About one in every five couples is affected by infertility, a problem that is increasingly common as people marry later in life wait longer to start a family. Diagnosis and treatment of infertility requires a thorough assessment of both partners.


1. How Does Conception Naturally Occur?

Conception is the beginning of pregnancy - when an egg (ovum) is fertilized by a sperm.

Under normal circumstances:

• A woman releases an egg from her ovaries each month (ovulation)
• The egg travels into a fallopian tube
• After sexual intercourse, the male partner's sperm swim from the vagina through the cervix and uterus into the fallopian tubes
• One sperm fertilizes the egg
• The fertilized egg (zygote) divides repeatedly as it travels down the fallopian tube to the uterus
• The zygote becomes a solid mass of cells
• After 3 to 5 days, it transforms into a hollow ball of cells called a blastocyst
• The blastocyst implants in the wall of the uterus (womb), where it develops and becomes an embryo
• The embryo first becomes visible within the blastocyst about 10 days after fertilization

The Female Reproductive System
Women have two ovaries both located in the pelvis alongside the uterus. Their main functions are to release eggs and to produce hormones.

This incredible process is orchestrated by the pituitary, an area at the base of the brain, and controlled by the hypothalamus. The pituitary secretes a complex array of hormones that stimulates the entire reproductive process. Hormone levels fluctuate from birth through puberty to menopause, and can be influenced by a huge number of factors.

In men, sperm formation takes place in the testes, which also synthesizes testosterone, one of the main male hormones:

The Male Reproductive System

• Sperm make their way from the testes to the epididymis, where they are stored until they mature
• It takes about 72 to 74 days for a cell to become a mature sperm cell
• Sperm are nourished by fluids produced by the prostate, the seminal vesicles, the vas deferens, and from mucous glands in the head of the penis
• These fluids account for most of the volume of semen that is expelled during ejaculation

2. When Should We Consider Getting Help?

It is reasonable to come in for an early assessment:

• if you have been unable to conceive after 6 months of trying; or
• if you have a history of irregular menstrual cycles or tubal disease; or
• if you are over 35 years of age

We often meet couples who feel like they don't have acess to information. They wonder why it's been taking so long to get pregnant or whether they're going about it the right way. We also meet couples who have been doing all the 'right' things and just need a little reinforcement. We want to reinforce that it's natural to have questions and it's reasonable to ask for help.

Please feel comfortable about contacting us at any time to schedule an appointment.

Email thefrmc@rogers.com
Telephone 416-609-8868

3. What Are Our Chances of Getting Pregnant?

The good news is that women do get pregnant with as little intervention as possible. Up to 60% of couples who haven't conceived after a year of trying, and who continue to try to get pregnant, will eventually conceive with or without treatment - even in cases when no clear cause of infertility can be identified. Success rates are influenced by a huge number of factors and therefore vary widely.

• Chances of conceiving with various interventions depend largely on the age of the woman, the status of her uterus and fallopian tubes, and the semen quality of the man.
• Intrauterine Insemination (IUI) - Approximately 10% of infertile couples conceive with each insemination, depending on the cause of their infertility.
• Couples, who have not conceived after 4 to 6 cycles of IUI, may wish to consider.
  in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). There is a 20% to 25% chance of conceiving in each cycle of IVF or ICSI, again depending on the cause of infertility.

4. How Long Do Fertility Treatments Take and How Much Do They Cost?

The costs and duration of treatments varies widely and it's normal for couples to wonder about the financial implications and time commitment involved. Within 4 weeks of your first visit, we can usually identify the cause of your infertility and define an effective treatment plan.

If all you need is some counselling, it may take a few weeks to get you on track. But if an IVF procedure is indicated, it may take longer. If more advanced reproductive technologies are necessary, these will be thoroughly reviewed and the appropriate management will be discussed.

• Many of the procedures for diagnosing causes of infertility, and some treatments are covered by the Ontario Health Insurance Plan (OHIP).
• OHIP typically covers the costs of everything that takes place during your first couple of appointments - your medical history, a physical (if required), semen analysis, and blood screening as well as uterine cavity and tubal patency testing.
• If the source of your infertility is blocked fallopian tubes, OHIP will cover some of the cost of IVF.
• If your employer provides a group health insurance plan, it will be helpful to review the details of your plan in advance of your treatments. Your benefit plan may cover medications such as Clomid to stimulate ovulation. Intrauterine insemination (IUI) is covered by OHIP, although sperm washing, which is often recommended along with IUI, is not.

Some couples require nothing more than lifestyle changes, education, and counselling. Others benefit from the assistance of prescribed medication while some will require more complex interventions to help them conceive.

Patient care drives every step of the way in tune with your individual needs and choices. If you have questions, there's always someone who can listen to you and help sort things out as quickly as possible.

5. How Will We Know How Far to Go and How Long to Continue the Treatment?

We believe that you and your partner will find the strength to make the informed decisions you need to make about options available to you at each stage of evaluation, diagnosis, and treatment.

We do a good part of the work together with you to ensure you feel well informed each step of the way. At the FRMC, we are oriented towards a practical approach. We take a proactive approach, but we're conservative when it's in your best interest. And we're supportive should the time come when we must advise you that certain courses of action may not be viable. We won't hold out false hope, but we will support you in maintaining an optimistic and positive attitude.

It's normal for couples who need more complex intervention, possibly over several months, to be concerned that they're not "wasting time and money", and that their hopes and dreams do indeed have a chance of coming true. And in fact, for many couples, dreams do come true.

While time is of the essence, more than half of the couples who seek treatment for infertility are successful in getting pregnant.

We recommend that you thoroughly assess your financial situation before you embark on any of the more advanced treatments. Together we'll set limits on each treatment option as we develop your individual treatment plan.

Some people will, in their hearts, never give up on their dream of having a child. That said, you'll want your decisions to be grounded in reality and not driven solely by the various and, sometimes, intense emotions that bubble to the surface during the treatment phase.

It's essential that you also attend to your health - keep the dialogue open about your hopes and fears and take advantage of all the available counselling, education, and support services.