Following basic blood work and cultures, we proceed, in descending order with:
- Tubal patency confirmation (3/4 D sonohysterogram )
- Assessment of uterine cavity (3/4 D sonohysterogram and assessment of uterine artery blood flow)
- Verification or improvement in ovulation
- Detailed sperm analysis including checking for sperm antibodies
- Oral fertility medications / Letrozole / +/- DHEA +/Co Q 10/+/- P.Q.Q.
- Subcutaneous gonadotropins
- Controlled ovarian hyperstimulation (COH) with sperm wash intrauterine insemination , I.U.I. (husband or donor sperm)
- IVF with ICSI / assisted hatching , at C.R.E.A.T.E.
- Freezing of non fertilized eggs, at C.R.E.A.T.E.
We proceed through these various steps as rapidly as possible, but give each step the appropriate amount of time to get the expected number of pregnancies as per the recommendations of the Canadian, European and American Fertility Societies.