Services
Fertility
At HEARTLAND we take great pride in the services we offer and the skills, training and expertise each service requires. We are a unique facility that offers our clients three types of services: fertility, women's health and minimally invasive surgery. Whether your concern is general health or fertility, we are here to help you.
These are the fertility services we provide:
Ovulation Induction
Ovulation induction involves ovarian stimulation by medication to induce ovulation, the release of a mature egg from its follicle in the ovary. Ovulation induction is one of the most successful means of treating infertility in women who do not ovulate naturally or reliably.
Not all women are candidates for ovulation induction. To determine the need for ovulation drugs, patients undergo a series of tests to identify the presence and exact cause of the ovulation problem. Reversible causes of anovulation include stress, weight gain or loss, drug use, medical illness or strenuous physical activity. Adrenal disorders, thyroid problems and liver dysfunction should be ruled out prior to therapy. Once a diagnosis is made, it can take months to determine the right drug and dosage to trigger ovulation.
Infertility specialists rely on a group of ovulation drugs, often called "fertility drugs," to temporarily correct ovulatory problems and to increase a woman's pregnancy potential. These drugs are used to control the time of ovulation or to regulate erratic ovulation patterns. They are also used to correct post-ovulatory problems, increase the frequency of ovulation in women who ovulate infrequently, and cause ovulation in women who do not ovulate.
Ovulation drugs are necessary to treat women who do not menstruate but who desire fertility. Ovulation drugs can stimulate the ovaries to produce more than one egg per cycle. This is done in preparation for various forms of assisted reproduction such as insemination or IVF. The intent is to develop several mature eggs so that at least one egg may be fertilized and result in pregnancy. Before medication to stimulate ovulation is taken, an evaluation should be performed to look for other hormonal imbalances. Correction of such problems may allow ovulation to occur without the use of fertility drugs.
The drugs do not make all women fertile. If they make women ovulate, they have a 5 to 25 percent chance to conceive each month. They only work during the month in which the medication is taken. There are potential risks and side effects associated with the use of ovulation drugs which may require close monitoring during their use. Women should discuss these issues with their doctor and weigh the risks against the benefits of ovulation-inducing agents.
Therapeutic Donor Insemination (TDI)
Therapeutic donor insemination (TDI) involves placing sperm from a male other than the female's partner into the female's reproductive tract near the time of ovulation for the purpose of producing a pregnancy. This process is an easy and inexpensive way to achieve pregnancy in a fertile woman. It is one of the most effective methods for couples with severe male factor infertility to experience pregnancy and childbirth.
Patient Consultation
Patients considering TDI are given a consultation to discuss issues associated with donor insemination. A number of tests may be done to assess the fertility of the patient. Once a patient is admitted into the TDI program, a suitable donor is selected. It is recommended that donor characteristics closely resemble those of the patient's partner. Blood type, race and eye colour are the most important selection criteria; additional characteristics may also be considered.Donor Semen
Donor semen is available from a variety of reputable sources. Donors are required to undergo a rigorous screening process involving physical examination, in-depth family history and tests for transmittable bacterial, viral and genetic abnormalities. Once accepted as donors, follow-up blood and fluid testing continues for at least six months after their last semen donation. Donor pregnancies are monitored to ensure that donors have adequate fertility and that a limited number of women are impregnated using the same donor.The TDI Cycle
The woman's cycle is monitored using temperature charting and urinary tests to determine the time of ovulation. When these tests indicate that the time is optimal, insemination is performed. Insemination involves inserting a catheter through the cervix into the uterus and injecting the semen using a syringe. The procedure takes approximately 5 minutes.Candidates
TDI is commonly used when male partners exhibit low sperm counts or absence of sperm. It may also be indicated when either partner is a carrier of a known hereditary or genetic disorder such as Huntington's disease or hemophilia, and when there are abnormalities involving chromosomes.Success Rate
The success rate of TDI depends on several factors. The female's age is important as fertility gradually declines with age. Irregular or absent ovulation and tubal disease decrease the success rate. Success is more likely if the woman has had a pregnancy. When inseminations are performed monthly, the success rate is about 15 percent per month, or 60 to 70 percent after six attempts.Hyperstimulation/Intrauterine Insemination (HS/IUI)
HS/IUI represents a two step treatment for infertility. First, hormone therapy is used to improve the ovulatory response. Second, an optimally-prepared semen sample is injected directly into the uterine cavity. In bypassing the vagina and cervix, this treatment is designed to increase both the number of eggs and the number of motile sperm which reach the fallopian tubes. Intrauterine insemination compensates for mild male factor infertility.
Ovarian Stimulation
A number of ovarian follicles begin to develop during each normal menstrual cycle. However, the effect of hormones released by the pituitary gland usually result in the production of only one mature follicle capable of ovulating an egg.Hyperstimulation therapy involves a daily injection of hormone preparations which increases the number of ovarian follicles capable of ovulating an egg.
Monitoring
During hyperstimulation cycles, it is necessary to monitor the rate of ovarian follicular development to minimize the risk of excessive stimulation and multiple pregnancy. Monitoring involves ultrasound and blood testing. When monitoring indicates that an appropriate number of follicles have developed sufficiently, final maturation is initiated by hormone injection.Candidates
HS/IUI is used in patients with unexplained infertility and in situations where mild male factor infertility (slightly low sperm count or slightly low sperm motility) exists.Note:
 | The success of HS/IUI varies widely depending on the cause of infertility. In certain ovulatory disorders and male factor conditions, the rate of conception may approach 25%, similar to that of fertile couples. |
| Multiple pregnancy occurs in approximately one in every four pregnancies. |
| Fallopian tubes must be intact and unobstructed. |
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is a popular and successful infertility treatment. This procedure involves removing eggs from the ovaries and inseminating them in a culture dish. Following fertilization and early embryo development, the embryos are transferred to the uterus.
View Success Rates
The IVF Cycle
IVF treatment is a multi-step process involving ovarian stimulation, monitoring and ovulation induction, egg retrieval, and embryo development and transfer.
- Controlled Ovarian Stimulation
During the IVF cycle, one of several hormone preparations is administered by to stimulate the growth and maturation of a number of ovarian follicles. The follicle is the structure in the ovary which contains the egg. - Monitoring and Ovulation Induction
Monitoring involves ultrasound and blood testing. When monitoring indicates that follicles have developed sufficiently, final maturation is initiated by hormone injection. Egg retrieval is scheduled approximately 34 to 36 hours later. - Egg Retrieval
This procedure is performed under local anesthesia. A combination of medications is used to facilitate patient comfort and relaxation. Mature follicles are identified by vaginal ultrasound; a needle is guided through the wall of the vagina and into each of the mature follicles. The follicular fluid containing the eggs is then aspirated into culture tubes for subsequent in vitro fertilization. - Embryo Development and Transfer
A semen sample is obtained shortly before or after egg retrieval. The sample is assessed, processed and inseminated into defined media containing the eggs. Approximately 20 hours later, fertilization is determined. On the day of embryo transfer (three days after egg retrieval), continuing embryo development is assessed by confirming that embryonic cells have divided. This procedure is simple and requires no anesthesia. Two or three embryos are transferred depending on the patient's age. The embryos are placed into a catheter which is then passed through the cervix into the uterus where the embryos are released. Embryos that are not transferred may be preserved for future use.
Typical IVF Treatment Cycle
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| Procedure | |
Approximate Timing |
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| Suppression | |
Starts Approx. 21 days prior to stimulation |
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| Stimulation | |
Day 1 to 11 |
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| Blood Monitoring | |
Days 1, 7, 10, 11 |
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| Ultrasound | |
Days 8, 10, 11 |
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| Hormone Injection | |
Day 11 |
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| Egg Retrieval | |
Day 13 |
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| Embryo Transfer | |
Day 16 |
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| Pregnancy Test | |
Day 29 |
Note:
| The potential for success may be significantly increased when IVF is used in combination with other reproductive technologies including intracytoplasmic sperm injection (ICSI) and assisted hatching. |
| Multiple births occur approximately once in every four pregnancies. |
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) involves depositing a single sperm directly into the cytoplasm of a mature egg using a micromanipulation tool. Other than the micromanipulation process and subtle differences in semen process, all aspects of ICSI treatment are the same as those for IVF. ICSI is performed during a routine IVF cycle.
Steps 1 through 4 as well as 6 of this process are the same as those for IVF. (*See IVF for more details) Step 5 includes the ICSI procedure along with embryo development. A single suitable sperm is loaded into a small injection pipette. A second pipette is used to hold the egg while the injection pipette is passed through the outer wall of the egg (zona pellucida) and into the egg cytoplasm. The egg is released once the injection pipette is removed.
Success Rate
Fertilization rates for ICSI are in the range of 60% - 70%. Individual pregnancy rates vary depending on female age, day 2-3 FSH levels and sperm quality.Risks
The most common complication of ICSI treatments is multiple pregnancy, which occur in approximately 1 in 4 pregnancies. As a precaution, no more than three embryos are returned to the uterus during embryo transfer. Hyperstimulation syndrome, enlarged ovaries and fluid accumulation in the abdomen, occurs in about 2-5% of ICSI cycles. A possible increase in chromosomal abnormalities is possible.Candidates
This procedure is ideal for couples diagnosed with severe male factor infertility. In the past, low sperm numbers and/or poor sperm motility necessitated the use of therapeutic donor insemination (TDI). Since ICSI theoretically requires only one motile sperm per egg, many of these couples now have a realistic hope of conceiving and giving birth to their own biological offspring.Potential candidates also include patients with failed vasectomy reversals and those experiencing repeated fertilization failure in previous IVF cycles.
Frozen Embryo Transfer
When excess embryos are created during IVF and are not transferred to the uterus, they may be frozen for future use. When you decide to use these embryos, they are thawed and transferred to the uterus in the same process as in a routine IVF treatment. Because there is a shorter preparation stage and no retrieval process, some women find it a simpler and less stressful process.
Oocyte Donation
Ooctye donation treatment is done in conjunction with an IVF cycle and is useful for specific causes of infertility. Treatment involves removing eggs from the ovaries of a female donor and inseminating them in a dish or tube with the sperm of the recipient's partner. As in IVF, embryos are returned to the uterus of the recipient following fertilization and early embryo development
HEARTLAND Fertility & Gynecology Clinic currently does not have a program with unknown or anonymous oocyte donors. Recipients must provide their own oocyte donor.
Assisted Hatching
Like oocyte donation, assisted hatching is a procedure done in conjunction with IVF. It is believed to enhance embryo implantation by assisting interaction between the embryo and the lining of the uterus. To date routine use is not recommended, however, it may improve implantation rate in frozen embryos of older women.
How It Works
In the process of assisted hatching, the embryo is held with a holding pipette. A smaller pipette containing an acid solution is then used to make a small hole in the zona pellucida. The embryo is then released and transferred as in regular IVF procedures.Fertility Preservation
Fertility preservation is a welcome option for individuals experiencing early menopause or in cases where an individual is undergoing potentially sterilizing medical therapies such as cancer treatment. It may involve the cryopreservation of sperm or embryos. Fertility preservation presents opportunities to people concerned with their future ability to conceive and creates hope for a fertile future.
Surrogacy
Surrogacy is viable option for women with damaged or absent uteri, serious health concerns, a history of recurrent miscarriages or for same-sex couples wishing to start a family. It is the process in which a woman assists an infertile couple by carrying and delivering a baby to term when they are unable to do so themselves. Most often surrogacy involves the woman of the donor couple undergoing IVF, but not receiving embryos. Her eggs are fertilized in a dish or tube with her partner's sperm. Once the surrogates cycle has been synchronized with that of the donor female, the embryos are planted in the uterus of the surrogate.
Surrogacy can be limited as it may be difficult for a couple to find someone to act as a surrogate. While a surrogate may be a family member, friend or supplied by an agency, Canadian law specifies that surrogacy can only be done altruistically. No payment or compensation can be given to the surrogate for their gift.
At HEARTLAND, surrogacy is reviewed on an individual basis.
Testicular Sperm Extraction (TESE)
Testicular sperm aspiration is a process by which sperm is extracted from the testicle when natural and other medicinal methods are unsuccessful. During this process, a biopsy is performed, taking a small sample of tissue from the testicle itself. Sperm extracted using TESE is incapable of fertilization on it's own, so it is injected into the egg by ICSI.
