Infertility is a diagnosis that affects one in every six couples. With a
one-in-five chance to conceive per month, only about 86 per cent of couples will conceive within their first
12 months of trying. If left for more than 18 months, chances can decrease significantly — some estimate up
to five per cent less per every month after. If a couple has been trying for more than two years, their
chance of success per month is likely less than two per cent. With individuals marrying later in life and
couples waiting longer before starting a family, complications influenced by lifestyle choices as well as the
natural aging process can result in couples being unable to naturally conceive.
Although the term “infertile” may seem like a final verdict, most types of infertility are treatable, so long
as the right course of treatment is identified and the appropriate steps are taken.
Dr. Sony Sierra of First Steps Fertility, located in north Toronto, explains that couples under the age of 35
often get pregnant within one year; therefore, if they are unable to conceive within a year they need to be
tested. “Couples over the age of 35 should try between three to six months to conceive on their own,” she
says. “If they are unsuccessful, they should request a referral to an infertility specialist as soon as
possible.”
Sierra cites the aging process as the principal factor affecting egg quality, which can cause difficulties
with fertilization and normal early embryo growth. These struggles can result in further trouble with
infertility and increased rates of miscarriage. “As we get older it’s not that we use up our eggs; as time
goes by, the healthy machinery needed for eggs to fertilize and then multiply to form a healthy embryo ages,
leading to infertility and miscarriage.”
Certain lifestyle factors, such as smoking, drinking and exposing oneself to other toxins, can also hinder a
couple’s chances of achieving a pregnancy. For couples who are considering starting a family, Sierra advises
that men and women live an overall healthy lifestyle, maintain a healthy weight and use multivitamins. All
women who are considering conceiving in the near future should also be taking 1 mg of folic acid daily. For
men who have other risk factors such as smoking or ongoing heat exposure as a part of their lifestyle, it may
also be useful to start treatment with antioxidants. This is something they should discuss with their
fertility specialist.
Often, couples shy away from seeking help because of the uncertainty associated with the process of testing
and treatment. Dr. Fay Weisberg of First Steps Fertility says the first step is to get a comprehensive
history on both partners to answer questions about their medical history and lifestyle choices.
“People come in with a lot of myths and misunderstandings. We take that initial meeting to get to know the
couple, answer their questions and address their concerns. It is a stressful time and it’s important to
establish a relationship with our patients,” explains Weisberg.
Once the history is collected, the investigation begins. Three major categories must be addressed in order to
become pregnant, and an issue with any one can result in infertility. Weisberg puts it simply: “You need a
healthy egg, sperm and uterus.
Difficulty truly arises when these aspects are entirely normal and there are clearly other factors involved
with the couple. These particular situations may be more difficult or even impossible to diagnose.
Depending on test results, other steps such as referrals to other specialists or possible surgery may be
needed. Some women may be advised to undergo cycle monitoring to determine if and when they are ovulating, so
that doctors may advise them when it’s best to conceive.
Once the cycle is fully assessed, the patient can move on to treatment such as ovulation induction,
intrauterine insemination or in-vitro fertilization (IVF). “Medication and manipulation of the cycle is used
to increase chances of a pregnancy,” says Weisberg. “With ovulation induction, medication is used to force an
egg to be matured and released; with ovarian stimulation, medication is used to stimulate the ovaries to
produce more eggs.”
IVF consists of retrieving an egg from the female and fertilizing it outside of the uterus, either with the
partner’s sperm or a sperm donor. The fertilized egg is then transferred to the uterus for further
development. IVF is the most successful fertility procedure.
Dr. Marjorie Dixon has seen successes and advancements working alongside Sierra and Weisberg at the clinic
the three doctors founded, but says there are still many ongoing issues in the delivery of fertility
treatments.
“There’s a huge stigma attached. It’s not like another medical problem, where people feel more open to talk
about it,” says Dixon. “With fertility, especially with women, we feel like we’re somehow deficient. We all
know about eating well and taking care of our bodies, but fertility is out of our hands and there’s this
feeling of shame and disbelief.”
In addition to the emotional turmoil that infertility can induce, the discovery that financial coverage may
not be available can also be a heavy burden. Until 1993, IVF in Ontario was covered for many situations,
whereas now it is only offered for women with blocked fallopian tubes.
“It needs to be considered a medical problem, everyone should have rights to access fertility care and it
shouldn’t be dependent on socio-economic status, your geographic location, your sexual orientation, or other
medical illnesses,” says Dixon.
Bringing together their individual knowledge, experience and areas of expertise, these three women strive to
provide their patients with a culturally sensitive, female-centred health care, and hope to change the
reputation of infertility for many want-to-be mothers to come. •
TESTIMONIAL
I met my doctor in May of 2006. I was 37. We hadn’t been trying very long but you see the movies and the
books and you think you can get pregnant right away. So when we didn’t, red flags came up.
There are so many different processes and things I had heard about and they cleared up each one for me. They
discussed it with me in layman’s terms, and that’s why I went with First Steps, because I liked their
approach. It’s a clinic by women for women. Regardless of nationality, ethnicity or religion you are treated
with the utmost respect.
My first round was routine; we did the tests and I had a tilted uterus, which is sort of like built-in birth
control.
I loved my doctor because she was always accessible. No question was a dumb question. I recommend that you
research your clinic. Make sure it’s accessible to you and that they understand you. There should never be a
barrier between you and your doctor. You should never be afraid to ask a question.
They also really put my husband at ease. Men are not usually emotional, but they really do involve the
husband, which is lovely.
Three years had passed and I called the clinic. The team remembered me and it was like coming home. You
aren’t just a number. They know your name, your case. You’re already dealing with the fact that there’s
something wrong with you, you’re an emotional mess, and to go in there and feel at ease is important.
My second round was a bit more complicated because I ended up miscarrying twice. The thing about the clinic
is that it doesn’t matter what day or time or hour it is; if you have concerns they just say, “Come in.” They
really do put your concerns at rest.
They don’t use a cookie-cutter approach with their patients. It’s not a normal clinic; they know their stuff.
They don’t just put you through random tests for the sake of doing them. They know which tests to do to
figure out what’s wrong. They develop a plan per patient per need. •
For more information on First Steps Fertility, visit
» firststepsfertility.ca
