1 in 8 Canadian couples experience infertility.
That’s a big number!
You might think that you can get pregnant at any time during the month. And that’s actually not true. There are about 6 days where you are actually fertile. So if you’re not seeing that big fat positive 2 weeks after you have sex, you simply might not be having sex at the right time.
First things first, you need to figure out when your body is ovulating.
If you know when you’re ovulating and timing sex around that, when should you be concerned? And if you don’t get pregnant on the first try, does that automatically make you infertile?
Types of Infertility
This might be you if you are younger than 35, and have not gotten pregnant within 1 year of having unprotected sex, or you may not be able to carry a pregnancy to term.
If you are 35 or older, you might have primary infertility if you haven’t become pregnant within 6 months of having unprotected sex, or you may not be able to carry a pregnancy to term. This might be due to the declining egg quality as you age.
You might have secondary infertility if you have been able to get pregnant after 1 year of having unprotected sex, or you can’t carry a pregnancy to term, DESPITE being able to have done so at least once.
Women who are experiencing irregular or absence of periods, endometriosis, PCOS, painful periods, pelvic inflammatory disease, more than one miscarriage, should seek care before the 6 month or 1 year mark.
43% of infertility is because of women. Causes include endometriosis, tubal factor including completely blocked fallopian tubes, scarring from pelvic inflammatory disease, etc.
32% of infertility is due to men, and is based on sperm parameters. These parameters include: sperm count, how the sperm is moving, if the sperm is moving in the right direction, the size and shape of the sperm, total semen volume, and if sperm can transition from a gel-like to liquid state after ejaculation.
Causes may also include testicular trauma, chemotherapy, hernia surgery, or infertility with another partner.
About 25% of infertility cases are due to an unknown factor, otherwise known as unexplained infertility.
What Causes Infertility?
You need to be ovulating and have unobstructed fallopian tubes for fertility to occur as per normal. Although this may not account for unexplained infertility if both those factors are normal.
When you’re not able to ovulate, this is known as anovulation. Some conditions that can affect ovulation are:
PCOS: A condition that may cause anovulation in women, or irregular periods
Diminished ovarian reserve: Fewer eggs remaining in the ovaries than normal
Hypothalamic functional amenorrhea: Symptoms include low body weight, excessive stress and exercise
Premature ovarian insufficiency: Premature menopause (before you turn 40), your ovaries are unable to function normally
Menopause: A decline in ovarian function, usually when you are in your 50s
An egg needs to pass through a fallopian tube to be fertilized by semen. But some conditions may cause obstruction. These include:
History of pelvic infection
History of sexually transmitted infections like chlamydia and gonorrhea
History of abdominal surgery
Risks of Infertility
In women, risks include:
Your diagnostic workup can be overwhelming and include:
Hysterosalpingogram: an X-ray investigating the shape of your uterine cavity and fallopian tubes, as well as investigating if there are any obstructions within your fallopian tubes.
Sonohysterography: ultrasound exam that will create images of your uterine lining. It uses fluid (administered into the cervix) and sound waves to do so.
Laparoscopy: The insertion of a thin telescope-like instrument vis a small incision in your belly button. It allows doctors to visually examine your abdominal and pelvic organs (uterus, fallopian tubes, ovaries), and determine if you have endometriosis, scar tissue, fibroids, or any other ‘defects’.
Lutenizing Hormone: This is the hormone that triggers ovulation. If there is no LH surge mid-way through your cycle, it’s suggestive of anovulation. It can also provide information about your ovarian reserve, and if your ovaries are functioning normally.
Hysteroscopy: Examining your cervix and the inside of your uterus using a thin, tube called a hysteroscope.
Transvaginal Ultrasound: Examining a your uterus, ovaries, tubes, cervix and pelvic area, using a ultrasound probe inserted in your vagina.
Ovarian Reserve Time: Estimating the supply of remaining eggs within your ovaries.
Other blood tests
Ironically (or should I say infuriatingly), the diagnostic workup for men simply involves a semen analysis. Although at recent conference that I attended, one of the speakers had mentioned that sperm DNA methylation could serve as a biomarker for male infertility.
Trying to get pregnant and not being able to do so can be frustrating, frightening and overall incredibly depressing when you are trying to grow your family. Not to mention the effects that it has your psyche.
Sometimes treatment can be as easy as reducing toxic exposure (like smoking or alcohol), decreasing stress, or losing weight. It really all depends what you’re ready to do.
Waitlists to meet with a reproductive endocrinologist can be long, so in the meantime you can work with me so we can figure out what’s going on and which changes can you and/or your partner can make now, to help in the longterm. And who knows? Maybe you’ll get pregnant, and not need that REI appointment after all!
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