How To Get Started 2 – Victory Reproductive Care
 

"I'm having trouble getting pregnant, what should we do?"

Many couples are surprised to learn that even in the fertile population, the chance of conception is only 15-20 percent each month, so it might take longer to conceive than expected.


How do you know if you should seek help?

Because fertility is intimately tied to maternal and paternal age, we advise the following:
 

For Women


If your cycles are irregular, occurring less than every 21 days, or more than every 35 days, you should seek help immediately. Chances of conceiving on your own will be low, and irregular cycles can reflect conditions that carry significant health risks.

If your cycles are regular then follow these guidelines:

1<34 Years of Age:
Seek help if you’ve been trying for more than one year.
2Age 35-40:
Seek help after six months of regular intercourse.
3Age > 40:
This is a unique population with special considerations. If you’re not successful within 3 months, we would advise assistance.

For Men:


Men should undergo evaluation if they have been trying to conceive with their female partner for more than one year without success.
There are several additional groups that merit earlier and/or immediate evaluation:
.
- Men with erectile dysfunction.
- Homosexual male couples.
- Men over 50 years of age.
- Men unable to ejaculate (aspermia), low volume (oligospermia) or painful ejaculation.
- Men with a history of a genetic or chromosomal disorder.
 

Supports

 
 

Ontario Resident


If you are a resident of Ontario with valid Ontario Health Insurance Plan (OHIP) coverage, it is in your best interests to ask a family physician for a referral to our clinic. These referrals are processed daily and we will make the earliest possible appointment to see you, or you and your partner.

Non Ontario Resident


If you are a non-resident of Ontario or don’t have OHIP, our clinic is fully insured to manage your care. In addition to full Canadian certification, Dr. Victory is American Board of Obstetrics and Gynecology certified, and has helped many families from the United States and abroad. You can book an appointment directly by calling the clinic. If you’d like to book your appointment now click here.
 
 
 

Initial Evaluation

At your initial consultation visit, we take an extremely thorough history to make sure we are better able to cater to your specific needs. Our clinics are paperless, with a highly secure computerized electronic medical record system. Your contact with us is person to person, with no papers to fill out, or boxes to check. It’s important for us to hear from you and know your personal journey.

Dr. Victory will review every detail with you at that visit and then give you a thorough explanation of infertility, possible causes in your case, and what tests are necessary to determine a diagnosis. (hyperlink each of these to the next two tabs). Examples of important aspects of your history include demographics, duration of infertility, menstrual regularity, pregnancy history, gynecologic history, medical/surgical history, and psychosocial concerns/factors.

Your history is private and personal and we make this an incredibly comfortable environment for you to share your story with us, adhering strictly to all regulations regarding patient privacy and confidentiality, including HIPPA compliance of US patients.

Learning About Infertility

Infertility is caused by one of three simple factors: male, female, or both. Approximately 40% of the time it is either male or female, and 20% of the time both members have a fertility concern.
 

Female Factor

Ovulation:


Are you regularly producing an egg? This can easily be tested with urinary ovulation kits.

Anatomical and Structural Factors:

Are the sperm and the egg able to meet and is there a supportive environment for embryo development? Examples of complications might include:
a. Cervical narrowing from previous infection or surgery
b. Uterine scarring from previous uterine procedures including dilation and curettage
c. Tubal damage from previous chlamydia or gonorrhea infections, previous pelvic surgeries, or even appendicitis
d. Other pelvic diseases including endometriosis, adenomyosis, or fibroids

Egg Quality:


Are you producing a good quality egg? Egg quality is intimately related to a woman’s age. Through the reproductive life cycle egg quality slowly diminishes. This impacts the genetics of the eggs and the energy efficiency of eggs, making it either harder to conceive, or more likely to suffer a miscarriage. Other factors critical for egg quality include:
a. Chronic diseases including thyroid disease, diabetes, arthritits
b. Extremes of weight including those with a low or an elevated body mass index
c. Chemical or environmental exposures
d. Smoking
e. Alcohol
f. Drug use (including marijuana)

Unexplained:


In about 10-15% of couples a cause is not easily identified. We often categorize this as a female factor, because we can evaluate most male factor issues by looking at the sperm. But because so much of the fertility process goes on inside a woman’s body, it is not always possible to find a cause. Examples of this may include undiagnosed infection, endometriosis, immunologic issues. In the next few months we will delve deeper into each of these factors on a dedicated page.
 
 
 
 

Male Factor

Male factors focus entirely on delivery and quality of the sperm. These factors include:
• Being able to ejaculate at least every 2-3 days
• Critical aspects of semen quality/analysis include:
 
 
1

Volume

Having adequate amount of semen
2

Count & Motility

Having the right number and moving sperm
3

Progression

Sperms ability to move in a straight line.
4

Morphology

The overall shape of sperm (head, neck and tail piece)
 
 

Diagnostic testing for Females:


Diagnostic testing for females is aimed at determining whether there are any contributing factors.


Our testing is comprehensive and designed to make sure we can give you an accurate assessment of your fertility potential. Our studies may include:

Baseline Hormonal Assessment: We check to ensure that all of your hormones are normal at baseline.

Natural cycle fertility monitoring: assessment with both ultrasound and blood analyses to evaluate the growth, maturation and release of your eggs

Saline Infusion Sonohysterogram: This is a test to evaluate your cervix, the inside and outside of your uterus, and whether or not your tubes are open. We use the most advanced 3-D ultrasound technology for this, providing a pain- and radiation-free process for your comfort and safety.

Ovulation Assessment: This can easily be tested by assessment of your blood levels of progesterone between cycle day 21-23.

Ovarian Function Testing: This includes an assessment of your anti-mullerian hormone levels in your blood. This test represents the current state of the art in understanding how strong your ovaries still are, or even how close you are to menopause. While it can’t predict pregnancy, it is a good predictor of the number of eggs you can produce in a stimulated cycle.

Additional tests: Additional tests include but are not limited to Vitamin D levels, cholesterol, insulin and glucose levels, blood type and comprehensive sexually transmitted disease screening. For patient with recurrent pregnancy loss, we do an additional panel of tests.
 

Diagnostic Testing for Males:


Hormone analysis: We check hormones routinely to find out if there are any indications of irregularities, including abnormal LH, or FSH levels, thyroid dysfunction, or low testosterone levels.

Metabolic profile: your cholesterol, glucose and insulin levels can have an impact on your sperm performance and fertility. We pay careful attention to all of these.

Semen analysis: We do a detailed semen analysis. In the presence of low volume, or abnormal test results, we will ask for a repeat sample. If two or more samples are abnormal, additional testing may be needed. These may include scrotal ultrasound, sperm DNA fragmentation assays, post ejaculate urine assessment, or sperm chromosome karyotyping. Men with no sperm (azoospermia) will also require additional testing with genetic tests (karyotype, y microdeletion and CFTR gene assessments).

Sexually Transmitted Disease Screen: It is imperative for all couples to undergo comprehensive evaluation for sexually transmitted diseases. Your safety is our highest priority, and we exercise every precaution necessary to protect you and your family.
 

Follow up visits

To understand your circumstances, we need all the information. So when your results are done, you will go over them together with Dr. Victory in an in-depth, education-filled session. When you come for that visit we are able to give you a diagnosis in over 95% of cases. We give you a detailed review of every investigation, explain what each test value was, what it represents for you, and show you any graphics that we can to make sure you’re getting the whole picture. There is always ample time for questions, and we don't complete the session untill you’re comfortable with the information you’ve received.

Management:

There are several strategies to help patients achieve a family. To learn more about your options click here.

Support:

We know this process can be incredibly stressful. We are strongly committed to making it as comfortable and supportive a process as we can. That’s why we invest all our time into making sure you understand your results and what they mean.

Unlike so many others, we recognize that infertility represents a loss of control for many individuals and couples alike. “Why can’t we get pregnant on our own?”, “Why isn’t my body working?”, “Why do we need help, when so many of our friends are getting pregnant without any effort?.” All these questions are common and carry a huge burden of stress, and in many instances even guilt. We’re here to make sure you know this isn’t your fault, and we can help with your stress. Accordingly, we try our best to provide you with a range of options in almost every instance. We will never tell you what to do. We provide you with choices and the information and knowledge to make an informed choice. We’re returning the control to you.

For those experiencing difficulty with the process, or the news they receive, we have an unprecedented level of support with onsite psychological counselling and services from physicians, naturopaths, and a highly regarded regular support group.