 IVF is a big step, physically and financially, and you likely have questions before you commit but you just don’t know what to ask. Of course, how do you know what you don’t know?! The purpose of this blog is to inform you about the IVF process and provide you with some preliminary questions to ask your Reproductive Endocrinologist (RE). It’s important that you feel empowered and in-control when it comes to the decision of IVF. Don’t be afraid to ask questions and advocate for yourself, you always deserve to be in the know! What testing has been completed that makes IVF a necessary procedure for me? IVF is not typically the first option when it comes to Assisted Reproductive Technology (ART). You may have already gone through several unsuccessful IUIs, or you/your partner may have a specific circumstance that requires IVF. When it comes to female blood work, a low AMH level and/or high FSH level is an indicator of low ovarian reserve and IVF may improve you ovarian response. For men, if there is hypospermatogenesis, IVF with ICSI (injecting the sperm directly into the egg cytoplasm) may be the best option for you. Do make sure your RE walks you through the evidence that supports the need for IVF in your particular case. What does IVF involve? Ask your RE to go over the procedure with you, including how the medications are administered, the function of each medication (I get asked this one the most!), and how many appointments you will need. You or someone you know will need to be comfortable with the injections! You may also need to adjust your work schedule for the frequent cycle monitoring appointments. The egg retrieval procedure is indeed minor surgery so you should be advised as to how to prepare beforehand. How much does IVF cost? Do you have funding available? This one I’m sure is the most obvious question to ask, IVF is expensive! The funding gets confusing though. In Ontario, one IVF treatment cycle per female patient is funded. However, you are at the liberty of the waitlist at your fertility clinic. Depending on the fertility clinic, you may wait from 6 months to 2 years for your funding. The funding is based on a first come, first serve basis. In order to be eligible you (the woman) must be under the age of 43. The funding does not cover the medications, but it does cover the cost of ALL of your embryo transfers. For example: if you produce 3 viable embryos from your IVF cycle, each embryo will be transferred one at a time; each of these transfers is covered by the funding. What are the risks and side effects? You’ll want to ask about the side effects of the specific medications you are taking as well as the risk of ovarian hyperstimulation syndrome (OHSS) and egg retrieval. Long-term side effects are largely unknown (from my understanding), but you’ll want to know what to expect while taking the medications so you don’t have to resort to “Dr. Google” along the way. What is the success rate of IVF? The success is going to depend on your unique case, as well as your partner’s/donor’s, and both of your ages. The greater the number of high quality embryos produced, the greater your chances for a healthy live birth. The CDC has an amazing tool, based on their compiled data, to calculate your potential success rate. For example, the chance of live birth per embryo transfer between ages 38-40 is 27%. The chance of live birth per egg retrieval procedure between ages 38-40 is 19%. Based on my lab work how many embryos do you think will be produced? This is important for developing realistic expectations for the IVF process. Your RE should be able to predict this for you. To give you a real world example of a female age < 35 using stimulating medications: 10 follicles were retrieved, of these 10 follicles only 7 were mature and viable, of the 7 follicles 5 were fertilized, of these 5 embryos only 3 survived until day 5. That’s a total of 3, day 5 embryos to be transferred. Do you advise day 3 or day 5 embryo transfer? A 5-day-old embryo has more cells than a 3-day-old embryo; it is referred to as a blastocyst. Blastocysts are commonly higher quality embryos than embryos in the cleavage stage (day 3). They’ve survived an extra 2 days on their own! It is worth discussing which practice your RE uses. Will the embryo transfer be fresh or frozen? Frozen embryo transfers are now more common practice, as it gives your body a chance to rest before the transfer. This means you’ll wait until your next cycle to transfer the embryo, rather than right after egg retrieval. The research on live birth rates when comparing fresh and frozen embryos seems to show similar outcomes. Do you offer PGS (pre-implantation genetic screening)? This screening is completed on frozen (and then thawed) day 5 embryos. It is a test to determine whether embryos have an abnormal number of chromosomes. It can be used to prevent miscarriage or lack of embryo implantation. If an embryo has an abnormal number of chromosomes it will not be transferred. Not all clinics offer this technology, and it is an additional cost. Do you welcome the support of acupuncture and naturopathic medicine during IVF? Finally, the most important question of all! Choose an RE who supports a multidisciplinary approach to fertility. It can take a village to make a healthy baby and you deserve access to all tools in that village. Acupuncture and naturopathic medicine have been highly researched for fertility support. We can also help you navigate the IVF process and answer questions your RE may not have the time to answer. You should feel supported every step of the way. Have more questions? Meet with us! We offer a free 30 minute consultation to all new patients. Come in and meet with one of our Naturopathic Doctors to discuss your options for natural, supportive treatments, to help you make the most of your IVF cycle. Click the button below to book with us today! Written by Dr Caleigh Sumner ND References
Hatırnaz Ş, Kanat Pektaş M. Day 3 embryo transfer versus day 5 blastocyst transfers: A prospective randomized controlled trial. Turkish Journal of Obstetrics and Gynecology. 2017;14(2):82-88. doi:10.4274/tjod.99076. Aflatoonian A, Karimzadeh Maybodi MA, Aflatoonian N, et al. Perinatal outcome in fresh versus frozen embryo transfer in ART cycles. International Journal of Reproductive Biomedicine. 2016;14(3):167-172. Wong, K. M., van Wely, M., Van der Veen, F., Repping, S., & Mastenbroek, S. (2017). Fresh versus frozen embryo transfers for assisted reproduction. The Cochrane Library. Mastenbroek, S., Twisk, M., van der Veen, F., & Repping, S. (2011). Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Human reproduction update, 17(4), 454-466.
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 Uterine (or endometrial) lining thickness is a useful predictor of embryo implantation and pregnancy success. It is measured via ultrasound during cycle monitoring, IUI, IVF, and frozen embryo transfers. A thin lining can halt the entire fertility process, and not seeing any growth in thickness, despite medical efforts, can be really frustrating. The Lining “Norm” Uterine lining thickness varies depending on the phase of your menstrual cycle and hormonal influence. On your period: 2-4mm Follicular phase (before ovulation): 5-7mm Ovulatory phase: 7-11mm Luteal phase (after ovulation): up to 16mm A lining < 8mm is associated with implantation failure, poor receptivity, and low pregnancy rates. The numbers aren’t the only measurement that matters. The endometrial pattern is also relevant; the most receptive lining is called triple-line or tri-laminar (due to its 3 layer appearance). The most common pharmaceutical approach to a thin lining is supplementation with synthetic hormones; conjugated estrogen, progestin, or a combination of both like the oral contraceptive pill. Viagra is also used to increase pelvic blood flow (it ain’t just for men!) Not all women respond to these options, but thankfully there are natural alternatives. Naturopathic medicine can be used in conjunction with hormones or alone to optimize your lining.
When all else fails, remember that lifestyle makes a huge difference! Simple strategies like drinking at least 2L of water daily and moving your body with gravity can increase endometrial thickness. There are natural options to support the growth of your lining, such as supplements, herbs and acupuncture. We offer a free consultation to all new patients. Come and meet with us to discuss options for natural support strategies, to help make this your best cycle yet! Written by Dr Caleigh Sumner ND References:
Jimenez, P. T., Schon, S. B., Odem, R. R., Ratts, V. S., & Jungheim, E. S. (2013). A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reproductive Biology and Endocrinology, 11(1), 35. Zhao, J., Zhang, Q., & Li, Y. (2012). The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reproductive Biology and Endocrinology, 10(1), 100. Al-Ghamdi, A., Coskun, S., Al-Hassan, S., Al-Rejjal, R., & Awartani, K. (2008). The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reproductive Biology and Endocrinology, 6(1), 37. Hashemi, Z., Sharifi, N., Khani, B., Aghadavod, E., & Asemi, Z. (2017). The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure. The Journal of Maternal-Fetal & Neonatal Medicine, 1-8. Takasaki, A., Tamura, H., Miwa, I., Taketani, T., Shimamura, K., & Sugino, N. (2010). Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertility and sterility, 93(6), 1851-1858. Nasr, A. (2010). Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study. Reproductive biomedicine online, 20(3), 403-409. di Villahermosa, D. I. M., dos Santos, L. G., Nogueira, M. B., Vilarino, F. L., & Barbosa, C. P. (2013). Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupuncture in Medicine, 31(2), 157-161.  You've made it through the countless appointments, medications, and procedures! Now all there’s left to do is wait, and maybe wait a little more. These two weeks are a time for you to do absolutely nothing: love yourself, hug yourself, and reflect on how you’re stronger than was ever thought humanly possible! I’ve heard from my patients that the hardest part of the 2-week wait is feeling like there is nothing else they can do, which makes the wait that much…crappier. They want to support their body in every way they can and they’re not sure how to do this after the embryo transfer. Luckily there IS something you can do, and that’s optimize diet! There are simple foods you can eat to increase pelvic circulation, build blood, decrease inflammation, and support progesterone. Eat them often and feel confident that you’re supporting your embryo and overall health!
The 2-week wait is all about doing things that support your body and mind and make you feel happy; the hardest part of the IVF process is over. If you can fit in some of these healthy foods too, your embryo will thank you. Written by Dr Caleigh Sumner ND There are natural options to support you during the two week wait such as supplements, herbs and acupuncture. We offer a free consultation to all new patients. Come and meet with us to discuss options for natural support strategies, to help make this your best IVF cycle yet!
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