Fertility

Many people really want to become parents by having their own children. For some people though, getting pregnant can be a real challenge. If you are having fertility problems, the good news is that there are options and medical help for many couples experiencing infertility.

What is infertility?

Although there is no single definition of the term infertility, it typically refers to a lack of conception after a reasonable period of sexual intercourse without contraception (one year for women who are under 35 years, 6 months for women over 35 years).

Causes of infertility

Infertility can be traced to either the man or woman, or a combination of both:

• 3 times out of 10, the cause is in men.
• 4 times out of 10, the cause is in women.
• 2 times out of 10, the cause is a mix of factors from both male and female.
• 1 time out of 10, at first, no specific cause can be found.

Causes of infertility in women may include:

• age (fertility decreases after age 35)
• problems producing eggs (which shows up when she has no period/menstrual cycle, or no regular one)
• having a sexually transmitted infection (STI), like Chlamydia (which can cause blockages in the fallopian tubes)
• problems in the uterus (like fibroids or polyps)
• problems with the fallopian tubes (like missing tubes or blockages)
• endometriosis (excess of tissue that gathers around the reproductive organs)
• hormonal imbalances
• early menopause (before age 40)

Causes of infertility in men may include:

• poor sperm quality (their rate of movement and shape)
• low sperm count, or lack of sperm
• a history of sexually transmitted infection (STI), like Chlamydia
• hormonal imbalances

Other causes of infertility in both men and women may include:

• past treatments for cancer (like chemotherapy, radiation, and/or surgery)
• some chronic illnesses (like diabetes), as well as their treatments
• tobacco and alcohol use
• being under weight or over weight

Increasing your chances of getting pregnant

Here are a few things you can do to make it more likely you'll conceive on your own:

• If you're a woman, begin trying to have children before you are 35.
• Eat a healthy diet.
• Get regular exercise.
• Quit smoking.
• Drink fewer alcoholic drinks.
• Learn ways to deal better with stress.
• Try yoga or other stress-reducing activities. There is evidence that alternative therapies can help to increase the chances of getting pregnant.

Problems with fertility may also respond to:

• better timing of sexual intercourse
• drugs to fix hormonal imbalances or to help the ovaries produce eggs
• surgery to repair the reproductive organs

Getting medical help

Women

You should see a doctor:

• if you are 35 or younger and have not become pregnant after one year of trying
• if you are older than 35 and have not become pregnant after six months of trying

You should get medical advice even sooner if you:

• have severe pain during your periods (menstruation) or while you are having sex (these may be signs of endometriosis)
• have no periods or have irregular periods (this may point to problems with ovulation)
• had surgery in your abdomen or womb (uterus) in the past
• had more than one miscarriage
• have a history of a sexually transmitted infection (STI)
• had cancer treatment in the past
• have a family history of early menopause (before age 40)

Men

You should see a doctor if you:

• had surgery on your testicles or an injury to your testicles in the past
• have premature ejaculation or lack of erections
• have a history of a sexually transmitted infection (STI)
• had cancer treatment in the past

What to expect from your doctor

Your doctor will likely examine you physically and ask questions to:

• check your general health
• find out more about what you are doing to try to conceive
• identify any parts of your lifestyle that may be having an impact on fertility (like smoking, using alcohol or drugs, being obese, or being exposed to harmful chemicals)

Some common diagnostic tests for both women and men include:

• screening for sexually transmitted infections (STI)
• blood tests to check hormone levels

Tests for women only may include:

• an ultrasound exam of your pelvic region
• an x-ray dye test to find any blockage in your fallopian tubes
• a sonohysterogram, which is a special test that can help to find fibroids, polyps, or endometriosis in your uterus

Tests for men only may include:

• sperm and/or semen analysis
• genetic testing (if there is reason to suspect a genetic cause)

Fertility treatments

Your doctor may recommend fertility treatments (also called assisted human reproduction, or AHR). AHR is a way of getting pregnant using a medical procedure. It can include:

• ovulation-inducing drugs, often called "fertility drugs"
• intrauterine insemination (IUI), when a thin tube (catheter) carries sperm directly into a woman's womb (uterus) through the vagina
• in vitro fertilization (IVF), the manipulation of both sperm and eggs outside the body to help with fertilization

Procedures like IVF and embryo transfer usually take place in a fertility clinic or hospital where staff have specialized training.

Learn more about fertility treatment options.

What to ask your doctor

It is important to be as informed as you can be before you try fertility treatments. Here are some questions to ask your doctor or health care provider:

• What kind of treatments do you recommend for my situation?
• What are the known risks of the planned procedures for me, for my spouse or partner, for a donor (if this applies), and for any children born as a result?
• What is the full cost? Is any of it covered by my province's health care plan, employee benefits, or private health insurance plan?
• Taking into consideration my age, diagnosis, and treatment, what are my chances ofbecoming pregnant?
• If this procedure does not work, what would you suggest next?