Frequently Asked Questions
  1. What does We CARe stand for?
    We CARe stands for Westend Centre for Assisted Reproduction.
     
  2. What does all the Blood Work mean?
    Blood tests are completed  to measure the hormones that play a major role in a  woman’s cycle.
    The following hormones are being measured:    
     
    Estradiol (E2) is the estrogen produced by the ovaries in cells that surround the developing egg. Its main function is to stimulate growth of the endometrium. E2 levels are typically low during menstruation when the endometrium is being shed. They gradually rise during the first 14 days of the menstrual cycle and will peak in the mid cycle just before ovulation occurs. If there is no implantation, it will fall eventually to very low levels which contribute to the initiation of menstrual bleeding.
     
    To assess ovarian reserve, an AMH (Anti-Mullerian Test) is done. An AMH can be done  at any time during the cycle.     
     
    Follicle Stimulating Hormone (FSH) is a hormone released by the pituitary gland, located at the base of the brain. It is transported in the bloodstream to the ovaries, and FSH stimulates growth and development of eggs. In a  normal cycle, just enough FSH is released to stimulate the growth of the  egg. Ultimately, if the FSH on day 3 of the menstrual cycle is very high, the ovaries stop ovulating and menopause occurs.     
     
    Luteinizing Hormone (LH) is a pituitary hormone that is carried in the bloodstream to the ovaries. There are two main functions of LH in reproduction. The first is the mid-cycle LH surge, the signal to the ovaries to release the developing egg(s). The LH surge is initiated by a rapidly rising E2 (estradiol) level, which indicates that the egg is mature and ready for ovulation. The second function of LH is to stimulate the ovaries to produce Progesterone (P4) after ovulation. Mid-cycle testing of LH helps to predict when ovulation is imminent.
     
    Progesterone (P4) is an ovarian hormone. Its primary function is to mature the endometrium in preparation for implantation of the fertilized egg (embryo). It is also produced in the placenta during pregnancy and is very important in the maintenance of pregnancy. If no implantation occurs, P4 also causes the proliferation of the endometrial lining and when the lining gets thick enough, menstruation occurs.
     
    Thyroid Stimulating Hormone (TSH) is when a pituitary hormone stimulates the thyroid gland to produce thyroid hormones, which are  essential in normal cell metabolism. If the thyroid gland’s hormone production is insufficient, the pituitary gland releases even more TSH in an effort to stimulate the gland. Therefore, an elevated TSH indicates that insufficient hormone is being produced and the condition is known as “hypothyroidism”. When excess thyroid hormone is produced, the pituitary gland diminishes the release of TSH. An abnormally low TSH indicates too much hormone is being produced, and the condition is known as “hyperthyroidism”. Either of these two conditions may disrupt reproductive function, resulting in problems with ovulation or spontaneous miscarriage.     
     
    Prolactin (PRL), a pituitary hormone, is normally secreted in high amounts following childbirth, as it is necessary to stimulate production and release of breast milk. PRL is also known to interfere with normal ovulation and because of this effect, it has been referred to as “nature’s contraception”. This is why most women do not ovulate normally while they are breast-feeding. With  some women who are not breastfeeding, abnormally high PRL levels may be due to the presence of a prolactin-secreting pituitary tumor. The tumor is usually benign. In a lot of cases, PRL is also elevated in women who are under a lot of stress (physical and mental). The main effect of abnormally high PRL is the interference with normal ovulatory function. Therefore, a PRL test is included in the routine testing of infertility.     
     
    Human Chorionic Gonadotropin (hCG) is a hormone produced by the placenta during pregnancy. This determines whether or not a woman is pregnant. When the blood test is positive, pregnancy is diagnosed. The progress of early pregnancy is often followed by testing hCG every two days. A slow rising level may suggest an abnormal pregnancy, such as an impending miscarriage or tubal pregnancy. A rapidly rising level is suggestive of multiple pregnancies. On rare occasions, an extremely high hCG level early during  pregnancy is abnormal and is known as molar pregnancy.      
      
  3. What is Clomid (Clomiphene Citrate)/Serophene and what are its side effects?
    This is a pill used for ovulation induction and it works by increasing a patient's own FSH production, which in turn causes stimulation of follicles in the ovaries to grow. Some patients experience side effects like: mood swings, breast tenderness, insomnia, nausea and vomiting, blurred vision (rarely), headaches, fatigue, irritability, depression, weight gain, ovarian cysts, and the thinning of the endometrial lining.
       
  4. What is Femara (Letrazole)?
    Femara has been used for ovulation induction (Off-label use); it may have side effects like headaches, dizziness, drowsiness, hot flashes, nausea or vomiting and there may be Fluid retention. It should not be taken during  pregnancy and lactation.
     
    Most often patients start taking the tablet on day 3 of their menstrual cycle for five consecutive days. The monitoring is done from day 10 onwards for a few days at 7:30am. On the third day of th cycle, the patient comes with a full bladder for abdominal & vaginal ultrasounds.
     
  5. What is Cetrotide/Orgalutron?  
    Cetrotide/Orgalutron are antagonists used in some patients for controlled ovarian hyperstimulation.
     
  6. What is Ovarian Hyper Stimulation Syndrome?   
    This is a potential risk of the treatment  for the stimulation of ovulation. It can be mild, moderate or severe, with a possible need for  hospitalization.
     
    In mild cases, there may be abdominal distention and discomfort +/- nausea, vomiting, diarrhea, and enlarged ovaries (5-12cm).
     
    In moderate ascites, fluid in the abdominal cavity is also seen on ultrasound.
     
    In severe cases there may be clinical ascites and breathing difficulties with fluid in the thorax.
     
    The doctor will need to monitor you frequently, with blood tests and ultrasounds. Serious problems can be prevented with frequent monitoring, as appropriate measures will be taken when needed.
        
  7. What is Human Chorionic Gonadotropin (HCG) Ovidrel®?
    HCG is a natural hormone produced by the placenta and it works to trigger ovulation.

     
  8. Are there side effects to HCG?
    Some patients experienceheadaches, irritability, restlessness, fatigue, breast tenderness and nausea.

     
  9. What is Lupron?
    Lupron acts on the pituitary gland. This medication causes suppression of the ovarian response, unless the ovary has been stimulated with other drugs such as Puregon or Gonal F.

     
  10. What are the side effects of Lupron?
    Some patients experience  joint pain, headaches, hot flashes, bruising and tenderness around the injection site.

     
  11. What is Gonal F/Puregon?
    Both of these medications are made from highly purified human Follicle Stimulating Hormone prepared by recombinant DNA technology. Both contain FSH.

     
  12. Are there any side effects to Gonal F/Puregon?
    Some women experience abdominal discomfort, headaches, weight gain, irritability and breast tenderness. The most serious side effect is ovarian hyper stimulation. Hyper stimulation occurs when many follicles develop in response to Gonal F/Puregon stimulation. This causes sudden enlargement of the ovary and the abdomen may become distended with fluid. Hyperstimulation is usually mild to moderate, however, severe hyper stimulation occurs in 1-3% of patients. Treatment consists of bed rest and  careful monitoring of fluid levels.

     
  13. What is Intrauterine Insemination (IUI)?
    The objective of IUI is to introduce a quantity of sperm into the female partner’s uterus and thereby encourage fertilization.
     
    For an IUI, sperm are first washed and placed into a sterile medium. The sperm are then concentrated in a small volume of medium and are injected directly into the uterus.
     
    Which Couples Benefit?
    Because sperm (separated from the liquid portion of the semen) are inserted into the uterus, investigations should ideally show that the female is ovulating normally, has open fallopian tubes and has a normal uterine cavity. IUIs have  been found useful in couples with unexplained infertility.

    There has been some success with IUI in cases where the female partner has endometriosis and no mechanical distortion of the pelvic structures.
     
    However, IUIs can still be effective in women with ovulatory disorders, provided they respond adequately to fertility drugs. In such cases, ovulation is stimulated by a course of hormone treatment, such that intrauterine insemination is timed to take place during ovulation. Indeed, this technique of stimulating ovulation with hormones and introducing sperm (commonly referred to as “washed sperm”) just after ovulation, has proved very effective in a variety of cases.  It is now the preferred method for couples with or  without ovulatory disorder.
     
    Because IUIs rely on the natural ability of sperm to fertilize an egg within the reproductive tract, it is important that tests for male infertility indicate reasonable sperm function (numbers, movement, and shape).
    - Sperm Count (number of sperm per cc)
    - Motility (percentage of sperm moving)
    - Sperm Morphology (Shape and Size)
    Women with mild endometriosis are usually treated similarly to women with unexplained infertility.
     
    Studies show that IUIs will not be effective in cases where the male has a very lowsperm count or abnormal sperm.  Donor IUI can be done for couples who need to require (wording unclear). Similarly, women with severely damaged or blocked tubes will not be helped by IUI.
      
    How The Technique Works
    The most recent studies of intrauterine insemination suggest that the best results are achieved when insemination is coupled with ovulation induced by fertility drugs. For this reason, doctors refer to “controlled ovarian hyper stimulation” or “superovulation and IUI” to describe the technique.
     
    Because fertility drugs can produce several eggs, monitoring is important during this drug treatment phase in order to ensure that any side effects of treatment and / or the risk of  multiple pregnancies are reduced. Monitoring of treatment is carried out by measuring estrogen concentration in blood samples and by tracking the development of follicles by ultrasounds. Many follicles will produce too many eggs and increase the risk of a multiple pregnancy-so the usual aim of  IUI is to generate one to two eggs. (Superovulation and IUI differs from IVF in that the former aims to stimulate just one dominant follicle, while the latter aims to produce as many eggs as possible for laboratory fertilization).
     
    When two or three follicles have reached their target size, ovulation is induced with a further hormone injection (HCG) (should the H be capitalized here). Then shortly after the time of ovulation, a sample of fresh semen is collected by the male, washed, inserted through the cervix and placed into the uterus of the female partner through a fine catheter. This is a  painless procedure.
     
  14. What is Premature Ovarian Failure?   
    In this condition, the patient does not have ability to ovulate. This is diagnosed by abnormal hormone tests and atrophic ovaries seen on an ultrasound. In this condition, the patient will need IVF treatment with donor eggs. Some patients may have decreased ovarian reserve and may need similar treatment. These patients may even have regular periods, but they can easily be diagnosed by day 3 of the cycle, with FSH and estradiol levels and an antral follicle count on ultrasound. An AMH test can be done any time in the cycle to diagnose this.
     
  15. How many cycles of clomiphene citrate with intrauterine insemination can I do?
    We recommend 4-6 cycles.

     
  16. When is therapeutic donor insemination desired?
    TEM (therapeutic donor insemination) may be an option for treatment in the following situations:
    - When the sperm count is very low or sperm motility is very poor and fertilization of the egg would not   be optimal

    - When a patient cannot afford to do IVF with intracytoplasmic sperm injection
    - For single women
    - For same sex couples
    - When sperm cannot be obtained from the man's testicle or if it is, it cannot be used  for  intracytoplasmic sperm injection
        
  17. What is IVF (in vitro fertilization)?
    In vitro fertilization involves removing eggs from the ovaries, fertilizing them in the laboratory and then replacing the embryos into the uterus where they implant and mature. For detailed explanation on IVF, please refer to our Services Section.

     
  18. Who qualifies for IVF?
    IVF treatment was started to help women with blocked or absent fallopian tubes. Nowadays it is also done for couples with unexplained infertility, ovulation disorders, endometriosis and male factor problems. As of December 2015, Ontario is making fertility treatments more accessible by contributing to the cost of one in vitro fertilization (IVF) cycle per eligible patient per lifetime.

     
  19. Are there any age limits with IVF?
    Success of pregnancy with IVF is very dependent upon the age of the woman and her eggs. Success decreases significantly after the age of 40.  
    OHIP now allows IVF to be done up to the age of
    42 +365 days.

     
  20. Are IVF cycles are ever cancelled?
    Yes. Sometimes patients do not respond to the stimulation medications as expected. They produce too few eggs or eggs that are not growing at the same time. These women may benefit from stopping the cycle and starting again with a different protocol and/or a higher dose of medications at the start.

     
  21. Are the Procedures for IVF painful?
    Will I be awake during the procedure?
    Pain relief and mild sedation is used during the procedure.
     
  22. How much does it cost to do an IVF cycle?
    The cost can vary depending on the medications used and any other procedures if required.
    Please reference CReATe Fertility Centre (Createivf.com) for fees.

     
  23. What happens when IVF fails?
    Your physician will discuss the options for you.  If you have frozen embryos left, they can be transferred in one or two months time. You may also do another IVF cycle with a different protocol or use donor eggs for IVF or try surrogacy. If a number of cycles have failed and you do not want any more treatment, you may decide to adopt or choose a childfree life.

     
  24. What methods of payment do you accept?
    We accept VISA, Mastercard, American Express, debit, cash, certified cheque (with appropriate ID)

     
  25. When do I pay?
    All payments for treatments and procedures are to be made prior to the process being carried out.

     
  26. What does the lab look at in the sperm analysis?
    Your doctor will review the results of the sperm test with you and your partner. The sperm analysis looks at concentration, motility, how well they are swimming in a forward direction, viability, morphology (how sperm look, abnormal shape and size), presence of infection and the total number of sperm that are moving.

     
  27. What can be done if the sperms are extremely low?
    Sometimes IVF & ICSI are done after extraction of sperms from testicular tissue using a needle (TESA). This has proven to be successful.
     
  28. What is Polycystic Ovarian Syndrome (PCOS)?
    This is by far the most common  cause of female infertility. A patient may have two or more of these symptoms, including irregular cycles, excessive hair growth of the male pattern, acne, abnormal hormone profiles, and an ultrasound of the ovaries which shows numerous small, immature follicles commonly arranged around the outside of the ovaries.

    Most of these patients are overweight and have insulin intolerance, high fasting lipids, and a positive family history of diabetes. Most PCOS patients are treated with Metformin and when they get pregnant, they have a risk of gestational diabetes, sometimes requiring insulin. Long term complications include diabetes andheart disease later in life. High stress, anxiety, and depression can also be present. These symptoms should be treated for good results. Weight control with a proper diet and exercise is needed in overweight patients. Most of these patients may not experience ovulation on their own; they may need ovulation induction and cycle monitoring.
      
  29. What can be done to prevent weight gain during infertility treatment?
    Obesity is known to have a negative effect on reproduction. Both fertility and pregnancy outcomes are better when a woman is of normal weight. Weight gain during infertility treatment is not due to medications used during infertility treatment. Weight gain may be due to other contributing factors such as anxiety, leading to compulsive eating or fear of exercising. Some women may find some weight gain due to water retention that may be related to ovulation, but this would be minor. Weight gain can be prevented by regular exercise and by eating small healthy meals.

     
  30. Does weight gain affect the future baby?
    Obese women have a greater chance of pregnancy complications. They have a higher risk of developing diabetes in pregnancy, blood pressure problems and of having a cesarean section, which in turn increases their chances of having an infection of the incision site. Both diabetes and blood pressure problems can have negative effects the developing baby.

     
  31. Can I exercise during treatment?
    Moderate exercise is beneficial to the health and to reduce stress. Excessive exercise for the first time during treatment should not be done.

     
  32. What is endometriosis and how is it related to infertility?
    Endometriosis is a condition in which the normal lining of the uterus is found outside the uterus, on its surface, in the ovaries, fallopian tubes and the walls of the pelvis. lt occurs in 30-40% of infertile women, and sometimes the ovaries, fallopian tubes and bowels are stuck together, so it is difficult for the egg to pass through the tube. Also, the endometrial tissue may secrete hormones so that fertilization is effected.

     
  33. How is endometriosis diagnosed?
    It is suspected by painful periods, pelvic examination and by  pelvic ultrasound, but the definite diagnosis is only done by surgery.

     
  34. What is the treatment of endometriosis?
    Sometimes no treatment or anti-inflammatory medication is given during periods. Hormonal treatment or surgery or both together are helpful for some cases.

     
  35. What are fibroids?
    Fibroids are an abnormal growth of the muscle cells of the uterus. They can grow in the wall of the uterus, on the outside of the uterus and in the cavity of the uterus. They are almost always benign.

     
  36. How would I know if I have fibroids?
    An ultrasound can detect most fibroids and measure their size and location. Some women will have an MRI to view their fibroids.

     
  37. What are the symptoms of fibroids?
    Fibroids can cause many symptoms that are mainly in relation to their location. They may cause irregular bleeding if they are in the uterine cavity or the wall of the uterus. They can also affect fertility by decreasing pregnancy rates and increasing miscarriage rates, when they are in the uterine cavity. If fibroids are very large, they can also cause problems with pelvic discomfort, difficulty with urination and bowel movements and delivery.

     
  38. If I have fibroids, do they need to be removed?
    Not all fibroids need to be removed. It depends on the size and location if they need removal before
    infertility treatment or IVF.

     
  39. Is one’s sex life affected during treatment?
    Continuing with your sex life is important during treatment. You may be advised to use condoms when having a test in which a pregnancy could be negatively affected (HSG, sonohysterograrn). When women are undergoing IVF treatment, they may find intercourse uncomfortable when the ovaries are getting large during the stimulation. When it is approaching time for an insemination or production of sperm to be used in IVF, you will be advised to abstain from intercourse for at least 48 hours.

     
  40. What lifestyle behaviours are associated with infertility?
    Smoking and  recreational drugs affect both the sperm and eggs, in terms of their quality and  ability to fertilize. Success of IVF is also significantly affected. Excessive alcohol consumption is also known to decrease fertility. Further, stress also affects the reproductive tract in a negative way. A large amount of caffeine consumed on a daily basis also decreases fertility.

     
  41. What can be done to reduce stress?
    Communication with your partner and doctor are very important.Discuss fears, anxieties and financial concerns. Support groups, yoga and perhaps acupuncture may also be helpful.