1) Ovulation Induction

Ovulation induction is the process of taking medication to stimulate the ovaries to make eggs be released mid cycle. This can be done by taking oral medications or injectable medications. Clomid or Femara are oral medications often prescribed to be taken days 2 through 10 of the cycle followed by a transvaginal ultrasound to monitor the ovarian response to the medication. Timed Intercourse or artificial insemination (IUI) is the typical treatment option when taking these oral medications.

Gonadatropins (FSH) are injectable (subcutaneous) medications used to stimulate the ovaries to mature eggs. Serial ultrasounds and hormone levels are performed during the course of treatment. This allows the prediction of the number of mature eggs developing. When appropriate an HCG injection will be given to trigger ovulation and iui or IVF will be planned.

2) IUI: Intra-Uterine Insemination

Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus.

Avisena Fertility only use husband sperm for IUI procedure. It is often combined with superovulation medicine to increase the number of available eggs. The purpose of IUI is to achieve fertilization and pregnancy and is a relatively simple procedure.

3) In-Vitro Fertilization

In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually or by ICSI, combining an egg and sperm in a laboratory dish. Fertilised embryo(s) is then transferred to the uterus FIVE days later or defer the transfer.

IVF can be used to treat infertility in the following patients:

• Blocked or damaged fallopian tubes or women who have had their fallopian tubes removed
• Male factor infertility including decreased sperm count or sperm motility
• Women with ovulation disorders, premature ovarian failure
• Individuals with a genetic disorder
• Unexplained infertility

There are SIX basic steps in the IVF and embryo transfer process:

Step 1 – Fertility medications:

• To stimulate egg production of multiple eggs desired, as some eggs will not develop or fertilize after retrieval.
• A transvaginal ultrasound is used to examine the ovaries

Step 2 – Oocyte/eggs retrieval:

• Eggs are retrieved through a minor surgical procedure under ultrasound guidance
• Medication is provided to reduce and remove potential discomfort (Sedation)

Step 3 – Sperm Preparation:

• The male is asked to produce a sample of sperm, which is prepared for combining with the eggs

Step 4 – Insemination:

• The sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization
• In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used

Step 5 – Embryo Culture:

• Fertilized eggs divide and become 2 to 4 cell embryos 2 days after the egg retrieval.
• Embryos that have developed normally 5 days after fertilization are called blastocysts.
• When planning PGD/PGS, the embryo biopsy is performed on day 5 or day 6 embryos – blastocysts.

Step 6 – The embryos Transfer:

• A catheter or small tube is inserted into the uterus to transfer the embryos.
• This procedure is painless for most women, although some may experience mild cramping

** IVF-ICSI:

Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization.

** Embryoscope Time-lapse/ Time-Lapse:

The eggs are monitored in Embryoscope Time-lapse/ Time-Lapse to confirm that fertilization and cell division are taking place. Time-lapse imaging of embryo development is one example of an innovative technology that Avisena Fertility specialists have adopted to provide patients with the very best outcomes.

Once this occurs, the fertilized eggs are considered embryos are usually transferred into the woman’s uterus three to five days or ‘Freeze all’ then transfer later.

If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

**Side effects of in vitro fertilization

Although you may need to take it easy after the procedure, most women can resume normal activities the following day. Some side effects after IVF may include:

• Passing a small amount of fluid (may be clear or blood-tinged) after the procedure
• Mild cramping
• Mild bloating
• Constipation
• Breast tenderness

Some side effects of fertility medications may include:

• Headaches
• Mood swings
• Abdominal pain
• Hot flashes
• Abdominal bloating
• RARE: Ovarian hyperstimulation syndrome (OHSS)

Ovarian hyperstimulation syndrome (OHSS)

More severe risks associated with in vitro fertilization: (OHSS)

• Nausea or vomiting
• Decreased urinary frequency
• Shortness of breath
• Faintness
• Severe stomach pains and bloating
• Ten-pound weight gain within three to five days

Additional risks of IVF include the following:

• Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
• The chance of a multiples pregnancy is increased with the use of fertility treatment.
  • There are additional risks and concerns related to multiples during pregnancy including the increased risk of premature delivery and low birth weight.

• Though the rates of miscarriage are similar to unassisted conception, the risk does increase with maternal age.
• It had been reported that the risk of ectopic pregnancy with IVF is 2-5%.
  • An ectopic pregnancy is when a fertilized egg implants anywhere outside the uterus and is not viable.

• Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the part of a couple.
  • Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful.

IVF is expensive, and most insurance plans do not provide coverage for fertility treatment. The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, the cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.

4) Fertility Surgery

Surgery can be the solution to some fertility challenges. Avisena Fertility Reproductive specialist are experienced surgeons who routinely perform minimally invasive laparoscopic and hysteroscopic procedures, which require less recovery time than traditional “open” surgery.

In fact, many Avisena Fertility patients who thought that IVF was their only option for becoming pregnant conceived naturally after undergoing relatively simple, minimally invasive surgical procedures. Surgeries performed include:

Laparoscopy

Laparoscopy is a surgical procedure to evaluate the pelvic cavity and commonly treat tubal disease and/or endometriosis. The procedure is done at Avisena Hospital, under general anesthesia. A scope is placed through a small incision at the belly button. The abdomen is filled with gas allowing the pelvic organs to be seen clearly by the physician. The procedure is a day-care procedure. Recovery at home within 1-2 days of surgery is typical.

Hysteroscopy

Hysteroscopy is a surgical procedure to evaluate the uterine lining. Most commonly a hysteroscopy is performed to remove uterine polyps or adhesions from previous infection or surgery. The hysteroscopy is done under general anesthesia at Avisena Hospital. A thin-lighted tube is passed through the cervix into the uterus with instruments passed through it to treat anything found. The procedure is a day-care procedure. Most women are able to return to work the following day. 

Testicular biopsy

In select cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility or to retrieve sperm for assisted reproductive techniques, such as IVF-ICSI.

Percutaneous Epididymal Sperm Aspiration (PESA)

Surgical sperm retrieval procedures can be used in cases where a mechanical blockage of the vas deferens, either congenital or acquired as the result of vasectomy or disease process, means that sperm produced by the testes cannot be released and remain stored in the epididymis.

This trapped sperm can be removed by surgical sperm retrieval via a simple procedure known as PESA. In this procedure a fine needle is inserted through the skin of the scrotum to remove the sperm from the epididymis. The procedure is a day-care procedure under general Anaesthesia. Recovery at home within 1-2 days of surgery is typical

Testicular Sperm Extraction (TESE)

TESE is performed when PESA has been unsuccessful and in men suffering from early signs of testicular failure where no sperm is likely to be present in the epididymis. The procedure involves a small incision being made in the scrotum and testis, and a biopsy of testicular tissue is taken from which sperm is extracted in the laboratory. Unfortunately, in a small number of cases, we may be unsuccessful in retrieving sperm, and the options is abandoning egg recovery and advised for child adoption as Avisena Fertility do not offer donor sperm facility.

PESA and TESE procedures are carried out as a day-care procedure under general Anaesthesia, and are normally performed on the same day, but prior to the female partner’s egg recovery.

5) Genetic Testing

Genetic testing is an optional, offered at Avisena Fertility that can put patients at ease regarding the health of their embryo(s) in addition to their chances for a successful pregnancy with In-Vitro Fertilization (IVF). Each type of genetic screening is used prior to the embryo transfer procedure in order to help ensure a healthy embryo that is free of abnormalities.

PGS (Pre-implantation Genetic Screening)

PGS examines the chromosomes in several cells that have been removed from the embryo on day 5 or 6 of embryo culture. The cells are sent to a specialty genetic testing laboratory where the DNA is analyzed. Each embryo is frozen individually after the cells are removed.

The DNA analysis reveals if each embryo has the correct number of chromosomes and the sex. This allows the transfer of embryo(s) with the correct number (46) chromosomes to reduce the risk of miscarriage or other congenital defects in next cycle.

PGD (Pre-implantation Genetic Diagnosis)

Individuals or couples with a family history of a genetic disease, such as cystic fibrosis, can take advantage of PGD to determine if an embryo is a carrier, is affected with the disease, or does not have the disease.

Transfer of an unaffected embryo provides a much lower risk of passing along the disease. Testing is available for many genetic diseases or may be customized in some cases for rare conditions.