Your potential success rate is uniquely yours. However, the care you receive can greatly influence your chances of pregnancy within your natural range. At York Fertility Centre, you will be under the care of one of the most successful infertility clinics in the country. Our success rates are a testament to this: in the past year, more than 50% of our full IVF cycle patients have successfully gotten pregnant. Depending on your age and history, your potential for pregnancy could be higher.
While high success rates are what we aim for, patient safety is of utmost importance. At York Fertility Centre, the majority of successful pregnancies were the result of a single embryo transfer (SET). Dr. Pyselman pioneered the push for making single embryo transfers (SETs) the standard more than a decade ago, after conducting analyses of the success rates of her patients receiving SETs. Dr. Pyselman discovered that SETs significantly reduce the risk of multiple pregnancies, most often without lowering success rates. Multiple pregnancies (twins and triplets), put mothers at risk. This is why we always recommend SETs, unless your particular history suggests we do otherwise.
At York Fertility Centre, we are fully equipped to offer all of our services on-site, including any blood tests, ultrasounds, and laboratory procedures you may need during your time with us. We also work with specialists at the Markham-Stouffville Hospital, such as urologists and endocrinologists, to provide you with the most comprehensive care possible. In addition, we are pleased to offer our patients psychological and dietary counselling as well as acupuncture - on-site or nearby - ensuring a complete care package tailored specifically to your needs. Read more below.
We know that overcoming infertility can be time sensitive, expensive, and emotionally and physically stressful. That is why we work to systematically identify the underlying cause of your infertility, and then work with you to develop a personalized treatment plan that is as aggressive and yet as gentle and affordable as possible, given your personal history.
Infertility evaluation is the first stage in the treatment process. The goal is to assess what is causing a patient's particular case of infertility. Infertility evaluation starts by conducting a complete medical history and is followed by a series of tests for both the female patient and her partner (if applicable). The tests you will require will be tailored to your personal history. Many of the tests are conducted on the day of your initial consultation, however you will likely have to return for some tests depending on the timing of your menstrual cycle. Once all of the necessary testing is complete, you will return for a follow-up consultation to discuss the results and to plan for your chosen treatment option.
Please note: since each patient completes testing at a different rate, we ask that you please inform us when you are nearing the completion of your testing in order to book your follow-up appointment. This appointment will not be booked automatically.
Natural Cycle Monitoring
As part of the initial fertility evaluation, you may be offered Natural Cycle Monitoring. 'Natural' implies that no fertility medications are used and 'cycle' refers to your menstrual cycle. Natural cycle monitoring not only allows the doctor to explore potential causes of infertility but may also in itself result in pregnancy in some patients.
Natural cycle monitoring of a patient's menstrual cycle is comprised of blood work and/or ultrasounds performed daily for a few days around the middle of the patient's menstrual cycle. These tests assess hormonal factors surrounding ovulation, follicle development and the thickness of the uterine lining at the time of ovulation, which gives the doctor a better understanding of the ovary's natural functioning or potential problems, and indicates the optimal timing for intercourse or interuterine insemination (IUI).
An additional blood test - a Progesterone Level - is done one week after ovulation to confirm that ovulation has occurred and to determine the patient's progesterone levels are adequate to support a pregnancy. The successful implantation of a fertilized egg requires adequate progesterone levels.
Ovulation induction involves the use of various fertility medications to stimulate the release of one or more eggs from the ovary. Ovulation induction may be a recommended treatment option in one of two circumstances:
The first is in women who do not ovulate or who ovulate infrequently on their own. In these cases, the goal is to produce a single egg. Ovulation induction is often combined with cycle monitoring to determine the timing of ovulation and thus help time intercourse to improve chances of pregnancy. If there are other factors present, such as low sperm count, intrauterine insemination (IUI) may also be recommended.
The second case in which ovulation induction may be recommended is in women who have regular ovulatory cycles, but who have other causes of their infertility such as low sperm count or unexplained infertility. For these patients, the goal is to produce more than a single egg to improve pregnancy chances. This is also called superovulation or controlled ovarian stimulation. When medications are used for this purpose, there is an increased risk of multiple pregnancies and ovarian hyperstimulation syndrome (OHSS).
Intrauterine Insemination (IUI)
Intrauterine insemination is a procedure where the semen sample is specially treated in the lab and then placed directly into the uterus of the female patient.
In the lab, the sperm is "washed" and the healthiest, most motile sperm are isolated. The washed sperm is then placed inside the uterus, to help the best sperm reach the egg. A woman must have open fallopian tubes for this form of treatment.
Intrauterine insemination may improve the chances of pregnancy in patients who have unexplained infertility, male factor infertility (eg. low sperm counts) or for those patients who have difficulties having intercourse. IUI can be performed in natural cycles, or combined with fertility medications that enhance ovulation. Cycle monitoring with blood work and ultrasound helps to determine the time of ovulation and thus the ideal time for insemination. Success rates vary depending on the cause of infertility and a patient's age.
Therapeutic Donor Insemination (TDI)
Therapeutic donor insemination is offered to women who do not have a male partner, whether that patient is in a same sex relationship or is a single woman, or alternatively to couples in which the male partner has no sperm or has a very low sperm count and the couple doesn't wish for an IVF. Guidelines for donor insemination are highly regulated by Health Canada, ensuring patient safety.
Before entering the donor insemination program, potential recipients undergo an initial fertility evaluation. A counseling appointment is also arranged to ensure that all the social implications of a pregnancy with donor sperm have been considered.
Most frequently, a woman will start trying to conceive with donor insemination by monitoring her natural cycle with ultrasound and hormone tests to determine the timing of ovulation. At ovulation, the donor sperm is inserted into the uterus with the aid of a tiny catheter. If pregnancy is not achieved after 3-6 cycles, fertility medications may be prescribed to enhance the chances of pregnancy. Pregnancy rates for donor insemination approximate natural pregnancy rates.
In Vitro Fertilization (IVF)
In Vitro Fertilization is an advanced reproductive technology (ART) in which a woman's eggs are removed from her body and fertilized outside of the body in a lab. Three or five days later, the embryos that develop are placed into the patient's uterus; any additional embryos are frozen.
There are many situations in which IVF may be a recommended treatment, such as in patients with blocked fallopian tubes, endometriosis, male factor infertility or unexplained infertility. IVFs can also be used as a diagnostic tool to assess egg quality. IVFs are typically more successful than intrauterine insemination. The most important factor predicting the success of IVF is maternal age; pregnancy rates start to decline after age 35.
The steps involved in IVF are as follows:
- Pre-IVF preparation
- Ovulation Induction (stimulation of egg production using fertility medications)
- Oocyte retrieval (removal of the eggs from the body)
- Fertilization of eggs (done in the laboratory)
- Embryo Transfer (embryos placed into the uterus)
- Luteal phase support (after embryos have been transferred)
If there is a concern about the sperm quantity or quality, a procedure called intracytoplasmic sperm injection (ICSI) may be recommended. In this circumstance, the sperm is injected right into the egg with a very fine needle.
Since we strongly encourage a single embryo transfer, in many cases there are extra embryos available for freezing. If the initial embryo transfer is unsuccessful, or if a couple wants a second child, a frozen embryo transfer is offered using the extra embryos. This is much less costly and less invasive than the original IVF procedure.
Some patients with low ovarian reserve - caused by premature ovarian failure, late maternal age, or as a result of chemotherapy or surgery - may only be able to conceive with the aid of donor eggs.
Recurrent Pregnancy Loss
Approximately 25% of all recognized pregnancies result in a miscarriage, with rates increasing with age. The majority of losses are the result of abnormalities in the number of chromosomes present in the embryo. The number of women who have 2 miscarriages in a row is less than 5% and the number of women with 3 or more consecutive losses is less than 1%. After 2 losses consecutively, preliminary investigations are warranted to identify the potentially treatable causes of pregnancy loss.
Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is an area of special interest for Dr. Pyselman that has developed after many years of treating patients with PCOS for infertility.
As PCOS patients naturally make up a large proportion of the patients seen at York Fertility Centre, Dr. Pyselman is currently developing additional resources and services tailored specifically to the needs of an infertility patient with PCOS. These resources and services will be in addition to the already comprehensive treatment protocols in place at York Fertility for PCOS patients, which include sonohysterograms, ovulation induction and cycle monitoring, diabetes screening and education, endometrial sampling, additional care and monitoring during early pregnancy, and so on.
If you are struggling with infertility and think that diagnosed or undiagnosed PCOS might be a contributing factor, book a consultation with Dr. Pyselman.
Please note: At this time Dr. Pyselman treats only those patients who suffer from PCOS and who are trying to get pregnant.
Sonohysterogram & Obstetrical Ultrasound
Dr. Pyselman performs sonohysterograms (“sonos") on site at York Fertility Centre for both her patients and the patients of other physicians. A sonohysterogram is a special ultrasound that involves imaging the uterus and uterine cavity. Both a specially trained physician and an ultrasound technician must be present in order to perform the test. A sonohysterogram may be warranted for a variety of reasons, including to assess: irregular bleeding, infertility, recurrent miscarriages, any suspected abnormalities of the uterus such as polyps, sub-mucousal fibroids, scarring, or shape abnormalities, or as a preliminary evaluation for in-vitro fertilization.
If you think you might benefit from a sonohysterogram, and you are not a patient of Dr. Pyselman, speak to your doctor about getting a referral. The referral is typically made through our ultrasound partner, True North Imaging (TNI). Your doctor may already have TNI or similar ultrasound requisition forms. If not, you can download the referral form here. Once your physician has given you a referral, call (905) 472 4915, TNI's York Fertility Centre location, to book your appointment. Once your appointment has been booked, please fax your requisition form to TNI in advance (905) 472 4130, if possible.
Please read our Sonohysterogram Information Sheet if you have been booked for a Sono at our clinic.
Through our partners True North Imaging, York Fertility Centre also offers obstetrical ultrasound and imaging services. This includes viability scans, nuchal translucency scans, level 2 obstetrical ultrasounds and biophysical profiles. We provide these services to patients who have conceived at our clinic and also accept referrals from outside physicians.
To arrange any of these ultrasound services, you will require a referral from from a physician, who will fill out a requisition form for you. You can also bring a copy of the form to your physician by downloading the referral form here. Once you have a requisition, contact True North Imaging at York Fertility Centre by calling (905) 472 4915 to book your appointment. Once your appointment has been booked, please fax your requisition form to TNI in advance to (905) 472 4130, if possible.
Acupuncture & Alternative Therapies
Studies have shown that acupuncture can play an important role in aiding the treatment of infertility. Acupuncture has been shown to improve quality of life in infertility patients by alleviating pain, nausea and stress, and has been shown in some studies to improve fertility by increasing blood flow to the uterus, reducing stress, normalizing hormones and endocrine systems, and regulating the menstrual cycle.
York Fertility Centre provides on-site access to Acupuncture and Traditional Chinese Medicine consultations.
Infertility is not simply a medical concern, but also involves a vast array of emotional concerns. Fertility counselling provides a confidential, supportive environment for you and/or your partner to safely express concerns and anxieties, including decisions about whether infertility treatment is right for you, and if so, how to work through understanding and coping with infertility and its treatment.
Genetic Screening of Embryos
We are pleased to be able to offer genetic screening of embryos in conjunction with our partner, Markham Fertility Centre. This genetic screening can be done to look at chromosome numbers or to look for single gene disorders in families with a history of genetic diseases. This may be useful especially in cases of recurrent pregnancy loss or unexplained IVF failure.
For more detailed information on these services, please click here. Note that this information is intended for actual patients of Dr. Pyselman and York Fertility Centre.
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