Fertility and Andrology
Canadian Fertility and Andrology Society
Last updated: December 2025
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Preimplantation genetic testing for aneuploidy (PGT-A) was developed to help select the best embryos for transfer in an in vitro fertilization (IVF) cycle by screening out aneuploidy. However, there is no improvement in live birth rates compared with IVF alone. PGT-A adds extra cost, carries a risk of misdiagnosis, and there is limited long-term data reported on childhood outcomes. Patients should be counselled on the risks and limitations of testing.
Sources:
Chan C, et al. Preimplantation genetic testing for aneuploidy: A Canadian Fertility and Andrology Society Guideline. Reproductive Biomedicine Online. 2021; 42(1): 105-116. PMID: 33303366.
ESHRE Add-ons working group; Lundin K, et al. Good practice recommendations on add-ons in reproductive medicine. Hum Reprod. 2023 Nov 2;38(11):2062-2104. PMID: 37747409.
Ginström Ernstad E, et al. Preimplantation genetic testing and child health: a national register-based study. Hum Reprod. 2023 Apr 3;38(4):739-750. PMID: 36749096.
Munne S, et al. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good prognosis patients: a multicenter randomized clinical trial. Fertility and Sterility. 2019; 112(6):1071–1079. PMID: 31551155.
Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Electronic address: asrm@asrm.org. The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertil Steril. 2024 Sep;122(3):421-434. Epub 2024 May 18. PMID: 38762806.
Yan J, et al. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy. N Engl J Med. 2021 Nov;385(22):2047-58. PMID: 34818479.
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Several studies demonstrate that the use of high doses of gonadotropins does not result in an increased number of mature oocytes retrieved nor good quality embryos produced compared with lower dosing regimens. Given that there is a greater cost to the patient, with no evidence of an improved outcome, avoidance of high doses of gonadotropins is recommended.
Sources:
Ata B, et al. Guideline on Ovarian Stimulation for IVF/ICSI. [Internet]. 2025 [cited 2025 Dec].
Friedler S, et al. An upper limit of gonadotropin dose in patients undergoing ART should be advocated. Gynecol Endocrinol. 2016 Dec;32(12):965-969. PMID: 27345589.
Haas J, et al. Do poor-responder patients benefit from increasing the daily gonadotropin dose during controlled ovarian hyperstimulation for IVF? Gynecol Endocrinol. 2015 Jan;31(1):79-82. PMID: 25223892.
Ngwenya O, et al. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI). Cochrane Database Syst Rev. 2024 Jan 4;1(1):CD012693. PMID: 38174816.
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Assisted hatching (AH) is a technique where the zona pellucida is disrupted to improve implantation and therefore live birth rates from embryos created through IVF. Although there may be a benefit to performing AH in certain patient populations, the routine use of AH for all patients undergoing an embryo transfer has not been shown to improve live birth rates.
Sources:
Alteri A, et al. The effect of laser-assisted hatching on vitrified/warmed blastocysts: the ALADDIN randomized controlled trial. Fertil Steril. 2024 Jul;122(1):106-113. Epub 2024 Feb 9. PMID: 38342371.
Curfs MHJM, et al. A multicentre double-blinded randomized controlled trial on the efficacy of laser-assisted hatching in patients with repeated implantation failure undergoing IVF or ICSI. Hum Reprod. 2023 Oct 3;38(10):1952-1960. PMID: 37646072.
Lacey L, et al. Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI)). Cochrane Database Syst Rev. 2021 Mar 17;3(3):CD001894. CD001894.pub6. PMID: 33730422.
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Hysteroscopy before IVF in a person with a normal uterus on transvaginal ultrasound does not improve the live birth rate.
Sources:
El-Toukhy T, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet. Jun 25 2016;387(10038):2614-2621. Epub Apr 27 2016. PMID: 27132053.
Smit JG, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet. Jun 25 2016;387(10038):2622-2629. Epub Apr 27 2016. Erratum in: Lancet. Jun 15 2019;393(10189):2394. PMID: 27132052.
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Current available endometrial receptivity testing with personalized embryo transfer causes patient discomfort, additional costs, with no improvement in pregnancy rate.
Sources:
Doyle N, et al. Effect of Timing by Endometrial Receptivity Testing vs Standard Timing of Frozen Embryo Transfer on Live Birth in Patients Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA. Dec 6 2022;328(21):2117-2125. PMID: 36472596.
Glujovsky D, et al. Personalized embryo transfer guided by endometrial receptivity analysis: a systematic review with meta-analysis. Human Reproduction. 2023 Jul 1;38(7):1305-17. PMID: 37203432.
Richter KS, et al. Personalized embryo transfer reduces success rates because endometrial receptivity analysis fails to accurately identify the window of implantation. Human Reproduction. 2023 Jul 5;38(7):1239-44. PMID: 37119530.
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Repetitive hormone blood tests (FSH, LH, estradiol and progesterone) and ultrasounds during a menstrual cycle to advise infertile patients on when to time intercourse are not necessary. Optimal timing of intercourse to achieve pregnancy can be easily performed through at home urinary ovulation predictor kits or the use of a fertility application with high fecundability rates. Additionally, these tests create patient discomfort, require travel to the clinic, and use of plastic blood tubes and reagents, contributing to the growing negative impact of emissions and healthcare waste on the environment.
Sources:
Favaro C, et al. Time to Pregnancy for Women Using a Fertility Awareness Based Mobile Application to Plan a Pregnancy. J Womens Health (Larchmt). Nov 2021;30(11):1538-1545. Epub Sept 8 2021. PMID: 34495761.
Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-1265. Epub Oct 2 2021. PMID: 34607703.
Silverstein WK, et al. Reducing routine inpatient blood testing. BMJ. Oct 26 2022;379:e070698. PMID: 36288811.
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Travelling long distances to access treatment for infertility is not uncommon. Most fertility consultations and follow-up visits can be safely performed remotely. CO2 emissions from transportation contribute to greenhouse gas emissions and climate change, which can be significantly reduced by providing virtual visits instead of in-person visits. Virtual care can also reduce time away from work and costs to patients.
Sources:
Grens H, et al. Online fertility workup with video consultation for infertility patients; a randomized controlled trial. Fertil Steril. 2025 Sep;124(3):534-542. Epub 2025 Apr 24. PMID: 40280221.
Tennison I, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. Feb 2021;5(2):e84-e92. PMID: 33581070.
Tran HP, et al. The impacts of telemedicine on assisted reproduction: a systematic review and meta-analysis. Reprod Biomed Online. 2024 May;48(5):103752. Epub 2023 Nov 29. PMID: 38489925.
Willson S, et al. Navigating fertility care in the telehealth era: association of consultation mode with patient engagement and pregnancy outcomes. J Assist Reprod Genet. 2025 Oct;42(10):3453-3460. Epub 2025 Aug 19. PMID: 40826201.
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The Canadian Fertility and Andrology Society (CFAS) Choosing Wisely National Working Group used a modified Delphi consensus approach, consisting of 5 rounds, to generate item ideas, review supporting evidence, assess clinical relevance, estimate recommendation impact and narrow the items for the original list. The Working Group was comprised of 11 diverse clinicians with experience in the field. Round 4 of the Delphi process consisted of a National CFAS Membership Survey to rank the remaining 13 items. The top 5 items were selected based on 4 qualities: prevalence, cost, potential for harm and impact on clinical practice (round 5). The CFAS Board of Directors provided feedback which was incorporated into the composition of the final list approved by the Board. The first 5 recommendations were released in January 2020. Additional recommendations were added to the list in March 2024. The CFAS Choosing Wisely Canada Working Group Lead and the Clinical Practice Guideline Committee created the new recommendations and annual revision of the list which was approved by the CFAS Board of Directors.
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Choosing Wisely Canada’s climate-conscious recommendations are developed by clinician societies to improve planetary health without compromising patient care. These recommendations highlight everyday practices we can reduce or eliminate to minimize environmental harm. Visit our climate page to explore all the recommendations and learn more.
Sources:
Chan C, et al. Preimplantation genetic testing for aneuploidy: A Canadian Fertility and Andrology Society Guideline. Reproductive Biomedicine Online. 2021; 42(1): 105-116. PMID: 33303366.
ESHRE Add-ons working group; Lundin K, et al. Good practice recommendations on add-ons in reproductive medicine. Hum Reprod. 2023 Nov 2;38(11):2062-2104. PMID: 37747409.
Ginström Ernstad E, et al. Preimplantation genetic testing and child health: a national register-based study. Hum Reprod. 2023 Apr 3;38(4):739-750. PMID: 36749096.
Munne S, et al. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good prognosis patients: a multicenter randomized clinical trial. Fertility and Sterility. 2019; 112(6):1071–1079. PMID: 31551155.
Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Electronic address: asrm@asrm.org. The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertil Steril. 2024 Sep;122(3):421-434. Epub 2024 May 18. PMID: 38762806.
Yan J, et al. Live Birth with or without Preimplantation Genetic Testing for Aneuploidy. N Engl J Med. 2021 Nov;385(22):2047-58. PMID: 34818479.
Ata B, et al. Guideline on Ovarian Stimulation for IVF/ICSI. [Internet]. 2025 [cited 2025 Dec].
Friedler S, et al. An upper limit of gonadotropin dose in patients undergoing ART should be advocated. Gynecol Endocrinol. 2016 Dec;32(12):965-969. PMID: 27345589.
Haas J, et al. Do poor-responder patients benefit from increasing the daily gonadotropin dose during controlled ovarian hyperstimulation for IVF? Gynecol Endocrinol. 2015 Jan;31(1):79-82. PMID: 25223892.
Ngwenya O, et al. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF/ICSI). Cochrane Database Syst Rev. 2024 Jan 4;1(1):CD012693. PMID: 38174816.
Alteri A, et al. The effect of laser-assisted hatching on vitrified/warmed blastocysts: the ALADDIN randomized controlled trial. Fertil Steril. 2024 Jul;122(1):106-113. Epub 2024 Feb 9. PMID: 38342371.
Curfs MHJM, et al. A multicentre double-blinded randomized controlled trial on the efficacy of laser-assisted hatching in patients with repeated implantation failure undergoing IVF or ICSI. Hum Reprod. 2023 Oct 3;38(10):1952-1960. PMID: 37646072.
Lacey L, et al. Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI)). Cochrane Database Syst Rev. 2021 Mar 17;3(3):CD001894. CD001894.pub6. PMID: 33730422.
El-Toukhy T, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet. Jun 25 2016;387(10038):2614-2621. Epub Apr 27 2016. PMID: 27132053.
Smit JG, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet. Jun 25 2016;387(10038):2622-2629. Epub Apr 27 2016. Erratum in: Lancet. Jun 15 2019;393(10189):2394. PMID: 27132052.
Doyle N, et al. Effect of Timing by Endometrial Receptivity Testing vs Standard Timing of Frozen Embryo Transfer on Live Birth in Patients Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA. Dec 6 2022;328(21):2117-2125. PMID: 36472596.
Glujovsky D, et al. Personalized embryo transfer guided by endometrial receptivity analysis: a systematic review with meta-analysis. Human Reproduction. 2023 Jul 1;38(7):1305-17. PMID: 37203432.
Richter KS, et al. Personalized embryo transfer reduces success rates because endometrial receptivity analysis fails to accurately identify the window of implantation. Human Reproduction. 2023 Jul 5;38(7):1239-44. PMID: 37119530.
Favaro C, et al. Time to Pregnancy for Women Using a Fertility Awareness Based Mobile Application to Plan a Pregnancy. J Womens Health (Larchmt). Nov 2021;30(11):1538-1545. Epub Sept 8 2021. PMID: 34495761.
Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-1265. Epub Oct 2 2021. PMID: 34607703.
Silverstein WK, et al. Reducing routine inpatient blood testing. BMJ. Oct 26 2022;379:e070698. PMID: 36288811.
Grens H, et al. Online fertility workup with video consultation for infertility patients; a randomized controlled trial. Fertil Steril. 2025 Sep;124(3):534-542. Epub 2025 Apr 24. PMID: 40280221.
Tennison I, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. Feb 2021;5(2):e84-e92. PMID: 33581070.
Tran HP, et al. The impacts of telemedicine on assisted reproduction: a systematic review and meta-analysis. Reprod Biomed Online. 2024 May;48(5):103752. Epub 2023 Nov 29. PMID: 38489925.
Willson S, et al. Navigating fertility care in the telehealth era: association of consultation mode with patient engagement and pregnancy outcomes. J Assist Reprod Genet. 2025 Oct;42(10):3453-3460. Epub 2025 Aug 19. PMID: 40826201.
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.
Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada
Questions to Ask Your Health Care Provider
Four questions to ask about the benefits and risks of tests, treatments, and procedures.