Download Fertility and Infertility

Allison Coote, MLA/T, Laboratory Manager, Northern Reproductive Therapies,
Newmarket, ON and mom of twins born via IVF
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Fertility and Infertility
W
hat is Infertility? Infertility is
the inability to become pregnant after 12 months of unprotected intercourse. 1 in 5
couples are infertile.
There are 3 basic categories of infertility: Female Factor, Male Factor, and Unexplained/Combined.
Female Factor Infertility can be any of
the following: tubal obstruction, mullerian defects such as bicornuate, unicornuate uterus, adhesions due to endometriosis,
polycystic ovarian syndrome, hypothalamic
amenorrhea, advanced maternal age, abnormal karyotypes, such as balanced and unbal-
fertility. Smoking plays a major role for both
males and females. Nicotine (and the other
toxic chemicals in cigarette smoke) is known
to damage DNA in sperm and nicotine can
also be found in follicular fluid surrounding
the egg. Marijuana use also affects sperm
quality over time, decreasing motility, increasing abnormal forms, and decreasing
total sperm counts. Excessive use of alcohol
and other recreational drugs can also affect
fertility in both the male and female partner.
Sexually transmitted diseases, such as Chlamydia, can cause infertility by scarring and
blocking fallopian tubes. These are all preventable causes of infertility.
The impact of infertility is enormous and touches every part of an
individual’s life. Marriages are strained, sex lives are on-demand,
and family relationships are stressed.
anced translocations, or other genetic conditions such as Turner’s syndrome.
Male Factor Infertility can be any of the
following: azoospermia, oligospermia, asthenospermia, Sperm DNA fragmentation,
abnormal karyotypes, such as balanced and
unbalanced translocations, and other genetic
conditions such as cystic fibrosis or Klienfelter’s syndrome.
Unexplained Infertility can be described
when both partners have normal investigations and no distinct reason can be found
for their infertility. Combined infertility is
when both partners have conditions that impair fertility.
The impact of infertility is enormous and
touches every part of an individual’s life.
Marriages are strained, sex lives are on-demand, and family relationships are stressed.
Work relationships may be strained due to
time missed from work for treatment and
the secrecy a patient may feel. There is also
a strong correlation between stress and the
outcome of fertility treatment. Many alternative treatments are now being utilized by
patients to reduce stress and help improve
treatment outcome. These treatments can
include yoga, meditation, acupuncture, biofeedback, and counselling.
There are many lifestyle choices that affect
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Basic Causes of Infertility
20%
40%
40%
Male Factor
Female Factor
Unexplained/Combined
Some of the fertility treatments available
are:
Ovulation induction and Intrauterine Insemination - With the use of oral or
injectable fertility medications, cycles are
monitored using bloodwork and ultrasound
until an acceptable amount of mature follicles develop. Ovulation will be induced
with HCG or occur naturally. A sperm
wash will be done and an IUI performed.
This treatment overcomes hormonal issues,
cervical issues, and moderate male factor
issues.
In-Vitro Fertilization with or without
Intracytoplasmic Sperm Injection – With
the use of injectable fertility medications,
cycles are monitored using bloodwork and
ultrasound until an acceptable amount of
mature follicles develop, the number of mature follicles will be higher in IVF. Ovulation
will be induced, but instead of it occurring
naturally, eggs are then retrieved by the physician and fertilized in the lab. Traditional
IVF means to put the egg and sperm in a dish
together and let them fertilize on their own.
ICSI is taking a single sperm and injecting
it directly into an egg. ICSI has made it possible for men with extremely poor sperm
counts to become fathers.
Egg donor – Egg donors are needed by
patients wanting to have a child that are either advanced in age, have poor egg quality, or suffer from premature ovarian failure.
Since 2004 in Canada, it has no longer been
legal to pay for donor eggs. Patients may
find a family member, friend, or someone
else that is willing to donate their eggs without being reimbursed. Unfortunately many
Canadian women seek treatment with donor
eggs outside of Canada and will travel to Europe, Mexico, and the United States.
Sperm Donor – Sperm donors are used
by single women, lesbian couples, and couples who have severe male factor infertility.
Again, since 2004, it is no longer legal to
pay a sperm donor in Canada. The existing
sperm banks in Canada import semen from
Europe and the United States. Patients may
choose from on-line catalogues and have access to donor profiles and photos. Open Identity sperm donors are also readily available.
The children born to these donors will have
access to the donor’s information when they
turn 18 if they so choose.
Surrogacy – Once again, since 2004 you
may not pay a surrogate in Canada. Family,
friends, or travelling abroad to obtain a surrogate is the only option.
Costs of fertility treatment will depend
on the treatment required. Ovulation Induction with Intrauterine Insemination is
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approximately $1,000 per cycle (OHIP will
cover the bloodwork and ultrasounds), IVF/
ICSI is approximately $10,000-$12,000 per
treatment cycle. Donor egg cycles can run up
to $30,000 per treatment cycle. OHIP does not
cover the majority of treatment and the cost
must be covered by the individual. Quebec
has started to cover IVF treatment and although it has only been approximately a year,
the system seems to be working well. Cost
can be the main obstacle for patient treatment.
Only 50% of couples that require treatment to
conceive are able to afford the services.
Multiple Pregnancies have become a hot
topic in the news. Many people relate fertility
treatment to multiple pregnancies and births.
Multiple pregnancies have a much higher incidence of premature birth than singleton pregnancies, this in turn increases the healthcare
costs by a huge amount. With careful cycle
monitoring and conservative medication doses,
most higher order multiple births (triplets or
more) can be avoided. During IVF treatment,
transferring a conservative number of embryos
is a good way to avoid higher order multiple
pregnancies. The newest trend in Europe, and
it is slowly being adopted into North American
practice, is a SET or Single Embryo Transfer.
This does decrease the pregnancy rate slightly,
but the multiples birth rate dropped. These
countries also have subsidized fertility treatment, which changes the attitude of the patient;
they know if one cycle fails the government
will continue to pay for the treatment.
In conclusion, the good news is that the
field of fertility treatment is ever undergoing
change. New research is being conducted on
previously neglected areas, such as male factor infertility and other areas such as fertility
preservation (egg freezing). ❖
Preliminary results were reported for a combined total of 10390 IVF/ICSI
treatment cycles undertaken in all 28 IVF centres in Canada in 2009:
• The overall pregnancy rate was 37% per cycle started, 40% per egg retrieval procedure,
and 43% per embryo transfer procedure.
• 69% of pregnancies were singletons, 29% were twins, and 2% were triplets or more.
• A singleton pregnancy occurred following 24% of cycles started, 26% of cycles having
egg retrieval, and 27% of cycles having embryo transfer.
• The pregnancy rates per cycle started, by age of the mother, were:
• 46% for women under 35 years old
• 37% for women aged 35-39 years
• 20% for women 40 years old and over.
• The singleton pregnancy rates per cycle started, by age of the mother, were:
• 29% for women under 35 years old
• 24% for women aged 35-39 years
• 14% for women 40 years old and over.
• Complications occurred in fewer than 2% of treatment cycles.
IVF Success Rates as taken from CFAS Press Release on September 29, 2010 (www.cfas.ca)
Image courtesy of Todd Bowen
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Volume 18/Issue 2 Summer 2011
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