Could I be infertile? What to do next

It’s estimated that one in eight Canadian couples deals with infertility, so if you’ve been trying to conceive without success, you aren’t alone. But when should you seek help? And what might fertility treatments entail? Here is a primer on fertility treatments.

When do I need to start worrying about infertility? If you have been having unprotected intercourse for one year and haven’t conceived, you meet the clinical definition of infertility. At this point, it’s recommended that you see a fertility specialist. However, according to Ellen Greenblatt, the clinical director of Mount Sinai Fertility in Toronto, if you’re over the age of 35, you should see a specialist after six months of trying to get pregnant because your window for successfully conceiving is getting smaller.

What will happen when I see a fertility doctor? A fertility specialist will gather all the information she needs to figure out what might be preventing you from conceiving. Keep in mind that it could be something to do with the female partner, the male partner or a combination of both.

The doctor will start by asking you questions about your medical history, focusing on your menstrual cycle, reproductive history, underlying conditions (such as thyroid dysfunction) and previous illnesses or surgeries that might affect your fertility, as well as symptoms that may indicate endometriosis. “We’re looking for any red flags that point to where the problem might be,” says Greenblatt. To be prepared, bring information on any medications you’re taking, details on your menstrual cycle, reports from any surgeries you’ve had and relevant medical records (particularly if you’ve seen a fertility specialist in the past) to the appointment with you. Also, bring a list of questions you have (write them down or keep a running list on your phone) so that you won’t forget any important ones.

Some clinics require a referral from your family doctor, while others won’t. If you have a particular clinic in mind, contact them to find out how to become a patient there. The Infertility Awareness Association of Canada has a list of fertility clinics. When in doubt, your family doctor is a good place to start.

What kind of testing will be done? In addition to collecting your personal history, the fertility specialists will conduct some medical tests to help determine what the potential issues might be. Blood tests will look at your hormone levels, blood count and immunity to viruses that can cause complications during pregnancy, such as chicken pox and German measles.

You’ll also have a transvaginal ultrasound, which gives the doctor a look at your internal organs, including the ovaries, uterus and Fallopian tubes. At this point, an ovarian reserve assessment is done to see how many eggs are left in the ovaries, which can be done with a combination of blood tests and transvaginal ultrasound imaging.

The male partner will have his semen tested to find out if there are enough sperm and determine if they’re healthy and motile, which means that they’re able to move through the reproductive tract to meet the egg.

What could be the problem? There are many factors that can cause infertility, including a lack of regular ovulation, a low sperm count, low sperm motility, premature ovarian insufficiency (early menopause) and anatomical problems, such as blocked Fallopian tubes and problems with the uterine cavity. In some couples, there is no obvious reason, which is called unexplained infertility.

There is also the fact that it becomes harder to get pregnant as you age. “As women get older, both the quality and quantity of eggs left in their ovaries diminishes,” explains Greenblatt, “so the chance of each ovulation leading to a healthy egg that can lead to a viable pregnancy is diminished.”

What are my options for treatment? The kind of treatment you get will depend on the problem. For example, if you aren’t having regular menstrual cycles, you might be given fertility medications to encourage regular ovulation. If your Fallopian tubes are blocked, then you’ll likely go straight to in vitro fertilization (IVF), where the egg and sperm are combined in a lab and then transferred to the uterus. If there is a problem with the sperm, the doctor might recommend intrauterine insemination, where the best sperm is concentrated and injected into the uterine cavity. In cases where the quality of sperm is very low, you might be offered a type of IVF called intracytoplasmic sperm injection (ICSI), where one sperm is forcibly injected into the egg. Depending on the scenario, these treatments can also involve donor sperm, donor eggs or a gestational carrier.

Your doctor will walk you through the options, and there are also support groups and infertility counsellors out there who can help you. “Every problem has a solution,” says Greenblatt. “It just might not be the solution you were hoping for. You may have to widen your horizons as to how you thought you might form your family.”