Pelvic Ultrasound is a non-invasive technique using high frequency sound waves for visualizing pelvic structures (ovaries, uterus, etc.). There is no radiation with this procedure. It is performed transabdominally and transvaginally.

The endometrial sampling is a test to study the lining (endometrium) of your uterus. It is done to help find the cause of infertility, recurrent fetal losses (miscarriages), heavy periods, irregular periods, and bleeding after menopause. In infertility, the biopsy will show if ovulation has occurred, if the hormone progesterone is being produced and if the endometrium is responding to it normally. Click here for more information.

• Sonohysterography: This is an ultrasound examination that provides considerable information about your uterus in particular and also your fallopian tubes, without x-rays or an anaesthetic. It is done shortly after the end of your period. A preliminary ultrasound of your pelvis is arranged before this test.
• Hysterosalpinogram (HSG):An x-ray procedure performed to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal. An HSG is an outpatient procedure that takes about 5 minutes to perform. It is usually performed after the period has ended, but before ovulation, to prevent interference with an early pregnancy.

In addition to evaluation of tubal patency for our infertility patients, the sonohysterogram is also used to detect intrauterine pathology for patients with infertility, recurrent spontaneous miscarriage, abnormal uterine bleeding, suspected congenital uterine abnormalities, or suspected intrauterine scarring.

For couples having difficulty with conception, there is an equal chance that the man has a problem as well as the woman. These include too few sperm, blockage in the reproductive tract that does not allow the sperm to be released, sperm that don’t move forward rapidly enough, or too many sperm that are abnormally shaped.
 

• The first test is a semenalysis which documents: the number of sperm (sperm count)
• the percentage of sperm that are moving (motility)
• the percentage of sperm that are normally shaped (morphology)
• the amount of sperm in the sample (volume)

The sample is collected after 2 to 5 days of not having sex and brought in to the office within one hour of collection. We also request 2 samples three to four weeks apart. Other tests include hormone levels in the blood, urine test to rule out infection and sperm tests to rule out infection and the presence of sperm antibodies. A sperm DNA fragmentation test (sperm chromatin assay) that measures the amount of breaks in the sperm’s chromosome, will also be offered. If the sperm count is very low, you may need to have genetic testing to determine if this is the cause of the low sperm count. If no sperm are seen, a testicular biopsy may need to be arranged.

This is a minimally invasive surgical procedure requiring a general anaesthetic in which a Special telescope is inserted into the uterus through the cervix to look at the uterine cavity. This can be used for diagnosis or for treatment, such as removal of polyps, fibroids, or scar tissue.

This is a minimally invasive surgical procedure requiring a general anaesthetic. A different telescope is inserted through a small incision below the belly button into the abdominal and pelvic cavity to view the pelvic structures. This procedure can be used to diagnose and treat problems in the pelvis.

Ovulation induction involves stimulating the ovary to produce one or more eggs. It is accomplished by using a number of different medications, either oral or injectable. Cycle monitoring involves periodic visits to the clinic for bloodwork and ultrasound in order to monitor ovarian response to treatment. At the appropriate time, ovulation is triggered with HCG (Human Chorionic Gonadotropin) before timed intercourse or artificial insemination.

Controlled ovarian stimulation involves administration of injectable FSH (Follicle Stimulating Hormone) with or without LH (Luteinizing Hormone) in order to stimulate multiple follicular growth. The cycle is monitored with more frequent bloodwork and ultrasound testing in order to monitor ovarian response and avoid the development of ovarian hyperstimulation syndrome.

• Sperm washing is a procedure performed on a fresh sperm sample. The goal of sperm washing is to try to isolate the healthiest sperm from the semen sample. There are several different techniques used depending on the quality of the sample. After the wash, the sample is reassessed for reasonable sperm function which is required in order to make this a feasible procedure.
  
  
• The objective of intrauterine insemination (IUI) is to deliver washed sperm into or close to the uterus during the time that a woman is most fertile. This is done using a small, soft, sterile catheter and is generally a painless office procedure.

Therapeutic Donor Insemination is utilized in cases of severe male infertility or for single or lesbian patients who desire a pregnancy. The process involves assisting the patient to find an appropriate donor based on criteria that they have chosen. Cycle monitoring with or without ovulation induction is used to facilitate the timing of this process.

In Vitro Fertilization (IVF) and Embryo Transfer (ET) is a procedure that has been employed since the 1970’s for couples with infertility. It was originally known as the “test tube baby”. In order for a pregnancy to occur, an egg and sperm must unite. This occurs typically in the fallopian tube. During IVF, this process of fertilization occurs in the laboratory after the eggs and sperm have been collected from the woman and man respectively. The fertilized eggs (embryos) are then transferred to the uterus after 3 – 5 days in order to continue to develop and hopefully become a pregnancy.

Intracytoplasmic injection (ICSI) is an assisted microsurgical procedure in which a single sperm is injected directly into an egg. This technique has been available since 1992. It is employed when there is significantly reduced sperm quality. ICSI allows a much higher fertilization rate.

Donor egg procedures can employ a known or an anonymous donor. The procedure involves choosing an appropriate female who then undergoes ovarian stimulation for IVF and egg retrieval is performed. These eggs are then fertilized with the sperm from the male partner of the couple. The resulting embryos are then transferred into the uterus of the female partner.

A gestational carrier is used for a patient who is unable to carrier her own pregnancy. This person cannot be previously known to the couple. The couple would undergo an IVF procedure as usual. The resulting embryos would be transferred to the uterus of the gestational carrier for the duration of the pregnancy.

The failure to ovulate regularly (anovulation or oligoovulation) is one of the most common causes of infertility. This can be caused by problems with the pituitary gland in the brain or by local problems in the ovary. Examples include Polycystic Ovarian Syndrome (PCOS), Hypothalamic-Pituitary Syndrome, and Premature Ovarian Failure. The treatment involves raising FSH (follicle stimulating hormone) levels so that follicular growth and development is restored, ultimately resulting in the release of a healthy mature egg (ovulation).

Endometriosis is a chronic condition whereby the tissue lining the uterus refluxes through the fallopian tubes into the pelvic cavity. It implants in various places including ovaries, outside of uterus, bladder, and bowel. This tissue is hormonally sensitive and therefore bleeds with the period. This eventually produces scar tissue and ovarian cysts (endometriomas) in the pelvis.

Endometriosis can be associated with infertility because of a variety of factors, i.e. tubal scarring, ovarian cysts that interfere with usual ovarian response and follicular development, and biochemical substances that interfere with fertilization and implantation. Diagnosis and treatment of this condition occurs with a minimally invasive surgical procedure, laparoscopy.

We offer Nutrional and Psychological Counselling as needed.