Patient instructions > Information package for cycle monitoring

3 Feb 2017

Toronto West Fertility Associates

Edward A. J. Ryan, MD, FRCS©, FSOGC

Anne Claessens , M.D. FRCS©, FSOGC

Evan Taerk,  M.D. FRCSC©. REI               

Reproductive Endocrinology/Infertility, Gynaecology   

100-56 Aberfoyle Cres. Etobicoke, ON, M8X 2W4  Tel: 416-231-4100  Fax: 416-231-0845




(and Intrauterine Insemination [I.U.I.])



            This material should be read carefully by both partners and kept for easy reference. This material is intended for those who are already our patients or want to become our patients, to understand how the cycle monitoring is done.


            After reading this information, if there are any questions do not hesitate to call 416-231-4100.


            On Day 1 of your cycle (the first day of full, normal menstrual flow, not spotting) telephone 416-231-4100. Leave a message or tell the staff what day you will be coming in to the clinic so we can get your chart ready (this will be day 3 of your cycle, unless day 3 is a Saturday in which case you come in on Friday, or if day 3 is a Sunday come in on the Monday A.M.)


These are the steps for your cycle monitoring visit:

  1. SIGN IN - Sign in your name in our cycle monitoring board (you will do this at EVERY visit, independently of the reason for your visit) to comply with the P.I.P.E.D.A act. You may wish to sign your first name and last name initial instead of full name. Have your health card in hand (if the health card is not valid, or you do not have one, you will be required to pay for the services provided).
  2. BLOOD TEST - A staff member will instruct you to go to the laboratory to do your blood test. This and all services are in a first come, first served basis. However, you will notice that sometimes for blood test we will give preference to those patients that only need a blood test.
  3. ULTRASOUND - A staff member will also call you into one of our ultrasound rooms where you will have a detail ultrasound scan of the ovaries and uterus. This and all other ultrasounds should be done with an empty bladder.
  4. SEE THE DOCTOR - After having your blood test and ultrasound done, one of our staff physicians (Dr. Ryan, Dr. Claessens or Dr. Taerk) will sit down with you and your partner (if available) to plan the treatment of your cycle. The treatment might include no medications, oral treatment, injectable medication and/or procedures. The physician will also let you know when to return to our clinic for cycle monitoring.
  5. SEE THE NURSE - One of our registered nurses will give you the medication (if applicable) of your individual treatment. Or book the special procedure that the physician has indicated for you.


For your next cycle monitoring visits (until ovulation time) you will:


  1. SIGN IN – As in your fist visit
  2. BLOOD TEST – Blood test are done at each visit in order to monitor the hormones that will indicate the time when you are having a spontaneous ovulation, ready for ovulation induction, or at risk of hyperstimulation if you are taking injectable medication.
  3. ULTRASOUND – Ultrasounds are done to measure follicle size and number, and the thickness of the uterine lining.  This information will provide the physicians with information on when to expect or induce ovulation (with hCG, Ovidrel or Lupron). If you have ovulated on your own, this drug will enhance the development of your corpus luteum, (essential for normal early pregnancy development and survival), if you do not ovulate on your own, hCG/ Ovidrel/Lupron, will cause ovulation usually within 24 to 48 hours.  A follicle is a fluid filled sac that generally contains the egg.
  4. SEE THE DOCTOR - Any significant changes to your treatment plan will be done under the direct supervision of Dr. Ryan, Dr. Claessens or Dr. Taerk. You will be instructed on when to come back for your next visit.
  5. SEE THE NURSE – The registered nurse will give you any medication your physician has ordered for you, including adjustments to the doses or new medication if needed.


Ovulation time - When your E2 level is optimum, and your follicles are at an ideal size (between 1.8 to 2.2 cm in the average diameter), you may need an injection of hCG (or Ovidrel or Lupron ). The day after the hCG injection, you will return to the clinic for the usual blood tests and ultrasound. If you have previously arranged to freeze your partner’s sperm sample(s) or have chosen a sperm donor, we will provide you with the paper work needed in order to have the sample ready for the insemination.


Inseminations - If this is required in your treatment plan, they are usually done on two consecutive days after the hCG, Ovidrel or Lupron injection. If indicated by your physician the day after the “trigger “ injection, your partner should report to the reception desk between 06.30 am and 8.0 am to produce a semen specimen or if bringing the sperm sample in from your home, keep in close to your body in the sterile container provided, not more than 90 minutes after producing sample.  In case of using a frozen sample, we will have it ready in our office. Once the sperm is washed/thawed in our lab (which takes aprox. 1 hr for a fresh sample) the Doctor or our Nurses who are trained to do this procedure, will perform the insemination.  This procedure takes approximately 10 min and your bladder should be empty.  In the examination room, the physician or his designate will insert a speculum into your vagina allowing the physician to clean the cervix.  The washed sperm is loaded into a catheter and the catheter is gently inserted through your cervix into your uterus (this may cause a temporary cramping sensation). The sperm is then injected high into the uterus. For the next couple of days, be kind to yourself and try to avoid strenuous exercise. After your final insemination, your doctor will tell you when to come for blood testing. Pregnancy test is done 2 weeks from the date of the last insemination.



(not sperm wash assessment)

  1. ABSTINENCE: The optimal period of abstinence to obtain the best semen quality is 2  days (Not 5 days as previously suggested).
  2. Before producing the specimen, men should have a full breakfast and refrain from heavy physical exertion or exercise.
  3. SPERM SPECIMEN: You have the option of producing the sperm sample at home or in our audio visual rooms in the office.  Two audio-visual rooms are provided specifically for producing the sperm specimen (if your partner prefers to produce it in our clinic). The rooms are booked on a first come first serve basis. Please DO NOT use latex condoms or lubricants to collect the specimen.

                          Monday-Friday                 From  06:30 a.m. to 08:30 a.m.

                          Weekends & Holidays      8:00 a.m. @ CREATE IVF Centre.

Please note that specimens may not be dropped off before the indicated times.

  1. Please print clearly the following information on the container:

-          Your name & spouse’s name (if different)

-          Doctor’s name

-          The time specimen was produced.

We will not process any sample that is not properly identified.