If you’ve been trying to get pregnant for over a year, experts recommend that you see a fertility doctor, who will take a detailed history and run some tests to see what might be holding you and your partner back from conceiving.
The chosen treatment will depend on exactly what the problem is. Here’s a breakdown of fertility treatments and who they’re best for.
If a woman isn’t having a regular menstrual cycle (which can be quite common for those with polycystic ovary syndrome), medications like clomiphene citrate and gonadotrophins may be used to encourage regular ovulation. These medications are often used in conjunction with intrauterine insemination.
Cost Varies, depending on the dosage and the province you live in.
Good to know These medications can cause mood swings, breast tenderness, pelvic pain, flushing, abnormal uterine bleeding and headaches.
For couples in which the woman has at least one open and functioning Fallopian tube and the man has a low sperm count or issues with motility (ability to swim) or morphology (shape), doctors may try intrauterine insemination (IUI). For this procedure, the sperm is processed so that only the best are included in a small sample, which is placed into the uterine cavity with a catheter and timed with ovulation.
Cycle monitoring is often used to optimize timing, which involves several transvaginal ultrasounds and rounds of blood work to figure out when ovulation will occur. Fertility medications can also be used to increase the number of eggs.
Cost $300 to $500 (plus fertility medications) per insemination.
Good to know You may experience some cramping for a day or so after the sperm is injected into the uterus.
In vitro fertilization
If a woman has blocked Fallopian tubes or endometriosis, is older or has experienced recurrent pregnancy losses, in vitro fertilization (IVF) is used. For in vitro fertilization, the woman is given hormones to produce a supply of eggs, which are harvested from the mother and mixed with sperm in the lab. One or more embryos is then implanted in the uterus.
Cost $6,000 and up per cycle, depending on add-ons chosen and whether eggs or embryos are frozen after the cycle.
Good to know The fertility medications and hormones you take as part of the treatment can cause side effects, such as mood swings, bloating, soreness, insomnia and irritability.
Intracytoplasmic sperm injection
This is a more technologically advanced form of IVF that might be attractive to couples with low sperm quality. With intracytoplasmic sperm injection (ICSI), the sperm sample is processed and one high-potential sperm is injected right into the egg. The embryo is then implanted in the uterus as usual.
Cost $1,500 (in addition to the cost of the IVF cycle).
Good to know This procedure is similar to IVF, and you may experience some unpleasant side effects from the medications.
Pre-implantation genetic screening or comprehensive chromosome screening
To increase the success rate, some clinics offer pre-implantation genetic screening (PGS) and comprehensive chromosome screening (CCS). For this process, the embryo is checked for an abnormal number of chromosomes. The sample of cells that would eventually form the placenta is biopsied and sent to a genetic clinic for analysis, while the embryo remains frozen at the clinic until the results come back. This procedure may be recommended for women who are older or have had recurrent pregnancy losses.
A similar procedure, called pre-implantation genetic diagnosis, checks the embryo for specific genetic conditions.
Cost $9,000 and up (includes the costs of biopsy, freezing embryos and IVF cycle). The genetic testing fee, which can vary, is paid to the clinic that receives the sample.
For any of these procedures, donor eggs, donor sperm or donor embryos can be used. You can also use a gestational carrier, where the embryo is implanted in a woman other than the mother, who carries the baby to term. Donors and gestational carriers are used for medical reasons, as well as for same-sex couples.
Am I covered?
In most provinces, fertility treatments are not covered by provincial health plans. However, in Quebec, couples pay for the procedure upfront and can get between 20 and 80 percent back in tax credits, based on income. In Ontario, the provincial health plan will cover intrauterine insemination, as well as one cycle of in vitro fertilization for women under 43, but there are a limited number of funded spots and it can be difficult to snag one.