Intrauterine insemination is a fertility treatment where the sperm is placed in the woman’s birth canal, using a narrow catheter. The sperm is washed to separate the sperm from the seminal fluid so that the most vigorous motile sperm are deposited in the birth canal.

IUI can be done in a natural cycle where a woman does not desire or is unable to take fertility medications. This procedure is timed 12 to 48 hours after ovulation, when the ovary releases the egg into the fallopian tube.

IUI is often combined with Ovulation Induction to increase the chances of pregnancy. Follicle development is monitored using ultrasound scans, and a trigger injection is usually given when the follicles (containing eggs) are mature. IUI is timed 24 to 36 hours later.

When is IUI used?
There are many factors which can affect conception. IUI is often used as a first line treatment in mild or moderate male factor infertility as well as erectile and ejaculatory dysfunction (retrograde ejaculation).

IUI is necessary when using therapeutic donor insemination (TDI) to achieve a pregnancy. TDI is commonly used by single women, same sex female couples, or when the male partner has poor quality sperm. In this instance, sperm is purchased from a certified distributor who meets all of Health Canada Guidelines.

Unexplained Infertility:
IUI is typically one of the first treatment options used in unexplained infertility. Studies have shown that using IUI in combination with a drug to stimulate ovarian production, increases the chances of a pregnancy occurring.

What to Expect:

1. Monitoring Ovulation:
Intrauterine insemination must be done around the time of ovulation, therefore watching for signs that ovulation is about to occur is critical. At Oasis Fertility Centre we believe that accurate timing of ovulation is important to increase the success rate of IUI treatment. This means your follicle development will be monitored by ultrasound scans, a trigger injection of human chorionic gonadotropin (HCG) will be administered when the egg is ready, and IUI is then timed accordingly.
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2. Sperm Preparation:
Your partner will produce a sperm sample (frozen sperm is thawed) and the sample is washed to separate the motile normal sperm from poorer quality sperm. Washing removes chemicals and bacteria that can cause adverse reactions when placed directly into the uterus. Using a small sample of concentrated sperm can increase the chances of achieving a pregnancy.

Complications:
Intrauterine Insemination is a safe, low risk procedure. But with any medical intervention there is always a risk of complication. These include:

• Multiple Pregnancy – IUI alone will not increase the chances of multiple pregnancy by itself. However, when it is combined with ovulation induction (where medication is prescribed to stimulate the ovaries to create more eggs) there is a significantly higher chance of having a multiple pregnancy (twins, triplets, etc.)

• Infection – There is a slight risk of developing an infection as the result of placing the catheter into the uterus.

• Bleeding – Placing the catheter into the uterus can cause vaginal bleeding. Bleeding should not impact the chance of a pregnancy.

Success rates:
Success rates for IUI vary depending on the woman’s age, and the factors causing the infertility. Success rates can be as low as 5%, or as high as 25% if you are under the age of 35, but it is highly dependent upon the factors causing fertility issues..

Controlled Ovarian Hyperstimulation (also known as superovulation) is a highly effective fertility treatment which uses injectable medications to induce the production of multiple ovarian follicles, thereby increasing the chances of pregnancy. COH is used in conjunction intrauterine insemination (IUI).

When is it used?
COH is considered a second line therapy. It is a very effective fertility treatment for mild to moderate male factor and unexplained infertility. Recent studies have shown that COH and IUI is more effective than other forms of IUI.

It is not used when the female has blocked fallopian tubes or for females over the age of 40.

What to Expect:
The aim of COH is to have the woman produce between 2-4 eggs and to control the time of ovulation. Birth control pill may be used, and a baseline ultrasound performed before the start of the cycle.

If COH is indicated, you will be taught to self administer subcutaneous injections to promote the development of one or more follicles in the ovary. Follicle growth is monitored by ultrasound scans. A detailed schedule will be made by the nurses taking into account your schedule and a calendar will be provided detailing further appointments. Patients will start to take an injectable medication known as gonadotropins (follicle stimulating hormone) early in their cycle. Common injectable gonadotropins used in a COH cycle may include: Puregon, Gonal-F and Menopur.

A trigger injection of HCG is administered when the follicle(s) are ready. IUI is timed as between 24 and 36 hours later.

Complications:
As with any procedure there is always a risk of infection or bleeding. However, the two main complications related to COH are Ovarian Hyperstimulation Syndrome (OHSS) and Multiple Birth.

• OHSS is a potentially life-threatening complication of fertility treatment associated with injectable hormones (gonadotrophins). The exact cause of OHSS is unknown although increased leakiness of the blood vessels is thought to be responsible. The severity of OHSS varies from mild to severe. While it is common to experience mild symptoms of abdominal bloating and moderate weight gain, severe cases may be associated with accumulation of fluid in the abdomen, vomiting, diarrhea and shortness of breath. Fortunately, the incidence of severe OHSS is less than 5 %. The treatment used to reduce this complication is careful follicle tracking. Should your physician be concerned about the development of OHSS, your cycle may be cancelled, and/or other medications may be prescribed.

• Multiple Birth – is a serious complication of any fertility treatment. Following COH treatment should there be more than 4 follicles ready at the time of ovulation trigger, you will be given a choice of cycle cancellation, follicle reduction, or conversion to IVF in order to limit the potentially dangerous consequence of multiple pregnancy.

Success rates:
The success rate of COH is dependent upon several factors, including a woman’s age, her ovarian reserve, and the reason for her infertility. When used appropriately the following success rates can be achieved.

15%-20% for women age 30 and under
15% for women between the ages of 30-35
10-15% for women ages 35-39
5%-10% for women aged 40.

It may not be a suitable treatment for women over the age of 40.

In vitro fertilization is procedure used to treat certain fertility conditions. With In vitro fertilization, the fertilization of an egg takes place outside of the body. A woman’s eggs are removed from her ovaries, placed in a laboratory culture dish and then mixed with sperm. Fertilization takes place in the dish. Once the eggs have been fertilized and embryos have formed, one to two embryos are placed back inside the woman’s uterus. If the embryo implants in the uterus, the woman becomes pregnant. When is IVF used? IVF is often considered as a first line treatment for women with diminished ovarian reserve and severe male factor infertility in which case ICSI is used. However, it is also indicated for several other reasons and may be needed when other treatments fail or in cases of unexplained infertility. What to Expect: When an IVF cycle is the treatment option you and your physician decide is right for you, you can expect the following.

1. Ovarian Stimulation : Ovarian stimulation is performed (controlled ovarian hyperstimulation) using injectable hormones (gonadotrophins). Cycle monitoring is done using ultrasound scans. The aim of treatment is to develop an appropriate number of eggs in your ovary. This is done by adjusting the dose of the medication based on the results of ultrasound scans and blood tests. Ovulation is triggered (HCG) and egg retrieval is scheduled 36 hours later.

2. Egg Retrieval : Egg retrieval is a surgical procedure performed under conscious sedation in our specially designed operating room at the Oasis Fertility Centre. The retrieval is done using a needle mounted on an ultrasound scan probe. This probe is the same as the one used for cycle monitoring. The eggs obtained are handed to our expert team of embryologists. This procedure takes 20 to 30 minutes.

3. Insemination, Fertilization and ICSI: : Eggs retrieved are either placed in specialized IVF dishes and mixed with your partners sperm, or in cases of severe male factor infertility the sperm is directly injected into the egg using a procedure known as intracytoplasmic sperm injection (ICSI). The fertilized eggs are then placed in our state-of-the-art incubators for further development. At Oasis Fertility Centre we use real-time time lapse monitoring to assess the health of the embryos which helps us decide which are the best embryos to place in your uterus.

4. Embryo Transfer: : Fertilized eggs are called embryos. One or two embryos are transferred into the uterus either on day 3 or 5 of the cycle depending on various factors including the number of embryos available, their quality, and other clinical considerations. This is a painless procedure using a narrow catheter inserted under ultrasound scan guidance. The procedure generally takes 15 to 20 minutes. Progesterone, which was started before the egg retrieval, is continued until your pregnancy test. Progesterone may be in the form of either an intravaginal capsule or intramuscular injection.

5. Freezing of Embryos: When there are more good quality embryos than are being transferred, you will have the option to freeze these embryos so that can be used at another time to try to achieve a pregnancy. The process used to freeze embryos is called vitrification.

6. Pregnancy: A blood pregnancy test is performed approximately 2 weeks following the embryo transfer and is generally repeated within 48 hours to confirm pregnancy. A viability ultrasound scan is performed when you are approximately 6 weeks pregnant. You will then be offered of choice of being referred to your family physician or an obstetrician of your choice.

Complications: There are some risks associated with the IVF Procedure including infection and bleeding, along with:

• OHSS – OHSS is a potentially life-threatening complication of fertility treatment associated with injectable hormones (gonadotrophins). The exact cause of OHSS is unknown although increased leakiness of the blood vessels is thought to be responsible. The severity of OHSS varies from mild to severe. While it is common to experience mild symptoms of abdominal bloating and moderate weight gain, severe cases may be associated with accumulation of fluid in the abdomen, vomiting, diarrhea and shortness of breath. Fortunately, the incidence of severe OHSS is less than 5 %. The treatments used to reduce this complication is careful follicle tracking. Should your physician be concerned about the development of OHSS, your cycle may be cancelled, and/or other medications may be prescribed.

• Multiple Birth – is a serious complication of any fertility treatment.

• Ectopic Preganancy– An ectopic pregnancy occurs when the fertilized egg starts to grow in a location other than the uterus. In 95% of cases, ectopic pregnancies are in the fallopian tube, but they can also occur in other sites. The incidence of ectopic pregnancy is higher after IVF than in a naturally occurring pregnancy. The first indication of an abnormally situated pregnancy is a slowly rising pregnancy hormone in the blood (Beta HCG). However, ectopic pregnancy can only be confirmed by demonstrating an absent pregnancy sac in the uterus, seen by ultrasound. Ectopic pregnancies can be a life-threatening emergency if not detected early. Symptoms include severe lower abdominal pain, shoulder tip pain, abnormal bleeding, fainting and difficulty in urination. It is important to seek medical attention immediately as this condition can be managed medically or by conservative surgery if detected early.

• Miscarriage – A miscarriage is defined as the loss of a fetus before 20 weeks of pregnancy. 80% of miscarriages occur within the first 13 weeks of pregnancy. There is a slightly higher chance (approximately 22%) of a miscarriage when undergoing IVF. Women over the age of 35 have a higher (20% to 35%) chance of having a miscarriage than younger women. Chromosomal abnormality of the fetus is the most common reason why a miscarriage occurs. Women over the age of 35 and men over the age of 40 are more likely to be affected by chromosomal abnormalities than younger couples. If you have had multiple miscarriages Comprehensive Chromosomal Screening (CCS) should be considered.

• Stress – Undergoing any fertility treatment can be physically, emotionally, and financially stressful. We at Oasis Fertility Centre recognize how important it is to alleviate stress as much as possible to improve your fertility treatment outcomes. We have dedicated health care professional that can offer you support and counselling.

Success rates: Success rates for IVF are very dependent upon the age of the woman. National Averages representing live birth rates per embryo transfer, with a woman using her own eggs:

ICSI is a procedure whereby one sperm is injected directly into an egg for fertilization purposes. It is done in conjunction with an IVF treatment. The injection takes place in the lab, after the eggs have been retrieved.

When is it used?
ICSI is used in cases of male infertility. It is quite effective when the male partner has a low sperm count or the sperm has poor motility. It is also used when a man has ejaculation issues and the sperm has to be retrieved either surgically from the testes (mesa/pesa), or in the case of retrograde ejaculation (ejaculating into the bladder) since the sperm must be recovered from the urine. ICSI is also often indicated where fertilization failed in a previous cycle of IVF.

What to Expect:
From a patient perspective, ICSI is exactly the same as undergoing a regular cycle of IVF. The difference is that in conventional IVF several sperm are placed in a dish with the eggs to allow fertilization to occur naturally, where as with ICSI, one sperm is injected directly into the egg with the hope of fertilization occurring.

Complications:
The main complications associated with ICSI are actually those that arise from the IVF procedure itself. These include ovarian hyperstimulation, multiple birth, ectopic pregnancy, miscarriage, and stress. Patients often question if there is a higher risk of birth defects when ICSI is used. To date, research shows that the risk of birth defects after ICSI is the same as for babies conceived by IVF without ICSI. However, some studies have suggested that having IVF with or without ICSI might increase the risk for birth defects.

Success Rates:
ICSI greatly improves the odds of fertilization. Approximately 70% to 85% of eggs are fertilized when using the ICSI procedure. This does not mean that all of the eggs will develop into embryos that are suitable for transfer.

Frozen embryos are those embryos that were not used during a fresh IVF cycle and were frozen to use at a later date. For a frozen embryo transfer, the embryos are thawed and transferred back into your prepared uterus. It does not require the ovaries to be stimulated as they are for an IVF cycle, however, it does require the uterine lining be thickened before transfer.

When is it used?
Frozen embryos seem to have an infinite life span. They can be used to expand your family when you are ready, after an unsuccessful fresh cycle if frozen embryos are available or after CCS.

What to Expect:
In order for the embryo to implant, the uterus must be ready for implantation. Typically, this means that medications such as the birth control pill, Lupron or Synarel will be prescribed to stop you from ovulating unexpectedly. Once your pituitary has been suppressed you will start to take estrogen to thicken the lining of your uterus. Monitoring through transvaginal ultrasound and blood tests will be necessary to make sure that the uterus is thickening as it should. Once the uterine lining is sufficiently thick, progesterone will be added and the Lupron or Synarel will be stopped. Progesterone matures the lining and makes it receptive to embryo implantation. Your transfer will be scheduled accordingly.

Complications:
As with any transfer, there is always a risk of infection or bleeding. If you become pregnant, risks associated with pregnancy such as an ectopic pregnancy, miscarriage, premature birth or multiple birth can also occur.

Success Rates:
Pregnancy success rates after a frozen embryo transfer are the same as that of a fresh IVF cycle. For women under the age of 35, pregnancy rates can be as high as 60 %.

Comprehensive Chromosomal Screening (CCS) is a method used to help us to analyze, select and transfer only the embryos that are normal, thereby increasing the likelihood of a pregnancy. During a cycle of IVF instead of transferring embryos immediately, a few cells from each blastocyst (an embryo which has developed for 5-6 days) are removed and sent for DNA testing. These tests will determine if the blastocysts have the normal number of Chromosomes (23 pairs) and if the chromosomes are structurally normal. The blastocysts are then frozen until the results are received from the testing facility. By selecting an embryo that is chromosomally normal it is likely to result in a full-term pregnancy and healthy baby.

When is it used?
Comprehensive Chromosomal Screening (CCS) is often suggested for couples who appear to be chromosomally normal yet have had repeated IVF failures or have experienced recurrent miscarriage. It may also be prescribed for women of advanced maternal age.

What to Expect:
As noted above, CCS takes place during an IVF treatment cycle. Once the eggs are retrieved and fertilized, the embryos develop into blastocysts (which takes approximately 5-6 days). A few cells (5 to 10) are then taken from each embryo and sent for DNA testing. The embryos are then frozen (vitrified) until the results have been received from the testing facility. Once your physician has been advised as to which embryos are “normal”, Oasis will arrange for you to have a frozen embryo transfer (FET).

Complications:
As with any IVF cycle, you can experience certain complications. These include infection, bleeding, OHSS, and stress. If you become pregnant after your frozen embryo transfer, there is the risk of an ectopic pregnancy, miscarriage or multiple pregnancy.

Success Rates:
Research studies have shown, that CCS can increase the chance of pregnancy by up to 70%.

When is it used?
Single women who wish to have a family but do not have a male partner, same sex female couples, or a couple who has male factor infertility (no sperm, abnormal sperm morphology or sperm that carries a genetic disease) often choose to use donor sperm to achieve a pregnancy.

What to Expect:
Sperm must first be purchased from an approved Health Canada distributor. This sperm has undergone extensive testing, has been frozen and quarantined and then retested to ensure that it does not carry any infectious diseases. A list of suppliers can be found in our resource section. Each supplier has a catalog on their website which provides information on the sperm donor such as the donors race, ethnic origin, hair colour, eye colour and whether the donor is open ID. An open ID donor is one who is willing to release identity information when requested by donor offspring.

On the day of the procedure, the frozen donor sperm will be thawed and washed.

Intrauterine insemination (IUI) will be used to place the donor sperm in the uterine cavity. Timing of the IUI procedure is important. The sperm is placed into the uterus one to two days after ovulation occurs. Monitoring for ovulation is important. This can occur by using an in-home urine ovulation prediction kit. This kit detects when your body produces a surge, releasing luteinizing hormone known as LH. IUI with donor sperm is done 24-36 hours after the surge. It is important to call the nurses line when you detect your surge so that the IUI can be scheduled in the appropriate time frame

Complications:
IUI has very few complications

• Infection – There is a slight risk of developing an infection as the result of placing the catheter into the uterus.

• Bleeding – Placing the catheter into the uterus can cause vaginal bleeding. Bleeding should not impact the chance of a pregnancy.

Success rates:
The highest success rates occur in women who have no known fertility issues and are under the age of 35. Lower success rates are reported for women who have fertility related issues (endometriosis, problems with ovulation, adhesions, etc.) or are over the age of 35. Studies suggest that success rates can vary from 60%to 80%, but this is after several cycles of donor insemination.

Sperm freezing is also known as sperm cryopreservation. It is a method used to preserve sperm cells. Frozen sperm can be stored indefinitely.

When is it used?
Many men choose to freeze their sperm for future use. There are several reasons why this may occur. We recommend sperm freezing under the following conditions Before a medical procedure such as a vasectomy, testicular surgery or radiation therapy/chemotherapy for cancer patients. If you may not be available, the day of treatment (your partner is under going IUI or IVF) As back up if you have difficulty producing a semen sample. If you have a low sperm count that is starting to deteriorate. If you are at risk of injury or death (such as a member of the armed forces being deployed) Before a sex change operation.

What to Expect:
Before sperm can be frozen, you will need to be screened for sexually transmitted diseases including HIV and Hepatitis B and C. The procedure must be booked and paid for in advance. You must abstain from ejaculating (intercourse or masturbation) 72 hours prior to having your sperm frozen. On the day of the procedure you will be asked to masturbate into a sterile container which will be provided to you. We prefer this take place in one of the special rooms designed for this purpose at Oasis. Once the sample is produced, the sperm is frozen and stored in liquid nitrogen.

Complications:
There are no known patient complications resulting from sperm freezing, however, not all sperm may survive the freezing process.

Success Rates:
Pregnancy success rates using frozen sperm may be slightly lower than when using fresh sperm. One ejaculate sample usually can only be used for one cycle of IUI or IVF As with all fertility treatment, pregnancy success depends on a woman’s age.

It is a well-known fact that women’s biological clock results in decreasing fertility and ovarian reserve as they age. This decline is exaggerated after the age of 35. Egg (oocyte) freezing allows the freedom for women to preserve their fertility while their eggs are in their prime.

When is it used?
There are several reasons why you may choose to freeze your eggs. From a social perspective, you may not yet have found the right partner, are concentrating on establishing your career, wish to continue your education, and want to ensure that when you are ready to have a family, you are able to. Oocyte freezing allows you to have this option.

From a medical perspective, oocyte freezing is often recommended for young women undergoing cancer treatment since chemotherapy and/or pelvic radiation has the potential to affect the ovaries. It should also be considered for any surgery which can impact ovarian function, or for women whose families have a history of premature ovarian failure as a result of a chromosomal abnormality or has a history of premature menopause.

What to Expect:
You will be required to have all the same tests as those women undergoing a cycle of IVF (with the exception of the semen analysis).

Once your physician has determined that you are a candidate for egg freezing you will under go the first two steps of the IVF procedure, ovarian stimulation and egg retrieval. Once the eggs have been retrieved they will be examined under a microscope and the mature eggs will be cryopreserved (an ultra rapid cooling technique where the eggs are stored in liquid nitrogen).

Complications:
The complications that can arise from Egg Freezing include infection, bleeding, ovarian hyperstimulation syndrome (OHSS) and stress.

Success Rates:
Egg freezing is a relatively new technology with limited data available on success rates. Pregnancy success rates are dependent upon the age of the woman freezing her eggs and the number of viable eggs frozen.

At Oasis Fertility Centre we help couples and single individuals achieve their dream of parenthood using advanced technologies and personalized fertility care. We are dedicated to offer inclusive treatment options suiting patient’s medical needs. We continuously strive to nurture a compassionate environment for patients and the clinic’s team, alike, making this journey welcoming, comfortable, and safe.

In our efforts to reach out to every patient regardless of their marital status, gender, sexual orientation, race, and belief we are proudly the only fertility clinic in Alberta to be inspected and credentialed as “Compliant” by Health Canada for our Directed Donor (of Eggs / Sperm) Program. We are also partnered with experienced fertility counselors, fertility and surrogacy lawyers, and donor and surrogacy agencies that become an integral part of your parenthood journey offering counsel, advice, and support.

Every patient journey is unique depending on their circumstances and the personalization of the treatment plan. These include intrauterine insemination (IUI), in vitro fertilization (IVF), the use of directed (known) & anonymous donor sperm, the use of directed (known) & anonymous donor egg, gestational carrier, genetic testing, fertility preservation (egg freezing and sperm freezing).

Your journey at Oasis begins with a consultation with Dr. Imran Pirwany, assessment of your circumstances, and discussing the treatment options. Based on which, an individual treatment plan is devised by Dr. Pirwany.

Assigned Male at Birth (AMAB) Family Groups

Directed (known) donor eggs

Anonymous donor eggs

Gestational Carrier (Surrogate)

Shared IVF for couples

Assigned Female at Birth (AFAB) Family Groups

Directed (known) donor sperm

Anonymous donor sperm

IUI

IVF

Shared IVF for couples

Transgender Family building 

Directed (known) donor sperm / egg

Anonymous donor sperm / egg

Gestational Carrier (Surrogate)

IUI

IVF

Fertility Preservation

Matris™ is the only non-invasive diagnostic test that prevents a failed IVF cycle due to poor endometrial receptivity. With 25 years of science behind it, Matris™ gives you the clinical answers you need — quickly and easily.

You want to have the best chance of conceiving. When every variable counts, Matris™ helps your Assisted Reproductive Technology (ART) team make confident, informed decisions.

How It Works

The quality of an embryo and the receptiveness of the endometrial lining (the membrane which lines the uterus) are the two main factors for fertility. During each cycle, the endometrial lining changes in response to reproductive hormones. It also varies from patient to-patient, with different medications, and even from cycle-to-cycle. Knowing the optimal time for an embryo transfer is of critical importance during assisted reproduction cycles. Matris™ revolutionizes the ability to interpret and assess endometrial quality — so that you can improve your fertility odds.

To benefit from Matris™ technology, an additional ultrasound image is taken at the time of egg retrieval and then analyzed to create your Matris™ score. This estimates the probability of pregnancy on a transfer of a high-quality embryo during that cycle.

How your Matris™ score is used:

• It helps your clinician assess whether to proceed with the embryo transfer or consider freezing (or thawing) embryos for future cycles

• It evaluates endometrial development during mock transfer cycles, assists with understanding the synchronization between the ovaries and uterus during medicated cycles, and improves results during an elective single embryo transfer.

• It preserves the best quality embryo for the most receptive endometrium to increase your chances of pregnancy.

• It enables your clinician to make timely, informed decisions — well in advance of your transfer date.

Benefits

• Reduce Risk: an ultrasound image taken during regular ART protocols — there is no need for a biopsy

• Saves Money: it is invaluable when embryos are limited or ART costs are a factor

• Improves Assessment: it provides predictive assessment of endometrial quality for embryo transfers in fresh and FET cycles

• Increases Data: it enhances information on endometrial quality for each real and mock cycle

• Clinically Proven: it has been proven in clinics across North America and Europe

• Improves Outcomes: it increases your chance of pregnancy, reduces the number of transfers in sub-optimal cycles, and shortens intervals to pregnancy