But that doesn’t mean sexuality doesn’t matter.

Sexuality and fertility and, yes, love, are all mixed together for all of us.

If fertility is difficult, if your sex life is feeling stressful or unfulfilling, it can hurt your emotional well-being. It can hurt your relationship. It can hurt you.

For some couples, integrating your sexuality (your desires, preferences, and physical pleasure) into the process of trying to achieve pregnancy can make a big difference in the journey. Here are a few suggestions:

• Find a fertility counsellor. These counsellors specialize in fertility issues and are familiar with the stresses involved, including on your sex life. Here’s a list of Toronto-based ones.
• For women and their sexual partners — check out OMGYES. Based on a large-scale study of women (cisgendered), this modern website features thoughtful, graphic videos of sexual techniques that can elicit more pleasure, and assist you in reaching orgasm. It’ not a free service, but you can start with a free sample video to try it out.
• For men — it can be touch to talk about, but sometimes the pressures of “making a baby” can overwhelm sexual desire. If you have concerns, consider starting here and reach out to us if you are interested in referrals. Many men will temporarily use Viagra, for example, to assist in the fertility setting. And don’t hesitate to seek therapeutic support: for many, the quantification of sperm at a fertility clinic (the detailed discussion of how many, or how few, sperm are present) can take a toll on sexual self-esteem. Of course, logically we know that sexuality and sperm counts are different things. But for many men, the two feel like one and the same. An experienced therapist can help you, and your partner, regain confidence.
• Nowadays, many modern, independent sex shops offer educational courses and workshops led by professionals on sexual topics, including improving your sex life. While these events may not be geared specifically toward those trying to conceive, they can help you learn new techniques and approaches. These events also tend to be more LGBTQ-friendly.

Do you have other tips or resources? Feel free to share them in the comments.

The post My fertility struggle is taking the pleasure out of my sex life. What can I do? 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.

Sperm’s ability to fertilize an egg is dependant on healthy DNA. But some sperm are fragmented.

Healthy DNA is arranged in a double-helix spiral bound by cross-bonds resembling a ladder. DNA damage means the bridges become unstable or broken causing instability in the DNA ladder.

That instability is referred to as fragmentation or damage of the DNA. If there is a high amount, you’ll likely see a reduction in male fertility, poor embryo development and lower rates of implantation.

Scientific literature shows that the extent of DNA fragmentation has little relevance to the basic semen quality parameters (concentration, motility, morphology, etc.) For example, a “good” sperm sample with high concentration, motility and morphology doesn’t guarantee you’ll get pregnant if there’s poor DNA Fragmentation Index (DFI).

Why is DNA Fragmentation important in the assessment of male fertility?

The test (flow-cytometry or TUNEL assays) is used to count the number of sperm cells per sample that contain suboptimal, damaged or fragmented DNA.

What are the values and what do they mean?

DNA Fragmentation Index (DFI) is used to quantify DNA damage in the sperm. DFI is inversely related to sperm’s ability to fertilize an egg and produce a viable embryo. DFI of less than 15% in sample is considered optimal. DFI between 16-29% is considered to be good or fair fertility potential. Sperm with DFI over 30% is considered to have poor fertility potential. Although exceptions do exist, these percent ranges have been established based on numerous scientific publications over many years of research.

What does testing mean for our ability to conceive?

• More accurate assessment of semen sample quality
• May explain previous failed attempts to conceive
• Determine suitability for IUI versus IVF/ISCI
• Assessment of efficacy of medical intervention or treatment of infectious diseases to improve
• Ultimately improve fertility potential of the male partner

What are the causes of DNA damage?

We don’t yet know all of the factors that lead to DNA damage. Most common ones we do know are chemical/toxin exposure, heat exposure, varicocele, age, infection, smoking, alcohol, radiation or testicular cancer.

The post What is DNA Fragmentation? 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.

As physicians, it’s our duty to inform all patients that this is accepted dogma and that there is no minimal dose that is known to be safe and, therefore, no one should use any such substances.

But, speaking to patients who, regardless of the advice above, are going to continue with the lifestyle that they have chosen, we have the following to share.

(And on a personal level, we understand how some people come to those choices. After all, fertility is not something that lasts a couple of weeks, or even a month. It can last six months, twelve months, and longer, and it can be a dramatic and isolating lifestyle change for people to make at a particularly vulnerable time in their lives.)

So, if it comes to harm reduction – if you are looking to minimize stress, knowing that you should really be doing it through going to bed on time, eating better, and exercising in an appropriate fashion – you might also want to have a glass of wine with your friends from time to time.

Please understand we are not talking about excessive drinking or other abuses of alcohol. We all know that alcohol can be used for self-medication purposes. But, it can also be a gentle part of a social lifestyle. Red wine contains resveratrol, part of the antioxidant family that may or may not be beneficial for eggs. So if you are going to have alcohol, perhaps a glass of red wine with friends, as is socially appropriate to your life, would be the best choice.

And what about smoking? It’s true that smoking residues are found in seminal fluid and in the follicular fluid, i.e. the fluid that aids eggs and sperm. What would be an appropriate therapeutic dose? We aren’t sure, but it seems self-evident that if you can minimize smoking as much as possible, you can feel confident that you’ve done all you could at this short time in life to maximize the chances of pregnancy. Once you’re pregnant and delivered, as long as you aren’t smoking around your child, then it’s your decision to make.

We cannot be as calm about marijuana use. It’s very clear that it reduces sperm counts and quality for men, often dramatically. Yes, of course, you all know people who will smoke pot daily and father a pregnancy, but for many men who have average sperm counts, the use of marijuana decreases it substantially.

So, what about eggs? We can’t tell if egg quality changes with the use of marijuana or not. The effects are so profound for sperm that, by extrapolation, we are more worried about pot than cigarettes or alcohol.

And, of course, we cannot advocate for cocaine, MDMA, or other stimulants. We recommend a lifestyle change—perhaps aided by support groups, substance abuse treatment, or therapy, if you’re having a hard time discontinuing use of these substances—if you wish to get pregnant.

The post Smoking, illicit drugs, alcohol and fertility appeared first on Fertility.ca.

I was reading about the success rates of FSP (fallopian sperm perfusion) for unexplained infertility and how FSP may be more effective than IUI. It is suggested that couples with unexplained infertility may benefit from FSP over IUI, resulting in higher pregnancy rates.

I was just wondering what your thoughts were on FSP vs IUI and if you offer FSP treatments?”

We use a modified FSP technique much of the time.

FSP was developed in the 1990s, before ultrasound could be used widely. It addressed the concern: is it better to have the sperm highly concentrated and thus quite possibly left in the fundus of the uterus (“IUI”) or dilute the fluid 8x, put a balloon or other device to make sure nothing comes back, and thus ensure through higher pressure and volume that sperm must go up the tubes (“FSP”).

It took randomized controlled trials to see if there was a difference. The result: both techniques appear to deliver the same pregnancy rates. You can read more about this in The Cochrane review, here.

At our clinic we do a combination of IUI or a FSP variant with every insemination: we focus on ultrasound guidance and, when necessary, using a balloon catheter to keep the sperm up and inside. We’ve been doing this for about four years or so. When we started we saw a 50% boost in pregnancy rates from previous techniques. Now we find success rates are the same whether we use ultrasound or not (but M-F we use ultrasound).

In our opinion, pregnancy rates are maximized when your team is focusing on what you individually need. Its less about IUI FSP or ultrasound, more about your clinician taking care when completing the procedure.

Hope that helps!

The post What’s more effective: IUI or FSP? appeared first on Fertility.ca.

1. Oocyte (egg) quality

Implantation is more likely to happen when a healthy embryo is present, and the best predictor for a healthy embryo is a healthy egg. Egg quality is based on a number of factors.

2. Sperm quality

We now know that paternally imprinted DNA is disproportionately expressed in developing placental tissue. In other words, sperm quality matters a lot when it comes to implantation. For a successful pregnancy, sperm should have stable, well balanced DNA.

What you can do:

There are many ways that sperm quality can be maximized. Antioxidant vitamins are a popular intervention. We have more on sperm here and here.

3. Embryo quality

Embryo quality is a reflection of both egg and sperm. If you are doing an IVF cycle, embryo quality can be determined by grading systems. The embryos most likely to continue to develop will have 6, 7, or 8 cells by day 3 of development in the lab.

If you are considering a frozen embryo transfer (FET), embryo quality is also a reflection of the laboratory’s freezing-and-thawing success rates. In some labs, FET cycles have a pregnancy rate of one-quarter to one-half that of fresh cycles, but the rates vary by clinic and many of us are now seeing the same (and even higher) success rates with FET. Embryos may be frozen with the traditional slow-freeze protocols, but with the flash-freeze vitrification methods we are seeing better success rates.

Here’s what you can do:

Maximize egg and sperm quality before you start treatments.

Consider a repeat fresh IVF cycle instead of multiple frozen cycles.

4. The number of embryos transferred

There are some suggestions that embryos help each other to implant. In other words, the more embryos that you transfer, the greater the chance that each one will stick.

Be very careful with this one. The movement in our field is away from multiple-embryo-transfer, not towards it, because the risks associated with multiple pregnancy are very real. Some clinics even advocate for elective single embryo transfer. But if there are other impediments to implantation–say, embryo quality is a known concern–then our standard of care is to transfer multiple embryos in the hope that one will take.

We also find we have more success with blastocyst embryos transferred at day 5 rather than morula embryos transferred at day 3.

5. The woman’s overall health

An overall health screen tests many things, and usually includes thyroid function and prolactin levels.

Depending on your situation and family history, you may also be screened for other systemic diseases that can affect implantation. For example, we might look to rule out diabetes, autoimmune conditions such as elevated Natural Killer cells, a pre-disposition to hypercoagulability, markers for celiac disease…and many more.

If you and your immediate family are otherwise healthy, many of these tests are not routinely offered.

Here’s what you can do:

Eat well, exercise moderately, don’t smoke, and continue seeing your family doctor for annual check ups even when under active fertility care. If you have or suspect a specific medical condition, ask your doctor if further testing is warranted.

6. Shape of the uterus and fallopian tubes

Some women have an anterverted uterus, some women have a retroverted uterus. Both are fine: the terms simply refer to which direction your uterus tips. Of more importance, we need to confirm that the uterine cavity is a normal size and shape for implantation to be successful.

To check the structure of your uterine cavity, the gold standard of imaging is a 3-dimensional sonohysterogram. Hysteroscopy (surgery) is used when necessary for things like fundal polyps, impinging or submucosal fibroids, and/or a uterine septum extends 10mm or more.

The shape of your fallopian tubes should be confirmed by ultrasound, a hysterosalpingram, or (less often) surgery. We also screen for chlamydial antibodies, because a history of this infection can affect tubes. We know that dilated tubes (”hydrosalpinges”) may compromise implantation, and sometimes suggest that they’re surgically removed before IVF.

Here’s what you can do:

Make sure that you have all the imaging tests available to you updated before starting your treatments. If your doctor suggests uterine surgery, you may want to get a second opinion. But don’t be too hesitant: the surgery is often a day procedure, and the benefits can be profound.

7. Lining of the uterus

We look at the uterine lining itself, to judge whether or not implantation may be expected. The endometrial lining can be assessed in the following ways:

Appearance on the transvaginal ultrasound

An ideal lining will be at least 7mm thick on day of ovulation trigger (the day your HCG spikes). Ideally, it will also have a “triple line” appearance (an ultrasound finding that shows a good response to estrogen).

After ovulation, the endometrium compresses somewhat, and the triple-line pattern will be less distinct. These are normal findings.

Luteal endometrial biopsy

An endometrial biopsy is not part of every cycle, but it may be done in the luteal phase of a cycle before IVF, in an effort to confirm that the implantation window exists. Various markers for this implantation window have been identified, including histologic appearance and grading, specific findings seen only by electron microscopy, and the staining for various markers that are thought to be associated with implantation.

There are several tests which analyze endometrial biopsy further looking for markers of implantation. This is controversial, as it does not work as well as we would like, but some tests include Harvey Kliman’s Endometrial Function Test, the “E-tegreity Assay” for beta-3 integrin, and sending a biopsy specimen off for culture (this is most useful when intrauterine fluid is collecting and worries about infection persist).

We offer the EFT through our office in partnership with Dr. Kliman.

Here’s what you can do:

When endometrial thickness is low (the lining is never more than 6mm thick), you should talk to your fertility doctor, for management is highly individualized. Many authorities recommend a BMI of >18.5; a healthy lifestyle that involves no smoking and limited caffeine; and ask that you consider red meat to be part of your diet. Supplemental estrogen is regularly used and acupuncture may also be suggested. But again: you should really speak with your doctor.

If you have irregular cycles and a tendency towards a thick lining (>12mm), you might benefit from an endometrial biopsy to rule out hyperplasia.

Even if the EFT is limited, the very act of getting an endometrial biopsy may help with implantation. The proper studies have not yet been done to support this statement, but many smaller ones suggest that implantation may be boosted by as much as 20% in some cases.

8. Embryo transfer technique during IVF

In an IVF cycle, embryo(s) selected for transfer will be collected into about 0.020cc of fluid and inserted into the womb. The process of insertion is highly physician dependent: this means that it matters who does your embryo transfer. The following issues will be considered by your doctor:

(a) Transfer medications like progesterone, antibiotics, and steroids.

(b) Cervical preparation

(c) Use of a tenaculum

(d) Catheter type

(e) Ultrasound guidance

(f) Post transfer instructions

Here’s what you can do:

Work with a doctor and clinic that you really trust. Embryo transfer is very important. Some physicians even suggest doing a mock transfer prior to the IVF cycle itself. It has been our experience that the uterus is lying in a slightly different position every time. In other words, the mock transfer did not help as much as we would have hoped for. We now judge the value of a mock transfer on a case-by-base basis.

9. Luteal Support

We support the luteal (post ovulatory) uterine lining with progesterone whenever we are worried about natural progesterone levels. Progesterone may be taken orally, intramuscularly, vaginally, or rectally. Other medications that you may read about for the luteal phase, and into early pregnancy, include estrogen, ASA, dexamethasone, Fragmin, Lovenox, IVIG, HCG, and others. We are very cautious here: some of these medications have side effects that, in some circumstances, could be of real concern to you or your baby.

Here’s what you can do:

Definitely talk to your doctor. The medications that you take in the luteal phase, and into pregnancy, must be compatible with bringing a healthy child into this world. That said, the ideal balance will keep your endometrial lining stable. If you find that you consistently have your period before the planned pregnancy test day, your luteal support may need to be re-examined.

10. Lifestyle

You need to minimize caffeine, quit smoking, and avoid alcohol. Intercourse during the “two week wait”? We think it’s fine, but I would ask your doctor, as everyone has a different opinion on this subject.

Conclusions

To be successful, your clinic must focus on implantation. Many protocols and techniques are well standardized across fertility clinics, but implantation standards are not. Because of this, there are great differences in implantation success rates across both clinics and doctors. We hope this article will help shed light on some of the complications and what you can do to help achieve a successful implantation.

The post How do I improve my chances for embryo implantation? appeared first on Fertility.ca.

Not everybody needs IVF. Many patients may benefit from intrauterine inseminations.

IUI, where sperm is washed and placed high within the womb, can address a variety of concerns including:

• concerns around cervical mucus or scarring after a LEEP procedure
• erection concerns
• difficulty timing intercourse (perhaps due to work, or irregularity of ovulation)
• unexplained infertility
• donor sperm
• financial: And understanding that IVF may be “better”, but it is also much more expensive and invasive, and a hoped for success through a trial of inseminations

As you can see, there’s a wide variety of reasons why people may choose IUI, so success rates vary greatly from less than 5% to over 20% per cycle. You would really need to speak with your clinical team to understand what the odds of inseminations may be like for you.

It can be difficult to make sense of these wide-ranging numbers. Specific questions of what approach will maximize pregnancy rate can be actually quite tricky to answer. Here are two:

1. Should we always trigger ovulation?

One of the advantages of inseminations is we should be able to get the timing exactly right.

But for the timing to be “exactly right” we want to be able to place the sperm before the egg is released. We say a released egg is viable for twenty-four hours but we know from watching eggs in the lab that they are really optimized in their first six hours upon release.

Sperm, while functional for up to five days, is almost always very functional for the first twenty-four hours. That means we want to place the sperm into the womb before the egg is released, ideally the day before, so that they will be available when the egg is available.

The challenge with placing it the day before, however, is that while we are organizing for the insemination, we don’t actually know if the egg is going to be released on time.

To ensure the egg is ready on time, we often encourage using a “trigger shot”. This is an HCG hormone. It is actually a pregnancy hormone – and after a trigger shot, if you did a home test, it would suggest that you were pregnant. We use HCG because it is almost exactly the same structure as LH, the natural hormone that releases eggs. By taking the HCG shot, you can ensure yourself and us that the timing of the insemination will be ideal.

Different clinics will have different approaches. And it’s important to make note, it hasn’t been proven that HCG shots improve pregnancy rates.

2. Should you do one or two intrauterine inseminations?

The worry is that the timing of the insemination may not have been perfect. For that reason, it may be helpful to do inseminations two days in a row. If one insemination is too early (or the other is too late), at least one of them will be ideally timed. So is it worth doing IUIs two days in a row?

You can discuss this with your clinic. Pregnancy rates that peak at 30% are frustrating: It means that 70% of patients at least won’t succeed with their insemination cycle.

At my clinic, we do the double IUIs as our standard of care, not because we know that it increases pregnancy rates – we can’t know that – but because we are certain that it helps to minimize the stress of all involved. Everybody needs to be able to look back on the IUI and know that it was done in the best possible way.

Having said that, when it comes to donor sperm, which is so much more expensive, we generally encourage a single insemination. Clearly, every clinic is going to have a different opinion on this approach.

As long as you find a clinic and solution that minimizes your stress and maximizes your comfort level, then you have the best approach that fits you.

The post Should I have one or two intrauterine inseminations? appeared first on Fertility.ca.

You can talk to your doctor to find out whether HCG, clomiphene, letrozole, and rFSH preparations will be helpful for you.

Vitamin therapy is one of the easiest steps to take. We suggest Vitamin E up to 400IU/d, Zinc up to 70mg/d, Selenium up to 250mcg/d, Folate (1-5mg/d), Vitamin C (500-1000mg/d), and Co-enzyme Q10 (200mg/d). If red meat isn’t a part of your diet, L’carnitine supplements may be helpful.

A recent analysis of 12 studies from around the world found that lycopene could contribute to greater sperm health. Either way, a diet rich in red fruit and vegetables such as tomatoes, strawberries, peppers and watermelon isn’t bad for your health.

The good news is that the majority of men will see a sperm quality increase through some basic lifestyle changes. Stay away from the sauna and hot tub for a few months, get plenty of exercise, rest up and reduce or quit smoking.

The post How long does it take to improve my sperm quality? appeared first on Fertility.ca.