Conception and Fertility Testing

What is conception?

Conception happens when sperm (produced by the testicles) meets an egg (from the ovaries) and implants in a uterus. This can occur through unprotected sexual intercourse between people who have this anatomy, through artificial insemination methods, or through the surgical implanting of fertilized eggs (IVF). This factsheet provides information for people interested in getting pregnant.

What is fertility?

• Fertility is the biological ability to create pregnancies and produce children.
• Fertility for people with testicles* means having the ability to produce sperm, which is released during ejaculation. They are fertile all day, every day once they start to ejaculate semen/cum containing sperm once they start puberty (ages 11-15 years).
• Fertility for people with ovaries* means having the ability to release mature eggs from their ovaries that can be fertilized by sperm. They are born with every egg they will ever have. They start to release those eggs around their first period (which usually starts at puberty, ages 9-14 years) and are only fertile on certain days of their fertility cycles.

What happens during the fertility cycle?

• A fertility cycle for a person with ovaries (sometimes called a menstrual** cycle) is the time from the first day of bleeding (their period) to the day before they start their next period.
• While 28 days is often used to describe a “normal” cycle length, normal cycles can actually range from 23-35 days. Only 15% of people have a 28-day cycle.
• The cycle begins when a person has their period (menstruation**). This sheds the lining of the uterus. A typical period lasts 3-7 days.

* People with testicles are usually designated male at birth while people with ovaries are usually designated female at birth. People with testicles don’t always identify as male and people with ovaries don’t always identify as female.

**We know that these aren’t the words everyone uses for their bodies (e.g. trans folks) and support you using the language that feels best for you.

• After menstruation, the uterine lining starts to build up again. At the same time, an egg in one of the ovaries starts to mature.
• Hormones trigger the egg’s release from the ovary into the fallopian tube (ovulation). Ovulation happens once per cycle, but sometimes 2 eggs can be released during the same ovulation. Eggs live for about 24 hours after they are released.
• If an egg is fertilized by sperm it travels down the fallopian tube to the uterus. If a fertilized egg attaches to the uterine lining it becomes a pregnancy.
• Because eggs live about 24 hours and sperm can live up to 5 days inside the body, pregnancy is possible if sperm enters the vagina** from about 5 days before ovulation until about 24 hours after ovulation.
• If the egg is not fertilized by sperm, it disintegrates. Hormone levels then drop and the uterine lining sheds (menstruation), restarting the cycle.
• The time from the first day of a period until the next ovulation can vary between different people and between cycles for one person. The time from ovulation until the next period begins is usually about 14 days but can vary a little from person to person.

Fertility signs for people with ovaries

• Cervical mucus: This is produced in the cervix (the opening to the uterus) and comes out through the vagina. Around ovulation, the mucus becomes more wet, slippery and stretchy (like egg whites) and helps sperm to swim up through the uterus towards the egg.
• Basal (resting) body temperature: After ovulation, there is a small increase in basal body temperature. This is best measured overnight or first thing in the morning before rising.
• Cervical position: Around ovulation the cervix becomes softer and more open and moves forward.

Do I need to have my fertility checked before trying to conceive?

Most people do not need to have their fertility checked prior to trying to conceive, especially if:

• You can ejaculate (if you have testicles)
• You are having menstrual periods, especially if they are regular
• You have no healthy or family healthy history of infertility or difficulty conceiving
• You have no known health issues that can impact fertility, and/or are not taking medications that could impact your fertility

What can impact my fertility?

• Medications, like contraception, chemotherapy, or some forms of hormone blockers. Hormone replacement therapy (HRT) can also lower fertility but does not cause infertility and is not an effective form of contraception. Fertility returns after stopping contraception, including medications or IUDs/implant.
• Certain health conditions like polyendocrine metabolic ovarian syndrome (PMOS) or endometriosis. These conditions do not necessarily cause infertility, but can make it harder or take longer to conceive.
• Structural differences in anatomy, like blockages in the tubes that eggs and sperm travel down, or a divided (or “septate”) uterus.
• Age and sperm/egg health, as conceiving can be more difficult over the age of 35 and the health of the eggs/sperm may be impacted.
• Smoking/vaping nicotine and THC and drinking alcohol can negatively impact fertility, but these effects stop around a year after quitting

This list is not exhaustive and there may also be other factors that we do not fully understand that impact fertility, like exposure to environmental pollution or chemicals. There is not a lot of strong current evidence that weight, diet, or exercise impact fertility. Using condoms or barrier protection is intended to prevent pregnancy, so you should stop using them if you are trying to conceive.

When should my fertility be checked?

If you are planning to conceive and do not menstruate (if you have ovaries) or are unable to ejaculate (if you have testes), it may be a good idea talk to a primary care provider about getting tested. Otherwise, if you are under the age of 35, fertility testing guidelines recommend testing if you have been trying to conceive for a year without success.

What does fertility testing involve?

• Blood testing to assess hormone levels, often repeated over several days to monitor trends
• For people with ovaries, vaginal and transvaginal ultrasounds with a fluid infused into the uterus to assess the uterus and fallopian tubes (this is called a saline infusion sonohysterogram)
• For people with testicles, several types of sperm assessment to check the health, swimming ability, and amount of sperm.

Is fertility testing covered?

• Most fertility testing is covered by OHIP if you have an Ontario Health Card. Some common tests, such as AMH (anti-mullerian hormone) are not covered by OHIP.
• People who choose to conceive using a known sperm or egg donor may need to pay out of pocket for testing of their donor, regardless of whether the donor is covered by OHIP.
• Some fertility treatments and freezing sperm/eggs are covered by OHIP with some limitations – you can read more about these options here: https://www.ontario.ca/page/get-fertility-treatments
• Genetic testing, fertility drugs, and the storage fees for storing sperm/eggs/embryos is not covered by OHIP.

Where can I get fertility testing?

• Specialized fertility clinics (see government link list below) can perform fertility testing, as some of these tests require specialized tools and processing.
• Some fertility clinics require a referral from a family doctor beforehand, but some offer free consultations as well.
• Like many specialized health clinics, fertility clinics often have a wait list that could be several months to years long. They may have additional waitlists for OHIP-funding treatment.
• Planned Parenthood Toronto is not a fertility clinic and does not provide fertility testing.

Resource list:

• Ontario Government List of Fertility Clinics: https://www.ontario.ca/page/get-fertility-treatments