Urgent Sperm Freezing: What to Do When Treatment Starts Soon

TL;DR: If you're facing cancer treatment, surgery, hormone therapy, or another medical situation that could affect fertility, urgent sperm freezing can help preserve your future family-building options before treatment begins. 

It typically involves a semen sample, routine infectious disease screening, and secure long-term storage. 

Timing matters because some treatments can permanently affect sperm production, and once treatment starts, the opportunity to freeze sperm may become limited. 

At King Square Fertility in Markham, the team works with patients facing tight timelines. We provide supportive, culturally sensitive care to help make the process as simple and stress-free as possible. 

If fertility preservation is important to you, speak with your doctor about a referral as soon as possible.

Urgent Sperm Freezing: What to Do When Treatment Starts Soon

You might be reading this because a doctor just shared news you were not ready to hear. 

Maybe it was a cancer diagnosis. Maybe it’s a surgery that needs to happen soon. Or maybe hormone therapy is scheduled to start within days. 

Then, somewhere in that conversation, fertility came up, and now you’re trying to make sense of sperm freezing while also processing everything else.

This isn’t how most men expect to learn about fertility preservation. You may have imagined sperm freezing as something planned far in advance, with plenty of time to think it through. But sometimes, the timeline is much shorter. 

At King Square Fertility, we understand that urgent sperm freezing often happens during a stressful and emotional time. 

We’ll explain what sperm freezing involves, how quickly it may be arranged, what could slow things down, and what you can do now to help preserve your future options.

Why Sperm Freezing Before Treatment Matters

Some medical treatments can affect sperm production, either for a short time or permanently. 

Chemotherapy, radiation near the pelvis, certain surgeries, and hormone therapies can lower sperm count, affect sperm quality, or stop sperm production altogether.

That’s why it’s important to talk about fertility before treatment begins. The Canadian Cancer Society recommends discussing fertility preservation before cancer treatment, since the chance to freeze sperm may become limited once treatment starts.

Sperm freezing, also called sperm banking or sperm cryopreservation, means collecting and storing sperm before treatment. The samples can stay frozen for many years and may be used later with fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

Timing matters because sperm production may take months or years to recover after treatment, and in some cases, it may not return. 

Since there’s no way to know exactly how your body will respond, freezing sperm beforehand can help protect your future options.

If you’re facing treatment that may affect your fertility, asking about sperm freezing before you begin is a practical step that can give you more choices later.

What Urgent Sperm Freezing Involves

The process is often more straightforward than people expect, even when the reason for doing it feels stressful or sudden.

The Collection Process

Sperm collection usually means providing a semen sample in a private room at the fertility clinic. For most men, this is done through masturbation. 

It may feel awkward to think about, especially when you’re already dealing with a medical situation, but clinics that handle urgent sperm freezing are used to supporting patients through this part with privacy and respect.

If collecting a sample this way isn’t possible because of medical, cultural, personal, or religious reasons, tell the clinic ahead of time. 

Other options may be available, including at-home collection in some cases or surgical sperm retrieval when needed.

Testing and Screening

Before sperm can be frozen, most clinics complete standard infectious disease screening. This usually involves blood tests for infections such as HIV, hepatitis B, hepatitis C, and other transmissible conditions.

This is a routine safety step. If your treatment timeline is tight, ask whether testing can be done the same day as collection or processed quickly. This can help the clinic move things along as efficiently as possible.

Freezing and Storage

After your sample is collected and cleared for freezing, the lab prepares it with a protective solution that helps sperm cells survive freezing. 

The sample is then stored in liquid nitrogen at extremely low temperatures, where it can remain usable for many years.

If time allows, your care team may recommend providing multiple samples. This can give you more options later. But if there’s only time for one sample, that still matters. It’s still a meaningful step toward protecting your future fertility.

How Quickly Can Urgent Sperm Freezing Be Arranged?

This is usually the first question people ask, and for good reason. When treatment is approaching quickly, timing matters.

In many cases, urgent sperm freezing can be arranged within a short window, sometimes within a day or two. However, timing can depend on appointment availability, lab schedules, and required testing.

At King Square Fertility, we understand that patients facing medical treatment may not have much flexibility. Our team works to accommodate urgent requests whenever possible, although we can’t always guarantee same-day appointments.

The best thing you can do is reach out as soon as you know sperm freezing may be needed. Even one or two days of notice can make a real difference.

If your oncologist, surgeon, or treating physician can send a referral or note explaining the urgency, that can also help move the process forward. 

Get Urgent Sperm Freezing Support in Markham at King Square Fertility

When medical treatment needs to move quickly, it’s easy for fertility questions to get pushed aside. But even one conversation, one referral, or one stored sample can make a meaningful difference later.

At King Square Fertility, we understand that this decision often comes during a stressful and emotional time. Our team handles urgent sperm freezing with privacy, respect, and clear guidance, helping you understand what can be done and how quickly it may happen.

If your treatment may affect your fertility, speak with your doctor about a referral as soon as possible. Then, contact us to ask about urgent sperm freezing and your next steps. 

Frequently Asked Questions About Urgent Sperm Freezing

How long can frozen sperm be stored?

Frozen sperm can be stored for many years when it’s kept under the right conditions. There’s no set expiration date, and successful pregnancies have happened using sperm frozen for 20 years or more. 

You’ll usually pay storage fees, so it’s important to keep your contact information up to date with the clinic.

What if I’m too unwell to visit the clinic in person?

If you’re too unwell to come in, ask the clinic what options may be available. Some clinics may allow at-home collection in a sterile container, provided the sample is delivered within a specific time window. 

If you’re in the hospital, bedside collection may be possible in certain situations. The best step is to speak with the fertility clinic directly so they can guide you based on your needs.

Is sperm freezing covered by provincial health insurance in Ontario?

In some cases, yes. Ontario’s Fertility Program may cover fertility preservation, including sperm freezing, for eligible patients who are facing medical treatment that could cause infertility, such as chemotherapy, radiation, or certain surgeries.

What Semen Analysis Before Sperm Freezing Reveals About Your Sample

TL;DR: Semen analysis before sperm freezing is a planning tool that helps your care team understand your sperm count, movement, shape, and overall sample quality before freezing. 

These results can guide how many samples you may want to store and how your sperm may be used later in fertility treatment. 

Even if your results are lower than expected, sperm freezing may still be possible. 

At King Square Fertility, the process is handled with privacy, clarity, and support so you can make informed decisions about your future fertility.

What Semen Analysis Before Sperm Freezing Reveals About Your Sample

If you’re considering sperm freezing, chances are you’ve already spent some time thinking about the future. 

Maybe you’re preparing for cancer treatment. Maybe a vasectomy is on the horizon. Or maybe work, life, or timing has made family planning feel like a question for another day. Whatever brought you here, there’s usually one step that catches people off guard: the semen analysis.

For many men, this is where the nerves start to creep in. After all, seeing your fertility reduced to numbers on a report can feel intimidating.

Rest assured that at King Square Fertility, this step is handled with privacy, clarity, and respect. 

Semen analysis before sperm freezing helps our fertility team understand your sample, plan how many samples may be worth storing, and decide how best to preserve your options.

What Semen Analysis Measures

When you provide a semen sample for analysis, the lab looks at a few key details. Each one helps your care team understand how your sample may respond to freezing and how it could be used in future fertility treatment.

Sperm Count

Sperm count looks at how many sperm are present in a certain amount of semen. In general, a higher count means there are more sperm available to freeze, which can help your care team decide how many vials to store.

A count of 40 million is often considered within a typical range. If your count is lower than 15 million, it may affect your chances, but it doesn’t define your fertility on its own. It simply gives your care team a useful starting point.

Motility

Motility refers to how well sperm move. The sperm that swim forward in a strong, steady direction are especially important for fertilization.

This matters for sperm freezing because freezing and thawing can affect movement. By checking motility before freezing, the lab can better understand how your sample may perform later.

Morphology

Morphology looks at the shape of the sperm. The lab checks how many sperm have a typical head, middle section, and tail.

Lower morphology is more common than many people realize, and it doesn’t always indicate a serious problem. It simply helps your care team understand whether certain fertility treatments, such as intracytoplasmic sperm injection (ICSI), may be helpful in the future.

Volume and Other Details

The lab also examines the total amount of semen, along with pH and signs of inflammation or infection.

These details help complete the picture. No single number tells the whole story. Together, the results help your fertility team understand your sample and make thoughtful recommendations for sperm banking.

Why This Information Matters Before You Freeze

You might be wondering why a semen analysis is needed before sperm freezing in the first place. The simple answer is that it helps you and your care team make informed decisions from the start.

Planning the Number of Samples

A semen analysis helps show how many sperm are present and how well they move. If your count or motility is lower than expected, your care team may recommend freezing multiple samples to give you additional options in the future.

Having this information early can help determine whether a single collection appointment is enough or whether a few collections over time may be beneficial.

For men facing time-sensitive situations, such as an upcoming cancer treatment, this planning can be especially important. 

Helping Plan for the Future

Your results can also help guide how your frozen sperm may be used later.

For example, some samples may be well-suited for treatments like intrauterine insemination (IUI), while others may be better matched with advanced fertility treatments such as In Vitro Fertilization (IVF) with ICSI.

Bringing More Clarity to the Process

One of the hardest parts of sperm freezing is that it is often tied to a future you can’t fully predict. You may not know when you’ll use your stored sperm, or even if you’ll need it.

A semen analysis can’t answer every question, but it can provide useful information that helps replace uncertainty with a clearer picture of where you stand today. 

Having that clarity can make the entire process feel more manageable.

The Testing Experience: What to Expect

Knowing what happens during the appointment can make the whole process feel less awkward and more manageable.

Before the Sample

Most clinics recommend avoiding ejaculation for two to five days before your appointment. This timing helps give the lab a clear picture of your sperm count and quality. Waiting too long or not long enough can affect the results.

Your clinic may also suggest avoiding alcohol, tobacco, and recreational drugs in the days before the test, since these can temporarily affect sperm quality. If you take any medications, let your care team know so they can factor that into your results.

During the Appointment

Sample collection usually takes place in a private room at the clinic. The space is designed to be discreet and comfortable.

If you’re worried about producing a sample on-site, tell your clinic in advance. In some cases, you may be able to collect at home and bring the sample in within a specific time window.

Once you provide the sample, the lab takes it from there.

After the Analysis

Your results are usually ready within a few days to a week. A member of your fertility team will review them with you in plain language, explaining what each result means and how it may affect your sperm freezing plan.

This is also a good time to ask questions, address any concerns, and decide on your next step.

Get Semen Analysis and Sperm Freezing Support in Markham at King Square Fertility

At King Square Fertility, semen analysis is part of a personalized fertility preservation plan. The team understands that sperm freezing can raise many questions, especially during a stressful or uncertain time.

Testing is handled with privacy and care, and your results are explained clearly so you know what they mean for your next steps. 

With culturally sensitive, multilingual staff, we help patients feel respected, understood, and supported throughout the process.

If you’re thinking about sperm freezing, speaking with your doctor about a referral is a helpful first step. You can also contact us to learn more about how semen analysis fits into your plan.

FAQs About Semen Analysis Before Sperm Freezing

Does a low sperm count mean I shouldn’t freeze my sperm?

No. A lower sperm count doesn’t automatically mean sperm freezing is off the table. 

It may mean your care team recommends freezing more than one sample, so you have more options later. 

In some cases, treatments like ICSI can use just one healthy sperm per egg, so freezing may still be very worthwhile.

How long does semen analysis take, and when will I get results?

The sample collection itself is usually quick. After that, the lab reviews the sample, which can take a few days to a week, depending on the clinic. 

Your care team will then walk you through the results and explain how they fit into your sperm freezing plan.

Can lifestyle changes improve my semen analysis results?

Sometimes, yes. Reducing alcohol, quitting smoking, managing stress, getting enough sleep, and maintaining a healthy weight may support healthier sperm over time. 

If you have time before freezing, your clinic may suggest a few changes and possibly repeat the test. If timing is urgent, such as before medical treatment, freezing sooner is usually the priority.

What happens if my results vary between samples?

That can happen, and it’s very normal. Sperm results can shift because of stress, illness, sleep, medications, or other short-term factors. 

If your initial results are unexpected, your clinic may suggest a later semen analysis to get a clearer picture.

Sperm Storage Fees in Ontario: What You Should Understand Before Making a Decision

TL;DR: Sperm storage fees in Ontario can include several separate costs, such as the consultation, semen analysis, infectious disease screening, sperm processing, freezing, and annual storage. 

Prices vary by clinic, the number of samples you store, and how long you keep them frozen. Public funding usually does not cover long-term sperm storage, so it is important to ask about fees upfront.

King Square Fertility can explain what applies to your situation and help you plan with clarity before you move forward.

Sperm Storage Fees in Ontario: What You Should Understand Before Making a Decision

If you’re facing a cancer diagnosis, preparing for fertility treatment, or planning, you deserve clear numbers and straight answers.

How much does it cost? What are you paying for? What happens if you need storage for years?

At King Square Fertility, we know these questions matter. For men researching sperm storage fees in Ontario, pricing can feel unclear because the total isn’t always one simple number. It can depend on how many samples you store, how long you store them, and whether extra testing is needed.

This guide breaks down the costs in plain language, so you know what to ask, what to expect, and how to make a smart decision without second-guessing yourself.

Why Sperm Storage Fees in Ontario Aren’t One Simple Price

If you’ve searched for sperm freezing costs in Ontario, you may have noticed that pricing can be hard to compare. Some clinics list one fee. Others offer packages. Some provide very little detail until you ask.

That can feel frustrating, especially when you’re trying to make a clear plan. But sperm banking usually includes several steps, and each step may have its own cost. 

When everything is bundled together, it can be hard to know what you’re paying for. When everything is listed separately, the total can feel overwhelming.

Here are the services that will incur costs:

Initial Consultation

Most fertility clinics start with an initial appointment before collecting a sample. This gives the care team a chance to understand your situation, explain the process, and confirm whether sperm banking is a good fit for your needs.

Semen Analysis

Before freezing, your sample is usually checked through a semen analysis. This looks at sperm count, movement, and shape.

These results help the lab understand the quality of your sample and how well it may respond to freezing and thawing. 

Infectious Disease Screening

Before sperm can be stored, fertility clinics usually complete blood testing for certain infectious diseases. This may include HIV, hepatitis B, hepatitis C, and other tests depending on your medical history.

Sperm Collection and Lab Processing

Depending on the clinic, sample collection may be included in the package or billed separately.

After collection, the lab prepares your sperm for freezing. The sample is then divided into smaller vials, which gives you more flexibility if you need to use it later.

Cryopreservation, or Freezing

Cryopreservation is the actual freezing step. Once your sample is processed, it’s frozen using specialized equipment and stored at extremely low temperatures.

This fee usually covers lab work, the freezing method, liquid nitrogen, and the technical expertise needed to safely preserve the sample.

Annual Storage Fees

After your sperm is frozen, there’s usually an ongoing fee to keep it stored. This is often billed annually, though some clinics may offer quarterly billing or multi-year storage options.

The Questions Many People Forget to Ask

When people think about sperm banking, they often focus on the upfront costs. What can get overlooked is how long the sperm may need to stay in storage.

That’s completely understandable. If you’re freezing sperm before cancer treatment, your attention is likely on the treatment itself. If you’re preparing for IVF, you may assume you’ll use the sample within a year or two.

But life doesn’t always stick to the timeline we imagine. Treatment plans can change. Relationships can change. Even your thoughts about parenthood may evolve.

That’s why it’s worth having a few practical conversations before moving forward. Consider asking yourself and your clinic questions like:

These may not be the most exciting questions, but they can save you stress later. A little clarity now can help you feel more confident about your decision and avoid surprises down the road.

At King Square Fertility, our male fertility services include support for patients making these decisions. Our team can explain your options clearly, respectfully, and without pressure.

What Ontario's Public Funding Does (and Doesn’t) Cover

If you’re exploring fertility preservation costs in Ontario, you may have heard that some support is available through the province. This is true, but the details matter.

Ontario's Fertility Program may cover fertility preservation, including sperm freezing, for eligible patients who are facing medical treatments that could cause infertility, such as chemotherapy, radiation, or certain surgeries.

However, ongoing storage fees for sperm are generally not covered. This means the initial fertility preservation cycle may be funded in specific medical situations, but the cost of keeping sperm stored over time is usually paid out of pocket.

If you’re facing cancer treatment or another medical condition that may affect fertility, ask your oncology team, family doctor, or fertility clinic what funding may apply to your situation. You may also want to ask about hospital programs, charitable support, or private insurance coverage.

Understand Sperm Storage Fees in Markham With King Square Fertility

When people first look into sperm banking, it’s natural to focus on the immediate costs. But as you’ve seen, sperm storage fees in Ontario are only one part of the bigger picture. 

Understanding what’s included, what may cost extra, and how long you might need storage can help you make a decision that feels right for both your plans and your budget.

At King Square Fertility, financial conversations should be clear, straightforward, and free of surprises. Our team takes the time to explain your options, answer your questions, and help you understand exactly what services and fees apply to your situation.

Whether you’re preserving fertility before cancer treatment, preparing for fertility care, or simply planning, you deserve information that helps you move forward with confidence.

If you’re considering sperm banking and want a clearer understanding of sperm storage fees in Ontario, speak with your doctor about a referral to King Square Fertility, then contact us. 

Our team is here to provide transparent guidance, compassionate care, and the support you need to make an informed decision.

Frequently Asked Questions About Sperm Storage Fees

How long can sperm be stored?

Sperm can remain viable for many years when properly frozen. There’s no strict expiration date, though clinics may have policies on long-term storage. 

Some patients have used sperm stored for over 20 years with successful outcomes. The key is maintaining consistent storage conditions, which is why annual fees cover ongoing monitoring and maintenance.

What happens if I stop paying my storage fees?

Policies vary by clinic. Most will send reminders before taking any action. If fees remain unpaid for an extended period, the clinic may eventually dispose of the samples. 

It’s important to clarify this policy upfront and keep your contact information current with the clinic.

Can I use my stored sperm at a different clinic than where it was frozen?

Yes, in most cases. Sperm can be transferred between clinics, though there’s usually a transfer fee and coordination required. 

If you’re planning to move or switch providers, ask about the process before you need it.

Sperm DNA Fragmentation Testing: What It Is and When It Matters

You've done the standard semen analysis. The numbers came back normal; sperm count, motility, and morphology are all within range. And yet, conception hasn't happened. Or it has, but pregnancies haven't continued.

This is one of the most disorienting places to find yourself: told everything looks fine, while your lived experience tells a different story.

If this sounds familiar, there's something important to understand. A standard semen analysis, while valuable, examines only the surface of sperm health. It counts sperm, watches them swim, and assesses their shape. What it doesn't do is look inside.

A sperm DNA fragmentation test does exactly that. Let’s examine how it helps you find answers that have been hard to come by.

What Happens Inside a Sperm Cell And Why It Matters

To understand sperm DNA fragmentation, it helps to know what sperm are actually carrying.

Every sperm cell contains half the genetic material needed to create an embryo. This DNA is tightly coiled and compacted, far more densely packed than in other cells, to fit inside the sperm's small head.

When sperm meets egg, this genetic material combines with the egg's DNA to form the complete blueprint for a new life.

The quality of that genetic material matters enormously. If the DNA strands within a sperm cell are broken or damaged, a condition called DNA fragmentation, the resulting embryo may struggle to develop normally. In some cases, fertilization still occurs. The embryo begins to form.

But the underlying genetic instability can lead to:

Failed implantation

Early pregnancy loss

Recurrent miscarriage

Lower success rates with In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI).

Here's what makes this particularly challenging: sperm with fragmented DNA often look completely normal. They swim well. They have the right shape. But they wouldn’t pass an advanced semen analysis without raising any flags.

What a Sperm DNA Fragmentation Test Actually Measures

A sperm DNA fragmentation test measures the percentage of sperm in a sample that have damaged or broken DNA strands. The result is typically reported as a DNA Fragmentation Index (DFI).

Different laboratories may use slightly different testing methods. The most common include:

TUNEL assay: Identifies breaks in DNA strands by labelling the damaged ends

Sperm Chromatin Structure Assay (SCSA): Uses a dye that changes colour based on DNA stability

Comet assay: Separates damaged DNA from intact DNA using electrophoresis

Each method has its own technical approach, but all aim to answer the same question: how much of the sperm's genetic cargo is intact?

Results are generally interpreted as:

Low fragmentation (under 15%): Associated with better fertility outcomes

Moderate fragmentation (15-30%): May reduce success rates, particularly with natural conception

High fragmentation (over 30%): Associated with reduced pregnancy rates and increased miscarriage risk

It's worth noting that these thresholds aren't absolute. A result of 32% doesn't mean pregnancy is impossible, and a result of 12% doesn't guarantee success.

Fertility involves many factors working together. What a sperm DNA fragmentation test provides is one more piece of the picture.

When This Test Is Recommended And When It Isn't

Not everyone pursuing fertility treatment needs a sperm DNA fragmentation test. For many, a standard semen analysis provides enough information to move forward with confidence.

But there are specific situations where looking deeper makes sense:

Unexplained Infertility

When all standard tests for both partners come back normal, yet pregnancy hasn't occurred after a year of trying, sperm DNA damage is one of the hidden factors worth investigating.

Recurrent Pregnancy Loss

If you've experienced two or more miscarriages, particularly early losses, sperm DNA fragmentation may be contributing.

Failed IVF or ICSI Cycles

When IVF cycles don't succeed despite good egg quality and embryo development, or when ICSI embryos fail to implant or progress, sperm DNA integrity becomes an important variable to examine.

Advanced Paternal Age

If the male partner is over 40, testing may provide useful information about potential contributing factors.

History of Certain Lifestyle or Health Factors

Smoking, excessive alcohol consumption, obesity, exposure to environmental toxins, varicocele (enlarged veins in the scrotum), and certain infections have all been associated with higher rates of sperm DNA damage.

What Can Be Done If Results Show High Fragmentation

A diagnosis of high sperm DNA fragmentation isn't a dead end. It's information, and information opens doors.

Several approaches may help reduce fragmentation or work around it:

Lifestyle Modifications

Many causes of DNA damage are modifiable. Do the following to improve sperm DNA integrity:

Smoking cessation

Reduce alcohol intake

Achieve a healthier weight

Reduce exposure to heat (hot tubs, saunas, laptops on the lap)

Manage oxidative stress through diet or antioxidant supplementation

These changes don't guarantee results, but they address underlying factors that contribute to DNA damage. Sperm production takes roughly 74 days, so improvements may become apparent after two to three months of sustained changes.

Medical Treatment

If an underlying condition, such as a varicocele or infection, is contributing to fragmentation, treating it may improve sperm DNA quality. A fertility specialist or urologist can assess whether medical intervention is appropriate.

Adjusted Reproductive Techniques

For couples pursuing IVF, certain laboratory techniques may help select sperm with better DNA integrity.

Using freshly ejaculated sperm rather than frozen samples, or extracting sperm directly from the testicle (where DNA damage is often lower than in ejaculated sperm), are options that may be discussed depending on your specific situation.

FAQs About Sperm DNA Fragmentation Testing

How is a sperm DNA fragmentation test different from a regular semen analysis?

A standard semen analysis examines observable characteristics: how many sperm are present, how well they move, and what they look like. It doesn't assess the genetic material inside each sperm.

A sperm DNA fragmentation test specifically evaluates the integrity of that internal genetic material, revealing damage that would be invisible under a microscope. Think of it as the difference between inspecting a car's exterior and checking what's under the hood.

Is sperm DNA fragmentation permanent, or can it be improved?

In many cases, sperm DNA fragmentation can be improved. Because sperm production is ongoing, taking about 74 days per cycle, changes to lifestyle factors like smoking, diet, or heat exposure can lead to improved DNA integrity in future sperm.

Medical treatment of underlying conditions, such as varicocele, may also help. However, some causes of fragmentation are more difficult to address, and improvement isn't guaranteed for everyone.

Will my doctor automatically recommend this test?

Not necessarily. It's typically recommended in specific situations: unexplained infertility, recurrent pregnancy loss, failed IVF cycles, or when risk factors suggest DNA damage might be a factor.

If you feel this test might be relevant to your situation, it's worth raising the question with your fertility care team.

Get Clear Answers About Male Fertility at King Square Fertility

If you have been wondering whether there is more to investigate, there may be. You deserve a complete picture, and sometimes getting it means looking a little deeper.

At King Square Fertility, our male fertility services include diagnostic support tailored to your needs. In certain cases, our specialist may discuss sperm DNA fragmentation testing and whether it makes sense for your situation.

If you’re ready to move forward, speak with your doctor about a referral and schedule a consultation.

Taking that step can bring clarity, direction, and the reassurance that you are exploring every reasonable option with expert care.