New And Investigative Cycle Patients

After your initial consultation with your doctor, the diagnostic work up will be started in order to reach a diagnosis, followed by the formulation and execution of a thoroughly designed treatment plan directed to correct the specific cause of your difficulty conceiving.

The diagnostic work up involves the following:

First line investigations include all basic tests to assess semen quality, ovulation function, uterine cavity and tubal patency.

Second line investigations include sperm function testing, direct endoscopic visualization of the female reproductive genital tract (uterus and tubes). Immune testing to evaluate certain immune imbalances that may lead to implantation failure can also be done. Please, keep in mind that immune testing and subsequent suggested therapies will be considered experimental at this point in time.

You will need to let your nurse know when your cycle has started so that she will book all your tests and needed appointments including your review appointment with your doctor. Your nurse can be contacted by phone or email. Please leave the correct spelling of your name and date of birth and she will get back to you with your appointments date and time and any additional instructions if needed. Please ensure that you have updated your email and preferred phone number with a voice mail.

Cycle monitoring involves a series of blood work and ultrasound examinations done at selected days in your cycle aiming to assess your ovulation function and follicle behaviour in order to detect any hormonal imbalance that may delay and interfere with proper ovulation function.

Three to four visits are usually indicated starting on cycle day #3 (cycle day #1 is the first day you see period blood even if light as long as the flow is continuious and uninterrupted  by more than 12 hours interval). Most of those ultrasounds are transvaginal including a 3-D ultrasound on CD# 21(a week after ovulation).

Usually semen analysis and the sono-hysterosalpingogram are done concomitantly with cycle monitoring.

Appointments start, at any of our locations, as early as 6:30 am and until 1:30 pm in weekdays. All weekend appointments and holidays are in Mississauga location and start at 8 am.
Full bladder is needed only at the time of complete ultrasound pelvic exam as instructed. Rest of ultrasound scans require an empty bladder.

Instructions:

1. Call or e-mail your nurse when your period start
2. Expect a call back or e-mail with your appointments including day 3 appointment.
3. Ensure you have communicated with your primary nurse already by phone or e mail. You may see another nurse in the clinic following your testing who will be able to answer your immediate questions and advise you when to return to the clinic for the next visit. However, cycle guidance and management will be through your primary nurse who is the link between you and your doctor regardless of which clinic location you go to. The primary nurse is also responsible for your wellbeing and ensuring timely care and response for your needs. Also be aware of clinic emergency after hours phone line (416-508 9814), you can call this line if needed till 8:30 pm.
4. There are no restrictions whatsoever during your testing cycle. You can continue with your usual daily routine including exercise and frequency of intercourse.
5. During the testing cycle, you may get additional advice for more testing or treatment from your primary nurse based on your doctor’s advice.
6. Review appointment will be set for you by your nurse to review testing results with your doctor so that your diagnosis and future recommendation can be explained and followed.
7. Please take the time to fill an evaluation form regarding services received during your investigative cycle so that we can improve our services based on your perception, feedback and guidance. We strive to meet and exceed your expectations! Those evaluations are collected at the end of your testing cycle.

Your nurse will usually contact you within 24 hours with the results and what the results mean.

The sonohysterosalpingogram is a test done to evaluate the cavity of the uterus and patency of the fallopian tubes at the same time using ultrasound imaging. Usually it is coupled with a 3-D ultrasound for more precise assessment of the uterine architecture where some uterine abnormality previously missed on the usual 2-D ultrasound can be picked up by the 3-D ultrasound.

The test is done after the period flow finish and before your ovulation roughly between cycle days 6-12 in if you have a 28 days cycle. However, the test can be done at any time of the cycle after cessation of menses. There is no evidence that it can interfere with implantation or early pregnancy if done later in the cycle.

The test involves insertion of vaginal speculum, exposing the cervix and cleaning the opening with Betadine (antiseptic). A flexible thin catheter (tube) is inserted in the cervix passed the internal cervical opening and warm sterile saline solution is injected slowly to fill and visualize the uterine cavity. That will be followed by injected contrast (or agitated saline) further to show openness or patency of the Fallopian tubes.

The test is generally not more uncomfortable than doing a Pap smear if done properlywith smooth correct insertion of the catheter and slow injection of the saline. Significant bleeding or Infection following the test is not common.

Please note the following instructions:

1. You may want to take Advil 400 mg 1-2 hours before the test especially if you tend to have significant menstrual cramps.
2. After the test, please report any symptoms like significant bleeding, abdominal pain or abnormal discharge to your nurse immediately. You may need a script of antibiotics to prevent possible early infection. You may also be asked to come back to the clinic for further clinical assessment. Infection after sono-hysterosalpingogram is uncommon. We do not use routine antibiotic coverage for Sonohysterograms unless we suspect tubal disease or hydrosalpinx is discovered during the test.

Please do not interpret the results yourself before you meet your doctor. You may be stressing out unnecessarily. The observation of no flow seen through the tubes is not uncommon and it does not always mean that you have blocked tubes! False alarm with those tests can be as high as 40%. By the same talking, an open tube on the salpingogram does not always mean healthy perfectly functioning tube.

This process is very similar to the sonohysterosalpingogram, except the fact that the type of dye is different (contain Iodine) to show on X-Ray film, and images are obtained using X –Ray machine.

Because of the radiation used, the test should not be done after ovulation for fear of harming a potential early pregnancy.

This test is done less frequently nowadays. Sample of the endometrium (uterus inner lining where the Embryo implants) is obtained and sent for pathological analysis. It is valuable to assess the hormonal maturation of the endometrium. It can also reveal any chronic inflammatory or precancerous changes in the endometrium. There are some studies that showed that endometrial biopsy may improve implantation in the cycle following the biopsy.

The timing of the test will be relayed to you by your nurse. Usually it is done a week after ovulation or in conjunction with hysteroscopic assessment of the endometrial cavity.

The test involves insertion of vaginal speculum, exposing the cervix and cleaning the opening with Betadine (antiseptic). A semi rigid fine plastic tube is inserted through the cervix deep into uterine cavity vacuum is then created and the tube is pulled out. Collected tissue in the tube is then sent for testing. Short lived mild cramping is usually experienced. Taking Advil or Tylenol 1-2 hours before the test is advised.

Please note the following instructions:

1. You may want to take Advil 400 mg 1-2 hours before the test especially if you tend to have significant menstrual cramps.
2. After the test, please report any symptoms like significant bleeding, abdominal pain or abnormal discharge to your nurse immediately. You may need a script of antibiotics to abort possible early infection. You may also be asked to come back to the clinic for further clinical assessment. Infection after endometrial biopsy is uncommon.

Male factor contributes as much as 40% of sub-fertility causes. Proper assessment and treatment of the male can shorten the treatment duration and can avoid complicated expensive artificial treatments like IUI or IVF or at least make such treatments more effective.

Semen Analysis is the first line male assessment test in addition to some blood work.

For detailed sperm collection instructions, please refer to the instruction sheet included in your sperm collection Kit.

There is no restriction on sexual activities with the exception to the 2-3 days sexual abstinence before collecting a sperm sample for regular semen analysis.