This Chatelaine article delves into new research with regards to timing your egg freezing. The analysis found that women who pursue egg freezing in their early or mid-3os can often retrieve — and preserve — a promising amount of healthy eggs. However, if they start trying to conceive in their late 30s, they’re often able to reproduce without using their frozen eggs — making the cost and labour of egg freezing unnecessary.

On the other hand, the article notes that women who pursue egg freezing in their very late 30s, or early 40s, have a less successful chance of retrieving healthy eggs — which means the expense of egg freezing may not be ultimately worth it.

The study suggests that, in general, the optimal age to freeze your eggs is 37: it’s likely to result in the preservation of healthy eggs, and your odds of actually using those eggs are higher.

However, if you’re considering egg freezing, talk a fertility doctor about whether any individual factors (such as cancer treatments, premature reduction of fertility, etc) should sway that number.

The post When is the optimal age (medically and financially) to freeze my eggs? appeared first on Fertility.ca.

The government also reversed its recent move to cut funding for certain OHIP-covered fertility monitoring services (such as blood tests), which is a big relief for doctors and patients alike. It looks like those cuts are now off the table.

Read the government’s news release
Read the expert panel’s recommendations to the government

This is a big day for fertility care in Ontario — but there’s a lot of information we’re still waiting on.

We’ll keep this page updated with any information that comes in about the OHIP-covered IVF process, as well as answers to any questions you may have.

The post Important announcement: OHIP-covered IVF cycle to launch December 2015 appeared first on Fertility.ca.

(If you aren’t caught up, I recommend reading my post on the latest status of OHIP-covered IVF in Ontario.)

So far, all we know is that the expert advisory panel has recommended excluding women over 42, and severely obese women, from eligibility for this coverage — on the basis that they’re medically less likely to see success from IVF, and that IVF could be more risky for their health.

With the failure of Quebec’s provincially-covered IVF program due to ballooning costs, it’s not surprising that the panel is considering cost-efficiency.

However, this is also controversial news. Some experts believe excluding women like this could be unethical. (And, needless to say, heartbreaking and upsetting for women who find themselves ineligible for this free round of treatment.)

The advisory panel had more recommendations, but they won’t be released until sometime this fall. We’ll keep you updated here.

The post Panel advises excluding women over 42, severely obese women, from OHIP-covered IVF appeared first on Fertility.ca.

My suspicion is that this comes down to two reasons. Financial, yes, but importantly, emotional: For all of us, the plan was to achieve pregnancy naturally. It is a difficult step to move the act of fertilization into the laboratory.

But, if it has been more than six months of trying naturally together, there are three situations in which IVF may make the most sense:

1. Sperm

Whenever male factor is present, couples may choose to try to maximize sperm quality. This could be done through lifestyle management, through vitamins to maximize sperm quality, through medication such as Clomid to maximize the stimulation of the testes, and through intrauterine insemination to deliver more sperm to the ends of the fallopian tubes.

But none of the above is as effective as doing IVF. This is because with IVF, we can bypass all concerns associated with count, motility, morphology, or obstructions related to previous vasectomy or a congenital absence of the vas. All are treated with a single procedure, by doing intracytoplasmic sperm injection, or ICSI. ICSI places the sperm into the eggs.

It is an extraordinarily effective treatment, as long as the sperm’s DNA can support a healthy embryo.

And so before doing IVF, you might consider getting a karyotype done to confirm normal genetics, and a DNA fragmentation assay of the sperm, if available, to ensure that the DNA being delivered is well packaged and likely to be easily handled by the eggs.

For these reasons, male factor subfertility may often be a serious frustration, but if sperm’s DNA quality can be confirmed, then your expectations for successful IVF can be very high.

2. Tubes

It’s rare that compromised fallopian tubes will be able to be reopened through a cannulation procedure, very rare. The reality is that IVF is a far more successful approach, because it simply bypasses the fallopian tubes. Pregnancy rates can often be superb for a couple facing a situation where eggs and sperm are of good quality, the uterine structure is healthy, and the maternal health is excellent. If it is just a mechanical issue – sperm could not reach the eggs – IVF is a bypass.

As noted, we can try cannulation, or sometimes, if tubes are only partially compromised, we will look to inseminations.

“Partial compromise” can be very difficult to diagnose. Imaging, such as sonohystogram and HSG (hysterosalpingogram) will routinely miss compromised tubes, and the gold standard of investigation – laparoscopy – is highly interventional and invasive. For that reason, we miss fallopian tube compromise with great frequency, and arguably the number one cause for unexplained infertility will prove to be tubal dysfunction. It is for that reason that unexplained infertility is often also well treated through IVF.

A major risk for tubal compromise is low-grade endometriosis, but any source of pelvic scarring, including pelvic inflammatory disease from a previous STD like Chlamydia, a ruptured appendix, or other bowel surgery, all are risk factors for tubal compromise.

3. High quantity of low quality eggs

This situation is more complex. Many couples, particularly when women are over thirty-five years, increasingly worry about egg quality.

On the face of it, IVF would not seem to be all that beneficial; simply placing a sperm inside the egg does not increase its quality. Ninety-three percent of first trimester losses are related to embryo quality, 90% of which come back to egg. So, egg quality is a serious concern in any fertility setting.

The advantage that IVF can provide is this: Numbers. With high-dose fertility drugs, instead of the two to four eggs we will often encourage people to have intercourse or inseminations with, we would be aiming for ten, fifteen or twenty eggs with IVF.

And so it is a numbers game: If egg quality is a concern, and egg quantity is high, then IVF has a superb chance of being more beneficial than any other therapy for the shear advantages that come when ten to twenty eggs are fertilized at a time. It is like one to two years of trying naturally all focused into a single cycle.

And so when is IVF less successful?

Arguably, IVF is less successful when none of the elements above are present: If egg quality is a potential concern, but egg quantity is low, with all other parameters being normal, then IVF is unlikely to be of great benefit. When the issue is related only to uterine structure or implantation, IVF is unlikely to be successful, and if the issue is related to the couple’s overall health, IVF is unlikely to be successful.

IVF, therefore, may be our gold standard of therapy, but it is not for everybody. Still, if any of the three diagnoses above apply to your situation, and it has been a number of months of trying with other means, then IVF may well be considered as a reasonable option.

The post 3 situations where you’ll want to consider IVF appeared first on Fertility.ca.

We can help you monitor your cycle – we can even make sure you have maximal fertility while taking medications – but we cannot complete a cervical or intrauterine insemination.

This could put you in the difficult position of being tempted to doing inseminations at home yourself. We cannot speak to the medical safety of doing so, or to the emotional risks of the parties involved, nor to the legal risks up to and including the child support implicit in the biological father’s participation.

What alternatives do you have?

Health Canada will approve known-donor insemination, when the sperm is frozen for six months in an approved setting. As noted above, the only approved setting in Canada is at ReproMed. You would need to contact them directly.

Unfortunately, your known donor may not match Health Canada’s criteria for suitability for known sperm donor. Under these circumstances, there is a special release called “DSSAP”. For example, if your potential donor has had homosexual relations, or is over the age of forty, then sperm could only be released through DSSAP. At Hannam Fertility, we do not work with DSSAP sperm, as it is not in our opinion a process regulated and approved by Health Canada. We can, however, forward your care to other clinics that may well be willing to provide this service.

Though we cannot support known donor sperm insemination, we are comfortable supporting your right to understand and maximize your own personal fertility through cycle monitoring and/or medications where necessary.

These, and additional, guidelines were put in place by Assisted Human Reproduction Canada (AHRC) in 2006, to enforce the Assisted Human Reproduction Act of 2004. However, the AHRC was wound down in 2012 in response to a 2010 Supreme Court of Canada ruling. Health Canada now administers the guidelines. Specific limits of jurisdiction continue to be debated and interpreted. These limits are of particular interest to people interested in third party reproduction (donor eggs, donor sperm, and gestational carriers). Since the legal restrictions to clinical care are not always straightforward, different clinics are responding differently. We believe we have a very conservative interpretation of the law that maximizes healthy outcomes for all parties concerned. If you have any specific questions about how the laws of Canada may impact you, you may want to speak with Sherry Levitan (416-784-1222) or Kelly Jordan (416-203-2899 x 29), lawyers with a particular interest in and experience with reproductive medicine.

The post What are the guidelines for known sperm donation? appeared first on Fertility.ca.

However, there are some logistical challenges limiting choice. There is only one Canadian sperm bank: ReproMed, based in Toronto.

To allow for a greater variety of sperm available to Canadians, Health Canada has allowed for the importation of non-altruistically-donated sperm. Including ReproMed, there are three organizations that import sperm, the other two are Outreach Health Service and CanAmCryo. At our clinic we endorse Outreach and ReproMed.

When you choose sperm, Health Canada recommends that women who have never been exposed to Cytomegalovirus (i.e. “CMV negative”) should choose sperm that is also CMV negative. We test for CMV status for all women considering donor sperm.

When you make a purchase you’ll be offered washed and/or unwashed sperm samples. We re-wash the sperm regardless. From our perspective, there’s no functional difference which sample you’d choose to purchase. We see equal pregnancy rates from either approach.

When doing donor sperm inseminations, we ask that women trigger ovulation (usually with Ovidrel), to ensure that the timing of insemination is ideal. We use one sperm unit per cycle.

We’ll provide you with information on the count of the sperm being inseminated, and the average motility. Using fresh samples as a reference frame, we like to see at least 5 million sperm in the washed sample with 80% or greater motility. We won’t always see these numbers with frozen-thawed sperm: you may have a reduced success rate.

The success statistics that support the donor-sperm program are available from your clinical team and can be individualized to your specific situation by your doctor.

Next post, we’ll be covering guidelines for known donors.

The post We’re considering using an anonymous sperm donor. How does it work in Canada? appeared first on Fertility.ca.

Women who are not yet ready to start a family may choose to freeze their eggs to keep the option on the table for longer.

There has been significant promise, but also significant disappointment, with egg freezing to date. The disappointment stems from the relative lack of success rate data. Many more women are freezing eggs than thawing them. And until they are thawed, how do we know how successful the treatment really was?

At first, the data was generally only coming from egg donors, women pre-selected to have eggs that would be expected to succeed. Significantly less data was available for “social” egg freezing, that is, women who are choosing to delay their reproduction and hope to be able to freeze their eggs in time. The majority of our patients were waiting for the latter data sets to come through, as we tried to keep expectations firmly in check.

We are now finally seeing the numbers, and it appears that for most patients egg freezing works as well as embryo freezing, with success rates often in the range of 60% (see this article for more). This published data fit our internal data suggesting clinical pregnancy rates 55-60% per set of eggs for women under 38.

Egg freezing is promising when we have enough good eggs to freeze. If you are under 38 years old (age being a marker for egg quality) and have been told you should be able to freeze 12-20 mature eggs (ie. you have a good ovarian reserve), and are working with a good lab able to offer vitrification, you may anticipate having three or more fertilized egg develop to blastocysts and a reasonable expectation for pregnancy in the future. No, it isn’t perfect – all things being equal frozen eggs do not work as well as fresh eggs – but with good counselling egg freezing may provide some measure of reassurance that had been missing until now.

For a good video that walks you through the process check out this video, or a more detailed scientific review, see this article.

The post New data on non-donor egg freezing success rates! appeared first on Fertility.ca.

Sometimes, these are valid concerns. But there are things you can do about it.

1. Get a sperm test with DNA fragmentation. Women may not be able to confirm their egg quality until they complete an IVF cycle, but for men it’s much more straightforward.

2. If you have sperm quality worries, it may be appropriate to introduce lifestyle changes and vitamin therapy.

3. Get further testing done. Your testosterone levels can be checked with a simple blood test. Low testosterone levels can often be treated successfully with Clomid or Arimidex. You can also check for varicoceles, dilated veins that heat the testes. They can be found with a physical exam or scrotal ultrasound, and treated through minimally invasive surgery with faster recovery times than in the past.

4. Talk to your doctor to find out if Viagra or Cialis is right for you. You may not need these in other sexual encounters, but procreational intercourse can be quite stressful. If you worry that you can’t have an erection with timed intercourse, it’s okay.

Another option is intrauterine insemination. You might find it easier to just let your sex life be your sex life, and procreation can take the form of providing sperm samples in the morning for the clinic to inseminate later that day. In the event you’re unable to provide a sample one day, frozen sperm is available as a backup. This lessens some of the pressure to have procreational sex.

5. Take your overall health seriously. Some men worry that their ejaculate has less volume than it did when they were younger. In many cases, this can be addressed through better hydration. A volume drop may be related to other health concerns, such as retrograde ejaculation (ejaculate travels backward into the bladder rather than out the tip of the penis). Take care of your overall health by having frank discussions with your doctor.

Now and again, men are concerned they don’t “shoot” as far. Well, it does happen with age. Let me reassure you, there’s absolutely no proof that it makes any difference to anything whatsoever.

I don’t think the distance the ejaculate moves is as important as volume, which is necessary to protect the sperm with seminal fluids while they find their way out of the acidic vagina, into the cervical mucus, and ultimately up into the uterine cavity.

6. Do IVF with ICSI. Intracytoplasmic sperm injection (ICSI) will ensure eggs will be fertilized. Newer techniques in the lab have been shown to be associated with lower DNA fragmentation rates, rather than higher. That’s right! It’s possible the modern techniques are better able to sort out the “best sperm” than nature alone.

The only real problem with IVF is the expense. I don’t mean to minimize it – expense is a very real stress for most couples – but so can be the month-in/month-out lack of success for pregnancy and the strain of a sexual act that can make you feel further away from your partner, rather than bringing you closer.

In our clinic, we strongly recommend that couples consider IVF after all other reasonable options have been exhausted over a five month period. Fertility treatment can take an emotional toll on a couple, and we want to see you move past the hopeful phase and into the pregnant phase as quickly as possible.

The science behind paternal aging and how it may affect the health of children is interesting and changing all the time. (At least, it’s interesting to us.) If you want to know more, please let us know in the comments. I will be very happy to expand this section further.

The post What impact does aging have on male fertility? appeared first on Fertility.ca.

The oldest patient I helped achieve pregnancy through a fresh IVF cycle with her own eggs was 45 when she delivered; a colleague of mine diagnosed a (very surprised) 51 year old with “stomach flu” as being in her second trimester.  So there is a lot more to fertility success than age. But it’s an inescapable variable, and such stories remain the exception.

But let’s dig a little deeper.

Studies have shown that cycle fecundity – the odds of getting pregnant in a given cycle – starts to fall from the age of 27 years.

Now, don’t freak out too much about that. The number 27 is a statistical average. In fact, for nearly all women, when fertility does start to change, it doesn’t fall very fast at all. Most women will have no troubles with egg quality when they are less than 35 years old. (If you’re young, and have been told that you have egg quality issues, you may wish to look into the tests associated with premature ovarian failure.)

Once they’re 35 years old, a few women will have difficulties with egg quality. But most won’t. In fact, most women can count on good eggs until at least 38 – but there are enough 35-year-old women with egg quality issues that we can start to make generalizations based on age. As a population, when comparing women over 35 to those under 35:

• It takes longer to get pregnant
• There’s an increased chance of having an early miscarriage
• There’s an increased risk of Down’s syndrome

Again, for most women, these effects will not be immediately apparent at first.

However, by age 38, most women will be affected by the realities of decreasing egg quality. The average age beyond which a woman will be unable to have a healthy pregnancy is 42.

Again, “42″ is a statistical number only: there are many women who can achieve pregnancies at age 43 or older. However, these pregnancies are matched by an equal number of women younger than 42 who cannot.

The bottom line is this: over age 38, it is reasonable to assume that age will be playing a role in egg quality. It may not matter, for example, if a woman at age 32 decides to put off her family for another two years. But for someone 40 years old, two years matters.

The post “How serious are those scary statistics about a woman’s fertility as she ages?” appeared first on Fertility.ca.