Navigating the IVF Journey: A Step-by-Step Guide

Whether you're just beginning to explore your fertility options or you're well on your journey, understanding the ins and outs of IVF can make all the difference in how you experience it. In this blog, we will explore:

• What IVF is
• When IVF should be considered and who it is best suited for  
• IVF success rates and factors that can impact them
• The step-by-step process involved in a typical IVF treatment cycle
  

What is IVF?

‍In vitro fertilization (IVF), is the most effective fertility treatment available today and most often the fastest route to a healthy pregnancy. It is also a highly effective method of fertility preservation.

IVF involves stimulating the ovaries with hormonal medications to develop multiple eggs, retrieving mature eggs from the ovaries, and fertilizing them with sperm in a controlled laboratory setting. The fertilized eggs, now embryos, can then be transferred back into the uterus, aiming for a successful implantation and pregnancy. Alternatively, these embryos can be genetically tested and frozen, or simply frozen for future use. 

When should IVF be considered and who is it best suited for?

IVF can help overcome and treat causes of infertility and may be considered in various situations including:

• Failed other fertility treatments: If other fertility treatments such as medication or intrauterine insemination (IUI) have been unsuccessful, IVF may be considered as the next step.
• Age-related infertility: IVF may be recommended for women of advanced maternal age who are experiencing age-related declines in fertility.
• Same-sex couples or single individuals: IVF allows same-sex couples or single individuals to have a biological child by using donor sperm, eggs, or embryos.
• Blocked or damaged fallopian tubes: IVF bypasses the need for fallopian tubes by retrieving eggs directly from the ovaries and fertilizing them in the laboratory.
• Male factor infertility: IVF can be used in cases where there are issues with the quality or quantity of the sperm. Intracytoplasmic sperm injection (ICSI), a procedure often used in conjunction with IVF, involves injecting a single sperm directly into an egg to achieve fertilization.
• Ovulation disorders: Women who have irregular or absent ovulation may benefit from IVF, especially if other treatments to induce ovulation have not been successful.
• Endometriosis: IVF can be an option for women with endometriosis, particularly if the condition has not responded to other treatments. By retrieving eggs directly from the ovaries, IVF bypasses the potential effects of endometrial implants on fertility.
• Unexplained infertility: When no specific cause of infertility can be identified, IVF may be recommended as a treatment option. By closely monitoring the growth and development of embryos in the laboratory, IVF can help identify any issues that may be affecting the development of the embryo or implantation.
• Genetic disorders: IVF with preimplantation genetic testing (PGT) can be used to screen embryos for genetic abnormalities before transfer, reducing the risk of passing on inherited disorders.
• Recurrent miscarriage: For couples experiencing recurrent miscarriages, IVF with PGT may help identify chromosomal abnormalities in embryos, potentially reducing the risk of miscarriage.

Success Rates of IVF

Understanding the success rates of IVF is crucial for managing expectations and making informed decisions. It's very important to note that not every IVF cycle results in pregnancy, and individuals may require multiple cycles to achieve success. Success rates of IVF vary depending on several factors including:

Age:

Age stands as one of the most significant determinants of IVF success. As individuals age, the quality and quantity of their eggs decline, making conception more challenging. Women in their 20s and early 30s typically have higher success rates with IVF compared to older counterparts. Advanced maternal age, typically defined as 35 and older, is associated with decreased ovarian reserve and increased chromosomal abnormalities in eggs, leading to lower success rates.

Ovarian Reserve:

Ovarian reserve refers to a woman's remaining egg quantity. Assessing ovarian reserve helps predict response to ovarian stimulation during IVF and the likelihood of success. Tests such as antral follicle count and anti-Müllerian hormone (AMH) levels provide valuable insights into ovarian reserve. Women with diminished ovarian reserve may require higher doses of fertility medications or alternative treatment approaches, impacting their IVF success rates.

Reproductive Health:

Various reproductive health factors can influence IVF outcomes. Conditions such as endometriosis, polycystic ovary syndrome (PCOS), and uterine abnormalities can affect fertility and implantation. Additionally, male factor infertility, including low sperm count or poor sperm motility, can impact fertilization rates during IVF. Addressing these underlying issues through medical interventions or lifestyle modifications may improve the chances of IVF success.

Lifestyle Factors:

Lifestyle choices can significantly impact IVF success rates. Factors such as body mass index (BMI), smoking, alcohol consumption, and stress levels can affect fertility outcomes. Maintaining a healthy weight, adopting a balanced diet, and avoiding tobacco and excessive alcohol can enhance fertility and optimize IVF success rates. Moreover, managing stress through relaxation techniques or counselling may positively influence treatment outcomes.

Treatment Protocols and Techniques:

Advancements in IVF protocols and techniques have expanded treatment options and improved success rates. Tailoring treatment protocols to individual patient needs, such as utilizing preimplantation genetic testing (PGT) to screen embryos for chromosomal abnormalities or selecting the most suitable embryo transfer strategy, can enhance success rates. Additionally, innovations like blastocyst culture, intracytoplasmic sperm injection (ICSI), and assisted hatching contribute to improved embryo development and implantation.

Clinic Expertise and Quality:

The expertise and quality of the fertility clinic play a crucial role in IVF success. Experienced reproductive endocrinologists, a state of the art lab,  skilled embryologists, and a supportive multidisciplinary team can provide personalized care and optimize treatment outcomes. Factors such as clinic success rates, laboratory standards, and patient-centred care should be considered when selecting a fertility centre for IVF treatment.  

Ultimately, the decision to pursue IVF should be made in consultation with a fertility specialist who can assess individual circumstances and recommend the most appropriate course of action.

Learn more about IVF Treatment in Toronto at Pollin Fertility.

The IVF Step-by-Step Process & Timeline

The IVF process can vary from clinic to clinic and is dependant on protocol, but a typical Pollin IVF journey and timeline includes the following 10 steps:

1. Consultation and Diagnostic Phase (Approximately 4-6 weeks)

The timing of this phase varies, but it needs to be done at least one month before you start an IVF cycle.  The information gathered during the consultation and through diagnostic testing allows your doctor to personalize your treatment plan in order to optimize your results.

• Initial Consultation: Meeting with your fertility specialist to discuss your complete medical and fertility history as well as your family building goals.
  

• Fertility/General Health Diagnostic Testing: Various diagnostic tests that are personalized to you, and if applicable, your partner.  These may include:
  
  • ‍Blood tests: to evaluate general health and all reproductive hormones, AMH testing for ovarian reserve, immunity, genetic and infectious disease screening, thyroid health, and a complete blood count (CBC).
  • ‍Pelvic & Transvaginal Ultrasounds: These tests assess the condition of the uterus and ovaries as well as assess Antral Follicle Count, which helps determine your ovarian reserve. 
  • ‍Sonohysterogram: This highly specialized ultrasound helps your doctor see inside the uterus to assess any potential problems involving the uterine cavity and lining, as well as the health of your fallopian tubes.
    Understanding Fertility and Reproductive Health Tests: A Guide to Help you During Your Fertility Journey‍
  • Semen Analysis: A sperm sample is used to test sperm health for volume, concentration (number of sperm), motility (ability to swim), morphology (sperm shape), and if there are any infections present.  If a semen analysis comes back abnormal, more testing may be required, including additional hormone testing, a scrotal ultrasound or a Sperm DNA Fragmentation test which reports the percentage of DNA breaks or damage in a sperm sample’s DNA. 

2. A Personalized Care Plan - (Approximately 2 weeks-2 months)

‍Once all test results are in, your doctor reviews and explains all relevant findings from your, and if applicable, your partner’s diagnostic tests.  They will discuss IVF treatment options that will achieve the best possible outcome.

For many cases, you will start your IVF cycle on Day 1 of your next menstrual period.

If your personalized plan calls for Priming, this means extra time is required to prepare your reproductive system and optimize your ovaries for the timing of your IVF cycle and various hormone pre-treatments such as Lupron, testosterone, estrogen, DHEA or the birth control pill may be used.

3. Ovarian Stimulation (Approximately 10-14 days)

You will take injectable fertility medications for 10-14 days to help the follicles in your ovaries grow.  In non-medicated cycles, ovaries grow a group of follicles, but only one ovulates while the others regress.

“Stimulation” drugs (FSH,LH,hMG) override this process and “stimulate” the other follicles to grow and mature as well.

4. Ovulation Inhibition & Trigger Shot (On a specified day during Ovarian Stimulation Phase):

It is natural for your ovaries to want to ovulate, or release the eggs from the growing follicles.

“LH inhibitor” drugs are used to suppress the LH (luteinizing hormone) surge that naturally triggers ovulation, keeping the eggs in the follicles so they can be retrieved.

The “trigger” shot (HCG, Lupron) is a carefully timed, final injection taken when your follicle size and estradiol levels are optimal, maturing and preparing the eggs for retrieval.

5. Egg Retrieval & Sperm Collection (1 day):

A minor surgical procedure where eggs are retrieved from the ovaries using an ultrasound-guided needle and combined with sperm collected from you, your partner, or a donor.

6. Fertilization & Embryo Development (5 days)

‍The retrieved eggs are fertilized with sperm on the same day as the Retrieval in the laboratory.  If using a fresh sperm sample, the sperm is washed to remove debris and damaged or dead sperm and the best appearing sperm is selected to be used for fertilization. If using previously frozen sperm, the sperm is thawed for use.  

There are two different ways to fertilize your eggs: In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

IVF: The retrieved eggs are combined with washed sperm in a petri dish or a specialized container and the sperm and eggs are left together in the dish to allow fertilization to occur naturally.  This method is typically used when there are no significant issues with sperm quality or quantity.  It relies on the sperm’s ability to penetrate the egg’s outer membrane and fertilize it on its own.

ICSI: With ICSI, a single sperm is selected and directly injected into the cytoplasm of an egg using a specialized needle and microscope. This method is often used when there are issues with sperm quality or quantity, such as low sperm count, poor sperm motility, or abnormal sperm morphology.  It bypasses the need for the sperm to penetrate the egg’s outer membrane on its own. 

Your doctor will review these options with you and recommend the fertilization method that best applies to your plan. 

After fertilization, any resulting embryos are incubated and carefully monitored over the course of the following 5 days by the embryologist. The embryos are then frozen and if elected, sent for genetic testing.

7.  Preparation for FET (2-4 weeks)

An FET cycle can be done either by relying on your own ovulation and the hormones naturally released from the ovary, or by using a medicated approach. In a medicated approach, hormone medications (estrogen and progesterone) are administered to prepare the uterine lining for embryo transfer, typically lasting around 2-4 weeks depending on your protocol.

Frozen Embryo Transfer (FET): Everything You Need to Know

8. Embryo Transfer (1 day) and Post Transfer Instructions

‍The embryo of the highest quality is selected and thawed, and then transferred into the uterus during a brief outpatient procedure.

Post-Transfer Instructions: You will typically start some form of progesterone medication to support implantation and will receive guidance on the length of time you are to take medication and activities that are safe post-embryo transfer.

9. Two-Week Wait (9-11 days)

‍A waiting period post transfer to allow for the implantation of the embryo.

10. Pregnancy Test

A blood test will be conducted in the clinic to confirm pregnancy and establish baseline HcG hormones.

In conclusion, IVF represents a beacon of hope for individuals and couples facing infertility, offering a pathway to parenthood that was once considered impossible. By understanding the intricacies of the IVF process, along with its success rates and indications, individuals can make empowered decisions on their fertility journey. 

At Pollin Fertility Clinic, we have reimagined the IVF experience with our patients in mind to make it simpler, more comfortable and more effective and we're dedicated to supporting you every step of the way as you embark on this transformative journey toward building your family.