Dr. Kashyap discusses Canadian surrogacy laws.
VANCOUVER (NEWS1130) – It can be a last resort for couples struggling to conceive. But what are the rules surrounding surrogacy in Canada, and why might a couple look somewhere else for someone to carry their baby?
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In 2013, Genesis Fertility Centre became the first and only clinic in Canada to independently verify our clinical results. We did this to improve transparency about our clinic’s pregnancy rates and translate for patients procedural success rates that are often reported in different ways.
In the U.S., reporting of pregnancy rates by fertility clinics is mandatory, audited and identifiable. In Canada, reporting is voluntary, de-identified and unaudited. Websites may contain only biochemical pregnancy rates* and use different denominators, making it virtually impossible for patients to compare the success rates of different fertility clinics.
At Genesis, we ensure validity of our pregnancy rates annually through third-party auditing conducted by two independent, unrelated industry organizations: Fertility Authority, a leading authority in patient advocacy, and IVF Reports, an authority in IVF standards.
At Genesis Fertility Centre, we believe that singleton pregnancies are healthiest for mothers and babies as multiple implantation’s increase the risk of pre-term delivery and obstetrical complications.
Between January 2011 and December 2012, Genesis’s elective and mandatory single embryo transfer rate was 18%.
In 2013, elective day-five single embryo (eSET) utilization increased to 76% for eligible women under age 37 (table 3).
What do these numbers mean?
Pregnancy rates may be reported in several ways due to various definitions of pregnancy (see Table 4). The denominator against which positive pregnancies are measured also vary:
- The start of an IVF cycle, i.e. the start of fertility medication
- Egg retrieval
- Embryo transfer
We report according to fresh embryo transfer.
Why do we report according to fresh embryo transfer?
Many patients now choose to freeze their embryos for later use rather than proceed with embryo transfer immediately. Also, some patients with poorer prognoses or more challenging histories (e.g. AMH levels of <0.5; multiple previous failed cycles at the same or different fertility clinics) may have poorer progression to transfer, i.e. no embryo to transfer. In the past, these patients may have been denied a chance to try. We take pride in accepting these “challenging cases” provided the patients understand the prognoses. We are honoured to help them build their families.
Not all egg retrievals result in embryo transfer:
- Fertility preservation for patients with cancer or other medical issues
- Cryopreservation of embryos for later use due to:
i. Genetic screening (day-five embryo biopsy and freezing while awaiting results of testing)
ii. Risk of ovarian hyperstimulation
iii. Uterine factor infertility
iv. Other, e.g. personal or health reasons
- No eggs retrieved (this occurs at a frequency of <1% in a normal responder)
- Failed fertilization (occurs in <5% of cases)
- Failed embryo development (occursin <1% of cases)
We intend to post our pregnancy rates according to age, AMH levels and previous attempts on our website to allow patients to interpret their individual circumstances. Stay tuned!
*Biochemical pregnancy rates are defined as positive blood tests done 17 days after the embryo transfer.
At Genesis, supporting our patients through successful treatment is our top priority. This applies to all the procedures we perform at our centre, including egg freezing.
Egg freezing is a delicate process and its success rates are highly dependent on method and experience. Thanks to our talented and seasoned team we have managed to achieve high success rates (Table 1).
Most women do not return for their frozen eggs for many years, so the number of women who have attempted to become pregnant from these eggs is limited. For this reason, quality assurance in the egg survival process is paramount, and has helped us achieve a thawed egg survival rate of 95%.
An increasing number of women are interested in having children later in life for a variety of reasons:
- Meeting the right life partner
- Focusing on education and career development
- Seeking financial stability prior t o having a child
When a woman is in her late 30s or older, there is a decreased chance of pregnancy and an increased chance of pregnancy loss and chromosomal abnormalities. Women can now choose to freeze their eggs through vitrification at Genesis.
Patients with Cancer
Advances in cancer treatment have increased survival rates over the past decades. However, many cancer treatments can permanently affect fertility for both men and women. In women, cancer treatment may deplete the number of eggs in the ovaries and trigger early menopause. If you will be receiving chemotherapy imminently, your doctor may refer you and you will be seen within 24 to 48 hours to discuss your fertility options.
Fertility can be preserved through the freezing of sperm, eggs and embryos. Our team works closely with oncology teams to ensure any fertility treatment is safe.
Steps to Egg Freezing
Women who elect to freeze their eggs undergo the same initial steps as an IVF treatment cycle. Vitrified eggs are then banked and can be stored for many years. Women are encouraged to access this treatment prior to age 38 to increase the chance of pregnancy when their eggs are thawed, fertilized and transferred at a time in their life when pregnancy is desired. We have observed success of frozen eggs up to age 38 but consider patients on a case by case basis up to 42.
Our medical director Dr. Sonya Kashyap recently penned a detailed article for the Huffington Post entitled “Egg Freezing Deserves Serious Consideration.” The article provides detailed background information on the fertility procedure and how it applies to Canadians.
It was great to be able to end 2014, and begin 2015, with a trip to Thailand. I visited Bangkok, Chiang Mai, and Phuket.
Some highlights of the trip I would like to share, in no particular order, include:
- Spending the day with newly rescued Elephants. These elephants were rescued from being abused (logging, trekking, circus, etc). The rule was that we were there fore the elephants, not the other way around. We fed and bathed them. No riding :-). They were a pleasure to spend the day with.
- Food, food and more food! So many things to eat, so little time. We tried lots of street food, restaurants that didn’t have any English on their menu (these were the best!), and my favorite of all, the Northern Thailand Specialty “Khao Soi.” It is a curry-based broth with both soft and crispy noodles.
- New Years Eve in Chiang Mai – The floating lanterns everywhere made me feel like I was in a storybook. They were beautiful to watch and fun to light up and release with our 2015 wishes scribbled on them.
- Thai Cooking Class – Besides learning to cook delicious food, we got to tour and learn the main Thai ingredients at the market.
- The view of Bangkok from skybar – one of the most spectacular views I’ve ever seen.
- Colors and details – Thailand is such a colorful country. I lost count of the different taxi colors that existed in Bangkok. And their architecture (specially the temples) have such intricate details. It was beautiful.
There were so many other places I wanted to explore and so many more things to do. Clearly, two weeks was not enough. But now it’s back to work with all of the lovely people at Genesis Fertility Centre! See you soon!
Genesis Fertility Centre is committed to fertility patient care, and screening for chromosomal abnormalities can help reduce the probability of a failed cycle, miscarriage or abnormal pregnancy from an IVF cycle. At our clinic, we offer both comprehensive chromosomal screening (CCS; Table below) and pre-implantation genetic diagnosis (PGD).
What is Comprehensive Chromosomal Screening?
CCS, also known as preimplantation genetic screening (PGS), allows fertility specialists to identify a chromosomally balanced embryo for transfer with 98% certainty. Screening embryos prior to implantation can help achieve higher success rates and fewer pregnancy losses, particularly for women over 35 years old, patients with multiple-failed IVF cycles, implantation failures or repeated miscarriages.
For women under age 35, more of their embryos will be balanced (euploid). Nevertheless, there are some younger patients who prefer CCS. An example would be unexplained recurrent pregnancy loss or previously chromosomally abnormal pregnancies.
Due to age-related infertility, for women over age 38, most of their embryos will be abnormal (aneuploid) and CCS can help reduce the time needed to successfully conceive by avoiding the transfer of an abnormal embryo.
What is pre-implantation genetic diagnosis and how is it different than CCS?
PGD is a test offered to patients who have a high risk of transmitting a known single-gene defect to their child, such as Tay-Sachs disease, haemophilia and cystic fibrosis.
If you would like to speak with one of our nurses about CCS or PGD, please call us at 604.879.3032
Hi, my name is Paul Wilkinson and I am an embryologist here at Genesis Fertility. You will meet me during your OPU and embryo transfer and I’ll talk with you about your embryos as they grow in the lab. You could call me your first baby sitter.
I’m originally from Halifax, Nova Scotia. I went to school at Dalhousie University and spent time working in research labs after my degree. I was able to work on multiple projects during that time, including research into heart disease and obesity, that inspired me to seek out a field where I could help people in a more direct way.