Before your first appointment it is important that each person within your family group have a basic fertility assessment. This will help us to identify what might be causing your fertility issues and create a personalized treatment plan for you at your initial consult.
When you are given your appointment with the fertility specialist (REI), all the testing requisitions will be uploaded to your patient portal for you to print off and take to the laboratory before your consultations. Testing is specific to each patient’s history so not all patients need all the testing.
Potential tests that may be recommended as part of your assessment are described below.
Your initial assessment includes testing for a standard panel of infectious diseases, a complete blood count and blood typing. In addition, the blood tests will measure your thyroid stimulating hormone and Anti Mullerian Hormone. Depending on ethnic background or other predisposing factors, genetic testing may be ordered to assess risks for possible inherited diseases.
In addition to problems with your general health, thyroid imbalances can cause menstrual disturbances, infertility, and miscarriage.
The AMH test which helps provide a picture of your ovarian reserve, how many eggs you have left. It is most useful to determine if the relative number of your remaining eggs is lower, normal, or higher compared to what is expected for others of your age.
This information can help us make some important decisions about your treatment plan. For example, if the AMH tells us that you are running out of eggs faster than we expect, we might advise that you consider more aggressive treatment.
On the other hand, if the AMH is better than expected, we might suggest you consider more conservative treatment.
Please note, unlike most blood tests, AMH is not covered by MSP. The cost of this test is $95.
Next: Imaging Tests
Assessing the health of your Fallopian tubes and uterus is an important part of your fertility evaluation. Your doctor will determine if it is necessary for you to have any of the following tests.
The AFC is a transvaginal ultrasound that gives us similar information to the AMH level about your ovarian reserve. Your doctor will determine if you need an AFC at the time of your initial consult.
An HSG is an X-ray test that looks at the inside of your uterus and fallopian tubes and the pelvic area around them. This is a very safe, informative, and possibly therapeutic procedure (many women conceive shortly after having the HSG).
Unlike the other imaging tests, the HSG is not performed at Olive but at a radiology facility. After inserting a vaginal speculum, the physician will insert a small catheter into the cervix and instill about 2 tablespoons of water-soluble dye. Several X-ray films taken while the dye is instilled will show if your fallopian tubes are open, and if there are any obvious problems within the uterine cavity that could cause infertility or complications during pregnancy. The procedure is performed in the first half of your menstrual cycle, after your bleeding has resolved but before you ovulate.
While most tolerate the procedure without significant discomfort, some patients find the procedure uncomfortable. Much of the discomfort can be prevented by taking 400mg of ibuprofen (Motrin) 1 hour before the procedure. (Patients allergic to ibuprofen can take 2 extra strength Tylenol.)
The procedure only takes a few minutes.
Hysterosalpingograms (HSGs) are booked at radiology centre or hospital in your area. Olive will determine the best location to have this test done and provide you with the instructions and requisition. HSGs are done between cycle days 8-12. HSG times are limited so it’s possible you may need to wait 3-4 cycles for an appointment.
Depending on your HSG findings or other reasons determined by your physician, a hysteroscopy may also be required.
A hysteroscopy is a procedure that involves a physician inserting a tiny camera through the cervix and into the uterus, to see if the environment within the uterus looks favourable for embryo implantation. This is the “gold standard” method for assessing the uterine cavity.
A sterile saline solution is injected through the camera to inflate the uterus and separate the walls so that all the interior surfaces can be seen. Minor problems such as small polyps or mild scarring can be dealt with during this procedure, but more significant problems may require additional treatment.
The procedure itself takes about 5 minutes and may cause some minor discomfort or cramping that can be minimized by taking 400mg of ibuprofen 1 hour before the procedure. (Patients allergic to ibuprofen can take 2 extra strength Tylenol.)
Hystero-Contrast-Salpingography (Hy-Co-Sy) is an ultrasound test performed by a fertility specialist to assess your uterus and fallopian tubes.
During the Hy-Co-Sy the doctor looks for possible polyps and fibroids and checks if your tubes are open or blocked. Your doctor may suggest a Hy-Co-Sy as an alternative option to the Hysterosalpingogram (HSG).
Hystero-Contrast-Salpingography involves the following steps:
This test is provided at Olive and is ideal for patients who are unable to get in for HSG appointments at outside labs. The fee for the HyCoSy is $250.
This can be booked by calling Olive on the first day of your period.
Next: Semen Analysis
A semen analysis involves analysing a freshly ejaculated sperm sample under a microscope to determine sperm quantity, motility (movement) and morphology (shape).
If a consistent and severe problem is found in the semen analysis, the patient may be referred to a urologist for additional evaluation.
Please call Novavita Laboratory or Lifelabs to schedule an appointment (phone numbers are on the requisition).
When you are given your appointment, if the specimen is produced at home, it should be delivered within 1 hour. A delay in processing the specimen can lead to inaccuracies in the interpretation of results.
If you book with Novavita Laboratory you will produce a specimen at the clinic in one of the comfortable, well-appointed, semen production rooms.
Ideally, before producing the semen sample for analysis, abstinence should be practiced for 2-3 days, but not more than 5 days.
Olive clinic experts have shared helpful insights on the Olive blog. Check out the following quick reads to learn more.
Inclusion of all gender & 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).
© 2022 Olive Fertility Centre. All Rights Reserved.