Infertility: It’s the seemingly taboo subject that’s spoken about at a whisper level even among the closest of friends. Defined as the inability to get pregnant after one year of unprotected sex, infertility is way more common than you think. In fact, one in six of those trying to conceive struggle with infertility, a number that’s doubled since the ’80s. Factor in the assisted reproduction options for those belonging to the LGBTQ+ community and it really feels like fertility is an issue that’s all around us.

It’s why, during Canadian Infertility Awareness Week, from April 24 to 30, we’re talking about everything fertility health: uncovering the new innovations, debunking the myths and putting the power in your hands. We spoke with three top fertility specialists across the country, and they answered your most pressing questions, including which lifestyle factors can help you conceive, when you should seek guidance and what the available options are for those in the LGBTQ+ community.

Dr. Shannon Corbett, MD, FRCSC, GREI
The Reproductive Care Centre (Mississauga & Oakville, Ontario)

What are some signs that point to a fertility issue that requires the guidance of a specialist? Is there a specific age cut-off—either at the younger or the older end of the range—for seeing a specialist?

“We can look at it from the perspective of fertility, but we can also look at it from a preservation perspective, so there are many situations in which you might seek fertility care: You are single or in a partnership requiring donor egg or donor sperm; you have a known reproductive issue such as endometriosis or an ovulation disorder; you or your partner have sexual dysfunction, a history of sexually transmitted disease or a personal or family history of genetic disease; or you have had two or more miscarriages. In terms of age, we recommend seeing a specialist if you are under age 35 and have had regular exposure to sperm for 12 months with no conception; 35 or older and have had regular exposure to sperm for six months with no conception; or you are 40 or older (but less than 50 to 55 years of age, depending on clinic policies) and wish to conceive.”

In what ways have fertility-health providers become inclusive of gender and sexual diversity?

​​“Fertility care has evolved from the early years of exclusively treating infertility and expanded into a much broader specialty that strives to meet the reproductive-care needs of all individuals and partnerships. Inclusive language and non-discriminatory practices have been adopted to reflect the diversity of family structures, gender identities and sexual orientations. Now, those who identify within the spectrum of gender and sexual identities (LGBTQ+) can represent up to 30 percent of the population accessing fertility care in large urban Canadian centres.”

Dr. Ingrid Lai, MD, FRCSC, GREI
Generation Fertility (Vaughan & Newmarket, Ontario)

What are some newer innovations in treatment options to help people conceive?

“Insemination and in vitro fertilization (IVF) are the standard ways that we help people conceive. Some of the newer options help assess preconception risk and predict outcomes that could potentially influence reproductive-decision-making. This includes pre-implantation genetic testing, which looks at the chromosomal makeup of embryos before we put them in the uterus, or extended carrier screening, which looks at the risk of the offspring having some inheritable conditions. Predictor calculators help us understand the likelihood of successfully giving birth to a baby following an egg freezing cycle or an IVF cycle. These are all newer algorithms that are based on a lot of research to help us counsel patients appropriately so they can make their decisions knowing they have that information.”

We often hear that treatment for fertility can be stressful. How do providers support their patients so they stay emotionally and physically healthy throughout treatment?

“The journey can be very overwhelming for most people. By the time someone comes to see us at the clinic, we know that they’ve already tried for some time on their own and encountered some disappointment along the way, or that assisted reproduction is crucial to achieving their family. It’s very important for fertility clinics to provide a welcoming, supportive and encouraging environment that will help make this process a lot less scary. Some of the ways we can support them is by collaborating with other specialists as well so that it’s not just about fertility—it’s about a whole-system perspective. We encourage people to seek out therapies that help complement their care here, like counselling or alternative medical disciplines, to provide a more holistic approach.”

Dr. Ginevra Mills, MD, FRCSC, GREI
Olive Fertility Centre (British Columbia)

Is there anything that can be done lifestyle-wise to improve our fertility?

“I tell patients that a healthy lifestyle, such as moderation in alcohol consumption and omitting smoking, is important overall. However, there isn’t anything specific you can do lifestyle-wise—eating a certain diet, for example—to enhance or preserve your fertility aside from usual healthy habits. People with ovaries are born with all the eggs that they’re ever going to have, and eggs accumulate mutations in the same way other cells accumulate mutations.”

Is it accurate to say that infertility is mainly a women’s issue? For those with a male partner, how should they be involved in evaluating fertility issues?

“When we look at heterosexual couples experiencing infertility, over 40 percent have a male factor contributing. Often, there’s overlapping problems. As an example, we’ll have a woman with polycystic ovary syndrome (PCOS) who isn’t ovulating regularly and comes to the appointment by herself. The fact that she’s not ovulating does not automatically exclude the possibility there could be a problem with her partner’s sperm. So even if people think there’s an obvious reason they’re not getting pregnant, it’s important that both partners undergo investigations at the same time.”


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