Half of conception.
Often half of the story.

For most patients, the simplest entry point is a Fertility Check for Sperm. It includes a full semen analysis and a 20-minute virtual review with one of our fertility specialists, plus a personalized report. It’s $250 in both Toronto and Vancouver, requires no referral, and gives you a clear baseline. If your results suggest further evaluation, your specialist will guide you to the right next step, whether that’s a Family Building Consult or deeper diagnostic workup. You can book directly through our website.

A few things. Our Toronto and Vancouver labs both perform ICSI, PICSI, and sperm freezing in-house. We have a reproductive urologist on staff who performs surgical sperm retrievals (PESA and TESA) on-site, rather than referring out. For complex cases requiring microTESE at a hospital, we coordinate the surgical date and the sample transport so the experience stays seamless. Most Canadian fertility clinics handle the IVF side but refer out the surgical urology piece. We don’t.

The first step is a fertility consult with one of our specialists. A semen analysis gives a snapshot in time, but the right next step depends on the full picture: hormone levels, medical history, lifestyle, and the reproductive picture of the person you’re planning to conceive with. We’ll review the data and discuss what’s most likely to help: lifestyle changes, medication, IUI, IVF with ICSI, or further specialized testing.

IVF (in vitro fertilization) is the cycle that combines eggs with sperm in our lab to create embryos. ICSI (intracytoplasmic sperm injection) is a specific fertilization technique used during IVF, where one sperm is injected into each egg. ICSI dramatically improves fertilization when sperm counts or motility are low. PICSI is a refinement of ICSI that uses hyaluronic acid to select more mature sperm with intact DNA, which may help patients with elevated DNA fragmentation or recurrent early pregnancy losses.

Sperm regenerate on a 2 to 3 month cycle, so changes you make now show up in a semen analysis about a season later, and most sperm providers can meaningfully improve their parameters in a single quarter. The biggest levers: stop smoking and vaping, cut back or stop cannabis, minimize alcohol, avoid scrotal heat (hot tubs, saunas, laptops on the lap), stay active and keep a healthy weight, avoid anabolic steroids and testosterone, and eat a Mediterranean-style diet. Antioxidant supplements like CoQ10 and L-carnitine, started at least three months ahead, may help, especially with elevated oxidative stress. Your Twig team can pinpoint what's worth changing for your specific picture.

About 2 to 3 months. That’s the length of the sperm life cycle. Lifestyle changes you make today (better sleep, less alcohol, better diet, more exercise, less heat exposure) will be reflected in a semen analysis a season from now. The corollary is that the sperm in today’s ejaculate reflect the past 3 months of your life.

Most children born to older sperm providers are healthy. Research suggests risks begin to gradually increase around age 40, with weak associations to slightly higher rates of certain conditions. The risk of a child with one of the rare genetic conditions associated with sperm age is less than 0.5%. If you’re a sperm provider over 40 considering family building, we can discuss your specific picture during your initial consult.

Surgical sperm retrieval recovers sperm directly from the epididymis or the testicle in cases of obstructive azoospermia (a blockage preventing sperm from reaching the ejaculate) or severe ejaculatory dysfunction. The two main on-site procedures are PESA (aspiration from the epididymis) and TESA (aspiration from the testicle). Both are minimally invasive, performed under local anesthesia, and take place at the Twig clinic with a reproductive urologist on staff. For more complex cases (non-obstructive azoospermia), microTESE is performed at a hospital with our coordination.

Sperm freezing is worth considering if you’re starting cancer treatment (chemo and radiation can permanently affect sperm production), if you’re undergoing a surgical procedure that could affect fertility, if your current job involves prolonged exposure to fertility-affecting environments, or if you’re planning a family later in life and want to preserve current sperm quality. Sperm freezing at Twig is $600 and includes the first 3 months of storage; ongoing cryostorage is $800/year in Toronto, $900/year in Vancouver.

Some diagnostic tests are covered by OHIP in Ontario, including semen analysis, hormone testing, and infectious disease screening. DNA fragmentation tests are typically not covered. In British Columbia, MSP covers some baseline tests, but self-pay applies for many sperm-specific tests. The Ontario Fertility Tax Credit covers 25% of eligible expenses up to $5,000 per year. Funded IVF cycles are available to eligible Ontario residents.