Family Building
There are many ways to create/build a family. Read below for more information!
What are my options?
Family building may look different for people depending on their medical and social background. Some options discussed below include :
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Spontaneous conception
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Fertility treatments (ovulation induction, intrauterine insemination, in vitro fertilization)
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Donor egg, donor sperm and surrogacy
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Adoption
Fertility Preservation through egg freezing, sperm freezing and/or embryo freezing is also discussed here​
Understanding Your Fertility
If you fall into one of the categories below, ask your healthcare provider for a referral to a fertility specialist (Reproductive Endocrinologist and Infertility specialist (REI) ): ​
Persons in a heterosexual relationship in which the :
Female is under 35 and the couple has been trying to conceive for one year without success
Female is between 35-40 and have been trying to conceive for 6 months without success
Female over 40 and are trying to conceive without success
Female with anovulatory/irregular cycles (it is reasonable to still try to conceive with regular intercourse every 2-3 days for 6 months before seeing a fertility physician)
Persons with more than 2-3 pregnancy losses
Persons considering fertility preservation (in vitro fertilization, egg freezing or sperm freezing) for medical or proactive reasons
Persons with a known medical condition that may impact fertility (e.g. prior sexually transmitted infection, endometriosis, prior testicular surgery, prior tubal surgery, prior ectopic pregnancy)
Persons who are in a same-sex relationship ​
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No, not necessarily!
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If you fall into one of the categories above, then yes, you should ask for a referral to a fertility specialist for a discussion about possible testing if appropriate.. However, if you are under the age of 40 and just starting to try to conceive, testing may be confusing. Fertility tests look at the number of eggs (ovarian reserve) at a static time in a female's life, the motility and concentration of sperm, the uterine cavity and the fallopian tubes. This is a very surface level assessment of whether conception may be successful. We know that at least 15-20% of individuals who have normal tests will still be unable to conceive. Similarly, those with abnormal tests may still be able to conceive spontaneously.
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Females often wonder about getting ovarian reserve testing "just in case." Anti-Muellarian Hormone (AMH) and antral follicle counts (AFC) are tests of ovarian reserve. AMH is a blood test while AFC requires a transvaginal ultrasound. AMH is not covered by provincial health plans and costs between $75-150. It is primarily used to understand how a patient may respond if they were to be stimulated, such as during controlled ovarian stimulation or IVF. Ovarian reserve testing can be helpful to help you predict your personal timeline if you are considering delaying childbearing and/or fertility preservation, however, there are important caveats. Importantly, ovarian reserve measures do not predict spontaneous conception. In addition, ovarian reserve testing provides one static value in time and that alone cannot predict future decline.
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Fertility treatments such as ovulation induction, intrauterine insemination, and/or in vitro fertilization are not necessarily better forms of conception if they are not indicated by clinical situation. As medical interventions, they carry risks.
All females who are trying to conceive should start on 0.4 mg of folic acid and 2000 units of vitamin D 2-3 months prior to conception to support critical phases of early development in a pregnancy, which often occur before a person realizes they are pregnant.
Approximately 75-80% of couples will conceive within 6 months, 85% will conceive within 1 year and 95% will conceive within 2 years.
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Here are some ways to optimize natural conception :
Use a calendar or app to track your ovulation (i.e. Glow) - in general, you ovulate 2 weeks before your menstrual period
Measure ovulation with an LH testing strip (have intercourse if LH positive and next day)
Have intercourse every 1-2 days in the 6 days before ovulation if you have regular cycles, or every 2-3 days if you have irregular cycles
If using lubricant - look for those that do not affect sperm quality (i.e. mineral oil, canola oil or hydroxyethylcellulose-based lubricants)
Avoid smoking, alcohol and recreational drug use
Optimize BMI
Limit caffeine intake to < 500 mg per day (i.e. 2-3 cups of coffee per day)
Infertility & Fertility Assistance
Infertility is defined as not being able to conceive after 12 months of actively trying without contraception. There are broad categories including female infertility (ovulatory dysfunction, tubal issues), male infertility and unexplained infertility.
Investigations typically ordered include :
Ovarian reserve measurements : AMH (anti-Mullerian hormone) and AFC (antral follicle count)
AFC is obtained through transvaginal ultrasound
Uterus/ovarian structure, uterine cavity and fallopian tube patency assessments : transvaginal ultrasound and sonohysterogram
a sonohysterogram is a procedure in which saline is inserted into the uterine cavity with a small catheter placed during a speculum exam by an OBGYN in combination with a transvaginal ultrasound ​
Assessment of semen concentration and motility : semen analysis
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Other investigations may also be recommended based on your medical history.
The discussion of treatment costs below is an average in Ontario in 2022. It is also important to note that not all fertility centres will offer all treatments.
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Ovulation Induction/Controlled Ovarian Stimulation
Treatment Description : The ovulating partner takes medication to achieve ovulation with one follicle or increase the number of follicles (2-3) per cycle. Medication may include letrozole (tablets) or injectable gonadotropins. This is combined with timed intercourse or intrauterine insemination. This is usually recommended for 3-6 cycles, but may be recommended longer depending on the medical indication.
Cost per cycle: Costs include medications, cycle monitoring and/or sperm wash. This may range from $30 - $1500 depending on whether intrauterine insemination is indicated and what medication was prescribed. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum)
Timing: takes 1 menstrual cycle to complete
Intrauterine Insemination (IUI)
Treatment Description: Placement of sperm into the uterus of the ovulating partner at the time of ovulation. This can occur with male partner’s sperm or with donor sperm. Sperm is usually produced or thawed, washed and prepared and then placed via a catheter during a speculum exam for the female. This may or may not be combined with ovulation induction/controlled ovarian stimulation.
Cost per cycle: ​
Sperm processing + procedure: $600-1000
Medications: $100-1500
Donor sperm: $750-1000 per vial
In Ontario, there is partial cost coverage but eligibility varies by clinic. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum).
Timing: takes 1 menstrual cycle to complete.
In Vitro Fertilization (IVF)
Treatment Description: IVF involves ovarian stimulation with medications to produce more than one follicle per cycle, transvaginal egg retrieval with ultrasound guidance, combination of sperm with eggs in the laboratory to achieve fertilization via traditional IVF or intracytoplasmic sperm and the growth of embryos within the laboratory. Embryos can be transferred in a fresh IVF cycle or frozen for use at a later date.
Costs per cycle: Costs for IVF include procedural costs, medication costs, storage costs, embryo transfer costs and add-on costs. A popular add-on is pre-implantation genetic testing for aneuploidy (PGT-A), which is optional but may be quoted to you by clinics.
Procedural Costs of IVF : $11 000 - $15 000
Medications: $3000 - $8000, average $5000
Storage of embryos: $500-900 per year
Frozen Embryo Transfer Costs : $1600 - $3000
PGT-A (optional) : $4000 - $7000
In Ontario, one cycle of IVF is covered by OHIP if under the age of 43 years. One cycle consists of ovarian stimulation, egg retrieval, IVF or ICSI fertilization, and all embryo transfers for embryos created during the funded cycle. Medications, storage and add-ons are not covered. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum).
Timing: A typical IVF cycle includes 1 menstrual cycle for priming (optional), 1 menstrual cycle for ovarian stimulation, egg retrieval, fertilization and growth of embryos. If embryos are frozen, the transfer can take place during a natural menstrual cycle or medicated cycle in the future.
Donor gametes
Treatment Description: Donor eggs or sperm can be used in each of the above family building options. Embryo donation is also possible. Donation may be directed (identified) or non-identified. Egg donation may be fresh or frozen. Not all clinics can facilitate all available options as they may not have the appropriate Health Canada approval to do so. There are agencies and banks that may be used by clinics.
Cost:
Cycle costs as above
Coordination fees : $1000 - 3000
Sperm: $750-1000 per vial
Oocytes: $18000-42000
Legal fees: $1000 - $3000
Counselling fees : $200 - $500
Timing: The time to find donor gametes is highly variable depending on the options selected
Gestational Carrier (GC), also known as Surrogacy
Treatment Description: An individual who agrees to carry a pregnancy but is not genetically related to the embryo. This involves the creation of embryos through IVF. GCs can be known to you, found by word-of-mouth or found through agencies. Different clinics also have different requirements for finding GCs and GC screening.
Cost:
Cycle costs as above
Coordination fees : $1000 - 3000
Legal fees: $1000 - $3000
Counselling fees : $200 - $500
Timing: Variable, dependent on finding a GC.
Adoption
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There are four types of adoption : public adoption, private adoption, international adoption, and family adoption.
Adoption costs range from $15 000- $50 000 depending on the type of adoption.
It can take several months to a year to complete the registration/preparation process for adoption. It can then take several months to several years to find and adopt a child.
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Click on the links below for more specific provincial adoption information :
2SLGBTQI+
Family planning for 2SLGBTQI+ couples can be overwhelming. Connecting with a fertility specialist early can be helpful for planning.
Understanding whether you are able to provide eggs, sperm and/or uterus to support a pregnancy is an important first step in building your family plan. You should then consider whether you will have a partner that is able to provide eggs, sperm and/or uterus. Lastly, you may consider whether there is anyone else in your life who may be able to provide eggs, sperm, and/or a uterus.
Depending on the answers to the above questions, options to conceive may include :
Natural conception
Conception with fertility assistance (ovulation induction/controlled ovarian stimulation, IUI, IVF)
Identified (directed) or non-identified Donor Egg/Sperm & Gestational Carrier services as described above
Reciprocal IVF (one partner provides the eggs, donor sperm is used for insemination, the other partner provides the uterus)
Adoption