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. Donor sperm may come from a sperm bank or a known donor.

In both cases, safety standards guided by Health Canada are rigorously applied to protect the health of women and unborn children. Donors are required to undergo various medical tests and controls. People with certain health problems, such as sexually transmitted infections or certain genetic diseases, cannot donate sperm.

Those wishing to donate sperm from a donor they know can go to an assisted reproduction center to have access to the tests required to make sure the donation is safe.

You may be eligible to receive insured reproductive services, which include:

• Directed sperm and ova donations
• Up to six banked sperm donations for artificial insemination
• One banked sperm donation, as part of an in vitro fertilization cycle

To find out more, talk to a doctor.

Some people choose to undergo so-called home-made insemination. Artisanal sperm donation takes place outside the legal framework in force for assisted reproduction activities. In this case, the safety of the sperm donation cannot be made sure. People who choose to donate sperm by hand expose themselves to certain risks, including the risk of acquiring a sexually transmitted infection (STI) for the person receiving the donation. Also, in the absence of an assessment of the donor's state of health, the transmission of hereditary disease to the unborn child is possible. Other problems may arise due to the lack of anonymity of those involved.

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