How to receive medically assisted reproduction services

Some people have trouble conceiving a child because of infertility or the inability to reproduce (single women, single men, woman-woman couples or man-man couples). Medically assisted reproduction (MAR) is a medical way to help those people become parents.

MAR services in Québec are subject to the Act respecting clinical and research activities relating to assisted procreation  to make sure that practices are safe, ethical, and of high quality. Services are only available to people who are eligible for the Québec health insurance plan.

Your fertility exam may be done by your family physician or a gynecologist, or at an assisted reproduction centre (ARC).

A fertility exam allows the physician to see whether a diagnosis of infertility is warranted and try to determine the cause. Various tests will be recommended in order to arrive at a diagnosis. Test results are used to establish a baseline for the couple or individual. Physicians use that baseline to recommend ways to promote fertility. Test results may show that the difficulty in conceiving is caused by something other than infertility.

If your exam is performed by a family physician or gynecologist, you may be referred to an assisted reproduction centre (ARC). There you will receive further tests or treatment as warranted by the circumstances.

The choice of MAR treatment will differ depending on the cause of the infertility. You and your attending physician will talk it over and decide on the best treatment for you.

Possible treatments are:

• Stimulation or induction of ovulation
• Artificial insemination
• In vitro fertilization

Certain medically assisted reproduction treatments involve collecting gametes. Gametes are an organism’s sexual and reproductive cells (human spermatozoa and ova). They are used in reproduction.

Depending on the situation and health problem, sperm collection may be done through masturbation or surgically.

Male infertility or serious genetic conditions may require the use of donor sperm. A single woman or female couple may also use donor sperm for their planned family.

There are many different ways of using a third-party donor to carry out one's parental plan. These decisions can have an impact not only on women and their safety, but also on the children born from them. In fact, certain practices can be risky for the health of both the woman and the child born from the donation. The risks are heightened when the donor is unknown. There are also fewer measures to control these risks when donation is carried informally.

There are various ways of obtaining a sperm donation:

• Assisted-reproduction centers
• Informal sperm donation (also known as informal donation)

In an assisted-reproduction center, you can obtain services with:

• a sperm donation from a bank accredited by Health Canada,
• a directed donation from a known donor, i.e. one who is part of the recipient's circle, by conducting the tests required to make sure the donation is safe;

Advantages of this option:

• Guidance by an authorized health care professional is provided.
• Services are provided to those who meet the eligibility criteria. A maximum of $950 per sperm sample is reimbursed by the program.
• Safety standards guided by Health Canada are met.
• The donor selection process is stringent: medical examination and tests to limit the risk of transmission of sexually transmitted infections (STIs) and certain genetic diseases.
• Sperm quality is assessed to maximize chances of conception.
• There is a limit to the number of families to which a single donor can contribute. In Québec, there is only one sperm bank. The number of families to which a single donor can contribute is limited to 10, thereby limiting the potential number of half-siblings. This approach is aimed at preventing psychosocial consequences and those affecting children's future reproductive choices.
• Personal data is protected in compliance with current laws and regulations. To learn more, visit the page on the knowledge of origins in assisted reproduction involving the contribution of a third party.

Limitations of this option:

• There may be waiting periods for assisted-reproduction services.
• There are no assisted-reproduction centers in all regions of Québec. Travel may therefore be required.
• A fee may be charged to purchase a sperm sample from a donor bank.
• Although a medical evaluation is performed on the donor, the accuracy of certain information provided depends on the donor's own knowledge of their state of health and on their good faith.

To find out more, talk to your doctor.

Informal sperm donation (also known as informal donation): sperm donation takes place between two people outside assisted reproduction services. Insemination is done by hand, at home, or in a specific location, using:

• a known donor, who is part of the recipient's circle or,
• an unknown donor selected from volunteers who are most often posted on the Web (social media, classified ad sites, pages, etc.).

Limitations of this option:

• They are not protected by Health Canada mechanisms. Recipients may therefore be exposed to sexually transmitted infections (STIs).
• The health history of the donor and their family may be unknown or undisclosed. No medical evaluation is conducted to reduce health risks.
• There is a risk of obtaining false information from a donor.
• There is no monitoring mechanism allowing the number of families to which a donor contributes to be limited. It is not always possible to know how many families a donor has already contributed to, or how many more will be donated in the future. Having many half-siblings could have a psychological impact on some people.
• The absence of intermediaries and guidance can lead to misunderstandings about expectations and agreements, and to difficult situations.
• When it comes to safety, risks are unpredictable. The process generally involves sharing personal information. People making informal donations may be exposed to people with questionable motives, harassment, or violence at the time of donation or afterwards.

For these reasons, artificial insemination is not an option to be recommended. However, using a family donor allows us to reduce some of these risks. The following points should be considered when choosing this type of donor:

• donor's health status (health problems, family history, STIs, etc.);
• relationship of trust (long-term acquaintances);
• motivations for donating sperm;
• expectations regarding involvement in the child's life;
• conditions of donation;
• number of children conceived as a result of the donation or number of families to which the donor has contributed;
• intention to limit the number of families to which he/she will offer donations (as an indication, the Québec sperm bank accredited by Health Canada limits the contribution of a single donor to 10 families);
• mechanism for informing the donor of a birth resulting from their donation;
• personal characteristics that are important to you (e.g. physical appearance).

As with all online activities, vigilance is essential. For example:

• On online platforms, choose volunteers who reveal their identity in the conversation thread visible to other group members rather than those who only introduce themselves in private messages.
• Take your time when choosing a donor. Meet them and get to know them before the day you want to donate, to give yourself a pressure-free period of reflection before the procedure.
• It's best to meet in public places.
• Consider being accompanied by your partner or someone close to you.
• Decide which personal details you wish to share and when you feel comfortable doing so.
• Put the expectations and commitments of those involved in writing to promote common understanding and reduce the risk of misunderstandings.
• If you experience violence or harassment, report it to the police.

Please note: it is forbidden to buy sperm from a donor. No donor has the right to sell their sperm.

Egg retrieval can be done by following the woman’s natural cycle without medication. This involves working out the exact time of ovulation. A physician can usually only retrieve a single ovum this way, or at best a very limited number. The egg is retrieved just before natural ovulation would occur.

It is also possible to use a combination of drugs for ovarian stimulation. Doing so stimulates the production of a larger number of mature ova.

Women who do not ovulate or whose ova are not viable may use another woman’s eggs. Women needing donor eggs may find their own donor or purchase frozen eggs from an egg bank.

Egg donations are subject to certain rules. To find out more, talk to your doctor.