People who experience infertility and pregnancy loss, or face other barriers to starting a family, can find the journey is fraught with isolation, worry and financial hardship.
“It’s really tough to see patients struggle with infertility,” said Dr. Mike Ripley, an obstetrician/gynecologist and reproductive endocrinologist in Halifax. “They have a lot of stress and fear that they won’t be able to start a family. It’s so rewarding when we can give them good news.”
Dr. Ripley works at Atlantic Assisted Reproductive Therapies (AART), a clinic in Halifax specializing in assisted reproductive treatments. Established 30 years ago by Dalhousie University’s Department of Obstetrics and Gynecology, AART became a private not-for-profit clinic in 2005. The clinic’s staff includes medical director Dr. Renda Bouzayen and Dr. Heather Cockwell, plus a team of embryologists and nurses.
It’s the only clinic in Nova Scotia providing treatments such as in vitro fertilization (IVF), frozen embryo transfer, intrauterine insemination and egg freezing. Most patients are Nova Scotians, though the clinic also serves patients from Prince Edward Island and Newfoundland and Labrador, where IVF is unavailable.
“We do about 250 IVF cycles per year, but have capacity to do 400,” said Dr. Ripley, a graduate of Dalhousie Medical School who joined the AART team in 2015, after completing a fellowship in infertility at the University of Ottawa. Besides his work at the clinic, he also provides prenatal care and works on-call for labour and delivery at the IWK Health Centre.
Assisted reproduction is a fairly new area of medicine, with treatments growing rapidly. “The first IVF baby was born in 1979, back when the treatment was major surgery,” Dr. Ripley said. “The current version of IVF hasn’t been around very long.”
“Even in the last 20 years, the way we fertilize eggs has changed. Egg freezing just started in 2012. We’re now able to test the genetics of embryos to determine if they’re genetically normal or not. All of these things are now the bread and butter of what we do.”
Over the years, he’s seen a shift in how patients and physicians discuss fertility problems. Patients have led the charge, especially through social media. “There’s less stigma about reproductive issues like infertility and recurrent miscarriage,” said Dr. Ripley. “Patients can connect with each other and realize that it’s not just happening to them.”
The clinic treats couples of all sexual orientations and genders, as well as individuals wanting to start a family on their own or preserve their fertility before undergoing chemotherapy or gender transition.
“We’re an inclusive, non-judgmental clinic,” said Dr. Ripley. “In the last five years, we’ve seen an increase in transgender patients freezing their eggs or sperm before they transition. It’s a credit to the physicians who are counselling their patients and suggesting a referral to AART.”
When it comes to fertility, age matters. Statistics Canada reported that the average age of first pregnancy for Canadian moms in 2016 was 29.2 years. The average age of moms who gave birth that year was 30.8 years.
“As patients age, it becomes statistically harder to conceive a pregnancy and the success of fertility treatments decline as well,” said Dr. Ripley. For patients under age 35, IVF is successful about half of the time. At age 40, it drops to between 25 and 30%. By age 43, it’s less than 1%.
He recommends referring patients to the clinic who are over age 35 and have been unable to conceive after six months, and after one year of trying for patients under age 35. “If someone has blocked fallopian tubes or doesn’t ovulate spontaneously, they don’t need to wait,” he said.
For Dr. Ripley, helping patients find their way through a complicated process is what he enjoys most about his work. “For an embryo transfer, you use a transparent catheter and place the embryo into the patient’s uterus. The embryo is microscopic, so you have to check the catheter under a microscope to make sure it went in. Nine months later, there’s a baby. It’s magical.”