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

Ovarian stimulation is for women who ovulate and stimulates the production of one or multiple eggs per menstrual cycle. It involves medication.

Ovulation induction is for women who do not ovulate or whose cycle is very irregular and is done to induce and control ovulation. It involves medication.

Intrauterine insemination, commonly known as artificial insemination, is when processed sperm is placed directly in the woman’s uterus. Spermatozoa may come from her partner or a donor. For artificial insemination, it may be necessary to start by stimulating ovulation.

In vitro fertilization (IVF) is when fertilization is done in the lab using the woman’s retrieved eggs and sperm provided by her partner or other donor. The resulting embryo is then transferred to the woman’s uterus or frozen for possible later use.

The medical acts required for a cycle of in vitro fertilization are:

• Ovarian stimulation
• Egg retrieval or egg donation
• Sperm collection or sperm donation
• Embryo freezing and transfer

Preimplantation genetic testing, also known as preimplantation genetic diagnosis, is also possible.

The IVF process generally produces several embryos. Only one embryo however is transferred to the woman’s uterus, except in certain rare cases. The others are frozen and stored for transfer at a later date.

When the number of embryos produced exceeds the couple’s needs, the supernumerary embryos may be donated or destroyed. The couple’s consent is always required.

Preimplantation genetic testing refers to genetic tests of embryos resulting from in vitro fertilization. It can be used to identify chromosomal abnormalities that can often lead to miscarriage. It can also be helpful in identifying embryos with genetic abnormalities known to run in the family.

Preimplantation genetic testing is not mandatory and may be insured under certain eligibility criteria. If you do not meet these criteria, this service may be performed at your expense.

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

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.