Fertility treatment options
Are you or your partner having fertility problems? Are you single or a same sex couple, and looking to start a family? If so, you'll be happy to know there are many treatment options, and new practices are quickly evolving. The ones listed here are only some of the most commonly used options for helping you to get pregnant.
What to try first
If you are a heterosexual couple, see Increasing your chances of becoming pregnant for ideas of things you can do on your own before seeking help.
If you have been trying for a while to get pregnant and not been successful, the next step is to see a doctor. Your doctor will ask you what you have tried and discuss the best options for you. Your doctor may suggest:
- better timing of intercourse (around the woman’s ovulation cycle)
- lifestyle changes
- drugs to fix hormonal problems or stimulate ovulation
- surgery on your reproductive organs
- assisted human reproduction (AHR)
You may want to ask for a referral to a fertility centre for more testing and/or treatment options.
About 80% of heterosexual couples who have sex regularly (2–3 times a week) and who do not use contraception will get pregnant within a year. Of the other 20%, most become pregnant within two years of trying. Others may need medical help (assisted human reproduction) to conceive.
If you are a woman, you may need to inject drugs made of human hormones (called gonadotropins) to stimulate egg growth and ovulation, and make your uterus more likely to allow an embryo to grow. You can also take other drugs not made of human hormones (like Clomiphene citrate) to stimulate egg growth.
Fertility drugs are sometimes used in combination with the medical procedures listed below to give you the best possible outcome.
When fertility drugs alone do not help, these medical procedures may be used:
- Surgery - Surgery may be done to unblock fallopian tubes, retrieve eggs or sperm to be used in fertility treatments, or reverse sterilization surgery (like a vasectomy or tubal ligation).
- Intrauterine insemination (IUI): A thin tube (catheter) carries sperm directly into a woman's womb (uterus) through the vagina. Often, the woman must take fertility drugs to help her ovaries produce one or more eggs. This procedure can be done with sperm from a partner or donor (when the male is infertile or when the female is single or has a same sex partner).
- In vitro fertilization (IVF): This process involves a number of steps that will let fertilization happen outside a woman's body. First, fertility drugs help the woman's ovaries to produce one or more eggs. Next, the woman has surgery to remove the eggs from her body. Inside a lab, the eggs are fertilized with sperm in a dish to produce one or more embryos. If successful, an embryo is transferred to the woman's womb (or uterus) through a thin tube to achieve a pregnancy.
- Emybro transfer: A doctor transfers one or more embryos into the woman’s womb (uterus) after in vitro fertilization (IVF). Frozen embryo transfer involves transferring an embryo that was frozen (cryopreserved).
With IVF, you may use your own sperm or eggs, or use donated sperm, eggs, or embryos. With IUI, you may use your own sperm or eggs, or use donated sperm or eggs. You may also choose to use a surrogate to carry the pregnancy for you. See Using donors or surrogates for more information.
Finding a clinic
Canada has over 30 fertility clinics across the country. Lists of clinics can be found on several websites, including:
Not all clinics have the facilities needed to provide all fertility treatment options.
If you decide to use a fertility clinic, you should be ready to ask questions. You may also want to talk about this with your family doctor, particularly if you will need to travel to a fertility clinic and your family doctor will be coordinating your care when you return home.
Here are some tips to help you choose a clinic:
- Pick one that makes you feel at ease and that is suited to your needs.
- Ask questions to make sure you understand and are comfortable with the procedures being offered.
- Find out about the options available, their risks and advantages, as well as their success rates.
- Ask for a step-by-step breakdown of the process you choose, and the time and costs involved.
- You may also want to get counselling to help you make decisions.
It is important to be as informed as possible before starting treatment. Some questions to ask your health care providers include:
- Which medical procedures are recommended for me, given my situation?
- What are the risks of these procedures for me, my partner (if applicable), a third-party donor (if applicable), and any children born as a result?
- What is the full cost of these procedures?
- Is any of this cost covered by my provincial health care plan, my employee benefits, or my private health insurance plan?
- If this procedure does not work, what would be the next step?
Comparing clinic success rates
Most clinic websites will give you "success rate" statistics. There are several ways to interpret these statistics, depending on the analysis used and how you define "success".
- The pregnancy rate per cycle gives the percentage of patients who achieve a clinical pregnancy (confirmed with ultrasound) after a fertility treatment cycle. This number is lower than the "pregnancy rate per transfer" because it includes cycles where ovulation was induced, but where no embryo was transferred to the woman. This statistic represents the chance that a woman beginning a cycle will have a confirmed clinical pregnancy.
- The pregnancy rate per transfer percentage will be slightly higher than when "per cycle" statistics are used, because no cancelled cycles are used in the analysis. This statistic represents the chance that a woman who undergoes embryo transfer will have a confirmed clinical pregnancy.
- The live birth rate is often the rate that interests new patients the most. It represents the chance of a baby being born at that particular clinic. Live birth rates can be quoted "per cycle" or "per transfer."
Fast facts on fertility treatments in Canada (2006)
- Number of fertility clinics in Canada in 2006 - 25
- Number of fertility treatment cycles - 12,052
- Number of in vitro fertilization procedures performed - 8,278
- Number of AHR cycles resulting in a clinical pregnancy - 3,784
- AHR cycles resulting in a delivery - 3,006
- AHR cycles resulting in a live birli - 2,974
- Total number of multiple birli infants - 1,804
- Number of twin sets resulting from fertility treatments - 846
- Number of triplet sets resulting from fertility treatments - 36
- Number of quadruplet sets resulting from fertility treatments - 1
- Clinical pregnancy rate per cycle - 31.4%
- Live birli rate - 24.9%
Source: Gunby J., Bissonnette F., Librach C., Cowan L., IVF Directors Group, Canadian Fertility and Andrology Society. "Assisted reproductive technologies in Canada: 2006 results from the Canadian Reproductive Technologies Register," Fertility and Sterility. Article in Press 2009, accessed August 20, 2009
Adopting or fostering children
Adopting and fostering children are two other ways to build your family. These activities are coordinated by provincial bodies. These links may help direct you to resources in your area:
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