Questions from the Patient Information Session
We do not have a date of when the clinic will be able to resume seeing patients and providing care. This will be dependent on the activity of the virus and the direction from the Province and the City of Ottawa. We are making plans to open in the likely environment that COVID will still be present in the community at low levels.
We anticipate that we will need to change how we operate in this new COVID environment. We have been considering changes in our hours of operation. We will likely need to extend hours to accommodate spacing of patient visits, examinations, and treatments. We will update our website to communicate the changes in our clinic hours of operation, as we get closer to being able to open again
At this point, there is no indication from the Province that IVF funding will be decreased, or suspended. The funding is considered an ongoing budget item year after year and will continue this way unless the Province decides to change this. Specifically, we have not heard any news that would suggest the funding may change.
This will likely be the case. However, it is still too early to speculate on how this phased approach will look. It is safe to say that we will be offering care in a different way when we re-open.
When we open up for fertility treatments again, we will resume the cycles that were cancelled. Cancelled patients will have priority to resume their cancelled treatment. With respect to the process of opening the clinic once we have direction that we can re-open we will promptly resume services. Prior to this we will be; developing and implementing infection control policies for patient and staff safety, ensuring our laboratory is well equipped with consumables and other materials, and ensuring we have adequate staffing and protective equipment to safely resume operations.
Patients who had consultations cancelled will be called and rebooked once we are able to offer testing and treatments again. There will likely be very little wait time for these initial consultations as we have been busy catching up on our follow-up appointments and will have lots of time in our schedules to see new patients, most likely through virtual visits. For those patients looking to rebook treatments, this will be done in a phased-in approach so that we are able to reduce the number of patients in our waiting rooms and ensure proper social distancing measures are in place. We have begun discussions on how this will be done and will communicate plans to our patients once we have a definitive plan in place.
We will be following any requirements or guidelines set out by Ontario Public Health in terms of what will need to be in place before we can reopen. At this point, we have not been given any information to this effect.
If you would like a follow-up appointment with your physician, you are welcome to call and request an appointment. These appointments are all being done virtually, either by phone or through the Ontario Telehealth Network. If you have not yet been seen for an initial consultation but have been referred, we will call you to book an appointment when we have reopened.
Our blood lab is currently closed. If blood work is needed, we are ordering it to be done at an outside blood lab and providing requisitions for this to be done.
Yes, we will be doing all appointments either by telephone or OTN unless there is a compelling reason to see patients in person. These consultations will be booked once we have reopened.
There will be many questions asked that are similar to the first info session as there are always new people joining our call. Our doctors will be giving up-to-date information on the current status of COVID-19 in Ottawa.
To get a copy of your chart please call our mainline and select option 1 to speak with our reception team.
Yes, we are expecting a possible delay in accessing our ultrasound resources for screening tests including baseline ultrasounds and saline infusion tests. In the initial few months of reopening, we expect our demand for these tests to exceed our ability to offer the ultrasounds due to limited ultrasound rooms and sonographers. Ultrasounds such as follicle tracking, treatment patients and early pregnancy ultrasounds will be prioritized without a delay. We do not expect a delay in blood work but our blood lab hours are expected to change.
This will depend on where you were in your investigation and treatment process. For instance, if you were already a patient doing SO/IUI call with your day 1 to begin treatment. If you have not signed a consent to treatment, this will need to be done first. In this case, you will need to see your doctor. If you have not completed your testing prior to treatment, you will need to complete testing.
I suspect blood labs and semen analysis labs are not doing this testing so as not to expose those of us who should be isolating. I would suggest you isolate and do your tests once we reopen.
Referrals are still coming in but we are not booking appointments yet. We will book consultations prior to the reopening of the clinic once we see our time to reopen is soon. These visits will be done via the Ontario Telemedicine Network (OTN). Appointments will be made based on when we received the referral.
All patients are treated equally. We do not prioritize based on age as there are many factors in addition to age that could prioritize a patient. We feel every patient is equal.
We do not make the funded IVF rules. The Ministry of Health makes the age cut off. You may do private IVF if you have a good ovarian reserve and a good chance of conception based on what you and your doctor together have decided. That certainly could be at age 42 or 43 depending on your ovarian reserve.
We do not have an age cut off for egg freezing. However, the chance of a live birth from your frozen eggs is lower the older you are when you freeze them. This would be discussed with your doctor after ovarian reserve testing which consists of antral follicle count, FSH, LH, Estradiol and AMH levels. Eggs can be kept frozen for years. We encourage each patient with frozen eggs to use them at an age when a pregnancy would still be safe for you and your baby’s health.
YES, the laboratory personnel is not working at the moment.
Please contact our office if you are in need of a prescription refill. Your doctor will be notified and advise if it is possible to prescribe the medication at this time. Prescriptions will be sent directly to your preferred pharmacy.
Unfortunately, at this time we are not able to offer IUI treatments due to COVID-19 and the requirement to close down our treatment facility. We will begin to offer this treatment again as soon as it is safe to do so.
Our patients are placed on our Funded IVF waitlist with the date of when they submitted their IVF quiz. Our waiting times have been between 12-14 months. With the closure due to COVID-19, we are expecting at least a 3-month extra delay. If you are not certain if you are on our waiting list, please contact firstname.lastname@example.org and we will advise you accordingly.
The Kingston Reproductive Centre is hoping to re-start IUI treatments when safe to do so and our hope is to re-open before September, but the exact timing remains uncertain. The decision will be made in coordination with the Fertility Physicians at KGH (Dr. Magee and Dr. Velez), the Department of Obstetrics and Gynecology and Kingston Health Sciences Centre.
Yes. Please call the clinic (select option #1 in the phone tree) to book your IVF consents. The nurse will then ask your doctor to review your chart. If the tests are complete, you will be able to schedule your appointment with your doctor to discuss IVF and sign the consents. The doctor will do the appointment via the Ontario Telemedicine Network (OTN). If you have not completed the testing required for IVF consents, you will be called and the pending tests will be listed. When the clinic reopens, you may call to book those tests and consents will then be booked for you.
This was a very hard decision as we knew this would greatly impact our patients’ treatments and procedures. However, we needed to put the safety of our patients and staff first; we knew that the risk of exposure was high over time and we could not let that happen. After reviewing the advice from public health officials and our industry governing bodies, we decided it was prudent to close before an infection occurred and while we could safely manage a controlled shutdown.
a) It will not be “business as usual” when we reopen.
b) We will have a dedicated resource to sanitize the clinic on an ongoing basis.
c) We are replacing our waiting room furniture to make it easier to clean and we will be increasing seating distances.
d) We will minimize exposure in the waiting room by limiting the number of people we bring into our clinic at any given time.
e) We will be doing all appointments that don’t require physical procedures via the phone or OTN.
f) We have a team working on plans now to minimize the risk to patients and staff and will communicate additional activities as they become available.
The OFC is providing monitoring services for pregnant patients to ensure a safe pregnancy; these include ultrasounds to rule out ectopic pregnancies. We are also providing certain visits with your physician via OTN and telephone.
We will rebook IVF related appointments first once we are able to reopen. Our staff have a list of all IVF appointments and will be going through them in order. For any other appointments such as office visits, semen analysis, blood work or ultrasound you will be required to call and rebook them.
For New Consultations: Once we reopen, the doctors’ offices will call you to rebook your appointment, please be patient as the number of appointments to rebook is high.
For Other Physician Appointments: You will need to call to book an appointment once we reopen. The doctor will be doing Follow-up appointments via phone and OTN as long as no additional tests are required.
For IVF Treatment Appointments: Once we reopen the clinic will call all patients who had treatments planned but were cancelled. After that, we will call patients who are in the queue for treatment. For IUI and Ovulation Induction (OI) patients please call in with your “Day 1” once we open, we will then determine if we are able to start your treatment.
We treat all patients equally. We sympathize with the older patient but please understand all patients are important. There are many younger patients who have issues of low ovarian reserve or longstanding infertility. Thus each patient has a unique issue which in many cases is time-sensitive. We do promise to increase our volume to try to see each patient at the most efficient rate we can safely offer.
No, we appreciate that you may have had an appointment booked whereby you may have used your samples stored with us. While we have been closed the expense of monitoring, keeping storage tanks full and paying insurance on them continues. Regardless of when you have your treatment appointment most of you still have other embryos in the tanks that continue to require storage.
Yes, the funding for IVF and IUI’s will continue this year and the waitlist that we had for procedures will restart once we are open.
If you have never done a frozen embryo transfer before, you will first need to have a virtual visit with your physician to sign consents for the frozen embryo transfer. This can be arranged now by calling the clinic. If you have previously signed consents for frozen embryo transfer, as for other treatments, please monitor our website and Facebook for when we will be able to start treatments again.
As all of our patients are struggling with fertility issues, we will continue to treat all patients equally. Given the many factors which contribute to urgency of treatment, we do not prioritize. We will work together with our patients to ensure that treatment for all can start safely and efficiently.
To ensure appropriate physical distancing when we reopen, we expect to have a graduated reintroduction of clinical treatments available. It may be that if you call with your day 1 that we can accommodate the monitoring and treatment required, and it is also possible we may have to defer because of limits on number of patients possible to have in clinic.
Your referral typically expires a year from the date you were last seen at our clinic, but your file with your previous test results will have remained with us. I would recommend that you obtain a new referral from your family physician, and we will happy to pick up where you left off.
As you can imagine there will be some delays to the funded IVF waitlist. Rest assured, you will not lose your spot on the list. We may be better able to provide you with an estimate timeframe once we open again. For the moment, there are no required paperwork, and I would recommend that you wait to be called.
Those who are expected to start an IVF cycle will definitely be called by our team and given instructions on how/when to start medications. Realistically this will occur in the first week(s) of opening, with the expectation of starting monitoring and procedures in the weeks that follow.
Every fertility operates in different ways, within the context of their own city and unique operating conditions. After many years without any changes, the OFC was finally forced to increase our prices in 2019, to catch up to inflation and the accumulated increases in our business costs. That was not a decision made lightly and the increase was informed by a market analysis of comparable Canadian IVF centres. Increased prices are directly contributing to necessary supplies, modern equipment, and employing and training our staff that provide your fertility services. We feel that those investments will contribute to better fertility care for you, and thus greater prospects for a successful pregnancy.
At this time, our plan is to reopen OFC as soon as public health authorities advise us that it is safe to do so. We also have new practices ready to help safeguard your health from new COVID-19 risks while accessing OFC fertility services. Based on input from public health authorities, the government is not currently offering COVID-19 testing to medical facilities such as the OFC. As Ontario’s testing capacity increases over time, we will continue to seek public health guidance on the best available options to safely run our services.
Each patient’s situation is unique, which is why the OFC develops and offers a customized care plans suited to your personal circumstances, to optimize your chances of a successful pregnancy. Your doctor will carefully examine your current medical situation and advise prior to any treatment if updated testing is recommended or required.
We do not have any matching services for donors/recipients of either donor eggs or sperm. Those patients needing donor sperm are given instructions on how to purchase this through a donor sperm bank that is Health Canada compliant and have the samples shipped to OFC. If someone needs donor eggs they can choose to have a known egg donor that they identify on their own, or they are given information on how to purchase donor eggs through anonymous donors in the United States.
The physicians at OFC have been seeing patients in follow up to make plans for treatment once we are reopened. We have also resumed booking new consults in anticipation of reopening in the near future. Treatments have not yet been scheduled as we haven’t been given any specific dates from Ontario Public Health or the Ontario Medical Association as to when fertility clinics can reopen. The OFC management t meeting almost daily to ensure that we are ready to reopen safely once given the go ahead.
Thank you for your appreciation and patience during this difficult time! We hope these sessions will provide current and future patients with as many answers as possible, recognizing that a lot remains uncertain at this time.
No, the embryology lab is currently close and cannot receive donor egg lots until it is safe to reopen.
The ultrasounds that we perform at OFC at very specialized and, for the most part, cannot be performed at other facilities. We are working hard to develop a plan for maximizing ultrasound access to accommodate the needs of our patients upon reopening.
The ministry of health fertility program does not get renewed annually but is rather an ongoing program with only the allocated budget being renewed every April 1st. This occurs automatically unless the Ottawa Fertility Center is told otherwise. We have not been instructed otherwise and therefore believe that IUI funding will be available when the clinic re-opens.
The ministry of health has not given direction allowing fertility clinics to open. The management and physician team are meeting regularly in order to make preparations for a re-opening. However, a firm start date has yet to be determined.
Given that the Ottawa Fertility Center closure was an unforeseeable event imposed by the Ministry of Health and the Ontario Medical Association, the drug costs for cancelled cycles cannot be recouped and will not be covered when services restart.
We are in the process of clarifying which phase of the Ontario re-opening plan fertility clinics fit in. Regardless of the specific date, the management and physician team are working tirelessly to make preparations for a re-opening.
The province has made their plan for reopening the province available on their website. We hope to be included in Phase 1 of the plan; however, the document does not clearly state were Fertility Clinics fit in with this plan. The province has made announcements on easing restrictions for certain seasonal businesses already and we hope to be hearing more announcements soon.
If you had your first meeting canceled you will be rebooked with the same doctor again. The doctors are all expected to have the same time frame for next appointments.
Yes. Your investigations, treatments, and other plans will resume where things stopped from the pandemic
Stimulating the ovaries with medication requires close monitoring with ultrasound and blood work to ensure that not too many eggs grow at once. This means that we can’t prescribe these medications because we can’t offer the monitoring needed to make sure it is a safe treatment for you.
If you need are rubella non-immune, then you can call your family doctor's office to arrange for an MMR booster shot. It is important you are not pregnant when you get this vaccine and that you avoid pregnancy for 28 days afterwards.
Folic acid is a safe supplement that you can take every day, regardless of when your next fertility treatment is planned. We suggest that every woman take folic acid supplementation during her reproductive years and you do not need to worry about taking “too much” or taking it for “too long.”
There are many different reasons why a good quality embryo may not end up leading to a pregnancy. This may be due to the embryo not being destined to implant or continue to grow, or due to uterine factors or other fertility issues. At OFC, we are constantly reviewing the most up-to-date research and guidelines and offering patients all evidence-based investigations and treatment options to maximize their chances of fertility. Each patient is unique and their case is best reviewed with their individual doctor over the phone or by OTN.
At this time, please store any purchased unopened medications as per pharmacy recommendations. Please inquire at the time of your treatment if the medication is still safe to use.
A luteal phase defect is difficult to diagnose? Once diagnosed it could be corrected pharmacologically under the care of a fertility specialist.
a) Males can take a multivitamin that contains Zinc, Selenium and Folic Acid. You could look for a formulation called Fertile Pro.
b) Female should take a Prenatal Vitamin and Vitamin D 2000IU
The greatest predictor of egg quality is age, which is not within our control. There are lifestyle factors that are within our control that we can optimize to minimize potential negative impact on egg quality, including smoking cessation, minimizing alcohol consumption and eliminating marijuana or illicit drug use. We also recommend daily prenatal vitamins (or folic acid) as well as vitamin D supplementation (2000 IU daily unless otherwise indicated or prescribed by a physician).
There are many studies evaluating particular diets and PCOS, none of which have been proven superior to others. A well-balanced diet, minimizing food or drink with added sugar and that are highly processed, with the goal of achieving or maintaining an optimal weight is ideal. Many patients find it helpful to work with a dietician or weight loss specialist when the goal is weight reduction to increase the chance of ovulation and/or optimize fertility.
A short period could be normal. The main thing to rule out is intra-uterine adhesions with a saline ultrasound.
If you have decided as a couple to pursue pregnancy at this time, the following considerations can be taken, in accordance with the American Society of Reproductive Medicine committee opinion on optimizing natural fertility:
For women having regular menstrual cycles, intercourse every 1-2 days starting prior to the fertile window, which includes the 3-6 days before ovulation. For example, in a 28 day cycle, the fertile window would be expected to start around cycle day 8-10. So intercourse every 1-2 days from cycle day 10-20 would be expected to cover the fertile window.
Avoid smoking, higher levels of alcohol (>2 drinks per day), and recreational drugs
Generally try to live a healthy lifestyle, with moderate exercise and varied, healthy diet.
Avoid use of water-based vaginal lubricants, which may inhibit sperm reaching the egg. If you require lubricant for intercourse, there are options available that have not been demonstrated to affect sperm. Ask your pharmacist.
Taking a prenatal vitamin containing 0.4 to 1mg of folic acid is recommended for all women who could become pregnant.
SSRIs (Selective Serotonin Reuptake Inhibitors), whose primary indication is for treatment of anxiety and depression have been shown to have sexual side effects including delayed ejaculation, which may impact fertility. Mood disorders themselves can also have an impact on sexual function including low libido, erectile dysfunction and abnormal ejaculation.
There is limited and conflicting data to say if SSRIs impact semen parameters in humans. Some studies suggest there may be an impact of these medications on sperm concentration, motility and DNA stability, however these studies all have problems with their methods, making conclusions difficult.
It is important to consider the risk of untreated depression or anxiety against the uncertain risk of side effects before stopping any medications. If you think SSRIs may be negatively impacting your fertility, speak with your doctor about your options.
Due to the closure of our embryology lab, the transfer of embryos is not possible at the present time. Once the lab is up and running, transfer of frozen embryos will again become available. Rest assured, your embryos will be kept securely frozen in the meantime.
Yes, we continue to offer essential services, including monitoring in early pregnancy and follow-up with your physician.
Recent literature surrounding endometrial scratch does not appear to support it as an effective addition to IVF treatment. However, there may be select cases where it is still considered. Please bring this up with your fertility specialist
Assisted hatching is a procedure performed on embryos in the ART laboratory. Recent literature suggests it may have little or minimal benefit in IVF cycles. We continue to review the current literature regarding assisted hatching and update our lab protocols based on best practices.
We are currently unable to offer initial testing. Once we re-open, we are re-structuring our hours of operations and capacity with the aim of minimizing any delay for patients requiring initial testing or updated testing. However, we can not guarantee no delay, and should there be a delay for initial testing our goal is to not have a delay of more than 1 cycle (month). We would like to make it clear to our patients that if you had testing scheduled prior to our clinic closing during this pandemic and your testing was cancelled, please call us when we re-open to reschedule (with your day 1 if applicable) – do not wait for a call to have this scheduled for you.
Our aim is to maintain your fertility services, while keeping both patients and staff safe in doing so. We have spent a significant amount of time during this government-ordered closure to implement measures to safely operate in these new pandemic conditions. We are all hopeful that our society’s collective efforts to manage the risks from this pandemic will prevail without further challenges. But no one can predict the future and we cannot rule out the possibility of a second wave. If that occurred and if it posed any new jeopardy to your safety, then we would follow all directions from public health authorities.
Ovulation predictor kits do not not detect ovulation in everyone, despite the fact that they do ovulate. The best predictor of an ovulation is a regular menstrual cycle. IVF medications do not have any long term affects on ovulation as they are cleared from the bloodstream very quickly (most within 24 hours). If you are having regular menstrual cycles then you are almost certainly ovulating and your OPK’s are just not detecting your ovulation surge. Your OFC physician is available for follow up appointments and would be happy to discuss this and any other questions you have.
Already answered by Clara above. I would add the following: to have any embryo shipped to another clinic is possible. You first need to be a patient of that clinic before they will receive your embryos. Once you have been seen in consult by the receiving clinic you can call your OFC physician’s office for instructions on how to arrange for shipment of your gametes.
Supplementary services like acupuncture are also closed at this time. Once fertility treatment restarts, patients often schedule supplementary treatments before and after their fertility treatment.
The types of cycles that we will offer initially have not been determined as of yet. We are considering IVF with fresh transfer in selected patients at low risk of OHSS and no medical illnesses that could worsen covid-19 infection. Since the covid-19 virus will likely still be present in the community, patients could become infected with covid-19 during or after their treatment cycle. Ovarian Hyperstimulation Syndrome or other medical issues could worsen the prognosis of patients infected with covid-19. Your treatment plan will be determined by you and your OFC physician, and guided by information from recent of future guidance documents from National and International Fertility Societies
Our reproductive psychologist Dr. Gervaize is still available for consultations during this difficult time. She would be the best professional to offer psychological support resources for managing stress. Fertility Matters Canada is also a non-profit organization, which has a multitude of support resources and support groups designed for fertility patients.
Yes, currently we expect our allocation of funded services from the Ministry to remain the same. Depending on when we are able to re-open and our ability to put through higher patient volumes will determine if we can still accomplish the same amount of funded cycles within the fiscal year (April 1 to March 31).
There is controversy on the definition of an essential service. However, what seems consistent throughout the world, including the USA, is that fertility care is not considered simply, “elective.” At this time, no national governing or international bodies have defined Fertility Services as an Essential Service. Conversely, all national and international governing bodies(CFAS, ASRM, ESHRE etc) have consistently stated that no new fertility treatments should be initiated now, with the exception of fertility preservation for patients about to undergo possible fertility damaging treatment(chemotherapy, radiotherapy, or radical surgery for cancer, etc.). Although we truly wish to see the resumption of fertility care here in our Centre, we must respect the laws of the Province and our National and International guidelines for the treatment of infertility. We continue to keep updated with daily situational updates in hope that we will be opening soon.
You can find additional information about male infertility on our website: https://conceive.ca/fertility-treatments/male-infertility/.https://conceive.ca/fertility-treatments/male-infertility/.
Many additional factors, most importantly the age of the patient at the time of egg retrieval as well as prior history and outcomes of fertility treatments and quality of the embryos, is taken into account when deciding whether to transfer 1 vs. 2 embryos. The ministry of health (MOH) funded IVF program will only allow the transfer of a single embryo up to a certain age. Even beyond this age and within a privately funded cycle of IVF, we often recommend elective single embryo transfer given the significantly elevated risk of twins (and triplets) when two embryos are transferred. When the option exists of transferring more than 1 embryo and this is something you would like to review, we recommend a discussion with your fertility specialist taking into consideration the factors mentioned above.
The most important predictive factor is the patients' age at the time of egg retrieval, and the answer to this question will vary greatly based on age. At the age of ≤35 at the time of egg retrieval, the average number of embryo transfers before success is 2-3, and this will increase beyond the age of 35 and certainly near or beyond the age of 40.
Unfortunately, the quality, presence of multinucleation or an embryo's ability to make it to day 5 can not inform us that an embryo is genetically abnormal. While an embryo that makes it to a good quality embryo on day 5 (whether multinucleated or not) is MORE LIKELY to be euploid (genetically normal), this is not definitive or diagnostic of a euploid embryo, and a percentage of these embryos (based on a woman’s age) will be aneuploid (genetically different from normal).
Our policy at OFC, given the available literature, is that if an embryo grows to day 5 and is good quality evidence, it can be frozen (or utilized for embryo transfer). This is supported by evidence that bi/multinucleated embryos that are of good quality on day 5 appear to have no difference in pregnancy rates, birth outcomes or risk of anomalies. At this point we do not have any more recently updated statistics (compared to what is in our handout) on our experience with these embryos, however, we have certainly had many successful pregnancies and live births from these embryos.
This is a great question, and unfortunately, we don’t know the answer. In a recent review of the published literature, there were only 7 published studies on COVID-19 and fertility/early reproduction, none of which are able to address long-term fertility, which needs to be studied over several months to years for proper evaluation.
This is a topic under active review by our physician group. We will be releasing more updates on this subject as the situation evolves.