IVF versus IVM

Standard IVF Treatments

- Once a day for 10 days prior to the start of her period, a woman injects herself with an antagonist hormone that down-regulates her ovaries so that they will respond better to the coming stimulation.

- On Day 2 or 3 of her period, a woman must have two daily injections for a week to 10 days of a follicle-stimulating hormone to spur the production of eggs.

- By the 10th day, the follicles enlarge, indicating the maturing eggs. At this point the woman gets an injection of human chorionic gonadotropin, which triggers the egg ovulation process but fertility doctors retrieve the eggs for IVF 36 hours later prior to them being released naturally.

- On average, this standard IVF protocol yields 10 mature eggs.

What it costs

At McGill, one cycle of IVF costs $4,500 plus the drugs, which add at minimum $2,500 per cycle, depending on the age of woman and amount needed. Treatments can easily run more than $7,000.

In Vitro Maturation

- The patient contacts the clinic on Day 3 of her menstrual cycle and undergoes an ultrasound, where doctors count the number of follicles present. If there are at least 10 follicles, where the eggs reside, visible in her ovaries, a second ultrasound is scheduled.

- On Day 8 of the cycle, doctors recount the follicles and check the lining of the uterus to ensure it is at least 6 mm thick if an embryo is to be implanted. If the count holds up, the patient is given an injection to trigger the ovulation process.

- About 36 hours later, doctors collect the immature eggs from the woman's ovaries.

- The immature eggs are then submerged in a mineral-rich liquid medium that mimics the fluid of the ovarian follicles and are placed in an incubator. Most eggs mature within 24 to 48 hours.

- Mature eggs can be fertilized, or, as part of the McGill clinical trial, frozen.

What it yields

- On average, doctors can collect an average of 10 immature eggs from women with polycystic ovaries (who have abnormally high follicle counts). Data from Korea suggest that IVM on other women can yield one mature egg and three to five immature eggs.

What it costs

At McGill, one IVM cycle costs $3,975 for Canadian residents.

Source: Dr. Ri-Cheng Chian, McGill University Health Centre, Department of Obstetrics and Gynecology

Getting pregnant may simply be a matter of losing weight

FOR A year, Carolyn Clement endured hormone injections that made her moody and weepy. But three years into her baby-making endeavours, she still could not get pregnant.

Instead of sending her down the expensive and invasive IVF path, her doctor told her to lose weight. She weighed 135 kilograms, and wasn't ovulating. Lapband surgery and lots of exercise helped her shed 30 kilograms, which triggered her ovaries back into action. Within five months, she was pregnant.

It was always going to be hard, because she had polycystic ovarian syndrome. But it was compounded by her obesity. Fat tissue can cause a hormonal imbalance that stops a woman ovulating. Losing weight reverses the imbalance.

Doctors have been drumming into women's heads the consequences of waiting until they are older before attempting to go forth and multiply. But the impact that other lifestyle factors such as smoking, drinking and being overweight can have on fertility are not as well known.

Infertility affects about one in six couples, and the number of people turning to IVF has grown markedly, at huge expense to the health system. Medicare funding for assisted reproductive technology swelled from $39 million in 2000 to $108 million in 2005. But in at least some cases, adjusting lifestyle might negate the need for IVF treatment.

IVF doctors want people to do all they can to avoid IVF. The Fertility Society of Australia put in a submission to the federal budget for about $5 million for a public awareness campaign telling people how their behaviour can affect their fertility.

But, despite a Government-commissioned report last year recommending a campaign, there was no money for it in this week's budget. The Government says it is still considering it.

Health Minister Tony Abbott last week said he wanted people to have more babies. He wasn't concerned about the cost of IVF because he was in favour of anything that could increase the birthrate.

Read full article at Getting pregnant may simply be a matter of losing weight

Breaking the silence of IVF

IT took two-and-a-half years, seven stimulated cycles and 24 embryo transfers for her to fall pregnant. For months, Lahra Carey, who was in her early 30s, lived on a diet of “hope and despair”. She struggled to conceive and, with that, she recalls, came “a stigma, an awkwardness and a silent struggle”.

She stopped going to her friends’ birthday parties for their children she didn’t attend brit milahs or l’chaims. She became adept at making excuses and threw herself headlong into work.

But still the question begged: would she ever be able to start a family?

“The concept that we might never have a child was horrifying,” she says. “It was like being on a seesaw that I didn’t want to live on indefinitely, and that’s where I found myself,” Carey, 38, told the AJN. “I was getting older, all my friends were having children and there I was, holding a handbag and not a baby.”

During her struggle to conceive, Carey and her husband Ben Cowen were looking into their options and turned their attention to in-vitro fertilisation (IVF) at a Melbourne clinic.

At the time, she described a “cone of silence” that hung over IVF, which further isolated the Jewish couple.

Read more at Breaking the silence of IVF

Research may boost IVF success rate

Higher success rates for in-vitro fertilisation may result from a University PhD student’s research into measurements to assess the quality of eggs. Gabe Redding, who graduates with a Doctor of Philosophy in bioprocess engineering this afternoon, described his research as a novel integration of reproductive biology and engineering.

“The objective was to investigate tools and technologies that can be used to select the best eggs during IVF,” Dr Redding says. “The work focused on the oxygen levels in the follicle as a measure of egg quality.”

In addition to finding that current IVF techniques can expose the eggs to potentially detrimental temperature drops, Dr Redding investigated devices for measuring oxygen levels in the follicle. Such devices may enable the best eggs to be selected.

At present, most IVF clinics only use visual grading of the eggs after they are harvested and later similar checks on quality of the embryos. “But IVF could be dramatically changed if there was some measure of egg or embryos quality,” Dr Redding says.

Dr Redding’s study was undertaken as part of a wider programme contract awarded to AgResearch by the New Zealand Foundation for Research, Science and Technology, titled Advanced tools for the problem of infertility in women. His PhD was carried out through the University’s Institute of Technology and Engineering, supervised by Associate Professor John Bronlund and Dr Alan Hart (AgResearch).

Dr Redding is continuing to work on the project, including extending the mathematical models which he developed for oxygen to consider other substances which may be important to the egg.

“The long-term goal is to fully explore the contribution engineering can make to improving the outcomes of assisted reproductive technologies such as IVF. The work is really novel because reproductive biology and engineering are two disciplines which are seldom paired.”

Dr Redding, who is aged 27, is originally from Napier.