Understanding whether you are able to provide eggs, sperm and/or uterus to support a pregnancy is an important first step in building your family plan. You should then consider whether you will have a partner that is able to provide eggs, sperm and/or uterus. Lastly, you may consider whether there is anyone else in your life who may be able to provide eggs, sperm, and/or a uterus. Depending on the answers to the above questions, options to conceive may include : Natural conception Conception with fertility assistance (ovulation induction/controlled ovarian stimulation, IUI, IVF) Identified (directed) or non-identified Donor Egg/Sperm & Gestational Carrier services as described above Reciprocal IVF (one partner provides the eggs, donor sperm is used for insemination, the other partner provides the uterus) Adoption

In some cases, exclusively breastfed babies will reject a bottle if not introduced early. Before you go back to school/work, it is important to ensure your baby will take a bottle. If you are planning on bottle-feeding your baby at some point, it may be a good idea to introduce the bottle to your baby, even if you are initially planning to exclusively breastfeed. In most cases, if introduced early, babies can easily switch back and forth between breast and bottle. If you have any questions about this, reach out to your child’s primary care provider.

Pumps with all parts including chargers/cords (may want to consider an extra set of parts) Milk bags or storage containers A method of storage – either ensure there is a fridge at your school/workplace that you can use or bring along an insulated cooler bag with ice packs Marker or sticker to label milk Cleaning supplies for pumps Breast pads to absorb any leaks

YES! Breastfeeding can be challenging for many reasons. Some may include poor latch, low supply, lack of sleep and inability to find time or support for pumping on return to work. It is okay to stop breastfeeding & feed your baby with formula.

Speak to your rotation coordinator and your supervisor about how often you need to be away from clinical duties to facilitate pumping ​​ find out about spaces where you may be able to pump privately within your local hospital - this may be a designated space, a call room, and/or a spare office find out if you have access to a fridge, if not, plan to bring a cooler with ice​

Type of pump: There are so many different pumps on the market that it can be overwhelming to decide which is best for you. If you are pumping at school/work, you will want to consider using an efficient pump that will help you get the maximum amount of milk in the shortest amount of time. You may also want to think about whether the pump needs to be plugged into an outlet or whether it can be used wirelessly, which would provide more flexibility. Some moms really enjoy using wearable pumps which allows them to continue with their scheduled duties while still being able to pump. ​ Cost of a pump: There is a huge price range when it comes to breast pumps. You can find manual hand pumps from under $20 to wireless, wearable pumps that cost more than $500. Many insurance plans will cover a portion of the cost of a breast pump, so check your plan to see what you are eligible for. There are also options to rent a pump which can be an affordable option, especially if you are only planning on pumping for a short while after going back to work. There are several different breast pumps available. Some of them may not be available in Canada. In general, there are electric breast pumps, battery-operated breast pumps and manual breast pumps. Read more here ​ Here are some popular brands amongst medical trainees : Medela Baby Buddha Willow* Elvie* Spectra* ​ *Unfortunately, some breast pumps can only be ordered in the US (i.e. Willow, Elvie, Spectra). Consider using a company that accepts US deliveries for Canadians or asking a family member in the US to help.

If you know that you would like to continue giving your baby breastmilk once you return to work, you may want to start building up a supply of frozen milk in advance. There are many ways to do this, but some people find it helpful to pump after their baby has finished nursing and doing this at regularly scheduled intervals to encourage milk production.

Proactive Egg Freezing There are several reasons to consider proactive egg freezing. If you have medical conditions that may impact your ovarian reserve, most notably endometriosis, you may want to consider pursuing proactive egg freezing sooner rather than later. ​ Another reason to consider proactive egg freezing may be the choice to delay childbearing. Whether or not you have a partner, egg freezing allows females reproductive autonomy and an opportunity to delay the decision about whether to bear children until the future. With the introduction of vitrification leading to higher freeze-thaw survival rates (80-90%), egg freezing is no longer considered experimental and has become more popular. As discussed on our page on age-related fertility decline, both egg quantity and quality decline with age. In addition, not all eggs will survive the freeze-thaw process, not all eggs will fertilize (70-80%) and not all fertilized eggs will become embryos. The more eggs that are frozen, the more likely it is that a single batch of eggs will lead to the live birth of a child in the future. The graph below demonstrates the prediction of a live birth according to a female's age and the number of eggs frozen. Some people may require multiple egg freezing cycles to obtain higher numbers of frozen eggs. Frozen eggs cannot be genetically tested. At this time, there is no way to know the quality of eggs frozen until they are thawed and fertilized. Image citation : Goldman RH, Racowsky C, Farland LV, Munné S, Ribustello L, Fox JH. Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients. Human Reproduction [Internet]. 2017 Apr [cited 2022 Oct 28];32(4):853–9. Available from: https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dex008 ​ So when should I freeze my eggs? This question is hard to answer. Though there is a higher likelihood of live birth with younger eggs, the difference under the age of 35 appears to be minimal. In addition, younger women are less likely to use frozen eggs for conception in the future. Therefore, it is thought that the greatest cost-benefit is for people to freeze eggs around age 35-37. That being said, if you are certain that you plan to delay conception, would like to have a large family but plan to start later or would like to have some reassurance about the possibility of child-bearing in the future, the younger the better, as it means more higher quality eggs. Proactive Sperm Freezing There are several reasons to consider proactive sperm freezing. If you have medical conditions that may impact your sperm, you may want to consider pursuing proactive sperm freezing sooner rather than later. ​​ Another reason to consider proactive sperm freezing may be the choice to delay childbearing. Although not talked about often, this is an option that more and more men are considering. There are risks with aging. On average, 30% of frozen sperm does not survive the freeze-thaw process. ​ Proactive Embryo Freezing It is also an option to freeze embryos. If you have medical conditions that may impact your sperm or egg quality, you may want to consider pursuing proactive embryo freezing sooner rather than later. Embryos can be genetically tested prior to being frozen; euploid embryos have a higher chance of implantation. Embryo freezing may be done with partner eggs/sperm or donor eggs/sperm. It may be a consideration for a couple who are thinking of delaying the decision to bear children. It may also be a consideration for older people who want to know the genetic quality of embryos prior to freezing.

There are risks associated with egg and embryo freezing. The risks are outlined below : medication side effects (nausea, breast tenderness, mood swings, bloating) stimulation risks (ovarian torsion, Ovarian Hyperstimulation Syndrome) procedural risks during transvaginal ultrasound guided egg retrieval (bleeding, infection, injury to bowel/bladder/blood vessel) cycle risks (cancellation, poor ovarian stimulation, no eggs within follicles at time of retrieval, no mature eggs, fertilization failure, embryo arrest, poor quality embryos that cannot be frozen) risks in IVF-conceived pregnancies (pre-eclampsia, large for gestational age babies, multiple pregnancy)

Embryos used to be a lot more stable when frozen/thawed than eggs. This is no longer the case. 95% of embryos will survive the freeze/thaw while 80-85% of eggs will survive the freeze/thaw. Once eggs are thawed, there is attrition, meaning that they then have to be fertilized and grown to an embryo and you will have natural loss of numbers at each stage. Eggs cannot be genetically tested and you may not know what you have in the bank. Embryos can be genetically tested so you may have more reassurance that it If you would like reproductive autonomy - freeze eggs. Embryos frozen with a partner can get complicated unless you are certain you will remain with that partner. If you are older and want to be more certain about what you have in the bank, freeze embryos, either with partner or donor sperm.

Proactive Egg Freezing Cost per cycle: Costs for egg freezing include procedural costs, medication costs, and storage costs up front. In the future, there are costs to fertilization, embryo transfer and storage of embryos. Procedural Costs of egg freezing : $7000 - $9000 Medications: $3000 - $8000, average $5000 Storage of eggs: $500-900 per year Fertilization of eggs: $2500 - $5000 Frozen Embryo Transfer Costs : $1600 - $3000 Storage of embryos: $500-900 per year PGT-A of embryos (optional) : $4000 - $7000 In Ontario, you are able to use your one cycle of IVF funding to cover the costs of fertilizing frozen eggs and transferring any embryo created from the fertilization of frozen eggs (in the FUTURE, as it has to be used for current conception); some people choose not to apply their funding to previously frozen eggs and instead, undergo IVF again and use the funding for that retrieval, fertilization and embryo transfers. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum) ​ Proactive Sperm Freezing Cost per cycle: ​ Sperm processing + procedure: $600-1000 Sperm storage: $300 -900 per year ​ Proactive Embryo Freezing Costs per cycle: Costs for IVF include procedural costs, medication costs, storage costs, embryo transfer costs and add-on costs. A popular add-on is pre-implantation genetic testing for aneuploidy (PGT-A), which is optional but may be quoted to you by clinics. Procedural Costs of IVF : $11 000 - $15 000 Medications: $3000 - $8000, average $5000 Storage of embryos: $500-900 per year Frozen Embryo Transfer Costs : $1600 - $3000 PGT-A (optional) : $4000 - $7000 In Ontario, proactive embryo freezing is not covered by funding. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum)

Many people train in a province or city that is different from where they plan to practice. Eggs/embryos/sperm can be moved to another clinic, but there are some clinics that do not accept transferred eggs/embryos/sperm for liability concerns. You may have to travel back to the location where the gametes are frozen to complete treatment. It may be possible to do some monitoring locally but do the procedure where the gametes are located.

Proactive Egg Freezing​ You will need to ask for a physician's referral to a fertility specialist. After your first meeting with a fertility physician, you will complete ovarian reserve testing (serum anti-muellerian hormone (AMH) and antral follicle count (AFC) via transvaginal ultrasound). You will then have a discussion with your physician about reasonable expectations for number of eggs and medication dosing. A typical egg freezing cycle may include priming (starting a 1-3 weeks prior to stimulation), ovarian stimulation (lasts 10-12 days), and transvaginal ultrasound-guided egg retrieval (1 day)​. You will know how many mature eggs were frozen at the time of your egg retrieval. ​ During ovarian stimulation, you may require 4-5 early morning (7 - 9am) appointments for bloodwork and transvaginal ultrasounds. On the date of the egg retrieval, you typically receive sedation which requires you to be off-work for 24 hours and you will require a ride home. Most people feel well enough to work during priming and stimulation and return to work the day after retrieval. ​ Proactive Sperm Freezing You will need to ask for a physician's referral to a fertility specialist. You may have a semen analysis prior to discussing banking, or you may proceed with banking with a semen analysis at the time of banking. Sperm is washed and processed in the laboratory. It is then divided into different vials. The number of vials per ejaculate varies One vial of sperm is typically used in treatments such as IUI or IVF. Proactive Embryo Freezing You will need to ask for a physician's referral to a fertility specialist. If you are partner with eggs with a partner that produces sperm, then the female partner will complete ovarian reserve testing (serum anti-muellerian hormone (AMH) and antral follicle count (AFC) via transvaginal ultrasound) and the male partner will complete a semen analysis. You will then have a discussion with your physician about reasonable expectations for number of eggs/embryos and medication dosing. A typical embryo freezing cycle may include priming (starting a 1-3 weeks prior to stimulation), ovarian stimulation (lasts 10-12 days), and transvaginal ultrasound-guided egg retrieval (1 day)​. The eggs will then be fertilized via traditional in vitro fertilization or intracytoplasmic sperm infection and embryos will be cultured until day 5-7. You will receive periodic updates about the growth of embryos. Embryos that reach blastocyst stage can be biopsied to assess genetic makeup. They will then be frozen. You will receive an update about how many embryos were frozen. ​ During ovarian stimulation, the female may require 4-5 early morning (7 - 9am) appointments for bloodwork and transvaginal ultrasounds. On the date of the egg retrieval, the female will typically receive sedation which requires them to be off-work for 24 hours and will require a ride home. Most people feel well enough to work during priming and stimulation and return to work the day after retrieval. The male partner produces sperm on the date of egg retrieval. ​ If donor sperm or donor eggs are used, these need to be sourced. This can be directed (identified) or non-identified.

There is no effect on your natural fertility if you choose to freeze your eggs. It does not deplete the number as it is drawing from the available pool of eggs that would have died off anyway if they were not the "chosen" one to ovulate.

Some clinics will accept a self-referral, some will not. The reason for this is primarily billing. Some clinics may also see you with the self-referral program but then ask you to obtain a referral from a physician after (again for billing purposes). Other clinics will connect you with a doctor who could provide a referral if you are unable to obtain one on your own.

If you fall into one of the categories below, ask your healthcare provider for a referral to a fertility specialist (Reproductive Endocrinologist and Infertility specialist (REI) ): ​ Persons in a heterosexual relationship in which the : Female is under 35 and the couple has been trying to conceive for one year without success Female is between 35-40 and have been trying to conceive for 6 months without success Female over 40 and are trying to conceive without success Female with anovulatory/irregular cycles (it is reasonable to still try to conceive with regular intercourse every 2-3 days for 6 months before seeing a fertility physician) Persons with more than 2-3 pregnancy losses Persons considering fertility preservation (in vitro fertilization, egg freezing or sperm freezing) for medical or proactive reasons Persons with a known medical condition that may impact fertility (e.g. prior sexually transmitted infection, endometriosis, prior testicular surgery, prior tubal surgery, prior ectopic pregnancy) Persons who are in a same-sex relationship ​ ​ ​

All females who are trying to conceive should start on 0.4 mg of folic acid and 2000 units of vitamin D 2-3 months prior to conception to support critical phases of early development in a pregnancy, which often occur before a person realizes they are pregnant. Approximately 75-80% of couples will conceive within 6 months, 85% will conceive within 1 year and 95% will conceive within 2 years. ​ Here are some ways to optimize natural conception : Use a calendar or app to track your ovulation (i.e. Glow) - in general, you ovulate 2 weeks before your menstrual period Measure ovulation with an LH testing strip (have intercourse if LH positive and next day) Have intercourse every 1-2 days in the 6 days before ovulation if you have regular cycles, or every 2-3 days if you have irregular cycles If using lubricant - look for those that do not affect sperm quality (i.e. mineral oil, canola oil or hydroxyethylcellulose-based lubricants) Avoid smoking, alcohol and recreational drug use Optimize BMI Limit caffeine intake to < 500 mg per day (i.e. 2-3 cups of coffee per day)

No, not necessarily! ​ If you fall into one of the categories above, then yes, you should ask for a referral to a fertility specialist for a discussion about possible testing if appropriate.. However, if you are under the age of 40 and just starting to try to conceive, testing may be confusing. Fertility tests look at the number of eggs (ovarian reserve) at a static time in a female's life, the motility and concentration of sperm, the uterine cavity and the fallopian tubes. This is a very surface level assessment of whether conception may be successful. We know that at least 15-20% of individuals who have normal tests will still be unable to conceive. Similarly, those with abnormal tests may still be able to conceive spontaneously. ​ Females often wonder about getting ovarian reserve testing "just in case." Anti-Muellarian Hormone (AMH) and antral follicle counts (AFC) are tests of ovarian reserve. AMH is a blood test while AFC requires a transvaginal ultrasound. AMH is not covered by provincial health plans and costs between $75-150. It is primarily used to understand how a patient may respond if they were to be stimulated, such as during controlled ovarian stimulation or IVF. Ovarian reserve testing can be helpful to help you predict your personal timeline if you are considering delaying childbearing and/or fertility preservation, however, there are important caveats. Importantly, ovarian reserve measures do not predict spontaneous conception. In addition, ovarian reserve testing provides one static value in time and that alone cannot predict future decline. ​ Fertility treatments such as ovulation induction, intrauterine insemination, and/or in vitro fertilization are not necessarily better forms of conception if they are not indicated by clinical situation. As medical interventions, they carry risks.

The discussion of treatment costs below is an average in Ontario in 2022. It is also important to note that not all fertility centres will offer all treatments. ​ Ovulation Induction/Controlled Ovarian Stimulation Treatment Description : The ovulating partner takes medication to achieve ovulation with one follicle or increase the number of follicles (2-3) per cycle. Medication may include letrozole (tablets) or injectable gonadotropins. This is combined with timed intercourse or intrauterine insemination. This is usually recommended for 3-6 cycles, but may be recommended longer depending on the medical indication. Cost per cycle: Costs include medications, cycle monitoring and/or sperm wash. This may range from $30 - $1500 depending on whether intrauterine insemination is indicated and what medication was prescribed. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum) Timing: takes 1 menstrual cycle to complete Intrauterine Insemination (IUI) Treatment Description: Placement of sperm into the uterus of the ovulating partner at the time of ovulation. This can occur with male partner’s sperm or with donor sperm. Sperm is usually produced or thawed, washed and prepared and then placed via a catheter during a speculum exam for the female. This may or may not be combined with ovulation induction/controlled ovarian stimulation. Cost per cycle: ​ Sperm processing + procedure: $600-1000 Medications: $100-1500 Donor sperm: $750-1000 per vial In Ontario, there is partial cost coverage but eligibility varies by clinic. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum). Timing: takes 1 menstrual cycle to complete. In Vitro Fertilization (IVF) Treatment Description: IVF involves ovarian stimulation with medications to produce more than one follicle per cycle, transvaginal egg retrieval with ultrasound guidance, combination of sperm with eggs in the laboratory to achieve fertilization via traditional IVF or intracytoplasmic sperm and the growth of embryos within the laboratory. Embryos can be transferred in a fresh IVF cycle or frozen for use at a later date. Costs per cycle: Costs for IVF include procedural costs, medication costs, storage costs, embryo transfer costs and add-on costs. A popular add-on is pre-implantation genetic testing for aneuploidy (PGT-A), which is optional but may be quoted to you by clinics. Procedural Costs of IVF : $11 000 - $15 000 Medications: $3000 - $8000, average $5000 Storage of embryos: $500-900 per year Frozen Embryo Transfer Costs : $1600 - $3000 PGT-A (optional) : $4000 - $7000 In Ontario, one cycle of IVF is covered by OHIP if under the age of 43 years. One cycle consists of ovarian stimulation, egg retrieval, IVF or ICSI fertilization, and all embryo transfers for embryos created during the funded cycle. Medications, storage and add-ons are not covered. Some provincial union drug benefits cover the medications (i.e. PARO covers 100% of fertility medications). Similarly, some medical association drug benefits cover fertility medication (i.e. OPIP through OMA covers $7000 lifetime maximum). Timing: A typical IVF cycle includes 1 menstrual cycle for priming (optional), 1 menstrual cycle for ovarian stimulation, egg retrieval, fertilization and growth of embryos. If embryos are frozen, the transfer can take place during a natural menstrual cycle or medicated cycle in the future. Donor gametes Treatment Description: Donor eggs or sperm can be used in each of the above family building options. Embryo donation is also possible. Donation may be directed (identified) or non-identified. Egg donation may be fresh or frozen. Not all clinics can facilitate all available options as they may not have the appropriate Health Canada approval to do so. There are agencies and banks that may be used by clinics. Cost: Cycle costs as above Coordination fees : $1000 - 3000 Sperm: $750-1000 per vial Oocytes: $18000-42000 Legal fees: $1000 - $3000 Counselling fees : $200 - $500 Timing: The time to find donor gametes is highly variable depending on the options selected Gestational Carrier (GC), also known as Surrogacy Treatment Description: An individual who agrees to carry a pregnancy but is not genetically related to the embryo. This involves the creation of embryos through IVF. GCs can be known to you, found by word-of-mouth or found through agencies. Different clinics also have different requirements for finding GCs and GC screening. Cost: Cycle costs as above Coordination fees : $1000 - 3000 Legal fees: $1000 - $3000 Counselling fees : $200 - $500 Timing: Variable, dependent on finding a GC.

Investigations typically ordered include : Ovarian reserve measurements : AMH (anti-Mullerian hormone) and AFC (antral follicle count) AFC is obtained through transvaginal ultrasound Uterus/ovarian structure, uterine cavity and fallopian tube patency assessments : transvaginal ultrasound and sonohysterogram a sonohysterogram is a procedure in which saline is inserted into the uterine cavity with a small catheter placed during a speculum exam by an OBGYN in combination with a transvaginal ultrasound ​ Assessment of semen concentration and motility : semen analysis ​ Other investigations may also be recommended based on your medical history.

Adoption ​ There are four types of adoption : public adoption, private adoption, international adoption, and family adoption. Adoption costs range from $15 000- $50 000 depending on the type of adoption. It can take several months to a year to complete the registration/preparation process for adoption. It can then take several months to several years to find and adopt a child. ​ Click on the links below for more specific provincial adoption information : Ontario British Columbia Quebec Nova Scotia Alberta P.E.I. Newfoundland & Labrador Saskatchewan Manitoba

Infertility is defined as not being able to conceive after 12 months of actively trying without contraception. There are broad categories including female infertility (ovulatory dysfunction, tubal issues), male infertility and unexplained infertility.

Facebook groups in your area, especially physician groups Subscription websites such as nannyservices.ca OR canadiannanny.ca OR care.com Nanny agencies within your area (typical costs $3000-$5000)

Check local parent facebook groups Google daycares in your area Check if your University or Hospital has daycare options

Nannies on Call

This is highly dependent on where you live. In general, add your child as early as possible! Yes - this means in pregnancy! Daycares may ask you to fill out some basic information. You should add your child to multiple waitlists. Also, follow-up frequently with the daycares you are most keen on to find out if they have a spot available.

Decide on a start date Decide on job description Number of children Desired activities Hours that need to be covered ​ Do you need someone who drives? Will you provide gas money or a transit pass? Will there be additional duties such as housekeeping, cooking, and/or laundry? Do you have pets?​ ​​Decide what aspects of your job description you're willing to negotiate on as this will be important when you start finding candidates Decide if you are willing to sponsor a nanny Details on bringing in a nanny from overseas can be found here​ Look at average salaries in your area and decide what you are comfortable paying Many nannies speak in "net" terms - this refers to their post-tax income​ Start looking (post job on websites, hire an agency, check on facebook groups) within 1 month of start date Interview nannies by phone Set up in-person interview or trial date Set up payroll - many people use payroll services such as ADP

Staying active during your pregnancy is important to maintain your physical health. The following can be helpful : only do what makes you feel comfortable minimize lifting, bending and prolonged standing be conscious of posture - seeing a physiotherapist may be helpful to adjust appropriately in prolonged activities (i.e. surgery) use a support belt use proper lifting techniques take breaks when possible

hydration (flavour water if water makes you nauseous!) small meals/frequent snacks chewing gum/sucking on hard candies take prenatal vitamins in the evening, instead of in the morning medication (i.e. diclectin, maxeran, ondansetron, gravol)

This answer is specific to Ontario According to PARO - you should not be using vacation/professional days for medical appointments

This varies for many people. Some people work until the day they have their baby, others choose to take off more time beforehand. This may also depend on whether you experience any complications in your pregnancy that require you to be off work. If you do have medical complications during your pregnancy - discuss sick leave with your program/school before using your maternity leave. This may also depend on the rotations that you are scheduled for and what accommodations are possible if required.

exposure to X-ray - ensure appropriate dosimeter monitoring, wear proper shielding, minimize time of exposure and maximize distance from source ; speak to occupational health about adequate precautions. This further resource may be helpful : https://womenasone.org/radiation-safety/ exposure to chemotherapeutic agents exposure to anesthetic gases has been linked to miscarriage in a single study protect yourself as below if providing care to patients with infectious diseases

Stillbirth is much less common. In general - this is a loss occurring over 20 weeks gestation. It can be a result of maternal, fetal or placental factors. Read more here.

Pregnancy loss may be completely asymptomatic or present with cramping and/or bleeding. Bleeding and/or cramping occurs in up to 20-40% of normal (viable) pregnancies. If you are having bleeding and/or cramping, contact your healthcare provider for consideration of investigations such as bloodwork and/or an ultrasound if appropriate. Read more here. ​ Most early pregnancy losses can be managed at home. You should go to an emergency department if you have severe pain that is not relieved by Tylenol/Advil, feel faint, and/or have heavy bleeding (soaking a pad within an hour for 2-3 hours).

Depending on the gestational age of the loss, the options may include : Expectant Management Medical Management (usually Mifepristone + Misoprostol) Surgical Management (Dilatation + Curettage/Evacuation) Your care provider may recommend a specific option depending on your clinical situation. Read more here: PregnancyED

First-trimester pregnancy loss occurs in up to 30% of pregnancies overall, and up to 10% of clinically recognized pregnancies. If a pregnancy is visualized on ultrasound and a heartbeat is present, the occurrence of miscarriage is 3-5%. The incidence of pregnancy loss greatly varies with female age. Below the age of 30, pregnancy loss ranges from 7-15%. Pregnancy loss begins to rise for females aged 30-34 (8-21%), females 35-39 (17-28%) and is highest for females aged 40 and above (34-52%)​ Second-trimester pregnancy loss occurs in less than 1% of pregnancies.

First-trimester Pregnancy Loss Chromosomal abnormalities account for 50-70% of first-trimester pregnancy loss. Increasing female age is an important cause of chromosomal abnormalities. Other causes include maternal medical conditions (i.e. endocrinopathies, cardiovascular disease, and metabolic disorders), infection, diabetes, elevated BMI, thyroid disease, long-term stressors, inherited thromobophilias, presence of an IUD, medications, substance use, environmental factors, trauma, race/ethnicity and paternal medical conditions (i.e. metabolic conditions). ​ Second-Trimester Pregnancy Loss Second-trimester loss is much less common. Specific factors that may contribute include infection, chronic stressors, uterine malformations, cervical insufficiency, fetal malformations, thrombophilias, abruption, preterm prelabor rupture of membranes, and preterm labour.

Pregnancy termination for any reason is legal in Canada. Speak to your healthcare provider about options. You can also find more resources and a confidential phone line here.

Terminology There are many different terms to describe pregnancy loss. The most important ones to be aware of are : ​ Early Pregnancy Loss : Pregnancy loss under 20 weeks Stillbirth : Pregnancy loss over 20 weeks gestation Recurrent Pregnancy Loss : 2-3 pregnancy losses ​ Other terms used include : ​ Anembryonic Pregnancy/Blighted Ovum : gestational sac seen on ultrasound, but no yolk sac and/or embryo visible Embryonic Demise : embryo measuring over 7mm without cardiac activity Miscarriage : synonymous with pregnancy loss Biochemical Pregnancy Loss : pregnancy loss prior to visualization of pregnancy structures on ultrasound Second-trimester Pregnancy Loss : pregnancy loss occurring between 13+0 weeks and 20+0 weeks gestation Missed Abortion : pregnancy loss without any symptoms