Types of Assisted Reproductive Technologies (ART): Ovulation induction, IUI, IVF, FET

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.