Infertility is a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction. It affects both women and men. About a quarter of a million couples in Canada are affected by infertility. (Royal Commission for New Reproductive Technology, Reproductive Infertility: Prevalence, Causes, Trends and Treatments, January 2001.)
You likely have many questions about infertility, when to seek treatment, what’s involved in testing, and what to do if you are a same sex couple or single, and desire a child of your own. In addition to speaking with your family physician about fertility, the information contained here may help to answer some of your questions.
There are many factors that may contribute to difficulty conceiving. These include damaged tubes, abnormal ovulation, age and general health, and other unexplained factors.
Damaged Tubes - The Fallopian tubes (where the sperm and egg meet and fertilization occurs) can become damaged which can cause infertility. This is called tubal factor infertility. This can occur after a sexually transmitted infection, pelvic infection, endometriosis or surgery, or if you have had a tubal ligation.
Abnormal Ovulation - Ovulatory factors affect fertility. Ovulation is the cyclic (usually monthly) release of the egg. Some women do not ovulate at all, or ovulate infrequently, resulting in irregular or absent periods and infertility. Polycystic ovary syndrome, in which a woman’s reproductive hormones and metabolism are out of balance, is a common cause of abnormal ovulation.
Age - When to start a family is a very personal decision and the answer is different for everyone. You may choose to delay pregnancy based on whether or not you feel you are financially, physically and emotionally ready to have a child.
As you age, the number and quality of eggs in your ovaries diminishes. Fertility begins to fall in the early to late 20’s and early 30’s. By your late 30’s and early 40’s, it can become much more difficult to become pregnant. The chance of a miscarriage occurring also increases as you age. Although fertility treatments such as IVF can help to increase the chance of pregnancy in older women, they cannot fully compensate for the effect of reproductive aging.
Also, the older you are, the more likely you are to have had other medical problems which can reduce your fertility, like endometriosis, fibroids, tubal disease or polylps.
Unexplained Factors - In about 15-20 % of couples with infertility, a specific cause of infertility cannot be identified. We realize how frustrating this can be for couples, however there are many treatment options available such as IUI and IVF. It’s important to remember that every situation is different and there is still a good chance you could have a baby.
Many studies show that it takes normal, fertile couples an average of six months to conceive. For young fertile couples, the chance of conception is between 20% and 37% per month. Most couples, around 80%, will get pregnant by one year of trying and 90% after two years of trying. Fertility rates are lower if you are over the age of 35.
Prior to seeking help with fertility issues, there are some things you can do on your own to optimize your chances of becoming pregnant naturally:
Know Your Cycle - Paying attention to your menstrual cycle will help you recognize your most fertile days. You may find it useful to keep a menstrual calendar, noting the day on which your period starts, the day when it ends, any pre-ovulatory symptoms you notice, and so on.
The fertile window is the time in your cycle when pregnancy can occur and is usually the six-day interval ending on the day of ovulation. The day of ovulation is typically 14 days before your period starts. For example, a woman with a 28 day cycle likely ovulates around day 14 and her fertile window would be from day 8-14. It is not necessary to have intercourse every day during the fertile window, every 2-3 days is often enough.
Maintain a Healthy Lifestyle - Your overall health plays a large role in fertility. Ensure you are eating a balanced diet which includes all the food groups and drink lots of fluids. A healthy lifestyle also includes reducing stress. Talk with your partner, family, friends or a counsellor if you are feeling frustrated or anxious. Exercise is also a great way to reduce stress and improve your health.
Maintain a Healthy Weight - Obesity and being overweight can reduce your chances of conceiving naturally, but so can being underweight. Work with your doctor to determine your ideal weight range and take steps to stay within that range.
Take Vitamins - Multivitamins or prenatal vitamins that include iron, calcium and folic acid are essential when trying to conceive. Foods high in antioxidants are great, like brightly colored fruit, strawberries, cherries, and plums.
Don’t Smoke - Smoking, heavy alcohol consumption (more than two drinks per day), heavy caffeine consumption, and the use of recreational drugs have all been associated with reduced fertility. Stay away from smoking, recreational drugs, and limit or eliminate alcohol.
If you have had a tubal ligation (tubes tied) to prevent pregnancy, and have changed your mind about having a child, there are options available to have a baby. IVF is often used in this circumstance since open tubes are not required. Your tubes can be sewn back together through a surgical procedure called a tubal ligation reversal. The success of the reversal depends on your age, the type of tubal ligation performed, the skill of the surgeon completing the surgery, and whether or not there are other fertility issues present. While we don’t conduct tubal ligation reversal at Aurora, we can discuss these options and help provide the information and testing you will need to make the best decision for you.
Infertility isn’t an issue that affects women alone. About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors.
The health of a male’s sperm and his sperm count can be affected by factors like illness, medication, poor diet, smoking and a healthy lifestyle. Obesity has been clearly linked to impaired sperm production. Chronic medical conditions such as high blood pressure and diabetes can also affect male fertility.
While male age-related fertility is not as well defined, there is some research that suggests a decrease in fertility for men over 40, and an increase in genetic disorders for children of older fathers.
There are many things you can do on your own to optimize your chances of becoming pregnant with your partner naturally:
Maintain a Healthy Lifestyle - A healthy lifestyle includes limiting stress, eating a balanced diet, and exercising.
Maintain a Healthy Weight - Maintaining an ideal weight, and a diet rich in antioxidants (found in fruits and vegetables) are important fertility factors. Vitamins E and C have been found to improve the quantity and movement of sperm. Work with your doctor to determine your ideal weight range and take steps to stay within that range.
Take Vitamins - Multivitamins or prenatal vitamins that include zinc and selenium may improve the quality of sperm.
Don’t Smoke - Smoking, recreational drugs including steroids and marijuana can all reduce the quality of sperm. If you are a smoker and you and your partner are trying to become pregnant, you should attempt to quit smoking. Your doctor may be able to help or recommend a smoking cessation to help you quit.
If you have had a vasectomy and change your mind about having children, there are procedures that could help you have a child with your partner. Along with a urologist (doctor who specializes in medical care of a man’s reproductive organs), we can work with you to decide on the best option for you.
Vasectomy Reversal - A vasectomy reversal can be done to reconnect the vas deferens, which are the tubes cut during vasectomy. A urologist performs this procedure. Your urologist will help you to decide whether this is a good option for you. This surgery is less successful the longer it has been since the vasectomy was performed. Vasectomy reversal may let you and your partner have a baby naturally through sexual intercourse.
Sperm Aspiration (prior to your partner undergoing an IVF cycle) - This procedure involves removing (aspirating) sperm from your testes or epididymis (a duct close to the testes). It is usually performed under local anesthesia in the office, but can also be done under with mild sedation. This procedure is also call PESA (percutaneous epidydimal sperm aspiration) or TESE (testicular sperm extraction).
The sperm is then immediately frozen to be used to fertilize your partner’s eggs in a laboratory by using IVF/ICSI.
Donor Insemination - Donor insemination, which involves placing anonymous donor sperm into a woman’s uterus or cervix, is another option available to men who have had a vasectomy.
You will require a referral from your family physician or specialist (OB/GYN, urologist, oncologist, etc.), to be seen in our clinic.
Make an appointment with your family physician or specialist to discuss your fertility issues.
When speaking with your family physician or specialist, discuss a referral to Aurora Reproductive Care and give your family physician or specialist our referral form to complete. The physician will fax the form to our clinic. Once we have received the form in our office, we will contact you with an approximate wait time for an appointment.