?
13.Does weight gain affect the future baby?
14.What is polycystic ovarian syndrome?
15.What are fibroids?
16.How would I know if I have fibroids?
17.What symptoms do fibroids cause?
18.How can I get a referral to ISIS?
19.Are IVF cycles are ever cancelled?
20.Can I take herbal supplements during infertility treatment?
21.What about our sex life during treatment?
22.During monitoring when taking ovulation induction medications, when do the ultrasounds occur?
23.When is therapeutic donor insemination desired?
24.What is ICSI?
25.How do I know I am ovulating?
26.What is the ISIS refund policy for IVF cycles?
27.Who is eligible for OHIP-funded IVF cycles?
28.What lifestyle behaviours are associated with infertility?
29.Can I exercise during treatment?
30.Do I need to rest after an embryo transfer?
31.Is an IVF egg retrieval painful?
32.What if my husband or partner cannot produce a sperm sample on the day that it is required for treatment?
33.My husband travels a lot and may not be available to provide his sperm on the day of my insemination or treatment. What can we do?
34.How old is too old to do IVF?
35.Does ISIS treat same-sex couples (lesbians, gay men)?
36.Does ISIS treat single women seeking donor sperm for becoming pregnant?
37.What does the lab look at in the sperm analysis?
38.How many cycles of clomiphene citrate with intrauterine insemination can I do?
39.When do I pay?
40.What methods of payment do you accept?
41.I have fibroids. Do they need to be removed?
Q1. What success rates may be expected from various treatments such as clomiphene citrate alone, clomiphene citrate with intrauterine insemination, FSH alone, FSH with intrauterine insemination or IVF?
This is complex question and success rates are affected by the indication for the treatment. Clomiphene citrate (CC) is a fertility tablet most commonly used in two types of patients – those with regular menstrual cycles and normal testing (called unexplained infertility) and those with irregular cycles and otherwise normal semen analysis and other testing (called oligo-ovulation or anovulation). Studies have shown that when CC is used alone in women with regular cycles and normal semen analysis, pregnancy rates per cycle are in the range of 2-4%. When CC is combined with intrauterine insemination in such couples, pregnancy rates per cycle are in the range of 8-10%. When CC is used in women with irregular cycles with natural intercourse, pregnancy rates are closer to 20% per cycle. Intrauterine insemination may be added into the treatment plan if there are abnormalities in the semen analysis or if natural intercourse has not resulted in a pregnancy after 3 or more cycles. FSH is an injectable medication that can also be used in women with both regular and irregular cycles. When used in women with regular cycles and combined with intrauterine insemination, pregnancy rates are commonly quoted in the literature as 15-18% per cycle. This is also true for women with irregular cycles. Success rates for IVF also is influenced by the reason IVF is used. Success rates for pregnancy per cycle are quoted as 40-60%. All of these success rates are strongly influenced by the age of the woman. The majority of studies concentrate on women less than the age of 38. The older the woman, the less success per cycle attempt.
Q2. What is the success rate of fresh versus frozen donor egg cycles?
Fresh donor egg cycles in Canada must be from known donors that have donated their eggs altruistically. Most physicians would advise patients that the success of such a treatment is strongly influenced by the age of the woman donating the eggs. Most programs would advise using fresh donor eggs from women who have had children of their own and are of an age younger than age 35. In such ideal situations, pregnancy rates per cycle may be as high as 60%-70%.
Frozen donor eggs used for pregnancy is still considered an experimental procedure. Most women who request egg freezing are women who are about to undergo treatment with radiation and chemotherapy (processes that may affect or destroy eggs in the body). Egg freezing is a difficult process as eggs do not freeze, thaw and lead to pregnancies very well. Improvements in pregnancy rates have been achieved when frozen and thawed eggs are combined with ICSI for fertilization. World-wide literature suggests that pregnancy rates in such situations is around 2-4 %.Rates may be higher in young women and when multiple embryos are transfered. Overall, egg freezing is not considered a valid alternative to embryo freezing at present but specific areas of application are clearly areas of future investigation. This is a large area of research currently.
Q3. How does the success in terms of pregnancy compare between frozen embryos and fresh embryos?
Success of pregnancy from frozen embryos have steadily increased over the years. Not all embryos survive the freezing and thawing process. Quality of embryos being frozen influences how well they survive the thawing process and thus how well they result in pregnancy. A rough estimation is that pregnancy rates of frozen embryos are approximately half of the age-related pregnancy rates with fresh embryos.
Q4. How thick should the endometrium be to increase the chances of implantation?
To best optimize the chances of implantation, studies have shown that the endometrial thickness should be 6 mm or more. Best implantation rates in in vitro fertilization have been shown to be with lining thickness of 10 mm or more but there are many studies to show that implantation can occur with endometrial thickness as low as 5 mm – just not as easily.
Q5. When does the endometrium stop thickening?
Even in medicated cycles, the endometrium thickens in the same manner that it does in the natural cycle. Even while the period is still going on, the endometrial lining is preparing for the next cycle. It begins to thicken in response to estrogen and reaches maximal thickness in the mid-luteal phase (the phase of the cycle from time of ovulation to time of onset of menses). Then as the period time approaches, it begins to break down.
Q6. If the woman has an endometrium that is considered suboptimal for implantation (too thin), what can be done about this?
It is possible to provide estrogen in the form of vaginal suppositories to help increase the local estrogen that the endometrium is responding to. It is not clear that this helps implantation but does not appear to be harmful. Some women just make thinner linings than others naturally but still get pregnant. Some medications can have a side effect of promoting thin linings (such as clomiphene citrate) so in that situation, it may be better to stop using clomiphene citrate.
What options are there for obtaining donor eggs?
In Canada, donor eggs may only be obtained in an altruistic manner. Donor eggs may not be purchased. In the United States, anonymous donor eggs may be purchased.
Q8. What system does ISIS use to assess egg quality?
There are many features that embryologists look at to assess the quality of an egg. These features are different from those features used to assess the quality of an embryo. When looking at an egg, embryologists look for the following features:
Q9. Does endometriosis affect egg quality?
- Egg quality can only be assessed during ICSI (the entire complex (egg + follicular cells) is assessed for conventional IVF as the naked egg cannot be seen.
- Maturity is critical (presence of first polar body after retrieval)
- Shape, colour and granularity of egg
- Thickness and shape of the zona pellucida
- Darkness or lightness of the cytoplasm (jelly-like substance surrounding the chromosomes in the egg)
- Holes, vesicles or inclusions in the cytoplasm
- Features that may indicate poor egg quality are darkness of the cytoplasm, holes, granularity, etc
- Fertilized eggs and dividing embryos are graded on a similar basis with cell symmetry and fragmentation also being assessed. Grades 1 to 4 are increasing levels of fragmentation (1 is best).
Endometriosis is a very interesting condition in that there are many features of it that are not understood. It does appear that the presence of endometriosis can affect egg quality but in a manner that is not understood. It appears that women with endometriosis do not get pregnant as easily even with the assistance of in vitro fertilization as easily as women without endometriosis. The reason for this is likely very complex but there appears to be an effect of the endometriosis on how easily the potential eggs in the ovary are stimulated, a negative effect on the quality of the eggs itself and a negative effect on the lining of the uterus where the egg intends to implant. Interestingly, removing endometriomas prior to in vitro fertilization does not appear to improve outcomes suggesting that some of these other negative features may be playing a role too.
Q10. Do the medications used during in vitro fertilization lead to regrowth of the endometriosis?
Endometriosis growth is driven by estrogen. Estrogen goes up during ovarian stimulation but the duration of time is too short to cause regrowth of endometriosis. Endometriosis will likely return over time regardless of IVF treatment as long as the woman has sufficient estrogen in her body.
Q11. What assistance does Health Canada provide to Canadians for infertility treatment?
The Ontario Health Insurance Program provides partial funding to patients for IVF who have bilateral blocked tubes to a total of three cycles. Ontario is the only remaining province to provide this.
Q12. What can be done to prevent weight gain during infertility treatment?
Obesity is known to have a negative effect on reproduction. Both fertility and pregnancy outcomes are better when a woman is of normal weight. Weight gain during infertility treatment is not known to be a effect of the medications used during infertility treatment (clomiphene citrate, injectable gonadotropins). Weight gain in these situations may be due to other contributing factors such as anxiety leading to compulsive eating or fear of exercising. Some women may find some weight gain due to water retention that may be related to ovulation but this would be minor. Prevention of weight gain is commonsense – exercise, eat in moderation, watching what you eat.
Q13. Does weight gain affect the future baby?
It appears what obese women have a greater chance of pregnancy complications. They have a higher risk of developing diabetes in pregnancy, blood pressure problems and having a cesarean section which in turn increases their chance of having an infection of the incision site. Both diabetes and blood pressure problems can have negative effects on the developing baby.
Q14. What is polycystic ovarian syndrome?
PCOS is a condition that has 2 or more of the following features – irregular cycles, problems with acne or hair growth in a male pattern or elevated male hormones in the blood and ovaries that have lots of potential eggs most commonly arranged around the outside edge of the ovary. We do not know why women develop PCOS but it does appear that the underlying problem in the condition may be how the body handles insulin. Simply, the body has difficulty handling glucose so the insulin goes up and therefore the male hormones go up and then the menstrual cycle gets interrupted. There is no cure. There is some suggestion that a woman with PCOS will find her menses become more regular as she ages.
What are fibroids?
Fibroids are an abnormal growth of the muscle cells of the uterus. They can grow in the wall of the uterus, on the outside of the uterus and in the cavity of the uterus. They are almost never a cancer.
Q16. How would I know if I have fibroids?
One of the easiest ways to find out if you have fibroids is to have an ultrasound done. Ultrasound can see most fibroids and measure their size and location. Some women will have an MRI to view their fibroids.
Q17. What symptoms do fibroids cause?
Fibroids can cause many symptoms that are mainly in relation to their location. They may cause irregular bleeding if they are in the uterine cavity or the wall of the uterus. They can also affect fertility by decreasing pregnancy rates and increasing miscarriage rates but this only occurs if the fibroids are in the cavity of the uterus or very near it. If fibroids are very large, they can also cause problems with pelvic discomfort, difficulty with urination and bowel movements.
Q18. How can I get a referral to ISIS?
You may ask your family doctor or any other physician to make a referral. Referral forms are available on the internet website.
Q19. Are IVF cycles are ever cancelled?
Yes. Sometimes patients do not respond to the stimulation medications as expected. They produce too few eggs or eggs that are not growing together. These women may benefit from stopping the cycle and starting again with a different protocol and/or a higher dose of medications at the start. At ISIS, in order to maximize your opportunity for pregnancy, cancellation of an IVF cycle may be discussed when less than 4 or 5 eggs are growing together.
Can I take herbal supplements during infertility treatment?
Most herbal supplements are considered safe but because there is often minimal to no research on them studying how they influence outcome of infertility treatment, your physician is likely to recommend stopping all herbal supplements during infertility treatment.
Q21. What about our sex life during treatment?
Continuing with your sex life is important during treatment. There may be times when your physician recommends not having sex or using condoms if you do in order to prevent pregnancy. This is most commonly when having a test in which a pregnancy could be negatively affected (HSG, sonohysterogram). When women are undergoing IVF treatment, they may find intercourse uncomfortable when the ovaries are getting large during the stimulation. When it is approaching time for an insemination or production of sperm to be used in IVF, you will be advised to abstain from intercourse for 48 hours or more.
Q22. During monitoring when taking ovulation induction medications, when do the ultrasounds occur?
The timing of the ultrasounds occur on day 3 of the cycle and then again starting close to ovulation (most commonly on day 10). After day 10, you may be advised to have an ultrasound every day or every other day depending on your response and your normal cycle response. You will have an ultrasound until you ovulate and then may do one more to determine how many eggs ovulated. Monitoring ultrasounds occur in the morning at ISIS.
Q23. When is therapeutic donor insemination desired?
TDI (therapeutic donor insemination) may be a option for treatment in the following situations:
Q24. What is ICSI?
- When the sperm count is very low or sperm motility is very poor and fertilization of the egg would not be optimal
- When a patient cannot afford to do IVF with ICSI
- Single women
- Same sex couples
- When sperm cannot be obtained from the man’s testicle or if it is, it is not even able to be used for ICSI
ICSI is known as Intracytoplasmic Sperm Injection. It is a procedure when a single live sperm is trapped in a glass needle and injected straight into the egg. You need to do IVF in order to do ICSI.
Q25. How do I know I am ovulating?
The majority of women with regular menstrual cycles coming every 26-35 days are ovulating regularly at least 96% of the time. It is when cycles are outside of this range that ovulation may not be occurring in a predictable manner. Some women with polycystic ovarian syndrome can have regular bleeding episodes but not be ovulating regularly.
Q26. What is the ISIS refund policy for IVF cycles?
During the stimulation cycle, we would like to see at least 8-10 follicles. If there are less than 5 follicles, the cycle will likely be cancelled. You will be responsible for all drugs dispensed. You will also be responsible for all the bloods and ultrasounds up to that point except for the baseline ultrasound and bloods. This cost will be approximately $100/day for ultrasound and blood work.
Cycle Conversion to IUI Ė During the stimulation cycle, if it is recommended that your cycle be converted to an IUI cycle, you are responsible for all the drugs dispensed and IUI fees. Your procedure fee will be credited for a future cycle or refunded.
Q27. Who is eligible for OHIP-funded IVF cycles?
Women who have documented blockage of both fallopian tubes are eligible for partial funding of an IVF cycle from OHIP for a total of 3 cycles.
Q28. What lifestyle behaviours are associated with infertility?
Smoking is known to affect both sperm and eggs in terms of their quality and therefore ability to fertilize. It is known that women who smoke undergo menopause on average 2 years earlier than non-smokers. Success of IVF is also significantly affected. Excessive alcohol consumption is also known to decrease fertility. Though difficult to measure, stress affects the reproductive tract in a negative way. Large amounts of caffeine consumed on a daily basis also decreases fertility.
Can I exercise during treatment?
Moderate exercise is beneficial to the health and to reduce stress. You may be advised to limit the types of exercise during treatment by your doctor. It is not advisable to take up excessive exercise for the first time during treatment.
Q30. Do I need to rest after an embryo transfer?
Studies have shown the lying down after an embryo transfer does not impact the chance of a pregnancy establishing itself. You will be recommended to take it easy for the remainder of the day after your embryo transfer but you do not need to take the day off work.
Q31. Is an IVF egg retrieval painful?
All patients at ISIS are given appropriate amounts of pain medication during the egg retrieval. Some women are more sensitive to pain that others and some ovaries are more sensitive also. If you have pain during the procedure, tell the nurse and additional pain management will be administered.
Q32. What if my husband or partner cannot produce a sperm sample on the day that it is required for treatment?
If there is sufficient concern that sperm will not be produced as a fresh sample on the day of IVF and/or ICSI or when it is needed for an insemination, it is possible to arrange for freezing of a sample prior to the procedure.
Q33. My husband travels a lot and may not be available to provide his sperm on the day of my insemination or treatment. What can we do?
It is possible to arrange for freezing of a sample prior to the procedure. Speak to your doctor regarding this.
Q34. How old is too old to do IVF?
Success of pregnancy with IVF is very dependent upon the age of the woman and her eggs. Studies show that success of IVF is significantly reduced after the age of 43.
Q35. Does ISIS treat same-sex couples (lesbians, gay men)?
| Q36. Does ISIS treat single women seeking donor sperm for becoming pregnant?
Q37. What does the lab look at in the sperm analysis?
Your doctor will review the results of the sperm test with you and your partner. The sperm analysis looks at concentration, motility, how well they are swimming in a forward direction, viability, morphology (how sperm look), presence of infection and the total number of sperm that are moving.
Q38. How many cycles of clomiphene citrate with intrauterine insemination can I do?
It is considered that if pregnancy has not been achieved by 6 completed cycles, then success becomes less likely. Many couples will do additional cycles for many different reasons.
Q39. When do I pay?
All payments for treatments and procedures are to be made prior to the process being carried out.
Q40. What methods of payment do you accept?
ISIS accepts VISA or Mastercard, debit, certified cheque (with appropriate ID) and cash.
Q41. I have fibroids. Do they need to be removed?
Not all fibroids need to be removed. If they are causing symptoms (pelvic pain, bowel and bladder problems, heavy bleeding, miscarriage) then it may be advisable to discuss removing them with your doctor.