Treatment Options for both Male Fertility and Female Fertility Explained

Cycle Monitoring

Cycle monitoring is usually the first treatment options we offer. It is actually part investigation part treatment.  There is minimum intervention with this option. Usually, we start by a base line ultrasound at day 1 to 3 of a menstrual cycle. Then we repeat the ultrasound day 10 or so, and every other day to follow the growth of the 'egg'. Technically we cannot see the egg itself, but we see the follicle or the cyst in which the egg grows. 

We may add to that some blood testing to measure the changes in your hormones as the eggs are growing. If this is the only thing we are doing, the cycle ends when the eggs ovulate. Sometimes certain medications may be used to push your eggs to grow.

When we think the egg is mature and ready, we advise 'times intercourse'. 

Timed Intercourse

In general I am against turning the social and special aspects of intimacy into a chore. "hey, wake up, I ovulated, we need this now!" is not the best way of describing a natural and smooth relationship. True, all this investigation and treatment aspect of fertility does have its strain on the relationship. But, when are are trying, I try to add the least interventions. For the sake of getting pregnant, regular intercourse 2-3 times are week is more likely to get you pregnant than an ovulation kit. 

But if both of you are in shift work, then may be making time for intercourse may give us an opportunity into the fertility window of that particular month that may be otherwise missed.

Induction of Ovulation 'IoO'

That is, pushing your ovaries to make eggs. There are many way of doing that, as well as many indications, reasons and benefits for that. Even if you are ovulating on your own. we may want to make you produce more eggs. 

IoO can be done using pills or shots. The classic pill used for ages to induce ovulation, Clomiphene or Clomid or Serophene is no longer available in the Canadian market. Interestingly, it was not the best medication available.

Medications used include Letrozole (pills), FSH like medications (Shots, like Puregon, Gonal F, Repronex, Menopure, etc. The list goes on and on). These medications need to be as prescribed. It is very important to get the right information of dosing and timing.

Do remember that a lot of our plans rely heavily on timing and you need to always remember what day of the period to start a medication or end it, when to book ultrasound, follow up, etc. 

Always make sure you have enough medication until your next visit or next step in the treatment.

Letrozole For Induction of Ovulation

Letrozole, or Femara has largely replaced Clomiphene for induction of ovulation. It is typically take from day 3-7 from start of cycle, regardless of whether you still have bleeding or not. It will help your eggs grow, and as such may be associated with an increased chance of getting twins pregnancy. 

You will need cycle monitoring (ultrasounds and blood work) to follow up your eggs as they grow.

FSH Type of Medications

These have different names. There are a few difference in the way they are made, their purity, their cost, etc.

Pure FSH (no LH) are the better choice if you have PCO. Examples include Puregon and Gonal F. These may be used for IVF cycles or as an add on in IUI cycles. Repornex or menopure (as examples) have 1:1 FSH and LH. They may be added to your induction protocol  for some LH activity as well as to reduce cost. 

These medications need some training on how to use them, and you need to know hot o give yourself these shots.

These types of medications may be associated with increased risk of OHSS (see later). 

Lupron Superfact and Zoladex

These types of medications are used to prevent your egg from coming out too soon (prevent ovulation in an IoO cycle). We usually like to control ovulation to know when exactly did you ovulate. Timing is very important especially in IVF cycle. 

Treatments Explained

IUI or Sperm Wash

It is a simple procedure. We start with IoO (see above) to grow your eggs. You can get a combination of medications to do that. Once the egg is ready, we give you the trigger medication (shot). Usually the IUI is then planned for the following day. That following day, we ask for a sperm sample. (This can be produced at the Center or at home, as long as you bring it in within one hour of production). 

The embryology lab will then work on it for about 45-60 minutes and then it is ready for IUI. Through something very similar to a Pap test, the washed or processed sperm is then ijected into the uterus.  You need to rest for a few minutes and then you are free to go. Remember to follow the 'post' instructions. 

There is an additional cost to the embryology lab not covered by OHIP. 

IVF or Test Tube Babies

This is the treatment with the most chances of getting someone pregnant. It is also the most expensive. It is offered for many reasons, whether for anovulation, endometriosis, advanced age, unexplained infertility, etc. It is also useful for male issues, including low sperm count, decreased movement, etc.

This is the flag ship of fertility treatment. 

In this treatment, we make you produce many eggs, take them out and put them in a 'test tube' and then put sperm with them. When the eggs are fertilized, we freeze them, and then one by one, we transfer them back to the uterus (Embryo Trasnfer).

The procedure is a bit intense, and needs a lot of time commitment. We give you a certain protocol of IoO that makes you  produce many eggs. Like 10-15 many, some women will produce even more. 

The medications used are usually FSH type of medications that make you grow eggs. While you are doing that we follow your progress with daily blood work and ultrasound every other days. When the eggs have reached the proper stage of development, we give you a'trigger' medication.  Some 36 hours later we take your eggs out (you are put to sleep for that) and give them to the lab. We ask for a sperm sample. We might add ICSI.

Intra Cytoplasmic Sperm Injection ICSI

This is a marvel of a technique. Under the microscope, we inject one sperm cell into each egg we have collected by IVF. This is a great way in making sure the eggs has become fertilized. It has opened the door for many males with poor sperm parameters (low count, slow moving sperm) to become fathers.

Frozen Embryo Transfer FET

After the eggs are fertilized and have grown to about day 5, they are frozen to be transferred later.  Why day 5? This is a natural selection process, as only good embryo can make it that far. You actually do not want those eggs with abnormal division, or those eggs with excess fragmentation to be transferred to you on day 3.

We have had some couples really upset with this as they think 'fresh is better'. This may be true in other areas, but not here. The other, very important factor here is the effect of the hormones we use to make you grow all these eggs. These hormones may act on the uterus in a way that is unfavourable for the transferred embryo. It is actually better to postpone the transfer to as later cycle when there is no effect of hormones. We prepare the uterus by some medications (usually pills) to make it more receptive to taking in the transferred embryo.

We usually do an endo scratch the cycle before transfer.

Endo Scratch

There is this report that suggested that an endo scratch done before the frozen embryo transfer cycle actually increases the chances of the baby 'sticking' to the uterus. Consider this as a wake up call, or an early warning to the uterus to 'tell' it that a baby may be coming soon. The way the uterus reacts after the endo scratch makes it more receptive.

Yes, it does sound a painful And no, it is not that painful. It is somewhat similar to a pap test, with the added 'scratch'. Take an Ibuprofen before you come. If at all helpful to know, the cramping feels like your usually period cramps, and only last about 1 minute or even less.

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