If you have a question that you think others may also have or like answered for yourself, please submit it in a written form to RCC’s Front Desk and it may be added to this aspect of our website. Alternatively you may send your questions to info@rccfertility.com.


Q1. I have fibroids. Do they need to be removed?
Not all fibroids need to be removed.  If they are causing symptoms (pelvic pain, bowel and bladder problems, heavy bleeding, miscarriage) then it may be advisable to discuss removing them with your doctor. If you are not having symptoms then they do not need to be removed. For women who are attempting to become pregnant or have had miscarriages, it is thought that fibroids that are in the cavity of the uterus may be contributing to the problem. Your physician may discuss removing them.

Q2. What methods of payment do you accept?
RCC accepts VISA , Mastercard, debit, certified cheque (with appropriate ID) and cash.

Q3. When do I pay for my treatments?
All payments for treatments and procedures are to be made prior to the process being carried out. When you do IVF, all payments are expected prior to the start of the IVF cycle.

Q4. How many cycles of clomiphene citrate with intrauterine insemination can I do?
It is considered that if pregnancy has not been achieved by 6 completed cycles, then success becomes less likely.  Many couples will do additional cycles for many different reasons.

Q5. What does the lab look at in the sperm analysis?
Your doctor will review the results of the sperm test with you and your partner.  The sperm analysis looks at concentration, motility, how well they are swimming in a forward direction, viability, morphology (how sperm look), presence of infection and the total number of sperm that are moving.

Q6. Does RCC treat single women seeking donor sperm for becoming pregnant?

Q7. Does RCC treat same-sex couples (lesbians, gay men)?

Q8. How old is too old to do IVF?
Success of pregnancy with IVF is very dependent upon the age of the woman and her eggs.  Studies show that success of IVF is significantly reduced after the age of 43.

Q9. My husband travels a lot and may not be available to provide his sperm on the day of my insemination or treatment. What can we do?
It is possible to arrange for freezing of a sample prior to the procedure.  Speak to your doctor regarding this.

Q10. What if my husband or partner cannot produce a sperm sample on the day that it is required for treatment?
If there is sufficient concern that sperm will not be produced as a fresh sample on the day of IVF and/or ICSI or when it is needed for an insemination, it is possible to arrange for freezing of a sample prior to the procedure.
If it is unexpected that sperm is not produced on the day of the egg retrieval, your eggs can be frozen for use later on.

Q11. Is an IVF egg retrieval painful?
All patients at RCC are given appropriate amounts of pain medication during the egg retrieval.  Some women are more sensitive to pain that others and some ovaries are more sensitive also.  If you have pain during the procedure, tell the nurse and additional pain management will be administered.

Q12. Do I need to rest after an embryo transfer?
Studies have shown the lying down after an embryo transfer does not improve the chance of a pregnancy establishing itself.  Recent studies suggest that lying down after the embryo transfer with IVF reduces your chance of pregnancy. You will be recommended to take it easy for the remainder of the day after your embryo transfer but you do not need to take the day off work.

Q13. Can I exercise during treatment?
Moderate exercise is beneficial to the health and to reduce stress.  You may be advised to limit the types of exercise during treatment by your doctor.  It is not advisable to take up excessive exercise for the first time during treatment.

Q14. What lifestyle behaviors are associated with infertility?
Smoking is known to affect both sperm and eggs in terms of their quality and therefore ability to fertilize.  It is known that women who smoke undergo menopause on average 2 years earlier than non-smokers.  Success of IVF is also significantly affected.  Excessive alcohol consumption is also known to decrease fertility.  Though difficult to measure, stress affects the reproductive tract in a negative way.  Large amounts of caffeine consumed on a daily basis also decreases fertility.

Q15. Who is eligible for OHIP-funded IVF cycles?
Women who have documented blockage of both fallopian tubes are eligible for partial funding of an IVF cycle from OHIP for a total of 3 cycles.

Q16. What is the ISIS refund policy for IVF cycles?
If it is determined by you and your physician, that carrying on with the IVF cycle is not in your best interest, your may choose to cancel your cycle. If this occurs, you will be responsible for all drugs dispensed to date. You will also be responsible for all the bloods and ultrasounds up to that point except for the baseline ultrasound and bloods. This cost will be approximately $100/day for ultrasound and blood work.

Q17. What is ICSI?
ICSI stands for Intracytoplasmic Sperm Injection.  It is a procedure where a single live sperm is trapped in a glass needle and injected straight into the egg.  This is done to encourage fertilization of the egg in situations where it may be reduced. You need to do IVF in order to do ICSI.

Q18. When is therapeutic donor insemination desired?
TDI (therapeutic donor insemination) may be a option for treatment in the following situations:

  • When male factor infertility exists and the sperm count and/or sperm motility is too low to provide the female partner with the best chance to become pregnant
  • When a couple are not able to do IVF and ICSI and the sperm quality is too poor to have the best chance of success with an intrauterine insemination
  • Single women
  • Same sex couples
  • When sperm cannot be obtained from the man’s testicle during a biopsy or extraction

Q19. During monitoring when taking ovulation induction medications, when do the ultrasounds occur?
The timing of the ultrasounds occur on day 3 of the cycle and then again starting close to ovulation (most commonly on day 10).  After day 10, you may be advised to have an ultrasound every day or every other day depending on your response and your normal cycle length.  You will have an ultrasound until you ovulate and then may do one more to determine how many eggs ovulated.  Monitoring ultrasounds occur in the morning at RCC.

Q20. Can we have sex during treatment?
Continuing with your sex life is important during treatment.  There may be times during your treatment when your physician recommends not having sex or using condoms in order to prevent an unexpected pregnancy.  This is most commonly when having a test in which a pregnancy could be negatively affected (HSG, sonohysterogram) by the test.  When women are undergoing IVF treatment, they may find intercourse uncomfortable when the ovaries are getting large during the stimulation.  When it is approaching time for an insemination or production of sperm to be used in IVF, you will be advised to abstain from intercourse for 48 hours or more.

Q21. Can I take herbal supplements during infertility treatment?
Most herbal supplements are considered safe but because there is often minimal to no research on how they influence outcomes of infertility treatment, your physician is likely to recommend stopping all herbal supplements during your infertility treatment. This will be an individual choice.

Q22. Are IVF cycles ever cancelled?
Yes.  Sometimes patients do not respond to the stimulation medications as expected.  They produce too few eggs or eggs that are not growing together.  These women may benefit from stopping the cycle and starting again with a different protocol and/or a higher dose of medications at the start. At ISIS, in order to maximize your opportunity for pregnancy, cancellation of an IVF cycle may be discussed when less than 4 eggs are growing together. This is a decision that you and your physician will make together.

Q23. How can I get a referral to RCC?
You may ask your family doctor or any other physician to make a referral. Referral forms are available on the internet website.

Q24. What symptoms do fibroids cause?
Fibroids can cause many symptoms that are mainly in relation to their location. They may cause irregular bleeding if they are in the uterine cavity or the wall of the uterus.  They can also affect fertility by decreasing pregnancy rates and increasing miscarriage rates but this only occurs if the fibroids are in the cavity of the uterus or very near it.  If fibroids are very large, they can also cause problems with pelvic discomfort and difficulty with urination and bowel movements.

Q25. How would I know if I have fibroids?
One of the easiest ways to find out if you have fibroids is to have an ultrasound done.  Ultrasound can see most fibroids and measure their size and location. Some women will have an MRI to view their fibroids.

Q26. What are fibroids?
Fibroids are an abnormal growth of the muscle cells of the uterus.  They can grow in the wall of the uterus, on the outside of the uterus and in the cavity of the uterus. They are almost never a cancer.

Q27. What is polycystic ovarian syndrome?
PCOS is a condition that has 2 or more of the following features – irregular cycles, problems with acne or hair growth in a male pattern or elevated male hormones in the blood and ovaries that have lots of potential eggs most commonly arranged around the outside edge of the ovary.  We do not know why women develop PCOS but it does appear that the underlying problem in the condition may be how the body handles insulin.  Simply, the body has difficulty handling glucose so the insulin goes up and therefore the male hormones go up and then the menstrual cycle gets interrupted.  There is no cure.  There is some suggestion that a woman with PCOS will find her menses become more regular as she ages.

Q28. Does weight gain affect the future baby?
It appears that obese women have a greater chance of pregnancy complications.  They have a higher risk of developing diabetes in pregnancy, blood pressure problems and having a cesarean section which in turn increases their chance of having an infection of the incision site. Both diabetes and blood pressure problems can have negative effects on the developing baby. Being obese also increases the chance of not getting pregnant with fertility treatment and also increases your chance of miscarriage.

Q29. What can be done to prevent weight gain during infertility treatment?
Obesity is known to have a negative effect on reproduction.  Both fertility and pregnancy outcomes are better when a woman is of normal weight. Weight gain during infertility treatment is not known to be a effect of the medications used during infertility treatment (clomiphene citrate, injectable gonadotropins).  Weight gain in these situations may be due to other contributing factors such as anxiety leading to compulsive eating or fear of exercising.  Some women may find some weight gain due to water retention that may be related to ovulation but this would be minor. Prevention of weight gain is common sense – exercise, eat in moderation, and watching what you eat.

Q30. What assistance does Health Canada provide to Canadians for infertility treatment?
Endometriosis growth is driven by estrogen.  Estrogen goes up during ovarian stimulation but the duration of time is too short to cause regrowth of endometriosis.  Endometriosis will likely return over time regardless of IVF treatment as long as the woman has sufficient estrogen in her body.

Q31. Do the medications used during in vitro fertilization lead to regrowth of the endometriosis?
Endometriosis growth is driven by estrogen.  Estrogen goes up during ovarian stimulation but the duration of time is too short to cause regrowth of endometriosis.  Endometriosis will likely return over time regardless of IVF treatment as long as the woman has sufficient estrogen in her body.

Q32. Does endometriosis affect egg quality?
Endometriosis is a very interesting condition in that there are many features of it that are not understood. It does appear that the presence of endometriosis can affect egg quality but in a manner that is not understood.  It appears that women with endometriosis do not get pregnant as easily even with the assistance of in vitro fertilization as easily as women without endometriosis.  The reason for this is likely very complex but there appears to be an effect of the endometriosis on how easily the potential eggs in the ovary are stimulated, a negative effect on the quality of the eggs itself and a negative effect on the lining of the uterus where the egg intends to implant.  Interestingly, removing endometriomas prior to in vitro fertilization does not appear to improve outcomes suggesting that some of these other negative features may be playing a role too.

Q33. What system does RCC use to assess egg quality?
There are many features that embryologists look at to assess the quality of an egg.  These features are different from those features used to assess the quality of an embryo. When looking at an egg, embryologists look for the following features:

  • Egg quality can only be assessed during ICSI (the entire complex (egg + follicular cells) is assessed for conventional IVF as the naked egg cannot be seen.
  • Maturity is critical (presence of first polar body after retrieval)
  • Shape, colour and granularity of egg
  • Thickness and shape of the zona pellucida
  • Darkness or lightness of the cytoplasm (jelly-like substance surrounding the chromosomes in the egg)
  • Holes, vesicles or inclusions  in the cytoplasm
  • Features that may indicate poor egg quality are darkness of the cytoplasm, holes, granularity, etc
  • Fertilized eggs and dividing embryos are graded on a similar basis with cell symmetry and fragmentation also being assessed.  Grades 1 to 4 are increasing levels of fragmentation (1 is best).

Q34. What options are there for obtaining donor eggs?
In Canada, donor eggs may only be obtained in an altruistic manner.  You cannot pay a donor directly for her eggs.   In the United States and other countries, anonymous donor eggs may be purchased from egg banks.

Q35. If the woman has an endometrium that is considered suboptimal for implantation (too thin), what can be done about this?
It is possible to provide estrogen in the form of vaginal suppositories to help increase the local estrogen that the endometrium is responding to.  It is not clear that this helps implantation but does not appear to be harmful.  Some women just make thinner linings than others naturally but still get pregnant.  Some medications can have a side effect of promoting thin linings (such as clomiphene citrate) so in that situation, it may be better to stop using clomiphene citrate.

Q36. When does the endometrium stop thickening?
Even in medicated cycles, the endometrium thickens in the same manner that it does in the natural cycle. Even while the period is still going on, the endometrial lining is preparing for the next cycle.  It begins to thicken in response to estrogen and reaches maximal thickness in the mid-luteal phase (the phase of the cycle from time of ovulation to time of onset of menses).  The maximum measured thickness occurs after the egg has ovulated. Then as the period time approaches, it begins to break down.

Q37. How thick should the endometrium be to increase the chances of implantation?
This is a very difficult question to answer. It appears to depend on what type of therapy you are undergoing. With ovulation induction and intrauterine insemination, it is not clear if the thickness of the lining influences pregnancy rates or not. With IVF treatment, to best optimize the chances of implantation, studies have suggested that the endometrial thickness should be 6 mm or more.  Best implantation rates in in vitro fertilization have been shown to be with lining thickness of 10 mm or more but there are many studies to show that implantation can occur with endometrial thickness as low as 5 mm – just not as easily.

Q38. How does the success in terms of pregnancy compare between frozen embryos and fresh embryos?
Success of pregnancy from frozen embryos have steadily increased over the years.  This is due to a change in the way embryos are frozen. They are now frozen with a process called vitrification. With vitrification, embryo survival after thawing is high. There is now significant evidence suggesting that pregnancy rates with frozen embryos are as good if not higher than with fresh embryos. Studies also are showing that the health of the pregnancy and baby may be higher with frozen embryos. Your physician may suggest freezing all of your embryos from an IVF cycle and only doing a frozen embryo transfer.

Q39. What is the success rate of fresh versus frozen donor egg cycles?
Fresh donor egg cycles in Canada must be from known donors that have donated their eggs altruistically. This is commonly from a friend or relative. The success of such a treatment is strongly influenced by the age of the woman donating the eggs.  Most programs would advise using fresh donor eggs from women who have had children of their own and are of an age younger than age 35.  In such ideal situations, pregnancy rates per cycle may be as high as 60%-70%. Using frozen donor eggs used for pregnancy is becoming a common treatment for certain types of infertility. There are now egg banks around the world that function similarly to sperm banks. The eggs have been obtained by these banks from young healthy women who have undergone extensive testing. Success rates for pregnancy with frozen donor eggs is 60 to 70%.

Q40. What success rates may be expected from various treatments such as clomiphene citrate alone, clomiphene citrate with intrauterine insemination, FSH alone, FSH with intrauterine insemination or IVF?
This is complex question and success rates are affected by the indication for the treatment and the age of the female partner desiring to become pregnant. Clomiphene citrate (CC) is a fertility tablet most commonly used in two types of patients – those with regular menstrual cycles and normal testing (called unexplained infertility) and those with irregular menstrual cycles(called oligo-ovulation or anovulation).  Studies have shown that when CC is used alone in women with regular cycles and normal semen analysis, pregnancy rates per cycle are in the range of 2-4%. When CC is combined with intrauterine insemination in such couples, pregnancy rates per cycle are in the range of 8-10%. When CC is used in women with irregular cycles with natural intercourse, pregnancy rates are closer to 20% per cycle. Intrauterine insemination may be added into the treatment plan if there are abnormalities in the semen analysis or if natural intercourse has not resulted in a pregnancy after 3 or more cycles. FSH is an injectable medication that can also be used in women with both regular and irregular cycles. When used in women with regular cycles and combined with intrauterine insemination, pregnancy rates are commonly quoted in the literature as 15-18% per cycle. This is also true for women with irregular cycles. Success rates for IVF also is influenced by the reason IVF is used. Success rates for pregnancy per cycle are quoted as 40-60%. All of these success rates are strongly influenced by the age of the woman. The majority of studies concentrate on women less than the age of 38. The older the woman, the less success per cycle attempt.