Atlantic Fertility has many internal policies which may be shared with patients throughout their treatment as required. Below is information on two of our policies that many patients ask about before booking an initial assessment.

Age Limit

The Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guideline (2017) reports a significant drop in IVF live birth rates in women greater than or equal to 43 years of age and no live births for women greater than or equal to 45 years of age.

The American Society of Reproductive Medicine (ASRM) defines futile treatment as having less than a 1% chance of success. According to ASRM, patients undergoing IVF at age 44 or greater have a 0.6% chance of a live birth (ASRM 2014. Female age-related fertility decline Committee Opinion).

As a result of this information, a literature review, and input from our Ethics Committee, Atlantic Fertility’s age limit for IVF is under 44 years of age. This means the patient needs to complete their IVF stimulation cycle and retrieval before their 44th birthday.

If a patient who undergoes IVF at or near the age limit has any resulting frozen embryos and wishes to use them when they are 44 years of age or over, Atlantic Fertility can perform a frozen embryo transfer (FET) up to age 51 (the natural age of menopause), which is the internationally accepted age limit for gestational carriers.

Atlantic Fertility’s age limit for controlled ovarian hyperstimulation (COH) with or without intrauterine insemination (IUI) or donor insemination (DI) is up to age 51 (the natural age of menopause). This means the patient needs to complete the insemination before their 51st birthday.

BMI

There is no BMI limit to be seen for an initial assessment. For surgical and conscious sedation safety reasons, a patient has a BMI greater than or equal to 40 they will not be offered IVF at Atlantic Fertility. Atlantic Fertility may perform Intrauterine Insemination (IUI) and Donor Insemination (DI) for patients with a BMI greater than or equal to 40.  Atlantic Fertility can also perform a frozen embryo transfer (FET) of one embryo for patients who have a BMI greater than or equal to 40. The risks that morbid obesity present to the patient and fetus will be discussed with the patient prior to the procedure. 

Atlantic Fertility is a private clinic and does not operate in a hospital setting. The Department of Anesthesia, in many institutions throughout the world, recommend out of hospital anesthesia not be given in patients with morbid obesity. Numerous governing bodies in the IVF community recommend surgical procedures, such as IVF retrievals, not be performed outside of a hospital setting on patients with morbid obesity for surgical and conscious sedation safety reasons.

Additionally, patients with morbid obesity have an increased risk of being poor responders to stimulation and can be difficult to scan (ultrasound). They also have an increased likelihood of serious pregnancy complications for the mother and child.

If a patient has a BMI greater than or equal to 40 they will not be offered IVF at Atlantic Fertility. The patient will be counselled by the physician on our policy and if they wish to reduce their BMI we can provide a referral to a Dietician or physician who specializes in this area. If they are able to reduce their BMI to below 40 they can proceed with IVF.

If the patient is not interested in reducing their BMI to below 40 and wishes to undergo IVF, Atlantic Fertility can provide a referral to another clinic that is within a hospital setting.

Embryo Transfer Policy

Atlantic Fertility has a policy to transfer one embryo to patients under the age of 35, unless they have been diagnosed with Recurrent Implantation Failure (RIF) by a physician. RIF is defined as the failure to achieve a clinical pregnancy after 3 transfers of good-quality embryos. Patients who are age 35+, or have a RIF diagnosis, may discuss transferring two embryos with their physician and may be done so at the discretion of their physician.

The stated goal of assisted reproduction is to achieve a healthy singleton gestation, not to maximize pregnancy numbers. ASRM's guidance is explicitly designed to "promote singleton gestation and reduce the number of multiple pregnancies while maximizing the cumulative live birth rates." With a good-prognosis patient and a well graded embryo, transferring more than one embryo does not meaningfully increase the live birth rate — it mainly increases the multiple-pregnancy rate. Sequential single embryo transfers across cycles achieve a similar cumulative live birth to one double transfer, but with far fewer multiples.

Impact of Multiple Pregnancy

IVF and subsequent FETs are the infertility treatment with the lowest risk of multiple birth, but only if you have a single embryo transferred. With spontaneous conceptions, 1-3% of pregnancies will be multiples (twins, triplets, or more). If multiple embryos are transferred, the risk of a twin pregnancy is approximately 30% and that of triplets or more is approximately 2%. Risks increase with the number of embryos transferred to the uterus in IVF. For people dealing with the anguish of infertility, a multiple pregnancy may appear to be a good outcome. However, there are a number of serious complications associated with multiple pregnancy that make it considerably less desirable than a single fetus pregnancy. For patients undergoing IVF and subsequent FETs we will encourage single embryo transfers in most situations.

Many of the complications of pregnancy that a mother may experience (high blood pressure, diabetes, placental insufficiency, preterm labour) are increased with a multiple pregnancy. The number of physician visits, ultrasound examinations, and days in hospital is far more with a twin or triplet pregnancy. The frequency of caesarean section is in the range of 50% with a twin pregnancy, and is advised in virtually all triplet or higher number pregnancies.

The aim of fertility treatment is a healthy child. The biggest concern with multiple pregnancy is the risk of pre-term birth. Twins are born on average five weeks prior to term, triplets eight weeks prior to term, and quadruplets or higher more than ten weeks prior to term. A great majority of pre-term twin and virtually all triplets and quadruplets spend periods of time (sometimes prolonged) in newborn intensive care. There is a high likelihood of the need of a ventilator or respirator care, and complications such as brain hemorrhage, leading to increased risks of developmental delay and cerebral palsy. Chronic long-term respiratory difficulties, visual impairment, and bowel disorders are greatly increased with pre-term birth. The risk of death and cerebral palsy is up to five times greater for a twin newborn and more than ten times greater for a triplet newborn than for a single birth. For these reasons, Atlantic Fertility will transfer a maximum of two embryos and this is at the discretion of the physicians.

PGT

Regardless of age or diagnosis – Atlantic Fertility’s policy is strictly single embryo transfers for PGT tested euploid embryos.