WHAT IS OVULATION?

A standard menstrual cycle is 28 days. Day 1 is the first day of red bleeding.

Usually ovulation occurs  on the 14th day of a woman’s cycle.

If the egg is not fertilized, a menstruation cycle will begin on Day 28. Starting over on day 1.

**every woman is different, a normal cycle is around 25-35 days**

WHICH TREATMENTS ARE AVAILABLE?

Ovulation Induction Without Insemination:

One treatment considered by couples seeking help with ovulation without insemination is taking pills, Femara (letrozole) or clomiphene, depending on the treatment prescribed by the doctor. This medication is taken for five days every cycle. Couples then have sexual relations during the month, ideally mid-cycle. This continues month after month until they become pregnant. Ideally the TIME FRAME for this treatment is 6 months.

Ovulation Induction With Intrauterine Insemination (IUI):

Artificial insemination (IUI), is a simple procedure in which semen is collected, concentrated and deposited into a woman’s uterus.

As in the above-mentioned step, the process of taking pills, as per the treatment prescribed by the doctor. An ultrasound will be performed between day 8 and 12 to see the ovarian response, the endometrial line and to determine the best time for insemination.

An injection of Ovidrel or HCG (choriogonadotropin alpha, or human chorionic gonadotropin), helps follicle maturation and triggers ovulation (the release of mature eggs from the ovaries).

Reconstitution HCG:

Explanation about Ovidrel: 

The insemination technique is performed by introducing sperm into a woman’s uterus through a small catheter. The sperm is pre-processed using laboratory techniques to ensure only the best is used. It takes place about 36 hours after the onset of ovulation. Here is an explanatory video: 

Pregnancy rates are 40-45% over 3 or 4 cycles in women aged 35 and under in cases of unexplained infertility without a male factor. Usually 3 or 4 cycles of this treatment are tried.

Super Ovulation With Insemination:

Two protocol aides for procreation are performed: Super Ovulation with Gonal F or Modified Natural Super Ovulation with Femara (letrozole) and Gonal F. The doctor will discuss with you the best treatment option  according to your medical assessment.

• Super Ovulation with Gonal F: treatment begins at the start of the cycle (day 2) until an ultrasound is performed around day 8 to 10.
• Modified Natural Super Ovulation with Femara: treatment starts at the start of the cycle (day 2) with Femara (letrozole), and Gonal F is added until an ultrasound is performed around day 8 to 10.

Video using GONAL F: 

The ultrasound will be used to evaluate the ovarian response and determine the best time for insemination.

An injection of Ovidrel or HCG (choriogonadotropin alpha, or human chorionic gonadotropin), helps follicular maturation and triggers ovulation (the release of mature eggs from the ovaries)

Reconstitution HCG :

 or GYNESYS sheet in CC

Explanation about Ovidrel:

The insemination technique is performed by introducing sperm into a woman’s uterus through a small catheter. The sperm is pre-processed using laboratory techniques to ensure only the best are used. It takes place about 36 hours after the onset of ovulation.

Here is an explanatory video:

Pregnancy rates are 40-45% over 3-4 cycles in women aged 35 and under in cases of unexplained infertility without a male factor. Usually 3 or 4 cycles of this treatment are tried when Ovulation Induction with or without Intrauterine Insemination (IUI) treatment has not resulted from pregnancy.

In Vitro Fertilization (IVF):

In vitro fertilization or IVF is the process of removing eggs from a woman’s ovaries and fertilizing them with sperm in a laboratory. Embryos that develop for several days (usually 3-5) will then be frozen. Then during another cycle they will be transferred to the woman’s uterus. The process is known as frozen embryo transfer, FET.

IVF is used in conjunction with a multitude of drug protocols to produce more eggs of better quality.

Here is an explanatory video:

In the context of in vitro fertilization (IVF), the ovaries must be stimulated for the purpose of making several eggs grow simultaneously. Hormonal injections are usually needed at this stage. These injections increase the growth and maturation of the eggs. This stimulation step is monitored using blood tests and ultrasounds.

An injection for ovulation of the eggs is given 36 hours before the puncture. The egg puncture is usually done under light or local anesthesia. The number of eggs retrieved will depend on your age, history, fertility diagnosis, drug protocol, and response to medications.

The sperm is collected on the day of the puncture (sometimes before if it has been frozen), it is then “cleaned” of its seminal plasma and prepared in order to recover the most mobile and typical (normal) sperm. The prepared sperm is introduced into the woman’s egg cells through ICSI. The embryos are cultured for 48 hours to 6 days and then frozen.

Here is an explanatory video:

Embryos are classified according to their cellular quality, namely: their number of cells, their regularity (different cell sizes or not), and their fragmentation.

After developing the embryos inside a lab for several days (usually 3-5) they will then be frozen. Then during another cycle they will be transferred to the woman’s uterus. The process is known as frozen embryo transfer, FET.

**IVF is not covered under RAMQ**

Egg donation (Donor egg and IVF):

A fertilization cycle (IVF) with the eggs of another woman (usually a young, healthy and fertile donor) are fertilized and the embryo (s) are  implanted in the recipient’s uterus. Incredibly, the use of donor eggs gives recipients a similar chance of success as young fertile women who donated the eggs.

The main reasons for using donor eggs for IVF:

Repetitive IVF failures, age, ovarian reserve, genetics, for fertility after cancer treatment etc.

Donor: All donors were screened for diseases that are most strongly linked to genetics and selected according to several specific guidelines.

Above all, the minimum pre-treatment assessment of the recipient couple includes: assessment of the uterine cavity within one year. Blood tests for the pregnant woman and her spouse or sperm donor as well as a semen test within 1 year. All of this will be done with our GYNESYS team.

• Spouse’s sperm:

The spouse will have to come a few days before the donor’s cycle to give a sample which will be frozen before the donor’s cycle.

Likewise, if a donor’s sperm is used, the sperm must be in our office before the cycle begins.

• Donor: The chosen donor will do her IVF cycle and on the day of her puncture, your spouse’s or donor sperm will be used to create embryos. The embryos are cultured for 48 hours to 6 days and then frozen. Here is an explanatory video ICSI

Embryos are classified according to their cellular quality, namely: their number of cells, their regularity (cell sizes different or not), and their fragmentation.

After developing the embryos inside a lab for several days (usually 3-5) they will then be frozen. Then during another cycle they will be transferred to the recipient’s uterus. The process is known as frozen embryo transfer, FET.

**The egg donation is not covered under RAMQ**

Frozen Embryo Transfer (FET):

For both IVF and egg donation the process after the puncture is the same.

** (Stage 1 IVF and Stage 2 Transfer. Sometimes tests or a surgery need to take place  before) **

The transfer will take place during  another menstrual cycle with frozen day 3 or 5 embryos.

For this, you will need drug  stimulation to ensure the uterus’ endometrium quality to receive the embryos through a  Gynesys ultrasound. The transfer is the  act of placing one or more embryos back into the uterine cavity. It is done by inserting a catheter into the uterus through the cervical neck. The embryo transfer is painless or very painless and does not require anesthesia.

After this transfer, it takes approximately 10-12 days to be sure a pregnancy develops. This is the time it needed for the β-HCG, the hormone secreted by the embryo, to appear in the blood at a detectable concentration, which serves as a diagnosis for pregnancy.

**The FET is not covered under RAMQ**