Diagnosis & Treatment
- Physical examination: Routine physical (including blood pressure, heart rate, heart and lung, abdominal and internal examinations, pelvic and transvaginal ultrasounds);
- Blood work: For each partner to establish blood type and screen for Syphilis, HIV (AIDS) & Hepatitis viruses and Rubella immunization; (in women)
- Vaginal culture & cervicovaginal smear work-up: A sample of secretions from the woman’s cervix tested for Chlamydia, Gonorrhea and Cervical Screening (PAP smear – to screen for pre-cancerous cervical cells);
- Sonohysterogram: Saline solution is injected into the uterus and an ultrasound is conducted, showing its shape and any polyps or fibroids as well as whether the fallopian tubes are open;
- Laparascopy: A small incision is made in the abdomen (belly button) and a slim laparascope (camera/telescope) is inserted to look at the uterus, fallopian tubes etc. and also to screen for endometriosis. This is day surgery conducted under general anesthetic;
- Semen analysis: a fresh sperm sample is analysed under a microscope to show the number of sperm (in millions), the sperm motility (ability to move forward) and the sperm morphology (shape);
- DNA Fragmentation test: An additional variable in the semen analysis, DNA fragmentation is damage to the DNA in the head region of the sperm measured by DNA Fragmentation Index (DFI). Sperm with a high DFI (over 30%) is considered to have poor fertility potential;
- Endocrine testing: Hormones are measured in blood samples from each partner based on the presenting problem. It is also used when the semen analysis detects absence or low number of sperm;
- Anti-Mullerian Hormone (AMH) testing: AMH is a hormone, tested to assess the ovarian reserve in women. Blood AMH levels correlate well to a woman’s fertility and are an accurate predictor of success in IVF for example. However, high AMH levels can indicate the presence of Polycystic Ovarian Syndrome (PCOS). Some younger women may have AMH testing to establish a baseline of their fertility potential before deciding to postpone pregnancy.
- Cycle Monitoring: A combination of blood work and transvaginal ultrasounds scheduled every few days from day 1 to day 28 of your menstrual cycle to completely map it. This helps determine the optimal timing for intercourse and can identify abnormalities in your cycle which may be corrected with – natural remedies or medication;
- Ovulation Induction: This treatment is used to stimulate your ovaries to produce an egg if you are not ovulating regularly or at all. It normally consists of oral or injectable medications;
- Controlled ovarian hyperstimulation: Intended to result in multiple eggs being produced per cycle (superovulation). This treatment consists of injectable or oral medications administered in conjunction with insemination or in-vitro-fertilization (IVF). In the case of IVF, we give more medication and plan for more eggs;
- Intrauterine Insemination (IUI): In cases of low sperm count or motility or using cryopreserved sperm following cancer treatment or for unexplained infertility – a sperm sample from a partner or donor is painlessly placed into the uterus via a slim flexible catheter (similar to having a PAP smear). This sperm has been washed in the laboratory (Sperm Wash – SW) to increase its concentration and remove the semen;
- Donor Insemination (DI): Sperm samples purchased from a sperm bank or known donor samples (after appropriate quarantine) are appropriately processed and used for single female patients, same sex lesbian couples and for heterosexual couples where sperm motility or count may be low;
- In-Vitro-Fertilization (IVF): Instead of planting the sperm in the uterus, IVF facilitates conception outside the uterus, in the laboratory. Tubal factor, male factor, Polycystic Ovarian Syndrome (PCOS), endometriosis and idiopathic (unexplained) infertility can all be reasons to turn to IVF.