Infertility: When Should You Seek Help?

[ Disclaimer ] There are many different types of people and couples on the path towards creating new life. In this article, we refer to cis-female and cis-male individuals, but we recognize there exists more people trying to conceive outside of these genders. We also refer to the individual testing and roles that cis-females and cis-males may have as a couple, but we recognize that not all those trying to conceive are part of a partnership. We’re here to support all those trying to create their family.

About 1 in 6 Canadian couples will experience ‘infertility’. That broad term refers to no pregnancy after twelve months of unprotected intercourse. It is equally likely to be male-factor infertility as it is to be female-factor infertility – about 40% of the time, respectively, while the remaining 20% is both male and female factor. Most healthy couples trying to get pregnant will do so within the first 3-6 months of trying, but at what point should they start to ask questions and consult a health professional? The short answer is anytime, and sooner than later, but there are some definite red flags that warrant more immediate attention. 

Conventionally, a couple will be referred to a fertility clinic after 12 months of trying to conceive. Sometimes, if the female partner is 35 years old or older, they’ll be referred after 6 months. This goes for both couples who are trying to conceive for the first time, as well as couples who are trying to conceive after one or both have already had a child. However, this doesn’t mean that you can’t start asking questions and taking charge of your fertility sooner. 

Pre-Conception Planning

The best time to support fertility is before you start trying to conceive. A good rule of thumb is about 3-4 months beforehand – this is because it takes about 90-100 days for immature follicles to develop and for sperm to have a full life cycle. Generally speaking, the better the health of the sperm and eggs, the more likely a pregnancy will happen. Three months also gives a chance to take a look at any other contributing health factors and safely manage them before having to worry about certain product safety in the fertility stage. Some health factors that you’d want to ideally manage before trying to conceive include:

  • Irregular Periods: having heavy or extra light periods, or irregular timed periods, are signs of hormonal imbalances. If undiagnosed or uncontrolled, this can significantly impact fertility health.
  • Hormonal Imbalances: if you’ve dealt with heavy or painful periods, cycling mood changes, period-related acne, spotting between periods, or breast tenderness, your hormones may need some love. Figuring out what the issue is and supporting that before trying to conceive will make things easier when you are ready to get pregnant.
  • Stopping Oral Contraceptives: the birth control pill releases small amounts of hormones to prevent ovulation (and thereby pregnancy) from happening. Once you stop The Pill, your liveris going to need a bit extra support in detoxing these hormones and getting your body back up to its regular production.
  • Digestive Concerns: bloating, irregular bowel movements (constipation or loose stools), heartburn, or excess gas can all be signs that your digestive system isn’t working optimally. This can be caused by underlying conditions, like digestive infections, and can affect your chance of conceiving by creating inflammation and reducing absorption of vitamins and minerals.
  • Weight Loss: not everybody needs to be within a specific weight range to conceive, but for some women and men, moderate weight loss can enhance their fertility. Women who are overweight and have PCOS have been shown to have better pregnancy outcomes after just 5% weight loss.
  • Reducing Toxin Exposure: from what’s in your fridge and kitchen, to what you put on your face, there are many chemicals that disrupt the endocrine (hormone) system. Best to get them out of your body ASAP!
  • Antioxidant Support: to give the egg and sperm the best chances at creating a pregnancy, reducing oxidative damage and adding extra antioxidants can help. Quit smoking, limit alcohol, add in lots of fruits and veggies, and you’ll be in a good starting position. If you or your partner are older or have had many years of oxidative damage, consider starting a supplement with antioxidant support.
  • Fatigue: being tired in and of itself won’t affect your ability to conceive, but it’s more about the cause of your fatigue in the first place. Fatigue is a symptom of something else going on in the body, and the sooner it is investigated and treated, the better. Whatever is causing your fatigue will likely play a role in your future fertility.

Early Stages: 1-6 Months

Sometimes time is a factor. We can’t always afford 3-4 months of prep time if our biological clocks are ticking and we have to dive right in to trying to conceive. No need to panic if you’re not pregnant the first month that you’re trying. There’s only about a 20% chance of conceiving every month, even for healthy couples who are having intercourse at the right time. If none of the above factors from the preconception stage applies to you, then you may not need immediate support. It’s never a bad thing to check in with your health practitioner, though, especially if you’re unsure of the following things:

  • Ovulation: are you ovulating regularly? There are many ways to find out, and they range in convenience, cost, and invasiveness, so it is good to discuss what option would fit you best.
  • Timing: although many sex education classes in school may have led us to believe that if you have any unprotected intercourse you may get pregnant, that’s not true. There’s only about five days every cycle where unprotected intercourse can result in a pregnancy. Being aware of when these days are for you (i.e. when ovulation is happening) is going to be key in getting pregnant.
  • Prenatal Multivitamins: are you intaking and absorbing the right vitamins? Not all prenatal multivitamins are created equally, and some individuals with particular pre-existing conditions, family histories, or risk factors may need additional fertility support supplements.
  • Implantation Barriers: are there any signs that something may be interfering or preventing implantation of the embryo into the uterus? This may extend to thin endometrial lining, uterine fibroids, over exercise, healthy hormones levels, or immune issues.
  • Nutrient Status: doing a baseline check of certain minerals and vitamins can be helpful to fill in any nutritional gaps you may be experiencing. By reviewing your diet and ordering blood work, you can start eating (or supplementing, if needed), particular nutrients that may play a factor in your fertility.

Digging Deeper: 6-12 Months

If you are over 35 years old, you’ll be referred to a fertility clinic for further testing and treatment options (more on this in the next section). If you’re still waiting on your referral, and have considered or pursued all of the above already, it may be time for some more in-depth testing:

  • Semen Analysis: since it takes two to make a baby, a deeper look at fertility health can’t be done without the male half. The semen analysis is an important starting point to rule out anything major, but it may be followed up with additional blood tests to find out causes or contributing factors of fertility health (hormones, vitamins and nutrients, etc.).
  • Hormonal Blood Tests: sex hormones including estrogen, follicle stimulating hormone, luteinizing hormone, progesterone, and certain testosterones can be tested at particular times of your cycle and can confirm suspected conditions or may reveal something new. You can also test for a blood marker that can estimate your ovarian reserve – essentially how many follicles you have left. Testing for thyroid health should also be done if it hasn’t been already. This should include testing for multiple thyroid hormones, not just the standard Thyroid Stimulating Hormone (TSH), since it’s important to look at the bigger picture of thyroid health.
  • Urinary Metabolite Testing: this is a more in-depth look at specific hormones than the blood test. It looks at urinary metabolites of sex hormones, which tells us about the breakdown of the hormones. This can pinpoint exactly where the hormonal imbalance is occurring, and it may be surprising. For example, you might have symptoms of excess estrogen, but your estrogen levels are normal on initial testing; it could be that there’s an issue in the estrogen BREAKDOWN rather than an overproduction. Distinguishing between these two scenarios is important since it can significantly change the treatment plan.

“Infertility” Diagnosis: 12 Months and Beyond

By this point, you may have been referred to a fertility clinic and have begun additional testing and discussing options for treatments. New testing may include cycle monitoring (blood work and ultrasounds through your menstrual cycle to confirm when you’re ovulating), base hormone tests, as well as various physical tests like transvaginal ultrasounds or a hysterosalpingography (basically an X-ray look inside the uterus/ovaries/fallopian tubes with contrast dye injected to make sure everything is connected as it should be). Perhaps discussions around Intra-Uterine Insemination (IUI) or In-Vitro Fertilization (IVF) have started. Even if this is the case, it’s never too late to take a closer look and ask all of the questions we’ve explored above. 

While testing at fertility clinic is more specific than what your family physician may order, there are still many gaps that can be filled. Their testing is usually interpreted in the context of how you should be approaching an IUI or IVF (e.g. aggressiveness in timing, medications, etc.). Egg and sperm quality get often overlooked. Whether you’re planning on going forward with cycle monitoring, IUI, or IVF, there’s still loads of extra support you can get outside of the clinic, including testing and supportive treatment. There are certain supplements that have been studied to improve IUI and IVF outcomes, and certain supplements you’d want to avoid if you’re doing a medicated cycle. Additionally, treatments like acupuncture can also improve outcomes of conventional fertility treatments. 

No matter where you are on your journey, seeking extra support can always help. By digging deeper, looking at the bigger picture of your health, optimizing nutrient status, or just holding space for you to exhale and explore your feelings around fertility, your health practitioner can help you take charge of your fertility. You and your partner don’t have to feel alone in all of this; let someone else in to relieve some of the burden and ask the questions for you. We’re here for you. 

Dr Laura Smith ND

Written by Dr. Laura Smith, Naturopathic Doctor. Dr Laura has a clinical focus in women’s health including fertility and pre/postnatal health. She currently lives and works in Ottawa, Ontario, Canada.

Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.