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Fertility Treatments & Services

More than 15% of patients within reproductive age face challenges with fertility. We aim to educate our patients and the public about how advancements in reproductive health can overcome these challenges.

We can help you achieve reproductive health.  We use the very latest in diagnostic equipment, ultrasound, and other medical technology. Our fertility laboratories are world-class, and uur fertility treatments are designed to help patients with a range of specific reproductive needs. Please contact us today to learn more.

A patient is consulted by a fertility doctor at PCRM

Intrauterine Insemination (IUI)

IUI is typically performed in women receiving ovarian stimulation with clomiphene citrate or follicle stimulating hormone (FSH).

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For women with anti-sperm antibodies in their cervical mucus or “poor” mucus and for men with mild male factor infertility, intrauterine insemination (IUI) is a common first-line fertility treatment where washed and concentrated sperm are placed directly into the uterus to maximize the chances of fertilization.

IUI is typically performed in women receiving ovarian stimulation with clomiphene citrate or follicle-stimulating hormone (FSH). These treatments require close monitoring with ultrasound, estradiol levels, and physical examination to optimize the chances of pregnancy and to avoid hyperstimulation and multiple pregnancies.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is commonly performed in couples whose infertility investigations have failed to detect a specific cause of infertility (unexplained infertility) or have shown mild male factor infertility. It is also used for therapeutic donor insemination. The procedure involves the placement of prepared (“washed”) sperm into the female partner’s uterus using a small sterile catheter (fig 1).

In order for insemination to be successful, it must be performed prior to ovulation of the egg. To detect ovulation, urine ovulation predictor kits (OPK) are recommended, which detect the LH surge. These kits are available at PCRM as well as most pharmacies without a prescription. Electronic fertility computers/monitors are not recommended while using fertility medication as the higher hormone levels may give a false reading.

The insemination procedure itself requires a visit to the clinic by both partners. During the week, the male partner is required to produce a sperm sample around noon on the day of insemination, with the IUI occurring around 2 pm that afternoon. On weekends and holidays, the sample collection and IUI are performed in the morning. The insemination is typically performed by the nursing staff and is similar to having a Pap test. It is typically little or no discomfort experienced during the IUI procedure.

Generally, insemination is done each month until pregnancy is achieved or sufficient inseminations have been done to suggest that alternative treatments may be necessary. We will recommend a consultation with your physician after 3-4 inseminations have been completed to evaluate your treatment plan. For various reasons (e.g. vacations, illness) it may not be possible for you to have consecutive inseminations performed. This is not a problem and does not affect your chances of success.

The overall pregnancy rate with superovulation (production of more than one egg) and IUI is 10-20%, with a multiple pregnancy rate of 20-30%. This rate may appear low but is considerably higher than if the couple continued on their own. Your physician will discuss your individual situation and help you to understand your chances for success and treatment options. For couples with infertility, the pregnancy rate with IUI without medication is not higher than simply timing intercourse, so medication will traditionally be recommended.

Figure 1: Intrauterine insemination (IUI)
Figure 1

Superovulation IUI

Superovulation, or Controlled Ovarian Hyperstimulation (COH), combined with IUI has been demonstrated to be an effective method of treatment for couples where less invasive therapies have not been successful in achieving a pregnancy. The goal of superovulation is to increase both the number of eggs released (3-4 per cycle) to help offset the normal age-related decline in egg quality, that all patients experience to a certain degree. Multiple eggs are generated with the administration of follicle-stimulating hormone (FSH), which is the same hormone that the woman’s brain naturally produces to make eggs. Given the potential for the production of an excessive number of eggs, patients doing this treatment require close supervision through a fertility centre, to monitor ovarian follicle (contain the eggs) numbers and estradiol levels. Once the follicles have reached the optimum size (18-20 mm), an injection of a hormone called hCG to cause or “trigger” ovulation. HCG is in fact the pregnancy hormone but very similar to the hormone that is naturally released from the brain to cause ovulation. Intrauterine inseminations are typically performed 24 to 36 hours later. HCG is the pregnancy hormone, but structurally very similar to the hormone that causes ovulation naturally, luteinizing hormone (LH). IUI is always recommended when doing superovulation as this has been shown to optimize the likelihood of conception.

The most common side effects with superovulation are lower abdominal fullness and bloating. The most significant risks are high-order multiple pregnancies and ovarian hyperstimulation syndrome. The majority of multiple pregnancies are twins; however, more than two fetuses can sometimes develop. The risk of high-order multiples is actually greater with superovulation cycles compared to IVF, since the number of eggs ovulated cannot be precisely controlled, unlike IVF where eggs are retrieved and a select number of embryos are replaced.

Frequently Asked Questions

What is IUI’s success rate?

Studies have demonstrated that infertile couples treated with IUI will at least double their chances of conception when compared to timed intercourse or intracervical insemination.

Do I need to take medications with my IUI treatment?

Frequently, the IUI procedure is performed in combination with ovulation induction. This may be done using an oral medication called clomiphene citrate or with daily injections of gonadotropins (follicle-stimulating hormone [FSH]).

How does IUI increase my chance of pregnancy?

The IUI procedure works by concentrating the healthiest sperm in the ejaculate and placing the “washed” sperm into the uterus adjacent to the fallopian tube. This bypasses any potential cervical factor problems and removes the sperm that are less likely to fertilize the egg.

What is IUI's success rate?

Studies have demonstrated that infertile couples treated with IUI will at least double their chances of conception when compared to timed intercourse or intracervical insemination.

Do I need to take medications with my IUI treatment?

Frequently, the IUI procedure is performed in combination with ovulation induction. This may be done using an oral medication called clomiphene citrate, or with daily injections of gonadotropins (follicle stimulating hormone [FSH]).

How does IUI increase my chance of pregnancy?

The IUI procedure works by concentrating the healthiest sperm in the ejaculate, and placing the “washed” sperm into the uterus adjacent to the fallopian tube. This bypasses any potential cervical factor problems, and removes the sperm that are less likely to fertilize the egg.

Sperm in a dish | PCRM Fertility Clinic Vancouver

Egg Freezing

Eggs can be frozen at their best quality and used to make a family in the future

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Egg freezing is done for a variety of reasons, including fertility preservation after the diagnosis of cancer, but also for social reasons.  For information on egg freezing or sperm freezing before cancer treatments please see our section on Cancer Fertility Preservation.

Egg Freezing Revolution

Social egg freezing refers to the banking of eggs for the purpose of delaying childbearing.  In 2013 the American Society for Reproductive Medicine (ASRM) removed the ‘experimental’ label from this technology, and since then its popularity has increased exponentially.  Social egg freezing is important because women in our society are choosing to have children later in life.  According to Statistics Canada 2010 marked the first time in our history that more women in their 30’s were having children than women in their 20’s.  In British Columbia the percentage of live births to women age 35 and older rose from 11% in 1990 to 23 % in 2011.  The most common reason that women delay having a family is the lack of a suitable partner.

In order to freeze eggs, a woman must undergo a very similar process to an IVF cycle.  This involves injections of gonadotropin hormones for approximately 10 days to stimulate the eggs to grow.  The eggs are then removed from the ovaries and checked under a microscope for maturity.  Unfortunately, egg quality cannot be tested at this point but it can be inferred based on a woman’s age.  Mature eggs are then frozen (cryopreserved) using flash-freezing technology called vitrification. Eggs can be frozen for an indefinite amount of time without damage to the eggs.  According to Canadian guidelines, women can use their frozen eggs to achieve a pregnancy up until age 50.

Here are some helpful articles by PCRM doctors that might be of interest to you:

Frequently Asked Questions

What is the ideal age to freeze eggs?

Because a woman is born with all of her eggs, the decrease throughout life in both quality and quantity.  The ideal age to freeze eggs is around 34 years, although many women choose to wait until later in life and they can still have excellent results.  Our doctors published a review of social egg freezing in the British Columbia Medical Journal which can be found here if you would like to read more.

What is vitrification?

Vitrification (a.k.a. flash freezing) provides the ability to freeze eggs and embryos with a much higher degree of success than the ‘slow freezing’ method used in the past.  In vitrification, the tissue undergoes a controlled plunge into liquid nitrogen, within a protecting solution.  The thaw process permits excellent cell recovery, and in several trials, the survival rates of embryos is up to 15X higher versus older techniques.  This superior method permits multiple new fertility treatments such as high performance egg freezing, embryo biopsy for genetic screening, and a myriad of other benefits.

How much does egg freezing cost?

For an outline of costs, please see our Fees section.

The total cost of egg freezing, including medications, can range from $10 – 14 000. Our fees include the first year of storage. If you have extended medical insurance you might want to check whether fertility medications and/or fertility treatment procedures are covered. A list of Drug Identification Numbers (DINs) can be found here.

How long does the egg freezing process take?

The process for egg freezing is very similar to an IVF cycle.  You will take hormone injections for approximately 8 – 12 days and have regular ultrasounds to check on the follicle growth. Ultrasounds occur in the morning between 7 – 9 am and you should be prepared to attend at least 3 – 5 visits. You will have 2 days’ notice before your egg retrieval. On the day of egg retrieval you should take the day off work and ensure you have a ride home. You will be sedated for the egg retrieval, which takes about 10 minutes and is minimally invasive. In total that day, you will be at our centre for 1 – 3 hours and you might feel sleepy, bloated and/or have mild nausea that day.

Can I workout during my egg freezing cycle?

No, you cannot do heavy exercise during your treatment cycle. Because your ovaries will be enlarged, they are at risk for twisting (ovarian torsion) or trauma if you exercise. Gentle activity such as walking is safe and encouraged. You can resume your normal exercise routine about 7 – 14 days after your egg retrieval when you get a period.

What are the side-effects of egg freezing?

The most common side-effects of ovarian stimulation are bloating and abdominal fullness or cramping. Some people experience mild headaches or nausea. The injections may cause pain or bruising at the injection site.

The egg retrieval procedure is minimally invasive. Under ultrasound guidance, a needle is passed through the top of the vagina into the ovaries, in order to suction out the follicular fluid containing the eggs. Serious risks of this procedure are considered rare but can include infection, bleeding or damage to the bladder, bowel or internal blood vessels.

Does egg freezing cause me to go into menopause earlier?

No, egg freezing does not cause early menopause. Each month the ovaries produce a cohort (group) of eggs. Normally, one of these eggs ovulates and the rest die. That process repeats, month after month, regardless of whether a woman is on the birth control pill, pregnant, breastfeeding, etc. Therefore, when we remove eggs for freezing, we are removing eggs that would have died anyway – so the process does not ‘waste’ eggs or lead to earlier menopause.

What is the ideal age to freeze eggs?

Because a woman is born with all of her eggs, the decrease throughout life in both quality and quantity.  The ideal age to freeze eggs is around 34 years, although many women choose to wait until later in life and they can still have excellent results.  Our doctors published a review of social egg freezing in the British Columbia Medical Journal which can be found here if you would like to read more.

What is vitrification?

Vitrification (a.k.a. flash freezing) provides the ability to freeze eggs and embryos with a much higher degree of success than the ‘slow freezing’ method used in the past.  In vitrification, the tissue undergoes a controlled plunge into liquid nitrogen, within a protecting solution.  The thaw process permits excellent cell recovery, and in several trials, the survival rates of embryos is up to 15X higher versus older techniques.  This superior method permits multiple new fertility treatments such as high performance egg freezing, embryo biopsy for genetic screening, and a myriad of other benefits.

How much does egg freezing cost?

For an outline of costs, please see our Fees section.

The total cost of egg freezing, including medications, can range from $10 – 14 000. Our fees include the first year of storage. If you have extended medical insurance you might want to check whether fertility medications and/or fertility treatment procedures are covered. A list of Drug Identification Numbers (DINs) can be found here.

How long does the egg freezing process take?

The process for egg freezing is very similar to an IVF cycle.  You will take hormone injections for approximately 8 – 12 days and have regular ultrasounds to check on the follicle growth. Ultrasounds occur in the morning between 7 – 9 am and you should be prepared to attend at least 3 – 5 visits. You will have 2 days’ notice before your egg retrieval. On the day of egg retrieval you should take the day off work and ensure you have a ride home. You will be sedated for the egg retrieval, which takes about 10 minutes and is minimally invasive. In total that day, you will be at our centre for 1 – 3 hours and you might feel sleepy, bloated and/or have mild nausea that day.

Can I workout during my egg freezing cycle?

No, you cannot do heavy exercise during your treatment cycle. Because your ovaries will be enlarged, they are at risk for twisting (ovarian torsion) or trauma if you exercise. Gentle activity such as walking is safe and encouraged. You can resume your normal exercise routine about 7 – 14 days after your egg retrieval when you get a period.

What are the side-effects of egg freezing?

The most common side-effects of ovarian stimulation are bloating and abdominal fullness or cramping. Some people experience mild headaches or nausea. The injections may cause pain or bruising at the injection site.

 

The egg retrieval procedure is minimally invasive. Under ultrasound guidance, a needle is passed through the top of the vagina into the ovaries, in order to suction out the follicular fluid containing the eggs. Serious risks of this procedure are considered rare but can include infection, bleeding or damage to the bladder, bowel or internal blood vessels.

Does egg freezing cause me to go into menopause earlier?

No, egg freezing does not cause early menopause. Each month the ovaries produce a cohort (group) of eggs. Normally, one of these eggs ovulates and the rest die. That process repeats, month after month, regardless of whether a woman is on the birth control pill, pregnant, breastfeeding, etc. Therefore, when we remove eggs for freezing, we are removing eggs that would have died anyway – so the process does not ‘waste’ eggs or lead to earlier menopause.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) refers to fertilizing an egg, with a sperm, outside of the body. Fertilization occurs in a dish in the laboratory, which is why IVF translates to "fertilization in glass".

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In vitro fertilization (IVF) refers to fertilizing an egg, with a sperm, outside of the body. Fertilization occurs in a dish in the laboratory, which is why IVF translates to “fertilization in glass”.  The embryos are then grown (cultured) for five to six days in an incubator before being transferred back into the uterus to create a pregnancy.

There are 6 phases of an IVF cycle: pituitary suppression, ovarian stimulation, egg retrieval, fertilization, embryo transfer and luteal phase support.

Phase 1: Pituitary Suppression

Medications called GnRH agonists (Lupron) and GnRH antagonists (Orgalutran or Cetrotide) are used to inhibit production of the ovulatory hormone luteinizing hormone (LH) from the pituitary gland in the brain, to protect from a “LH surge” and premature ovulation. If a premature LH secretion occurs, the eggs could be lost from the ovary prior to the egg retrieval (ovulation), and the lining of the uterus (endometrium) put “out of phase” relative to the developmental stage of the embryos generated from the cycle, with failure to implant in the uterus.

Phase 2: Ovarian Stimulation

Ovarian stimulation involves the production of multiple ovarian follicles (fluid-filled sacs that contain the eggs). In a normal menstrual cycle, the ovaries typically produce a single mature egg. In IVF, we aim to grow many mature eggs to optimize a patient’s chances of pregnancy. An ideal egg number is considered to be 8 – 20 eggs but it varies widely depending a patient’s ovarian reserve.

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are administered by injection to stimulate the ovaries to grow many eggs. These injectable medications are required for 8-14 days (on average 10). The follicular development is monitored by a series of transvaginal ultrasounds and estradiol (E2) levels (fig 2). Once there are at least 2-3 follicles measuring at least 17mm in diameter the trigger shot is given (human chorionic gonadotropin (hCG) or triptorelin) is given to re-initiate meiotic development within the eggs (clinically referred to as maturation) and loosen the egg complex from the follicle wall to facilitate extraction during the egg retrieval procedure. HCG also serves to stimulate progesterone production from the ovary (corpus luteum generated at each follicle site) and thus provides luteal phase support for the implanting embryo and subsequent pregnancy. The trigger shot is administered by subcutaneous injection 36 hours prior to egg retrieval.

Figure 2: Ultrasound appearance of ovaries following stimulation with follicle stimulating hormone (FSH).

Ultrasound appearance of ovaries

Phase 3: Egg Retrieval

Egg retrieval is an ultrasound-guided needle aspiration procedure to drain the follicular fluid from the ovary (fig 3). Most are performed under conscious intravenous sedation using an opioid and benzodiazepine (fentanyl and midazolam). The fluid is then examined under a microscope by the embryology staff. Once eggs are located they are cultured in an incubator until the time of insemination or ICSI approximately 4 hours later, as described below.

Figure 3: Transvaginal egg retrieval for in vitro fertilization.

Transvaginal egg retrieval for in vitro fertilization

Phase 4: Fertilization and Embryo Culture

Eggs suitable for fertilization (mature) can undergo the process of fertilization, which starts the afternoon of egg retrieval. Embryology staff process the semen specimen provided by the male partner or donor and either perform standard IVF insemination by adding approximately 50,000 sperm to eggs in a culture dish, or directly inject the mature eggs with a single sperm through the process of intracytoplasmic sperm injection (ICSI).

The eggs are examined the next morning for evidence of fertilization, at which time they are termed zygotes, or a single-cell embryo. Embryos are cultured for 5 days prior to embryo transfer and observed regularly to follow their growth and appearance (fig 4). Various methods are used to assess the “quality” of the embryos. At PCRM we use a combination of visual grading under a microscope, time lapse imaging (Embryoscope™) and preimplantation genetic testing. On the 5th day of development the embryo is over 200 cells in size (blastocyst stage). This is the best stage of
development to select embryos that are most likely to lead to pregnancy, and also the stage that cells can be removed for genetic screening (preimplantation genetic testing).

Figure 4: Developmental day 3 and day 5 (blastocyst) embryos.

Fertilization and Embryo Culture  Day 3

Fertilization and Embryo Culture  Day 5

Phase 5: Embryo Transfer

Embryo transfer occurs 5 days after egg retrieval. The timing of embryo transfer is determined by the number of embryos and their quality.  The number of embryos transferred is based on several patient-specific considerations including the age of female partner, quality of embryos, past fertility history, and very importantly, the implantation rate (probability of each embryo developing in the uterus) of the particular clinic. The patient is requested to have a full bladder so that transfer may be visualized using ultrasound guidance and also helps straighten the uterus. The embryos are loaded into a soft, flexible catheter attached to a syringe and passed through the cervix into the uterus (fig 5). Gentle pressure is then applied to the catheter syringe and the embryos are released into the uterus.

Figure 5: Ultrasound-guided embryo transfer.

Ultrasound-guided embryo transfer

Phase 6: Luteal Phase Support

The IVF process requires the supplementation of progesterone to support the endometrial lining at the time of implantation and early pregnancy. Following the pituitary gland suppression that is required for treatments like IVF, endogenous production of progesterone can be inadequate and result in a luteal support deficiency and pregnancy loss. As mentioned previously, hCG stimulates progesterone production from the ovaries, and combined with a long half-life (48 hours) in the circulation, provides for an excellent form of luteal phase support. Progesterone supplementation is most commonly given as either vaginal suppositories or intramuscular injections.

Frequently Asked Questions

What is the difference between IVF and ICSI?

ICSI (intracytoplasmic sperm injection) and “standard” IVF are two different ways of fertilizing the egg. Standard IVF refers to placing the egg in a dish with approximately 50, 000 – 100, 000 sperm and allowing natural fertilization to occur. In order to be a candidate for standard IVF, the sperm quality must be normal. When the sperm is not optimal, an embryologist can select a single sperm for each egg and inject the sperm directly into the egg with a tiny needle – this is called ICSI.

Who needs to do ICSI rather than standard IVF?

A male factor component to infertility is present in up to half of all infertile couples, making it one of the most common causes of infertility. In the past, the only option for many male factor couples was intrauterine insemination (IUI) using donated sperm.

Intracytoplasmic Sperm Injection (ICSI) is performed as a part of an IVF cycle wherein a single sperm is inserted directly into the egg for fertilization. The ICSI procedure does not appear to damage the egg and optimizes fertilization rates in cases where a male factor exists. ICSI was a major advance in the treatment of male infertility, allowing virtually all men to father children, with the first case performed in 1990.

The decision to use ICSI is made in consultation with the couple, physician, and embryologists. At most fertility clinics this decision is made based on the sperm testing at the clinic. However, there are some instances where the semen sample collected at the time of retrieval is not optimal, and ICSI may be recommended at that time.

ICSI is performed on the day of egg (oocyte) retrieval. A sperm sample is provided by the partner, and approximately 4-6 hours after the egg retrieval, individual sperm from this sample are injected into each of the mature eggs (fig 5). Fertilization rates with ICSI are typically about 70-80% of mature (competent) eggs. Of note, standard IVF insemination of eggs should yield the same fertilization rates, but is reserved for cases when the sperm is considered normal and there is no history of poor fertilization with IVF in the past.

Figure 5: Intracytoplasmic sperm injection (ICSI).Figure 5 ICSI

 

Many times the sperm needed for ICSI are retrieved from the ejaculate; however, men with no sperm can often still produce sperm for ICSI. The sperm can be retrieved directly from the testicles using testicular sperm extraction (TESE) or from the epididymis using percutaneous epididymal sperm aspiration (PESA). Fertilization rates using ICSI are typically high, and pregnancy success rates are higher compared to standard IVF culture when a sperm factor is the cause of infertility.

PCRM pioneered a surgical procedure in Canada called microsurgical testicular sperm extraction (microTESE), for men with a complete absence of sperm (azoospermia). This is possible because of our unique ability to provide reproductive surgery under general anesthesia (as a level 1 surgical centre). In these cases only small numbers of sperm are available from the testicular surgery, such that freezing cannot effectively be performed for future treatments. This fresh sperm is then used to fertilize fresh eggs that have been collected from an IVF cycle which has been synchronized with the microTESE procedure.

Another common reason to use ICSI is for cases planning PGT – preimplantation genetic testing.

Is there a cost difference between standard IVF and ICSI?

Yes. The cost of ICSI is additional to the cost of standard IVF. Please see the price breakdown in our Fees section.

Can I choose to do ICSI on the day of egg retrieval?

No, unless there are unforeseen circumstances, we cannot choose ICSI at the last minute. This is because a number of items including consent forms and laboratory set-up need to be in place ahead of time to allow for ICSI.

What is the difference between IVF and ICSI?

ICSI (intracytoplasmic sperm injection) and “standard” IVF are two different ways of fertilizing the egg. Standard IVF refers to placing the egg in a dish with approximately 50, 000 – 100, 000 sperm and allowing natural fertilization to occur. In order to be a candidate for standard IVF, the sperm quality must be normal. When the sperm is not optimal, an embryologist can select a single sperm for each egg and inject the sperm directly into the egg with a tiny needle – this is called ICSI.

 

 

Who needs to do ICSI rather than standard IVF?

A male factor component to infertility is present in up to half of all infertile couples, making it one of the most common causes of infertility. In the past, the only option for many male factor couples was intrauterine insemination (IUI) using donated sperm.

 

Intracytoplasmic Sperm Injection (ICSI) is performed as a part of an IVF cycle wherein a single sperm is inserted directly into the egg for fertilization. The ICSI procedure does not appear to damage the egg and optimizes fertilization rates in cases where a male factor exists. ICSI was a major advance in the treatment of male infertility, allowing virtually all men to father children, with the first case performed in 1990.

 

The decision to use ICSI is made in consultation with the couple, physician, and embryologists. At most fertility clinics this decision is made based on the sperm testing at the clinic. However, there are some instances where the semen sample collected at the time of retrieval is not optimal, and ICSI may be recommended at that time.

 

ICSI is performed on the day of egg (oocyte) retrieval. A sperm sample is provided by the partner, and approximately 4-6 hours after the egg retrieval, individual sperm from this sample are injected into each of the mature eggs (fig 5). Fertilization rates with ICSI are typically about 70-80% of mature (competent) eggs. Of note, standard IVF insemination of eggs should yield the same fertilization rates, but is reserved for cases when the sperm is considered normal and there is no history of poor fertilization with IVF in the past.

Figure 5: Intracytoplasmic sperm injection (ICSI).

Figure 5 ICSI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Many times the sperm needed for ICSI are retrieved from the ejaculate; however, men with no sperm can often still produce sperm for ICSI. The sperm can be retrieved directly from the testicles using testicular sperm extraction (TESE) or from the epididymis using percutaneous epididymal sperm aspiration (PESA). Fertilization rates using ICSI are typically high, and pregnancy success rates are higher compared to standard IVF culture when a sperm factor is the cause of infertility.

 

PCRM pioneered a surgical procedure in Canada called microsurgical testicular sperm extraction (microTESE), for men with a complete absence of sperm (azoospermia). This is possible because of our unique ability to provide reproductive surgery under general anesthesia (as a level 1 surgical centre). In these cases only small numbers of sperm are available from the testicular surgery, such that freezing cannot effectively be performed for future treatments. This fresh sperm is then used to fertilize fresh eggs that have been collected from an IVF cycle which has been synchronized with the microTESE procedure.

 

Another common reason to use ICSI is for cases planning PGT – preimplantation genetic testing.

Is there a cost difference between standard IVF and ICSI?

Yes. The cost of ICSI is additional to the cost of standard IVF. Please see the price breakdown in our Fees section.

Can I choose to do ICSI on the day of egg retrieval?

No, unless there are unforeseen circumstances, we cannot choose ICSI at the last minute. This is because a number of items including consent forms and laboratory set-up need to be in place ahead of time to allow for ICSI.

A technician at PCRM works on fertility research | PCRM Fertility Clinic Vancouver

Preimplantation Genetic Testing (PGT)

Preimpantation genetic testing (PGT) can screen embryos for chromosome abnormalities before they are put in the uterus.

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Preimplantation genetic testing (PGT) can screen embryos for chromosome abnormalities before they are put in the uterus. This can help to reduce the odds of a genetic problem in the baby that might otherwise lead to a miscarriage or a failed IVF cycle. PGT is different from prenatal screening (e.g. NIPT, FTS, TRIO, SIPS) because those tests examine an existing pregnancy, usually after 10 weeks gestation.

PGT-M and PGT-A is the modern terminology, but in the past PGT was referred to as ‘preimplantation genetic diagnosis (PGD)’ or ‘preimplantation genetic screening (PGS)’ or ‘comprehensive chromosome screening (CCS)’. The IVF industry has standardized the terminology now and we use the term PGT.

Preimplantation genetic testing for monogenic/single gene defects=  PGT-M  (e.g. Huntington’s disease, Muscular Dystrophy, BRCA breast cancer gene)

Preimplantation genetic testing for aneuploidy = PGT-A (e.g. testing for missing/extra chromosomes that would lead to a non-viable embryo or extra chromosomes that cause genetic differences like Trisomy 21 – Down Syndrome)

 

PGT-M and PGT-A help examine an embryo, even before a pregnancy begins. PGT starts with the IVF process, where the egg is fertilized with sperm, in the  embryology lab.  Five or six days after fertilization, a biopsy is performed, where a small sample of cells is removed from each embryo, frozen, and sent off to a genetics lab. These cells are tested for the condition of interest and the embryos predicted to be unaffected are transferred to the woman’s uterus the following month, or later.

The biopsy of the embryos for either PGT-M or PGT-A is performed at PCRM by our skilled embryology team.  The cells are sent to a specialized laboratory, typically Cooper Genomics, for analysis.  After the biopsy, embryos are vitrified (frozen) and stored until the genetic testing is completed.  PGT results are ready about 1-2 weeks after the biopsy.

In a standard IVF cycle (.ie. without PGT), embryos are graded and selected for use by their appearance (morphology).  When an IVF cycle includes PGT, the selection of embryos is based on their genetic makeup.  Embryos predicted to be unaffected can be transferred back to the uterus at any time, even as soon as the next cycle.

Couples may choose  PGT for a number of reasons:

  • They wish to screen embryos before transferring them, in the hopes of choosing the one with the highest chance of success
  • They have undergone standard IVF cycles that have been unsuccessful or resulted in miscarriages.
  • One partner carries an inherited chromosome rearrangement, such as a translocation or inversion.
  • They have a child with a genetic condition and would like to reduce the chance of inheritance for their future children.
  • An adult has a genetic condition or has an increased risk of developing a genetic condition and would like to reduce the chance of inheritance for his or her future children.

The potential benefit of these techniques is determined during the first consultation visit with your fertility specialist.

If you would like more information about the benefits and limitations of PGT, you can call PCRM to make an appointment to talk to our genetic counselors. For more detailed information regarding PGT, you can also refer to the web sites of  Cooper Genomics and Natera, the laboratories to which PCRM sends biopsied cells for testing.

Types of PGT

Altogether, there are 46 chromosomes (23 pairs) in the human cell.  Not too long ago, the standard PGT-A analysis was able to examine only a few chromosomes.   Advancing genetic technology now allows scientists to assess the entire set for missing and extra whole chromosomes as well as large missing and extra pieces of chromosomes (deletions and duplications).

Evaluating an embryo’s chromosome make-up using PGT-A techniques helps to select the ones that have the desired number of chromosomes. Transferring these embryos may result in higher implantation and pregnancy rates and may help avoid miscarriage.

There are a number of different PGT-A platforms including array CGH (comparative genomic hybridization), SNP (single nucleotide polymorphism) array and NGS (next generation sequencing). Each technique ultimately performs the same task.  All are highly effective, with accuracies of 97-99%.

For the majority of patients undergoing PGT at PCRM, the biopsied cells are sent to Cooper Genomics. Cooper Genomic’s PGT-A method is a NGS platform.  The results provide highly accurate information for all 46 chromosomes.

Frequently Asked Questions

At what age should women consider PGT-A?

PGT-A is most effective for women over the age of 37 – 38 years old. This is because women are born with all of their eggs, and as they age, the eggs are more prone to making genetic mistakes. For example, a 30 year-old woman should expect about 25% of her embyros to be aneuploid (genetically abnormal) versus a 41 year-old woman should expect 70% or more of her embryos to be aneuploid.  PGT-A can help to screen a group of embryos to find the one with the highest potential for implantation and healthy pregnancy.

How much does PGT cost?

The added cost of a PGT cycle can range from $3000 – $7000+ in addition to a standard IVF + ICSI cycle. This includes the embryo biopsy fee, the cost (billed per embryo) of genetic testing which is paid to the genetics company, and the cost of a frozen embryo transfer.

I am 40 years old with very low ovarian reserve, should I do PGT-A?

This is a very common question and the answer varies based on the individual, or couple’s, objectives. On one hand, many couples desire to know the genetic makeup of an embryo before it is transferred, which can help to achieve a successful pregnancy faster by avoiding failed transfers and miscarriages. However, on the other hand, when there are only 1 or 2 embryos to choose from, a person might choose to transfer those embryos in a fresh cycle rather than incur the extra costs of testing them. In general, the most common reason an embryo fails to implant is due to genetic abnormalities, so the large majority of abnormal embryos will either not implant, or miscarry early in pregnancy.

What if I do PGT-A and there are no euploid (normal) embryos to transfer?

Unfortunately this can happen. Sometimes we test a group of embryos and all of them are found to be aneuploid (abnormal). In this circumstance we recommend not to transfer those embryos and your physician will discuss either attempting another IVF cycle or pursuing alternative options, such as donor eggs.

Can PGT-A ensure a healthy baby?

PGT-A can test for the number of chromosomes in an embryo. PGT-M can test for genetic diseases, for example if one of the parents is a carrier of the disease.  Neither PGT-A, nor PGT-M can guarantee a healthy baby. This is because PGT cannot rule out rare genetic diseases or random genetic or developmental differences. There are also developmental differences, such as autism, that are considered to be multifactorial and for which no distinct genetic cause has been identified.

At what age should women consider PGT-A?

PGT-A is most effective for women over the age of 37 – 38 years old. This is because women are born with all of their eggs, and as they age, the eggs are more prone to making genetic mistakes. For example, a 30 year-old woman should expect about 25% of her embyros to be aneuploid (genetically abnormal) versus a 41 year-old woman should expect 70% or more of her embryos to be aneuploid.  PGT-A can help to screen a group of embryos to find the one with the highest potential for implantation and healthy pregnancy.

How much does PGT cost?

The added cost of a PGT cycle can range from $3000 – $7000+ in addition to a standard IVF + ICSI cycle. This includes the embryo biopsy fee, the cost (billed per embryo) of genetic testing which is paid to the genetics company, and the cost of a frozen embryo transfer.

I am 40 years old with very low ovarian reserve, should I do PGT-A?

This is a very common question and the answer varies based on the individual, or couple’s, objectives. On one hand, many couples desire to know the genetic makeup of an embryo before it is transferred, which can help to achieve a successful pregnancy faster by avoiding failed transfers and miscarriages. However, on the other hand, when there are only 1 or 2 embryos to choose from, a person might choose to transfer those embryos in a fresh cycle rather than incur the extra costs of testing them. In general, the most common reason an embryo fails to implant is due to genetic abnormalities, so the large majority of abnormal embryos will either not implant, or miscarry early in pregnancy.

What if I do PGT-A and there are no euploid (normal) embryos to transfer?

Unfortunately this can happen. Sometimes we test a group of embryos and all of them are found to be aneuploid (abnormal). In this circumstance we recommend not to transfer those embryos and your physician will discuss either attempting another IVF cycle or pursuing alternative options, such as donor eggs.

Can PGT-A ensure a healthy baby?

PGT-A can test for the number of chromosomes in an embryo. PGT-M can test for genetic diseases, for example if one of the parents is a carrier of the disease.  Neither PGT-A, nor PGT-M can guarantee a healthy baby. This is because PGT cannot rule out rare genetic diseases or random genetic or developmental differences. There are also developmental differences, such as autism, that are considered to be multifactorial and for which no distinct genetic cause has been identified.

Egg Freezing Vancouver | Sperm Donor | PCRM Fertility Clinic in Vancouver

Donor Sperm

Some couples are faced with the fact that either the man’s sperm is inadequate to fertilize an egg, or the woman’s eggs are unable to produce a viable pregnancy.

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Donor Sperm

Donor sperm is commonly used by same-sex female couples, trans* couples and single women, and is sometimes required by heterosexual couples where there is a severe sperm factor or when there is a risk of transmitting a genetic disease from the male partner. To help you understand the process of using donor sperm in Canada please review the following.

Preparing for the process

Prior to starting any treatment using donor sperm at PCRM, some medical testing is required to ensure there are no undetected physical or hormonal barriers to conception. These tests consist of hormone blood tests, as well as screening tests for Hepatitis B and C, HIV, and syphilis and checking for immunity to chickenpox and rubella. As well, it is strongly recommended that an evaluation of your Fallopian tubes through a specialized X-ray (hysterosalpingogram or HSG) be performed prior to treatment. This test ensures your Fallopian tubes are not blocked. Additionally, patients using donor sperm will require testing for cytomegalovirus (CMV). If you are CMV negative, you should select sperm from donors who are CMV negative or ask about a waiver. If you have previously had CMV, you can choose a CMV positive or negative donor.

You are required to meet with a counselor with an expertise in reproductive health prior to embarking on treatments using donor sperm. Using donor sperm to assist in creating your family can have an impact on future family dynamics, and will be a part of your child’s genetic reality, and personal identity to varying degrees. The counselling session is important to help those planning to use donor sperm think about and plan for these issues, as well as to satisfy the pre-treatment requirement. Counselling can help to clarify which source (known donor or unknown donor) and type of sperm (ID-release or anonymous) is the best fit for your family (see below).

Sourcing Donor Sperm

Once the decision to use donor sperm has been made, it needs to be sourced. Donor sperm for use at PCRM can be obtained in two ways: it can be obtained from a sperm bank (unknown donor), or it can be sourced from a friend or relative (known donor).

Obtaining sperm from an unknown donor via a sperm bank requires the choice between ID-Release or Anonymous Sperm. Most donor sperm used in Canada is imported from the United States and Europe from ID-release donors, meaning that at the time of sperm donation, the donor had consented to have information about himself released to his offspring once reaching the age of majority, should they so request. The specifics of what information is made available vary between banks. It is important to understand that ID-release donors can, at any time, rescind their consent to have information released, so choosing an ID-release donor is not an absolute guarantee of future access or contact. Anonymous donors, on the other hand, choose to withhold consent at the time of the donation to the future release of information; thus additional information is not, and will not be available for future access.

If you want to use donor sperm from someone you know, Health Canada regulations revised in February 2020 made this easier. You and your donor would meet with one of our third party reproduction coordinators to review the steps, which include infectious diseases screening, physical examination, counselling and sperm banking.  The Assisted Human Reproduction Act prohibits the sale of reproductive material (embryos, sperm and eggs) so any donation must be altruistic, with reimbursement only of receipt-able expenses.

Donor Sperm Bank Phone Numbers & Websites

Repromed Ltd: 1-877-249-4282

Can-Am Cryo: 1-888-245-3471

Once you are a confirmed client of PCRM and wish to proceed with a cycle, it is your responsibility to contact the sperm bank(s) above to start the process of selection and purchase of a donor sperm sample. Once this has been done, you must contact the clinic, and ask for the donor sperm nurse. When you call, you must provide the following information:

a. Your physician
b. The distributor and contact information from where you have ordered the donor sperm
c. The donor number and the number of vials you have ordered

Once this has been done, PCRM will coordinate the transfer of the donor sperm samples to PCRM.

Prior to transfer of donor sperm samples to our facility, you will be responsible for prepayment of the fees associated with counselling, nursing orientation, and transfer and storage of sperm samples. These fees are as follows:

  • Donor sperm orientation (includes teaching and counselling session) $400
  • Donor sperm handling fee (fee required for arranging transport of specimens) $100
  • Annual storage fee (fee for annual storage of samples, or portion thereof) $420
  • TOTAL $920.00

All donor semen used in Canada, by law, must undergo rigorous infectious disease screening for Hepatitis B and C, HIV, syphilis, gonorrhea, chlamydia, and CMV.

To start your treatment cycle, your donor sperm samples must have arrived at the clinic and we ask that you contact us on the first day of the menstrual period. If your cycles are irregular or you do not have a period, please speak to your physician.

Making Families with Donor Sperm – Legal Implications

Provincial law defines legal parentage. The B.C. Family Law Act (2011) came fully into force on March 18, 2013, replacing the Family Relations Act. The legislation clarifies parental responsibilities and the division of assets if relationships break down, but most importantly for our patients, establishes a much needed framework for determining a child’s legal parents, including where assisted reproduction is utilized. The BC Family Law Act specifically addresses assisted reproduction in that if the intended parents are in an established relationship at the time of insemination, then they are considered the legal parents at birth, with no need for a legal contract, and no adoption necessary by the non-carrying parent. When surrogacy or a multi-parenting situation is planned, however, a legal contract IS required prior to the assisted reproduction process, so that the intention of parenthood is clear prior to conception.

For more information, please review this information from Barbara Findley, QC:
http://www.barbarafindlay.com/uploads/9/9/6/7/9967848/choosing_children_february_222013.doc

Legalities regarding parentage vary across jurisdictions. It is essential that out-of-province patients investigate the law in their own state/province and seek out relevant legal advice pertaining to their situation.

Here are some additional articles by PCRM doctors that you might find helpful:

Frequently Asked Questions

Does freezing affect the sperm?

Some sperm in each sample will not survive the freeze/thaw process, but there is no evidence that freezing affects the genetic material of those that survive. Different samples respond differently to freezing and it is not possible to predict this from the fresh sample. The PCRM laboratory performs a “test thaw” on a small portion of each sample that is frozen to give your doctor an indication of how the sperm react to freezing. The length of time a sample is stored does not affect its chance of survival, so your doctor can use this information in the future, when developing your fertility treatment plan.

How are the frozen sperm stored?

The semen sample is diluted carefully with a cryoprotectant solution designed to protect the sperm during freezing. Once diluted, the sample is divided up and put into straws for freezing.

How secure is my frozen sperm sample?

To access the PCRM storage facility, one would need to pass through 4 locked doors, that are only accessible to specific PCRM medical and laboratory staff. Our facility also has an independent security system and a security guard for the building 24 hours a day. The storage tanks are filled with liquid nitrogen, and the levels are checked and recorded weekly. The holding time for these tanks is several weeks, meaning that if for some reason it was not possible to top up the liquid nitrogen, the samples could still stay frozen. Also, because we use liquid nitrogen, and not electricity, samples will remain safely frozen during power outages.

Does freezing affect the sperm?

Some sperm in each sample will not survive the freeze/thaw process, but there is no evidence that freezing affects the genetic material of those that survive. Different samples respond differently to freezing and it is not possible to predict this from the fresh sample. The PCRM laboratory performs a “test thaw” on a small portion of each sample that is frozen to give your doctor an indication of how the sperm react to freezing. The length of time a sample is stored does not affect its chance of survival, so your doctor can use this information in the future, when developing your fertility treatment plan.

How are the frozen sperm stored?

The semen sample is diluted carefully with a cryoprotectant solution designed to protect the sperm during freezing. Once diluted, the sample is divided up and put into straws for freezing.

How secure is my frozen sperm sample?

To access the PCRM storage facility, one would need to pass through 4 locked doors, that are only accessible to specific PCRM medical and laboratory staff. Our facility also has an independent security system and a security guard for the building 24 hours a day. The storage tanks are filled with liquid nitrogen, and the levels are checked and recorded weekly. The holding time for these tanks is several weeks, meaning that if for some reason it was not possible to top up the liquid nitrogen, the samples could still stay frozen. Also, because we use liquid nitrogen, and not electricity, samples will remain safely frozen during power outages.

IVF Procedure Close Up | PCRM Vancouver Fertility Clinic

Donor Eggs

Donor eggs are a well-established infertility treatment option for advancing reproductive age, previously unsuccessful IVF attempts, early menopause, or for LGBTQIA+ families.

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Donor eggs are an increasingly common fertility treatment option. The most common reasons why patients choose donor eggs are:

  • advancing reproductive age
  • low ovarian reserve
  • previous unsuccessful IVF attempts
  • early menopause
  • LGBTQIA+ families
  • the female partner carries a genetic problem she does not want to pass on
  • women age 45 and older who are not eligible for IVF with their own eggs

Donor eggs can come from an ‘anonymous’ donor or a ‘known’ donor. ‘Anonymous’ donor eggs are the most common route. This process involves using an egg bank to purchase frozen eggs, which are then shipped to PCRM for fertilization with sperm. Because it is illegal to pay donors for their eggs in Canada, donor eggs come from banks in the United States, where woman are allowed to be financially compensated. Our third party coordinators will help you create a profile with which you’ll be able to browse online to search for potential donors. The egg banks provide a wealth of information about donors such as photos, medical history, genetic testing and infectious diseases screening. Once you order your eggs, they usually take 1 – 3 weeks to ship to PCRM. The eggs can be fertilized with your partner’s sperm, or with donor sperm, to create embryos. After the embryo has grown for 5 days in our laboratory, a blastocyst embryo is transferred into the uterus and extra embryos are frozen for future use.

‘Known’ egg donor is when a friend or family member chooses to give you eggs. This is legal in Canada provided that the rules laid out in the Assisted Human Reproduction Act and by Health Canada are strictly adhered to. The biggest difference between donor eggs in Canada and the USA is that Canada does not permit payment for eggs, sperm or surrogacy services. That means your donor must be altruistic and only receipt-able expenses can be paid (e.g. fertility treatment, medications).  Your donor would have to undergo a standard IVF cycle, including injections of ovarian stimulation medications and an egg retrieval procedure. The eggs would then be fertilized with the intended father’s sperm, or with donor sperm, and the resulting embryos transferred into the intended mother’s uterus.

Anyone undergoing third party reproduction is required to see a counselor with expertise in assisted reproduction before starting a cycle. Our coordinators can help you arrange this visit.

PCRM works with the following validated egg banks:

Note: Some banks may require additional information from PCRM before viewing donor profiles. Please contact one of our third party coordinators for more information.

PCRM Burnaby was recognized as one of the highest performing fertility centres in North America by Donor Egg Bank USA!

Check out the following links for articles about donor eggs, written by our doctors:

A frozen embryo transferred for fertilization | PCRM Fertility Clinic Vancouver

Gestational Carrier & Surrogacy

A gestational carrier is a woman who carries a baby on behalf of the intended parent(s).

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A ‘gestational carrier’ is a woman who carries a baby on behalf of the intended parent(s). The gestational surrogate is not genetically related to the baby. This is different from ‘traditional surrogacy’, where the woman uses her own egg to produce the embryo for the intended parent(s).

A gestational carrier might be indicated when the intended parent(s) cannot carry a baby. This could be because of a scarred or absent uterus, a history of recurrent miscarriages, or if the intended mother has serious health concerns that might make pregnancy dangerous. LGBTQIA+ families might also choose a gestational carrier or surrogate if the intended parent(s) lack the required egg or uterus to form a pregnancy.

For a gestational carrier pregnancy, the intended parents produce embryos through an IVF cycle which are then transferred into the gestational carrier’s uterus. The resulting baby will have the genetic makeup determined by the sperm and the egg and will not be related to the gestational carrier.

The gestational carrier or surrogate can be a family member, a friend, or acquaintance. Canadian law outlined in the Assisted Human Reproduction Act stipulates that people in Canada cannot be paid for sperm, eggs or surrogacy services. This means that the person must be altruistic and only receipt-able expenses may be reimbursed. Legal advice from a firm specializing in third party reproduction is recommended.

If you are considering building your family with a gestational carrier or surrogate, please ask to see one of our third-party reproduction coordinators.

Here is some additional information written by our PCRM doctors that you might find useful:

Frequently Asked Questions

What are the criteria for a gestational carrier?

  • 21 – 45 years old
  • Normal reproductive history, at least 1 normal birth
  • No serious medical or psychological conditions
  • Normal infectious diseases screening
  • Body Mass Index (BMI) < 40
  • Surrogacy agreement and counselling

What are the criteria for a gestational carrier?

  • 21 – 45 years old
  • Normal reproductive history, at least 1 normal birth
  • No serious medical or psychological conditions
  • Normal infectious diseases screening
  • Body Mass Index (BMI) < 40
  • Surrogacy agreement and counselling

A fertility specialist performs fertility research with a microscope | PCRM Fertility Clinic Vancouver

Micro-TESE

Microsurgical Sperm Retrieval (Micro-TESE) – Standard of Care for Non-Obstructive Azoospermia Male factor infertility is...

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Microsurgical Sperm Retrieval (Micro-TESE) – Standard of Care for Non-Obstructive Azoospermia

Male factor infertility is present in more than half of couples with delayed conception, making it the leading cause of subfertility in North America. Between 5 and 10% of these men have a complete lack of sperm due to reduced production (non-obstructive azoospermia). Testicular biopsy reveals that these men have Sertoli cell-only pattern, maturation arrest, or hypospermatogenesis. Until recently, these men with primary testicular failure were considered “sterile”, and donor sperm insemination or adoption recommended as the only means of having a family. Several observations have changed the approach to this condition. Direct evaluation of testis biopsy specimens often demonstrates sperm in men with non-obstructive azoospermia, but not at high enough levels to yield sperm in the ejaculate. It was previously assumed that sperm must traverse the male reproductive tract before acquiring the ability to fertilize an egg. These sperm do have severely impaired motility and function, and are ineffective when used for intrauterine insemination (IUI) or standard in vitro fertilization (IVF) culture. Using the procedure called intracytoplasmic sperm injection (ICSI), eggs can now be fertilized with these sperm by physically injecting them into the cytoplasm of the egg (ooplasm). ICSI was first performed in 1990 and has virtually cured male factor infertility world-wide. The vast majority of infertile men can eventually father a child using this technique.

With advances in sperm retrieval techniques, sperm can be found in nearly half of men with non-obstructive azoospermia. Microsurgical testicular sperm extraction (Micro-TESE) is a procedure that allows for the precise removal of tiny volumes of testicular tissue is areas of active sperm production using a microscope, improving sperm yield compared to traditional biopsy techniques. Seminiferous tubules (structures where sperm is produced and transported) containing sperm can often be identified under an operating microscope after opening the testis. This approach has a number of advantages over other sperm retrieval techniques. It maximizes the yield of spermatozoa while minimizing the amount of testicular tissue required and vascular injury created, by making identification blood vessels easier. Sperm harvested from these patients is very difficult to cryopreserve due to a combination of the limited numbers and quality, so optimal pregnancy rates are achieved using the sperm fresh.

Using fresh sperm requires synchronizing the Micro-TESE procedure with retrieval of the female partner’s eggs. The medical team at The New York Presbyterian Hospital-Weill Medical College of Cornell University, under the direction Dr. Peter Schlegel pioneered the technique and is the major referral centre in the U.S. for difficult azoospermia cases. In 2007, Dr. Schlegel performed the first Micro-TESE procedure at PCRM as a visiting professor. With a fully functional operating theatre on-site, and embryologists with years of TESE experience in an adjoining full-equipped IVF laboratory, PCRM has proven to be well suited for Micro-TESE. Since that day we have provided a consistent volume of Micro-TESE for these severe cases with a cumulative pregnancy rate of 78%.

We are the only centre in Canada capable of fresh Micro-TESE; this urological procedure is done through our Sub-specialty urology staff, Drs. Victor Chow, and Kenneth Poon. Many centres perform this outside the clinic, and freeze sperm, however, the ability to procure fresh sperm is highly linked to better pregnancy outcomes. Many other fertility centres in Canada refer patients to PCRM for this procedure.

Sperm Freezing

Sperm can be frozen and stored for future use with insemination (IUI) or in vitro fertilization (IVF)

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There are a number of reasons to consider sperm freezing (a.k.a. sperm cryopreservation). Some couples find it more convenient to have sperm frozen in advance of their IUI or IVF treatment, particularly if they anticipate collection difficulties, the sperm count is low, or if the male partner is going to be out-of-town.

Men about to undergo a vasectomy or a medical treatment that is expected to make them sterile, such as chemotherapy or radiation treatment, can freeze their sperm beforehand as a means of fertility preservation for use in the future. Transgender women can choose sperm freezing before, or after, starting hormone therapy.

The sperm is frozen and stored in liquid nitrogen at -196 C. It can be stored indefinitely with no apparent degradation in quality. In most cases, for IVF, frozen sperm works as well as fresh sperm.

The cost for sperm freezing and annual storage can be found on our Fees page.

Frequently Asked Questions

Why freeze sperm?

Here are some common reasons to freeze sperm:

  • For convenience in advance of IUI or IVF treatment, particularly for anticipated collection difficulties, or if the male partner is going to be out-of-town.
  • If the sperm count is low.
  • If the sperm count is low.
  • Prior to vasectomy.
  • Prior to cancer treatments like chemotherapy or radiation.
  • Transgender women prior to, or during, hormone therapy.

How secure is my frozen sample?

To access the PCRM storage facility, one would need to pass through a series of locked doors, which are only accessible to specific PCRM medical and laboratory staff. Our facility also has an independent security system and security guards for the building 24 hours a day. The storage tanks are filled with liquid nitrogen, and the levels are checked and recorded weekly. The holding time for these tanks is several weeks, meaning that if for some reason it was not possible to top up the liquid nitrogen, the samples could still stay frozen. Also, because we use liquid nitrogen and not electricity, samples will remain safely frozen during power outages.


How is sperm frozen?

The semen sample is produced at PCRM in one of our collection rooms. It is analyzed and then diluted carefully with a cryoprotectant solution designed to protect the sperm during freezing. Once diluted, the sample is divided up and put into straws for freezing. At PCRM, we use High-Security Straws, a cryopreservation system that minimizes any risk of sample cross-contamination in the storage tank. These straws have a separate compartment so that the sample’s identification and sample can be sealed inside the straw. The straws are heat-sealed at both ends and then cooled in controlled-rate freezers. Once the samples have cooled to -150°C, they are transferred into a storage compartment in a liquid nitrogen storage tank, where they are stored at -196°C until needed.

Why freeze sperm?

Here are some common reasons to freeze sperm:

  • For convenience in advance of IUI or IVF treatment, particularly for anticipated collection difficulties, or if the male partner is going to be out-of-town.
  • If the sperm count is low.
  • If the sperm count is low.
  • Prior to vasectomy.
  • Prior to cancer treatments like chemotherapy or radiation.
  • Transgender women prior to, or during, hormone therapy.

How secure is my frozen sample?

To access the PCRM storage facility, one would need to pass through a series of locked doors, which are only accessible to specific PCRM medical and laboratory staff. Our facility also has an independent security system and security guards for the building 24 hours a day. The storage tanks are filled with liquid nitrogen, and the levels are checked and recorded weekly. The holding time for these tanks is several weeks, meaning that if for some reason it was not possible to top up the liquid nitrogen, the samples could still stay frozen. Also, because we use liquid nitrogen, and not electricity, samples will remain safely frozen during power outages.

How is sperm frozen?

The semen sample is produced at PCRM in one of our collection rooms. It is analyzed and then diluted carefully with a cryoprotectant solution designed to protect the sperm during freezing. Once diluted, the sample is divided up and put into straws for freezing. At PCRM, we use High Security Straws, a cryopreservation system that minimizes any risk of sample cross-contamination in the storage tank. These straws have a separate compartment so that the sample’s identification and sample can be sealed inside the straw. The straws are heat sealed at both ends, and then cooled in controlled-rate freezers. Once the samples have cooled to -150°C, they are transferred into a storage compartment in a liquid nitrogen storage tank, where they are stored at -196°C until needed.

A woman holds a mug with a heart in her latte | PCRM Fertility Clinic Vancouver

Cancer Fertility Preservation

A program providing the latest in fertility preservation technologies to those patients whose fertility is compromised by cancer treatments.

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Although modern medical therapies for cancer in women have become immensely successful, the price paid for survival is often the loss of reproductive function from ovarian toxicity. Pacific Centre for Reproductive Medicine (PCRM) conducts a program providing the latest in fertility preservation technologies in an effort to offer hope and future fertility for woman undergoing potentially sterilizing medical therapies.

These services require the use of assisted reproductive technologies, including in vitro fertilization, and the cryopreservation of eggs, embryos and ovarian tissue. PCRM subsidizes these services for eligible patients and works with pharmaceutical companies to supply medication. Our staff are tremendously proud to be part of this program and excited to serve this important and compassionate cause.

Pacific Centre for Reproductive Medicine (PCRM) is unique in its ability to offer these technologies. The clinical staff have been assembled from the some of the finest IVF centres over the continent. The director of our fertility preservation program, Dr. Jeff Roberts, received special training during his fellowship at New York’s Cornell Medical Center, where the first human ovarian transplant was performed, and many of the commonly employed fertility sparing techniques pioneered. The PCRM IVF laboratory has the instrumentation and technical expertise required to conduct the techniques of egg, embryo, and ovarian tissue cryopreservation. In particular the PCRM laboratory staff have over fifteen years of experience freezing all developmental stages of human pre-embryos, and have a particular interest in egg freezing.

Program Requirements

The PCRM staff is here to support you through this very difficult time, and help provide you with future pregnancy in the event that your fertility is compromised by cancer treatments. In partnership with Fertile Future, PCRM will subsidize cryopreserve (banking) of eggs, embryos or sperm at our facility. Medication may be provided by PCRM Fertility Preservation Foundation; however availability of product is variable. Three of our pharmaceutical vendors, EMD Serono Canada, Merck Canada and Ferring Canada, may provide us with compassionate medication on request.

Female criteria for PCRM Fertility Preservation Program:

• Under 40 and resident of British Columbia with valid CareCard
• Medical clearance from both your oncology team and the PCRM physicians
• No prior exposure to chemotherapeutic agents or pelvic radiation
• Undergoing cancer therapy that will potentially reduce your future fertility (chemotherapy or pelvic radiotherapy)

PCRM will provide:

Female
• One (1) discounted IVF with ICSI treatment cycle at $4500 (regular $9500)
• Request for additional funding through the Power of Hope Cost Reduction Program through Fertile Future with reimbursement up to $2000.
• Free cryopreservation of any egg and embryos generated, with storage for a period of one (1) year

Power of Hope-Application for Women

Male
• Sperm cryopreservation at $300
• Request for additional funding through the Power of Hope Cost Reduction Program through Fertile Future with reimbursement up to $350.

Power of Hope – Application for Men

Patients are financially responsible for:
  • Cryopreservation storage fees for eggs, embryos and sperm beyond one year at $400 – $420 and any fees related to the utilization of the eggs and embryos for future treatments at 50% off.
  • Medications not provided by PCRM Fertility Preservation Foundation and our participating vendors will be provided “at cost” (no mark-up) through the PCRM Fertility Medication Dispensary. These costs uncommonly exceed $1000 and depend on the availability of compassionate product.

If you have any questions regarding your treatment or the PCRM Fertility Preservation Program please feel free to contact Dr. Jeffrey Roberts through the clinic, 604-422-7276 or directly by email: jroberts@pacificfertility.ca

Further Information

Fertility Preservation CFAS Guidelines

Donating

100% of the money donated to the PCRM Fertility Preservation Foundation will be used for the purchase of fertility medications for patients utilizing this program

Advocacy and Awareness – Fertile Future

Liz Ellwood is the founder of Fertile Future, a non-profit organization set up to improve awareness and educate patients and providers about the options of fertility preservation in cancer patients. For more information, please visit their website.

Fertile Future Power of Hope Brochure

Dr. Roberts is a medical advisor & President to Fertile Future and Dr. Dunne serves as Vice-President.

A fertility specialist smiles at the PCRM fertility clinic | PCRM Fertility Clinic Vancouver

Fertility Wellness

In order to optimize your chances of success with fertility treatments we want you to achieve optimal wellness.

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In order to optimize your chances of success with fertility treatments, the physicians at PCRM advocate for a healthy lifestyle. This includes the use of prenatal vitamins containing at least 0.4 mg of folic acid, a healthy balanced diet, maintenance of a normal body weight, sleep and physical activity. Patients should refrain from smoking and should discuss the use of any medications with their physician.

PCRM believes that some Complementary Alternative Medicine (CAM) therapies can be helpful in the management of infertility. Some patients may choose to do in vitro fertilization (IVF) with the addition of acupuncture. Many of our patients find value in yoga, meditation, mindfulness and exercise during treatment and throughout pregnancy. Naturopathic Medicine and Traditional Chinese Medicine (TCM) practitioners help our patients, by providing not just acupuncture, but also through a variety of life-style modifications that assist with weight loss and stress relief. Optimizing health is critical for success for both natural conception and with fertility treatments.

For patients who are interested, PCRM has worked closely with a number of CAM practitioners over the years to provide an integrated approach to their fertility care.

PCRM Burnaby clinic has facilities to offer TCM and acupuncture on-site if your practitioner desires. Dr. Spence Pentland (Traditional Chinese Medicine) and Drs. Charlene Chan and Danny Jui (Naturopathic Medicine) currently provide this service. They integrate fertility health through their private clinics, and finally have the opportunity to deliver their quality, compassionate care within the walls of PCRM.

  • Naturopathic Medicine
  • Traditional Chinese Medicine
  • Fertility Acupuncture
  • IVF Acupuncture Group

Please schedule all Integrated Wellness appointments directly through their respective offices:

Drs. Charlene Chan and Danny Jui (Coquitlam)
Ray Clinic
www.rayclinic.ca
For appointments: 604-461-7900
info@rayclinic.ca

Dr. Spence Pentland (Vancouver/Surrey)
Yinstill Reproductive Wellness
www.yinstill.com
office@yinstill.com

Stephanie Curran (Victoria)
Elements of Health Centre
www.elementscentre.ca

Dr. Alda Ngo & Christina Pistotnik (Edmonton)
Whole Family Health
www.wholefamilyhealth.ca
For appointments: 780-756-7736
info@wholefamilyhealth.ca
Wellness Links

PCRM fertility support flyer | PCRM Fertility Clinic Vancouver

Satellite Fertility Services

PCRM is pleased to serve as a satellite clinic for a number of fertility clinics throughout North America.

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Cycle Monitoring for Other Clinics (Satellite Monitoring)

PCRM is pleased to serve as a satellite clinic for many fertility clinics throughout North America.  Our role during your treatment is to provide the following services 7 days a week under the direction of your treating facility:

1. Fertility treatment monitoring:

  • Pelvic ultrasound (7 days a week starting from 7 a.m.)
  • Estradiol testing (7 days a week at starting from 7 a.m.)
  • LH, progesterone and bhCG testing through LifeLabs (private pay)

2. Medication services – on-site dispensing of fertility medications and reproductive hormones.

Treatments that you are receiving are not associated with services under the B.C. Medical Services Plan (MSP) or Alberta Health Care Insurance Plan (AHCIP).  The B.C. Laboratory Services Act (2014) prohibits the ordering of publicly funded laboratory tests under these circumstances.  This includes all prenatal infectious disease screening and hormone testing as part of your fertility work up.

Fertility Treatment Monitoring Services

In order to assist your clinic with the monitoring of your cycle, we will require clear instruction in the form of faxed orders from your physician.  The order must direct us on the specific service listed in (1) above and the date that it must be performed.  Our clinical staff is not responsible for treatment cycle planning and will not be making management decisions.  It is important that we receive instructions from your managing clinic regarding what services are to be provided, by fax no later than 3 p.m. (PST or MST depending on the PCRM clinic you are using) the day prior to the appointment.  Our clinic staff will do their utmost to provide your clinic with results prior to 12 noon on the day of your visit providing that you attend your appointment at or before the 7:00 a.m. appointment time.  Questions or concerns regarding your treatment must be directed to your treating physician.

Medication Services

Our satellite patients have the same access to our medication services 24/7, assuming your clinic provides us with prescriptions in a timely fashion.  During weekdays, we must receive a faxed prescription from your doctor before 12 noon (PST/MST depending on the PCRM clinic), in order for the prescription to be filled the same day.  On weekends and holidays, the prescription must be received before 10 a.m. (PST/MST depending on the PCRM clinic).

Fee Schedule for Satellite Monitoring

Administrative Fee $500
Pelvic Ultrasound $300
Serum Estradiol (blood test) $150
Sonohysterogram (SHG/SIS) $450

If you have any questions, or need to make an appointment please feel free to contact Christina, our PCRM Satellite Services Coordinator, during regular office hours:

Phone:  604-422-7276 Ext. 143 or Toll Free:  1-866-481-7276   Ext. 143