Understanding fertility

Knowing the factors that impact fertility is key to improving your chances of conceiving. But what particular factors influence fertility? And how do they impact your likelihood of conceiving? Get the answers you’re looking for and find out when to seek help from a fertility expert.

Fertility Factors When to Seek Help

What factors influence fertility?

A number of factors – including age, ovulatory disorders, sperm issues, and more – can impact a person's chances of conceiving. Oftentimes some factors are already known to patients coming in, while others may still yet be undiagnosed.

By consulting a fertility specialist and undergoing fertility testing, you’ll be able to gain more insight into the factors that are most likely influencing your ability to conceive.

Here are some of the most common fertility challenges:

Age

Female age is a common fertility challenge. Fertility decreases with female age, but the age effect, in general, becomes more significant from the mid-30s and markedly so from the late 30s onwards. When we’re younger, the ovaries have more eggs, which have a better chance of fertilization and implantation in the uterus, and they respond more easily to stimulation medications. Then as we age, the risk of miscarriage increases contributing to higher chromosomal abnormalities in the embryo.

Amenorrhea

Lack of menstruation, or amenorrhea, refers to the absence of menstruation ever, or the absence of menstruation for 3 or more periods. Amenorrhea requires investigation of the underlying cause for not only fertility, but health reasons too.

Endometriosis

Endometriosis is a condition where endometrial tissue (the tissue that lines the uterus) grows outside of it, typically in the abdominal cavity. Endometriosis can pose a challenge for conception because when tissue grows in the abdominal cavity, it can produce scar tissue, inflammation, or adhesions that bind the fallopian tubes, ovaries, and intestines. This can prevent transport of the egg to the fallopian tube or impact the implantation of the embryo.

Ovulatory disorders

To ensure the regular production of eggs, a very particular sequence of events needs to occur in the body. Ovulatory disorders are characterized by a disturbance in that sequence, which can be due to issues related to the regulation of reproductive hormones.

Ovulatory disorders include:
• Polycystic ovarian syndrome (PCOS)
• Thyroid disease
• Hyperprolactinemia
• Low levels of fertility hormones (hypothalamic amenorrhea, follicle-stimulating hormone, and luteinizing hormone)
• Premature ovarian failure
• Extreme weight change (loss or gain)
• Excessive exercise
• Eating disorders

In many cases, once diagnosed, ovulation disorders can be treated with fertility drugs.

Polycystic ovary syndrome & disease

Polycystic ovary syndrome (PCOS) is a common endocrine disorder when ovulation occurs irregularly and infrequently in some women and is associated with hormonal imbalances, and sometimes metabolic changes. Treatment varies from lifestyle modification, simple oral fertility medications, to assisted conception.

Recurrent pregnancy loss

A miscarriage is when a pregnancy is lost in the first 20 weeks of gestation. Most miscarriages happen in the first trimester and the incidence of miscarriages is more frequent with female age. (When trying to conceive over the age of 45, the risk of miscarriage climbs to 50%.) When a person miscarries more than once, that’s known as recurrent pregnancy loss.

There are many potential causes for a failed pregnancy. One of the most common is an abnormal chromosome number in the embryo. Other potential causes are abnormalities in the shape of the uterus, uterine fibroids (noncancerous growths that can appear in the uterus), genetic abnormalities, hormonal disorders, infections, and immunological factors.

Sperm issues

Sperm issues are behind fertility challenges in approximately 40% of cases. The spectrum seen varies from azoospermia (the absence of sperm in the ejaculate) to different degrees or combinations of oligo-astheno-teratospermia (sperm of low concentration, reduced mobility, and abnormal form).

One key consideration is that sperm health, motility, and quantity can be affected by nutrition, exercise, and lifestyle choices such as drinking, smoking, and recreational drug use. Long term testosterone use for body building can lead to azoospermia.

Tubal factor infertility

Because the fallopian tubes play an important role in the transport of the egg to meet with the sperm for fertilization, any damage to them can affect the ability to conceive or may contribute to the risk of an ectopic pregnancy in the tube. Many modern innovative techniques can help ensure healthy pregnancies when fallopian tubes are damaged or obstructed. Issues with the fallopian tubes may affect close to 1 in 4 individuals trying to get pregnant.

Unexplained infertility

For a number of patients, the causes behind infertility issues can be hard to identify. When ovulation, semen, pelvic cavity, and fallopian tubes appear to be normal, but trouble conceiving persists, we refer to this as unexplained infertility. Depending on female age and ovarian reserve, and the duration of infertility, IUI and IVF are recommended.

When is the right time to seek fertility help?

When you need the assistance of a donor or surrogate to access sperm, eggs, an embryo, or a uterus, seeking fertility care is of course a key consideration. But if this is not your situation, you may wonder if and when your circumstances warrant this type of care. Here’s a list of situations for which we recommend the support of a fertility specialist to increase your chances of conceiving:

You’re under 35 years old, and have been trying to get pregnant for 12 or more months

You’re over 35 years old, and have been trying to get pregnant for at least 6 months

You’re experiencing irregular periods, meaning your menstrual cycle is not typically between 26 to 34 days long

You’ve previously had a pelvic infection

You’ve been diagnosed with endometriosis, polycystic ovarian syndrome (PCOS), or polycystic ovarian disease (PCOD)

You’ve experienced more than 2 pregnancy losses

Your family has a history of early menopause or you’ve been told you’re at risk for early menopause

You’ve been diagnosed with a sperm problem or have had an infection, surgery, injury, or other testicle-related issue (e.g. mumps)

You or your partner has a health issue known to impact fertility (e.g. diabetes, high blood pressure, or a history of cancer treated through chemotherapy or radiation)

In modern day approach, screening of ovarian reserve by doing a blood test for anti-mullerian hormone (AMH), irrespective of female age will help decide the speed of fertility management.