In Canada, about 11.5 to 15.7% of couples experience infertility. After a certain period of time (1 year for people under 35, and 6 months for those 35 years or older), couples may choose to visit a fertility clinic to determine if there are any underlying issues keeping them from getting pregnant, and exploring what their options are.

Down below, I’ll be outlining the most common types of ART.

Ovulation Induction

Around ovulation, your body should be releasing an egg to be fertilized. However, if no egg is being released, this would lead to anovulation (which is the most common cause of infertility).

Ovulation induction uses certain medications to induce ovulation and lead to the release of an egg. These medications may include:

• Gonadotropins (synthetic FSH or LH, GnRH agonist, GnRH antagonist)
• Letrozole
• Clomid citrate
• hCG

Intrauterine Insemination (IUI)

IUI is a type of ART that inserts concentrated sperm (from a partner or donor) into a woman’s uterus (bypassing the cervix) around ovulation.

Cycle monitoring would be performed to determine when ovulation is happening.

This can be either a ‘natural’ cycle where no medications are used. Or, it can be a medicated cycle where there’s ovulation induction and/or a trigger shot.

Implantation will usually happen between 5-10 days later.

Who would benefit from IUI?

• Anyone with unexplained subfertility
• Male factor subfertility (ie. low sperm count, retrograde ejaculation, erectile dysfunction)
• Cervical factors (ie. mucus or cervical hostility)
• Endometriosis
• Couples with sexual dysfunction

Who would not benefit from IUI?

• Cervical issue (ie. blocked/narrow opening of the cervix, infections)
• Blocked tubes
• Severe sperm abnormalities (<5mil motile sperm)
• Amenorrhea
• After 6 failed attempts

In Vitro Fertilization (IVF)

This is the most common ART cycle in Canada. It involves the egg being fertilized by sperm in a lab setting. Medications are used throughout the cycle to produce around 10-22 eggs. Cycle monitoring is performed to assess follicular and endometrial development. Ovulation is stimulated to control for timing. Egg retrieval usually happens 36 hours after a trigger shot.

When eggs are retrieved, they are fertilized with sperm. This can happen naturally or through intra cytoplasmic sperm injection (ICSI) where sperm is injected into a mature egg.

The fertilized eggs (now called embryos) are incubated until the transfer day (usually day 3 or 5 of embryo development), where they are transferred into the uterus.

After retrieval, medications like progesterone can be used to produce a more favourable environment for the embryos.

Who would benefit from IVF?

• Unexplained subfertility
• Age-related subfertilty (ie. decreased ovarian reserve)
• Tubal issues (ie. blocked or damaged tubes)
• Endometriosis
• Cervical isses
• Uterine issues
• Hormone disorders
• Male factor infertility

Frozen Embryo Transfer (FET)

FET occurs when previously frozen embryos are thawed and transferred into the uterus. These embryos are usually prepared during a previous IVF cycle where there may be a surplus of embryos, if there were any complications or findings in a past IVF cycle, or simply for preserving fertility.

Implantation usually happens 2-5 days after the transfer.

Next Steps

Naturopathic Medicine can certainly play a huge role in combination with infertility. Particularly when we understand that it takes about 100 days for eggs to mature (that’s 3 menstrual cycles!).

Studies have shown that couple going through IVF specifically, are more successful if they are addressing their health prior to ART.

Things that I like to pay attention to, before and during IVF, are:

• Nutritional support for mom and embryo
• Supporting mitochondrial function
• Supporting ovarian health
• Protecting against oxidative stress
• Decreasing inflammation
• Managing and decreasing physical and emotional stress
• Supporting the immune system

For more information on how Naturopathic Medicine can support you during your ART journey, I encourage you to book a free 15 minute consult with me.

When you first start working with a fertility clinic, cycle monitoring is done as it determines when you’re ovulating so your fertility doctor can figure out the best time for insemination or have sex – to ultimately increase your chance of a pregnancy.

Cycle monitoring is done for:

• Natural cycles
• IUI, where ovulation timing is determined
• IVF, to measure the number and size of the follicles
• Donor cycles, where uterine lining is determined in the recipient

Monitoring is typically done in the mornings to get the best glimpse of your hormones, and to determine how you are responding to any drugs you may be taking.

When does cycle monitoring start?

Cycle monitoring takes place in the first half of your menstrual cycle. It begins when you start your period, and are experiencing substantial flow, not spotting. You will usually need to visit your fertility clinic around days 2-4 of your period where blood testing and ultrasounds will be done.

What does cycle monitoring monitor?

Blood work measures estrogen levels, a hormone that’s necessary for follicular growth as well as development of the uterine lining. Your ovarian reserve is also measured because your doctor will be looking for 6 to 10 follicles that will continue to grow in the next few days.

Ultrasounds are also done to visualize the progressive growth of the follicles and lining. Right before ovulation happens, a dominant follicle should be about 20 to 24mm in diameter. This, along with hormones (estrogen and LH), will indicate that ovulation will happen.

What happens after ovulation?

At ovulation, the dominant follicle is released, and is basically waiting for sperm to fertilize it. Your doctor may give you a trigger shot of hCG to facilitate ovulation.

At this point, you will be told to have sex or an insemination is done once (or twice) to fertilize your egg.

Depending on the type of cycle you have, you might go back to the clinic in the luteal phase to measure your progesterone levels, or and ultimately determine if you are pregnant.

Final Thoughts

Cycle monitoring can be particularly stressful because of the frequency of visits, as well as feeling anxious about how your hormones and follicles are doing.

Because you have a lot on the line – time, money, hope, there’s a desire to get everything right. Do the best you possibly can to get the outcomes you want. Expanding your health team, potentially including a naturopathic doctor, may support and enhance these treatments.

It’s no secret that infertility is on the rise. Women often delay parenthood to pursue higher education, advance their career and attain financial security. Because of this, as their age increases, as does their use of assisted reproductive technologies (ART) to become pregnant.

Acupuncture and IVF

When someone is on the IVF journey, they often use acupuncture as an adjunctive treatment as it has been shown to help with IVF success. Acupuncture is helpful in a couple of ways as it:

• Promotes and increases blood flow to your ovaries and uterus
• Causes the release of neurotransmitters to your brain which increases ovulation, menstrual regularity and overall fertility 
• Reduces stress and anxiety associated with IVF
• Decreases chances of miscarriage
• Decreases side effects of medications

In fresh, non-donor cycles, studies show that using acupuncture was associated with more live births and fewer biochemical pregnancies (compared to IVF alone). In fresh donor cycles, adding acupuncture was associated with more live births.

In the previous study, they use more than just a defined set of acupuncture points. Treatment may also include herbs, dietary and lifestyle recommendations, as well as vitamins or minerals. This serves as a reminder that individualized medicine is important, and can result in the effects that you want (aka. a live birth). 

When should you start acupuncture?

Unfortunately, having acupuncture done before and after your embryo transfer only isn’t good enough. Yes, it helps to reduce stress (which is incredibly important, because IVF is stressful), but it’s not sufficient to improve birth outcomes.

If you can, it’s best to begin weekly acupuncture treatments at least 3 cycles before you begin IVF as this increases your chance of live birth. Definitely consider starting when you are in the down regulation phase (ie. taking lupron or birth control).

Next Steps

(Unsurprisingly) a Naturopathic Doctor can help you as you tackle IVF! Not only can we help you with acupuncture, but we also take the time to go over your diet, lifestyle habits, and any herbs and vitamins that you might be taking.

References

Prior, Eugenie et al. “Fertility Facts, Figures And Future Plans: An Online Survey Of University Students”. Human Fertility, 2018, pp. 1-8. Informa UK Limited, doi:10.1080/14647273.2018.1482569.

Hullender Rubin, Lee E. et al. “Impact Of Whole Systems Traditional Chinese Medicine On In-Vitro Fertilization Outcomes”. Reproductive Biomedicine Online, vol 30, no. 6, 2015, pp. 602-612. Elsevier BV, doi:10.1016/j.rbmo.2015.02.005.

Hullender Rubin, Lee E et al. “Acupuncture And In Vitro Fertilisation Research: Current And Future Directions”. Acupuncture In Medicine, vol 36, no. 2, 2018, pp. 117-122. BMJ, doi:10.1136/acupmed-2016-011352.