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When to Seek Help

Approximately 1 in 6 families will have trouble conceiving and that number increases to more than 50% after a woman (intended egg provider) reaches the age of 39. If it is taking you longer than you expected to get pregnant, the first step is to talk to your doctor about getting a referral to a fertility specialist who will do a fertility evaluation. Often simple treatment or counselling can help solve the problem. In some cases, the solution requires more advanced technology such as in vitro fertilization (IVF). The good news is that advances in fertility treatment have made it possible for most people to achieve their dream of having a family.

How do you know when it is time to get medical advice?

  • You are under the age of 35 and have been trying to get pregnant for at least 12 months.

  • You are over 35 and have been trying to conceive for more than 6 months.

You should also consult a fertility specialist if:

  • Your menstrual cycle is irregular or very far apart (a regular cycle is between 26 and 34 days) as you may not be ovulating regularly.

  • You have been diagnosed with a condition known as endometriosis or have had a previous pelvic infection.

  • You have a condition known as PCOS (polycystic ovarian syndrome). This condition is one of the most common causes of infertility and is often undiagnosed until a patient has trouble conceiving. The symptoms can include fat around the belly area, irregular periods, facial hair, acne, and thinning of hair on the top of the head (male pattern baldness).

  • You have been diagnosed with a sperm problem, or have a history of infection (e.g., mumps), injury or surgery on your testicles.

  • You or your partner has a known health problem such as diabetes, high blood pressure, or a history of cancer treated with radiation or chemotherapy.

  • You are at risk of early menopause, such as having a family history of early menopause among the women in your immediate family (such as mother, sister).

  • You just need help! You do not have access to sperm, eggs or a uterus so need help to have a child.

Next: Common Causes of Infertility

Common Causes of Infertility

Polycystic Ovarian Syndrome (PCOS)

PCOS is one of the most common causes of irregular menstrual cycles and infertility. In individuals with PCOS, the eggs fail to mature and ovulate, and the ovaries usually have a distinctive appearance on ultrasound.

Other symptoms associated with PCOS are acne, oily skin, excessive hair growth (hirsutism) and pattern thinning of the hair. Some people are also overweight or obese. 

Tests for PCOS include:

  • Blood hormone testing

  • Transvaginal ultrasound

Treatment options 

The first approach to treating PCOS should be changes in lifestyle, including a low carbohydrate diet to help control insulin levels, regular exercise, and weight loss if you have a BMI over 25. Sometimes just these lifestyle changes are enough to normalize your menstrual cycles and restore ovulation. 

You might also be given one of several drugs to stimulate egg production like Clomid, Letrozole, or injectable FSH. Alternatively, you might be given Metformin and/or the supplement myo-inositol to help lower your insulin levels and regularize your cycle.

Fallopian Tube Blockage

You need to have open and functioning Fallopian tubes for the sperm and the egg to meet and for natural fertilization to occur. Scarring or blockage in your Fallopian tubes can prevent the sperm from reaching the egg. Infections like chlamydia, gonorrhea, or pelvic inflammatory disease are common causes of blocked Fallopian tubes.

Tests for Fallopian tube blockage include:

  • A detailed history and examination of your uterus and Fallopian tubes with a special X-ray called a hysterosalpingogram (HSG)

  • Possibly a laparoscopy.

Treatment options 

Sometimes minor surgery like tubal cannulation or a laparoscopy can repair blocked or damaged tubes. If that is not possible IVF is an option.

Thyroid Disease

Your thyroid is a gland in your neck which produces many hormones including hormones necessary for successful pregnancy. Both an overactive thyroid (hyperthyroid) and an under-active thyroid (hypothyroid) can cause problems with conception by disrupting ovulation or disturbing the hormonal balance of the uterus. Sometimes miscarriages are linked to thyroid dysfunction.

Tests for thyroid disease include:

  • Blood tests for thyroid stimulating hormone (TSH and thyroid antibodies)

Treatment options

If your thyroid activity is too low, you will typically be treated with an oral medication which is a synthetic form of your natural thyroid hormone (e.g., Synthroid). If your thyroid activity is too high, you will be referred to a specialist in endocrinology for further tests and treatment. 

New information suggests that tight thyroid control through fertility treatments and pregnancy might reduce miscarriage and perhaps help with the neurodevelopment of the fetus.

Endometriosis

Up to 10% of women may have some degree of endometriosis associated with pelvic pain and infertility. The condition causes inflammation in the Fallopian tubes and ovaries, producing scar tissue. If you have endometriosis, you may have pelvic pain that is worse when you menstruate and during intercourse.

Tests for Endometriosis include:

  • Transvaginal ultrasound

  • Laparoscopy

You may also be asked to keep a symptom diary.

 

Treatment options

If your endometriosis is relatively mild, more conservative treatments, such as a laparoscopy, may be options. However, in most cases, in vitro fertilization (IVF) offers you the best chance of getting pregnant. You can also receive separate treatment for any pain the endometriosis may be causing you.

Primary Ovarian Insufficiency

Although most women experience menopause around the age of 50, some stop menstruating at a younger age. This occurs in about 10% of women under 40 and 1% under 30. If you have had no menstrual flow for over a year, you may be checked for Primary Ovarian Insufficiency (POI). Women with POI have lost eggs at a greater than expected rate. Sometimes this condition is associated with autoimmune disease. 

Tests for POI include:

  • Blood tests (hormonal, genetic, and other tests)

  • Transvaginal ultrasound

Treatment options

If you have POI, your chances of getting pregnant naturally or with IVF using your own eggs are quite low. However, your chance of getting pregnant with donor eggs in an IVF cycle is excellent with an up to 80% success rate. Even though there is no medical treatment for POI about 5% to 10% of women with POI go on to conceive without medical intervention.

Recurrent Pregnancy Loss (RPL)

Many women experience at least one miscarriage. If you have had one or two miscarriages, it will not normally affect your chances of carrying the next baby to term. 

Some people, however, experience repetitive, consecutive miscarriages known as recurrent pregnancy loss (RPL). Recurrent pregnancy loss can be devastating, but it is important to remember that even if you have had multiple miscarriages, you still have a very good chance of eventually having a healthy pregnancy. In some cases, a cause can be identified and measures to taken to prevent future miscarriages.

Tests for RPL include:

A comprehensive evaluation (as there are various reasons why RPL might occur) including blood tests (hormones, blood clotting proteins, chromosome analysis) and imaging of the uterus (usually a hysteroscopy).

 

The male partner may also require testing, including blood test for chromosomal analysis. 

For at least 50% of women with RPL, a cause for miscarriage will not be found.

 

Treatment options 

If a cause for RPL is identified, treatment is targeted to the specific cause. This may include various medications, surgery, or genetic testing of embryos (PGT-A). If a cause for RPL is not found, your physician will discuss the best approach towards achieving a healthy pregnancy.

Unexplained Infertility

Unexplained infertility occurs in about 15% of couples and individuals trying to conceive. It doesn’t mean there is no reason for your infertility, it just means that we can’t identify the cause with any of our current testing. 

The good news is that even though we can’t determine what is preventing you from getting pregnant, we can still help you achieve a pregnancy. 

There are several treatments for unexplained infertility including:

  • Fertility drugs such as clomiphene citrate, or follicle-stimulating hormone (FSH)

  • Intrauterine insemination (IUI) (artificial insemination of sperm into the uterus)

  • In vitro fertilization (IVF)

Sperm Issues

Sperm issues account for approximately 40% of infertility. There are several heath and lifestyle factors that could be affecting the quantity and health of your sperm. 

Tests include:

A semen analysis to determine your sperm quantity and quality 

 

Treatment options 

If you are having sperm issues, eliminating lifestyle factors like smoking, excess alcohol, and recreational drugs like marijuana and maintaining a healthy BMI and taking a multivitamin with antioxidants may improve sperm parameters and allow you to conceive naturally. 

Assisted reproduction, such as IUI or IVF-ICSI can help in situations when you are not able to conceive naturally. In some instances, extraction of sperm directly from the testicles is necessary. This would be reviewed by your specialist.

Next: The Fertility Care Journey

The Fertility Care Journey

As each patient and family unit is unique, there is no "typical" fertility care process. However, a successful journey begins with understanding the important stages of the care path.

Your First Visit

During your consultation your doctor will listen to your concerns, discuss the results of your tests, review any previous treatment, and answer any questions you might have. You may also have transvaginal ultrasound performed during this visit to measure your ovarian reserve.

In most cases you and your doctor can formulate your treatment plan at your initial appointment so that you can begin your treatment. Occasionally more testing and a follow-up visit may be necessary to determine which course of treatment is best for you.

Learn more about how to prepare for your first visit and what to expect

Assessments

In order to create your personalized treatment plan, you and your partner (intended egg provider or intended sperm provider) need to complete a fertility workup with us, which includes blood tests to determine your overall health and the level of your reproductive hormones. Your fertility doctor may order some further imaging tests to determine the health of your reproductive organs. Tests may include:

  • Blood work and baseline hormone evaluation

  • Antral follicle count (ultrasound)

  • Hysterosalpingogram (HSG)

  • Hystero-Contrast-Salpingography

  • Semen Analysis

Fertility Wellness

We understand how physically and emotionally demanding fertility care can be. There are many things you can do to improve your overall wellbeing, and prepare yourself and your partner to conceive successfully. Olive works with practitioners that can support you on fertility journey by providing:

  • Acupuncture for fertility

  • Mindfulness for fertility

  • Nutrition counselling and weight management

  • Stress and relationship counselling

Treatments or Donor/Surrogacy Solutions

Your doctor will create a treatment plan based on your individual goals and diagnosis. Depending on the type of treatment, you may require several blood tests, ultrasounds, and procedures, during which time you may meet several different Olive team members. However, you will always be in contact with your personal care team and your doctor will be overseeing all your treatment.

 

Treatments and solutions offered at Olive include:

  • Treatment of ovulatory disorders

  • Minimally invasive surgery

  • Ovulation induction

  • Intrauterine insemination (IUI)

  • In vitro fertilization (IVF)

  • Third-party and reciprocal reproduction solutions

  • Awareness/support while using gender affirming hormones (for conception and sperm production)

Innovative Enhancements

The Olive team is always striving to give you the best chance of a successful pregnancy. In addition to IVF, we may recommend one or more innovative, evidence-based reproductive technologies, depending on your diagnosis and treatment plan. These technologies can allow your doctor to tailor treatment more precisely to your unique fertility profile, thus optimizing your chances of implantation, pregnancy and a healthy baby. These include:

  • Pre-implantation Genetic Testing (PGT-A/PGT-M)

  • Endometrial Receptivity Analysis (ERA)

  • Endometrial Microbiome Metagenomic Analysis (EMMA)

  • Analysis of Infectious Chronic Endometritis (ALICE)

Patient Portal

As a patient at Olive Fertility Centre, you will have access to a confidential, secure online patient portal that will allow you to access your electronic medical records and communicate with your personal care team. IVF patients will find this particularly convenient as you will be able to see your results as soon as they become available and won’t have to wait for a phone call. The portal will contain a list of all your medication and other information that will make it easier for you to manage and be informed throughout your treatment cycle. Once you have an account, you can find our portal link at the top right of every page of this site.

Next Steps

After your treatment course has ended, we will provide requisitions for blood pregnancy tests, and eventually schedule an early transvaginal sonogram to confirm a healthy pregnancy. Once the viability of the pregnancy has been established, you will be referred to your GP for continued prenatal care. If you do not have a GP, we will be happy to refer you to a provider. Furthermore, we can refer you to one of the maternal-fetal medicine specialists at Olive for non-invasive fetal testing (NIPT)

The Cost of Fertility Treatment

In BC, your consultation with a fertility specialist, as well as most tests for infertility, are covered by our provincial health plan with a referral from your family doctor or a walk-in clinic doctor.

In many cases treatment can involve minimal or no expense. Often, simple medications or just counseling can help solve the problem. In some cases, the solution requires more advanced technology such as in-vitro fertilization (IVF) which is not covered by the provincial health plan.

Next: Your First Appointment

Your First Appointment

Here is what you can expect at your first visit with your Olive physician and what steps you need to complete before your first appointment to ensure that there are no delays in starting your treatment at Olive.

Preparing for your First Appointment

Upon booking your appointment with Olive, you will receive a Welcome email from your care team nurse. Please retain this email, as it contains important information such as your username and login for the Patient Portal, and your personalized testing requirements.

 

It is essential that you complete these fertility tests and submit the results to the patient portal before your first appointment so that your Olive physician has a full understanding of your fertility status. This will enable us to start your treatment as soon as possible.

 

6 Steps You Need to Take Before Coming to Your First Appointment:

  • 1

    Review your Welcome Email for your personalized testing requirements and Patient Portal Login information

  • 2

    Login to the Patient Portal. A link to do so is on the top left of the Olive website (desktop) and is the first link in the menu (mobile devices). Your username and password can be found in your Welcome email.

  • 3

    Print and fill out your History Form (on the Patient Portal). If you have a partner, each person must login to their profile and fill out the History Form.

  • 4

    Print out any documents and requisitions on the portal. You can find this information under the Documents tab.Then, selectInstructions on that page.

  • 5

    Take printed requisitions to your local lab to have testing done on appropriate days.

  • 6

    If you have already had some relevant fertility testing done, please ask your doctor to forward copies to our office. Please sign the Consent Form and bring it to your doctor to authorize the transfer of files.

Please note that any upcoming appointment dates and times can be checked in the Patient Portal.

What to Expect

When you first arrive at Olive, the receptionist will welcome you and take your photo or a copy of your photo ID. Proper patient identification is essential for your care and safety. Your photo will never be shared or used for any purpose other than your identification.

 

Your consultation will be approximately 30 to 45 minutes. During your consultation your physician will listen to your concerns, discuss the results of your tests, review any previous treatment, and answer any questions you might have. You may have a transvaginal ultrasound performed during this visit to assess your ovaries and uterus.

 

Based on this information, we will try to figure out why you are not able to get pregnant and establish a treatment plan. Sometimes additional tests are required, but in most instances, we can figure out the “why” and then move forward with a plan for 'how' to get pregnant.

Learn More about this Topic

Olive clinic experts have shared helpful insights on the Olive blog. Check out the following quick reads to learn more.

Inclusion of all gender and sexually diverse people is an important value of Olive Fertility Centre. We are continuously striving to create an environment of compassionate belonging where all of the 2SLGBTQIA+ community are supported, valued and respected.

Olive Fertility Centre resides on the traditional, ancestral, and unceded territory of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and Tsleil-waututh Nations (Vancouver and Surrey clinics), of the Lekwungen people (Victoria clinic), of the syilx/Okanagan people (Kelowna clinic) and of the Lheidli T’enneh First Nation (Blossom Fertility clinic in Prince George).

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