By definition, artificial insemination delivers sperm into the woman's womb. In vitro fertilization goes beyond this point by bringing the woman's egg and the man's sperm together, and does so, outside the woman's body. The term "test tube babies" is synonymous with IVF.

Since 1978 and Louise Brown's birth in Great Britain, this technique has greatly surpassed its initial purpose, specifically as a means to deal with tubal infertility. Today, more than half of all IVF procedures are performed for other reasons, for example, it is used in response to unexplained infertility and is used to increase the success rate in cases of male infertility.

As far as most people are concerned, IVF is about two gametes being brought together in a test tube. But for the couples who have decided to undergo in vitro fertilization treatment, IVF means countless clinic appointments, blood tests, injections, a lot of probing and prodding and a great deal of waiting. Waiting for test results, waiting for embryos, waiting for the pregnancy test, waiting for the arrival of a child in their life.

The many challenges that couples undergoing IVF treatment will have to meet include, learning all about the matter and incorporating the mass of information available on the subject, a considerable amount of information that is not always easy to understand. Consequently, we suggest that, before you decide to undergo in vitro fertilization treatment, you find out as much as you can on the subject by speaking with your physician and by reading books on the topic or by consulting the Internet sites listed in the "Support and Resources".

The Preliminary Stages of the In Vitro Fertilization Program

Meeting with the specialist
You and your spouse will once again meet with the PROCREA Cliniques' physician who will give you the diagnosis specific to your infertility. Diagnosis in hand, together you will assess or confirm whether the in vitro fertilization treatment is best suited to your situation.

The General work-up and other additional tests and examinations
For further information about the various tests involved, go to the section "General work-up"

Besides the general work-up, you and your spouse will be asked to set aside some time for further meetings and interviews as well as for additional tests prior to in vitro fertilization:

A consultation with a psychologist specialized in fertility.

A second meeting with the physician to get your test results of the IVF general work-up, to sign the consent forms and to perform the transfer test.

A meeting with a nurse (immediately after your second meeting with the physician) where she will review all the information relative to each stage of the treatment with you. She will also give you the prescription for the medication and explain how to use the treatment calendar.

A consultation with the urologist when envisioning IVF with microinjection or the taking of epididymal or testicular sperm from the spouse. For more information on these topics, go to the section "For Him". Furthermore, a blood sample will also be required for genetic testing. Patients have the choice of having these tests performed at PROCREA Cliniques or elsewhere.

All of these preliminary stages allow you to better prepare yourselves for IVF by guarding against any improvisation and by correcting, beforehand, any factor that could reduce the success rate of the treatment.

The Stages of the in vitro Fertilization Program

First Stage: Ovarian Suppression
The first stage of the process consists in halting ovarian function by administering an oral contraceptive and a medication that inhibits the pituitary gland function. The concentration of estrogen then becomes as weak as during menopause. This stage is necessary in order to replace the patient's natural cycle by an artificial cycle to allow the control of all stages and to complete the in vitro fertilization treatment.

Second Stage: Ovarian Stimulation (superovulation)
Ovarian suppression is reached when the estradiol level is sufficiently low, as described in Stage 1. At this time, ovarian stimulation can begin in order to achieve an artificial cycle. Your ovaries usually produce and release a single egg per cycle. Although this is sufficient for normal conception, artificial conception requires more. It is therefore recommended that the patient's ovarian activity be stimulated. These medications prompt the development of several ovarian follicles resulting in the likely increase of the number of eggs.

Third Stage: Triggering the Egg Maturation Process
When follicles are large enough and when hormonal levels are adequate, it is time to incite the ovaries to prepare eggs for ovulation. This triggering is brought on by a pregnancy hormone, which is injected.

Estradiol levels: this blood test is used as an indicator to observe the response to the medication.

Transvaginal ultrasound: using a device equipped with a vaginal probe. This exam is performed by the physician to see the number and the diameter of the follicles that have developed during ovarian stimulation.

Fourth Stage: Egg Retrieval
Eggs are retrieved using the ultrasound guidance method that entails inserting an ultrasound probe into the vagina. Having located the mature follicles, the physician will insert a needle, attached to the probe, into each follicle and draw out fluid from each of them. The patient is given a local anesthetic and a sedative. The patient is entirely conscious throughout and can observe the procedure on the monitor. The embryologist analyzes the contents of every follicle under the microscope. Once the procedure is completed, the patient and her spouse are told how many eggs were harvested. On that same day, these eggs will be combined with the sperm, in vitro.

Fifth Stage: Embryo Transfer
Embryo transfer entails placing one or more embryos (usually two) inside the patient's uterine cavity.

Complete instructions regarding the various steps of the IVF program are detailed in the Fertility Treatment Handbook given by the physician to patients enrolled in treatment at PROCREA Cliniques.

What's Next?

The waiting period between the embryo transfer and the pregnancy test
Having to wait often give rise to a great deal of distress in couples undergoing IVF treatment. Nevertheless, you will have to wait 16 days after the egg retrieval before performing the pregnancy test and getting the long-awaited results.

The pregnancy test
A blood test is performed 16 days following egg retrieval. This test accurately detects the pregnancy hormone (hCG) in the patient's blood.

In Vitro Fertilization With Regards To Male Infertility

Intracytoplasmic Sperm Injection (ICSI)
This procedure is performed when sperm is unable to penetrate the membrane that surrounds the egg. Using a very fine needle, the microinjection technique provides the means to introduce a single sperm cell into the cytoplasm of the egg. The course of treatment then follows that of IVF without microinjection.

Today, this technique gives excellent results and enables couples, where the man is deemed infertile, to one day hopefully conceive a child. For instructions on the microinjection of sperm, please consult the Fact Sheets on the subject matter given by the nurse.

Percutaneous Epididymal Sperm Aspiration (PESA)
The procedure is only performed when dealing with in vitro fertilization with ICSI (microinjection of sperm). This procedure is performed under local anesthetic, when there is an obstruction of the vas deferens. The procedure most often consists of passing a small needle directly into the epididymis. Making a small incision in the epididymis is sometimes necessary. Sperm is then retrieved and treated, the healthiest sperm is used for IVF microinjection. Instructions on the microinjection of sperm are on Fact Sheets given by the nurse to the patient.

Testicular Sperm Aspiration (TESE)
The procedure is only performed when dealing with in vitro fertilization with ICSI (microinjection of sperm). It consists in taking sperm directly from the testicles and is performed under local anesthetic. This technique is used when there is a complete absence of sperm in the ejaculate or in the epididymis while the testicles continue to produce sperm. Sperm is then retrieved and treated, the healthiest sperm is then used for IVF with microinjection. Instructions on the microinjection of sperm are on Fact Sheets given by the nurse to the patient.

In Vitro Fertilization using donor sperm
In the case where the spouse experiences severe infertility, it is possible to perform in vitro fertilization with donor sperm. The process is identical to that of conventional IVF. Instructions on in vitro fertilization with donor sperm are on Fact Sheets given by the nurse to the patient.

To know more about the causes and treatments of male infertility, go to the section "For Him".

The Risks and Problems Associated with in vitro Fertilization Treatment

Multiple births
The risk of multiple pregnancies with IVF treatments is significant as it accounts for about 25% of twin pregnancies. Currently, PROCREA Cliniques' internal policy conforms to the international guidelines on the subject and generally recommends the implantation of only two embryos during each cycle, thus reducing the risks of multiple pregnancies.

Ovarian stimulation is deemed ineffective
In close to 5% of the cases treated, the IVF cycle can be cancelled due to an overly weak response to ovarian stimulation. This problem emerges following the triggering of the egg maturation process (Stage 3) thus canceling the IVF cycle before entering the egg retrieval stage (Stage 4). At this time, the couple should meet with the specialist in order to consider other viable therapeutic solutions appropriate to their situation.

Ovarian Hyperstimulation Syndrome (OHSS)
The risk of ovarian hyperstimulation can occur in 1 to 3% of the cases treated. It is defined as an abnormal increase of the size of the ovaries in the days following egg retrieval. A fluid build up in the abdomen, dehydration and blood imbalances often accompany this syndrome. Other symptoms include bloating, fever, nausea, diarrhea and respiratory difficulties. Hyperstimulation can be caused by medication and/or the secretion of the pregnancy hormone (hCG) produced during the implantation of one or several embryos during the embryo transfer stage (Stage 5).

Other risks
We often hear that in vitro fertilization leads to a higher percentage of miscarriages. However, the statistics prove that the number of miscarriages connected with IVF is not higher than that found in the general population.

The rate of premature deliveries and cesarean sections is slightly higher with IVF. As a rule, premature deliveries are most often associated to multiple pregnancies, which occur more frequently with certain fertility medication.

As for the risks of conceiving a child that may be affected by one of the most common birth anomalies, certain studies indicate that when the microinjection technique is used, the incidence may be higher then that found in the general population. Feel free to talk it over with your physician.