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Fertility Support: who to see and what helps

Fertility Support · Kitchener, Waterloo & Cambridge

Infertility is generally defined as not conceiving after a year of unprotected sex, and about one in six Canadian couples experience it. Alberta’s health service advises seeing a doctor after a year of trying, or after about six months if the person trying to become pregnant is over 35. CARESPACE supports the care of a physician or fertility clinic and does not replace it: a Nurse Practitioner can do a first assessment and refer you, and a Registered Dietitian, a counsellor or a Naturopathic Doctor can work with you alongside.

What infertility is

Canada’s obstetricians and gynaecologists define infertility as a year of unprotected sex without conceiving for women under 35, and six months for women over 35. More than 80 per cent of couples conceive within a year when the woman is under 40 and they have regular sex without contraception, and about half of the rest conceive in the second year. Where it can be traced, it is traced to the man about 30 per cent of the time and to the woman about 40 per cent; the remainder is a mix of both, or unknown. This page is for anyone trying to conceive, with a partner or with donor sperm.

When to get assessed

Infertility has no symptoms of its own. What counts is how long you have been trying and whether anything points to a cause. Alberta’s health service advises seeing a doctor if:

  • You have been unable to become pregnant after a year of sex without birth control
  • You are over 35 and have been unable to become pregnant after about six months
  • You have had two or more miscarriages in a row

The UK’s national guideline goes further. It says to offer both partners an assessment after a year of trying, or after six cycles of insemination, and to offer a specialist referral straight away when the person trying to become pregnant is 36 or over, or when either partner has a known or suspected cause, such as irregular or absent periods, significant pelvic pain, endometriosis, a past ectopic pregnancy, a history of testicular cancer, or past chemotherapy or pelvic radiotherapy. It also says to speed up a referral when a planned treatment, such as cancer treatment, could affect fertility, and not to restart the clock after a miscarriage or ectopic pregnancy.

What causes infertility

  • Ovulation that is irregular or absent
  • Blocked or damaged fallopian tubes
  • Endometriosis
  • Poor semen quality
  • Age. Fertility declines with age in women and, to a lesser extent, in men.
  • Smoking, heavy drinking, a body weight that is high or very low, and infections such as chlamydia
  • Exposures at work: some pesticides, solvents and metals
  • Nothing that can be found, in about a quarter of cases

How fertility is investigated

Both partners are assessed. The first tests are a semen analysis, repeated if it is abnormal; a blood test for progesterone about a week before a period is due, to confirm ovulation; and a check that the fallopian tubes are open, for most people an X-ray with dye. In the UK guideline, some popular checks are less use than they seem: temperature charts do not reliably predict ovulation, the AMH blood test should not be used to predict whether you will conceive naturally, and thyroid and prolactin tests are for specific situations, not for everyone.

When to get emergency or same-day care

Call 911 or go to an emergency department, and do not drive yourself, if you are having fertility treatment or could be pregnant and have any of these: difficulty breathing; chest or upper back pain; being very thirsty and passing less urine than usual; swelling in any part of your body; pain low down on one side of your abdomen; pain in the tip of your shoulder; or a sharp, sudden, intense pain in your abdomen together with feeling very dizzy or fainting, feeling sick or looking very pale. These are the emergency signs listed by the NHS, the UK’s health service: they can mean severe ovarian hyperstimulation syndrome, a reaction to fertility medicines, or an ectopic pregnancy, which is more likely after fertility treatment.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Contact your fertility clinic the same day (or a physician, nurse practitioner or urgent care clinic if you cannot reach it) if during or after fertility treatment you have abdominal pain and bloating, nausea and vomiting, feeling faint, coughing up blood, vaginal bleeding or a brown watery discharge, or pain or discomfort when you pee or pass stool. Get medical advice the same day, too, if you might be pregnant and have vaginal bleeding or a brown watery discharge, or discomfort when peeing or passing stool.

What the evidence says about improving your chances

  • Where this comes from. The UK’s national fertility guideline (NICE, 2026), a 2023 European guideline on unexplained infertility, and a Cochrane review. The European guideline grades each recommendation strong or conditional (“probably”), a measure of the panel’s confidence and not only of the quality of the evidence.
  • Smoking and alcohol. Smoking is likely to reduce a woman’s fertility, second-hand smoke is likely to affect her chance of conceiving, and in men smoking is linked to poorer semen quality. Excessive drinking harms semen quality; for the partner trying to become pregnant, UK advice is that not drinking at all is safest.
  • Weight, in both directions. With a body mass index of 30 or more, conceiving is likely to take longer; for women who are not ovulating, losing weight is likely to improve the chance, and a group program of exercise and dietary advice leads to more pregnancies than weight-loss advice alone. Under 18.5, with irregular or absent periods, gaining weight is likely to improve it.
  • Caffeine. No consistent evidence links tea, coffee or cola to fertility problems.
  • Folic acid. Canada advises 0.4 mg a day, usually in a multivitamin, ideally starting at least three months before pregnancy. Some people need a higher dose, set by their health care provider.
  • Other supplements. In the European guideline, antioxidant supplements taken alongside fertility treatment, by women or men, and inositol for women are “probably not recommended”: conditional recommendations, on very low-quality evidence. Complementary therapies as a group have not been properly evaluated, and more research is needed before any can be recommended.
  • Acupuncture. “Probably not recommended” for women with unexplained infertility: a conditional recommendation on low-quality evidence. A Cochrane review of 20 trials in IVF, with evidence to 2013, found no evidence that acupuncture improves live birth or pregnancy rates.

What a fertility clinic may offer

CARESPACE does not provide fertility treatment. Which treatment depends on the cause: medicine to bring on ovulation, surgery for endometriosis or damaged tubes, intrauterine insemination (IUI), or in vitro fertilization (IVF). For unexplained infertility the European guideline recommends IUI with ovarian stimulation first, a strong recommendation on very low-quality evidence.

The Ontario Fertility Program pays for treatment at participating clinics for people with an Ontario health card: one cycle of IVF if you are under 43, and insemination, IUI included, with no limit on cycles. Fertility drugs are not covered: about $5,000 for an IVF cycle and $1,000 for an insemination cycle. You can go through your doctor or contact a participating clinic yourself; the province’s list includes clinics in Kitchener and Waterloo, and each keeps its own wait list.

How each CARESPACE service supports fertility

Nurse Practitioner

Ontario authorizes Nurse Practitioners to order and interpret diagnostic tests, diagnose, prescribe and refer. For a couple that can mean the first assessment: both histories, a semen analysis, the blood test that confirms ovulation, a check of whether either partner’s medicines matter, and referral to a fertility clinic. So can your family physician.

See our nurse practitioner team →

Naturopathic Medicine

A Naturopathic Doctor’s part comes alongside the medical assessment, not ahead of it. Ontario’s naturopathic regulator lists clinical nutrition and lifestyle counselling among the profession’s therapies, so a Naturopathic Doctor can work with either partner on eating, activity and habits such as smoking and alcohol, the everyday factors tied to fertility in the evidence above. Fertility tests are ordered by the physician, nurse practitioner or fertility clinic doing your assessment. The positions on supplements above apply whoever suggests one, and your fertility clinic should know about everything you take.

See our naturopathic medicine team →

Nutrition

Apart from folic acid, weight is the food-related factor tied most directly to conceiving, and it cuts both ways. A Registered Dietitian’s work here is individual: eating when your weight is high and you are not ovulating, or when it is low and your periods have become irregular or stopped. A healthy diet and regular exercise are recommended in unexplained infertility too.

See our nutrition team →

Counselling

Fertility problems, and the tests and treatment that follow, can cause psychological stress. The UK guideline says to offer counselling before, during and after investigation and treatment, whatever the outcome, from someone who is not involved in managing the fertility problem itself. CARESPACE counsellors are Registered Psychotherapists and Registered Social Workers. At a first visit, the counsellor works to understand your concern and comes up with a plan. Partners who want to come together can ask about couples counselling.

See our counselling team →

Other services people ask about

Acupuncture. Probably not recommended for unexplained infertility, as set out above. Physiotherapy. None of the guidelines we read gives physiotherapy a part in treating infertility. Pain with sex is a separate problem that can be assessed: see Painful Intercourse.

Where most people start

With a medical assessment once you reach the timelines above, or sooner if there is a known cause: a Nurse Practitioner, your own physician or a fertility clinic. A Registered Dietitian, a counsellor or a Naturopathic Doctor can work with you alongside that care; none of them replaces it. Before then, the home steps below are the place to begin.

How your team works together

A fertility clinic or physician leads diagnosis and treatment. A Nurse Practitioner can start the assessment and refer you, and the other services can support both of you around it.

Browse by service: nurse practitioners, registered dietitians, counsellors and naturopathic doctors.

What to expect at your first visit

  1. Come together if you can. Decisions about tests and treatment affect both partners.
  2. Bring the dates of recent periods, results of any tests or fertility treatment so far, and a list of the medicines and supplements each of you takes.
  3. You may be asked about periods, past pregnancies, lifestyle, work and sexual history. Share what you are comfortable sharing.
  4. You leave with a plan.

What you can do at home

  • Have sex every two to three days; that timing gives the best chance.
  • If you could become pregnant, take a daily multivitamin with 0.4 mg of folic acid, and no more than one daily dose.
  • If either of you smokes, stop; a pharmacist, physician or nurse practitioner can help.
  • Keep alcohol low; none is safest for the partner trying to become pregnant.
  • Ask a pharmacist, physician or nurse practitioner about the medicines, over-the-counter products and supplements each of you uses, among them testosterone, anabolic steroids, finasteride, anti-inflammatory painkillers, cannabis and vaginal lubricants.

Outlook

In the UK guideline’s table, 86 per cent of women aged 30 to 34 conceive within a year and 94 per cent within two; at 35 to 39 the figures are 82 and 90 per cent. What we read gives no single success rate for treatment; ask a clinic for its own figures.

Fertility support in Kitchener, Waterloo and Cambridge

The assessment and any fertility treatment come from a physician, nurse practitioner or fertility clinic; the other services listed here support that care.

Kitchener. Nutrition in Kitchener, Counselling in Kitchener and Naturopathic Medicine in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nurse Practitioner in Waterloo, Nutrition in Waterloo, Counselling in Waterloo and Naturopathic Medicine in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutrition in Cambridge, Counselling in Cambridge and Naturopathic Medicine in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How long should we try before getting help?

Alberta’s health service advises seeing a doctor after a year of trying, after about six months if the person trying to become pregnant is over 35, or after two or more miscarriages in a row. In the UK guideline, a known or suspected cause in either partner means a referral without waiting.

Does acupuncture help you get pregnant?

The evidence does not show that it does: it is probably not recommended for unexplained infertility, and a review of IVF trials found no evidence that it improves live birth rates.

Does stress cause infertility?

Stress can lower sex drive and how often a couple has sex, and in severe cases it may affect ovulation and sperm production. Counselling is for the strain; it is not a fertility treatment.

Is IVF covered in Ontario?

One cycle is funded through the Ontario Fertility Program if you are under 43 and have an Ontario health card. The drugs are not.

Where can I get fertility support in Cambridge?

A physician, nurse practitioner or fertility clinic does the assessment and treatment. Nutrition, counselling and naturopathic medicine, which support that care, are offered in Cambridge; our location there is on Hespeler Road. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

PCOS · Endometriosis · Irregular Periods · Painful Intercourse · Erectile Dysfunction

The CARESPACE Central Reception Team

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Book online with a Nurse Practitioner or a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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