The failure to conceive (female) or to father (male) a child for a period of 12 months or longer due to a deviation from, or interruption of, the normal structure or function of any reproductive part, organ or system for reasons other than surgical sterility or use of contraceptives.
What causes infertility?
There are many conditions that may contribute to infertility. These are examples:
Endometriosis: Endometriosis is a condition in which endometrial tissue, the tissue that lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes.
Genetics: Trisomy is the presence of three chromosomes, rather than the usual pair of chromosomes. Monosomy is the absence of one member of a pair of chromosomes. Translocations can be balanced or unbalanced, describing the location of changed materials. Chromosome abnormalities may result in unviable embryos or miscarriage.
Immune Disorders: Disorders of the immune system, from increased NK (natural killer) cells to APA (anti-phospholipid antibodies), can contribute in a multitude of ways to the problem of infertility.
PCOS: Polycystic Ovarian Syndrome (PCOS) is a health problem that can affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance.
Raised FSH: the follicle-stimulating hormone (FSH) encourages the follicles to grow and the egg to ripen, if levels are raised and the body stimulates ovulation, the egg is likely to be of poor quality.
Tubal Issues: Tubal factor infertility accounts for about 20-25% of all cases of infertility. This category includes cases in which the woman has completely blocked fallopian tubes and also women who have either one blocked tube or no tubal blockage but tubal scarring or other tubal damage.
Premature Ovarian Failure: (POF), also known as early menopause, is a condition where the supply of eggs has prematurely declined or the follicles that supply eggs are less reactive to the follicle-stimulating hormone.
Male Factor: In approximately 40 percent of infertility cases, sperm abnormalities are either a factor or the factor. Treatments may include diet and lifestyle, surgery, or the ICSI procedure.
Primary reported causes of infertility (1656 reporting IVF.ca members) to August 2008
Cause
Number
Percentage
Male Factor
426
25.7
Unexplained
398
24.0
Tubal
244
14.7
Endometriosis
145
8.7
PCOS
143
8.6
Raised FSH
67
4.0
Genetic
20
1.2
Vasectomy
19
1.1
Cancer
13
0.7
Immunological
8
0.5
Injury
1
0.1
Other
172
10.5
What is an RE?
An Reproductive Endocrinologist (RE) is a physician specializing in the diagnosis and treatment of subfertility. REs order investigations and run treatment protocols, up to and including retrieval and transfer in an IVF cycle. REs are also responsible for management of the first trimester of pregnancy.
What is an Embryologist?
A Clinical Embryologist is a specialist in embryo development. In a modern laboratory, embryologists are responsible for sperm washing, IVF, ICSI, pre-implantation genetic diagnosis, cord blood banking, and research into new techniques such as egg freezing.
How much does IVF cost?
Each clinic has its own fee structure. Variation in fees from clinic to clinic may result from many factors, including, (but not limited to), staffing levels, building/location expenses, equipment investment, and service protocols. Here is an example range of service costs based on a small sampling of Canadian fertility clinics:
Consultation: $0-$200
Semen Analysis: $85-$350
IVF: $4355-$5,500
ICSI: $1200-$1535
Medications: $3000-$4000
Sperm Freezing - 1st yr: $125-$300
Embryo Freezing - 1st yr: $480-650
Annual embryo storage: $150-$300
Frozen Embryo Transfer: $540-$1100
There may or may not be other fees, including, (but not limited to), surgical procedures, hospital room fee, assisted embryo hatching, and donor-related services.
How many embryos are transferred during IVF?
A number of variables may be considered prior to a mutual patient-physician decision regarding how many embryos will be transferred in an IVF cycle. Here are some:
Patient age
Diagnosis
Ovarian reserve quality
Number of fertilized eggs
Embryo quality
Day of transfer (past retrieval)
Previous IVF/fertility history
Implantation factors
Ethics
Preference of patient
Financial considerations
Life circumstances
Third-party embryos/eggs (if any)
Clinic history
Legislation (if any)
2 embryos are common under age 35. Depending on many variables, some that are listed above, the number of embryos can range from 1 to 4, with 4 being for exceptional circumstances and/or over the age of 40. Each clinic and patient situation is different.
What about healthcare, insurance and taxes?
In Canada it is possible to use personal tax credits to recover a portion of the costs. Please see the CCRA Website for more information or speak to your accountant. Depending on your provincial residency, and your family tax situation, it could be possible to reduce your tax payable by the equivalent to approximately 20% of your out of pocket medical costs. This includes costs associated with travel, if you travel more than 40 kilometers, to receive treatment. In other words, you may receive back the equivalent benefit of approximately 20% of your associated costs through tax reduction.
If you have private medical insurance, please speak to your insurer about any possible coverage of prescription drugs.
Healthcare generally covers initial physician-investigated fertility tests, or a portion of tests. The only province that covers some IVF procedural costs is for residents of Ontario under OHIP, but coverage is limited to the diagnosis of dual naturally-blocked fallopian tubes. If you are a resident of Ontario, contact OHIP for more information about qualifying criteria.
