Fertility issues
Fertility issues, also called infertility, mean having trouble getting pregnant after trying for some time. For most couples under 35, this is defined as not conceiving after 12 months of regular unprotected sex. For those 35 and older, evaluation is recommended after six months. Fertility problems can affect anyone and may stem from one partner, both partners, or sometimes have no identifiable cause.
Common signs and symptoms
- Difficulty becoming pregnant after the expected period of trying
- Irregular, painful, or missed periods, which may indicate ovulation issues
- Difficulty maintaining a pregnancy or repeated pregnancy loss
- Sexual problems, such as trouble with ejaculation
- History of pelvic infections, pelvic or testicular surgeries, or injuries
What causes fertility problems?
For those who produce eggs: Polycystic ovary syndrome (PCOS), premature ovarian insufficiency, blocked fallopian tubes, uterine fibroids, congenital anomalies, scarring, diminished egg supply, endometriosis, and certain hormone disorders can contribute.
For those who produce sperm: Low sperm count or poor motility, blocked ducts, hormonal problems, prior testicular injury or surgery, genetic factors, or certain medications and exposures can play a role.
Combined or unexplained causes: Sometimes both partners have contributing factors, or testing does not reveal a clear cause, known as unexplained infertility.
Risk factors to consider
- Age, especially for people who produce eggs
- Smoking, heavy alcohol use, or recreational drug use
- Being overweight or underweight
- Past untreated sexually transmitted infections
- Past pelvic or abdominal surgeries
- Health conditions like diabetes, autoimmune disorders, or prior cancer treatment
- Work environments with heat, radiation, or toxins
How our team diagnoses fertility issues
At TidalHealth, evaluation begins with a thorough medical and sexual history for both partners. Physical exams and laboratory tests help identify causes:
For those who produce sperm: Semen analysis evaluates count, movement, and shape.
For those who produce eggs:
- Ovulation assessment using hormone tests, temperature charts, or predictor kits
- Egg supply testing with labs and ultrasound
- Uterus and ovary imaging with ultrasound
- Fallopian tube evaluation with hysterosalpingography (HSG)
- Additional testing as needed for hormone imbalance or infections
Emotional and practical considerations
Fertility challenges can cause emotional stress. Counseling, support groups, and close contact with your care team can help. Treatment decisions depend on cause, age, medical history, and personal values. Many people achieve pregnancy with thorough evaluation and proper care.
Next steps
If you have concerns about fertility, schedule an appointment with a primary care practitioner or specialist. Simple lifestyle changes — quitting smoking, maintaining a healthy weight, managing chronic conditions, and limiting alcohol — can improve fertility while your team coordinates testing and treatment.
When should we see a doctor about fertility problems?
Under 35, consider evaluation after 12 months of trying. At 35 or older, or with known risk factors like irregular cycles, prior infections or surgeries, or past chemotherapy, seek evaluation after six months or sooner.
What tests will we likely have?
Initial tests include semen analysis for the partner producing sperm and ovulation assessment, ovarian reserve testing, pelvic ultrasound, and tubal patency testing for the partner producing eggs. Additional blood tests or procedures may follow depending on results.
What treatments are available?
Treatment depends on the cause. Options include lifestyle changes, medications to support ovulation, surgery for anatomical issues, intrauterine insemination (IUI), or assisted reproductive technologies like in vitro fertilization (IVF). Donor eggs or sperm, surrogacy, or adoption may also be considered.
Can lifestyle changes make a difference?
Yes. Quitting smoking, moderating alcohol, maintaining a healthy weight, managing chronic conditions, reducing caffeine, and avoiding recreational drugs can all improve fertility and pregnancy outcomes.
How does age affect fertility?
Fertility in people who produce eggs declines with age, especially after the mid-30s, due to reduced egg number and quality. Fertility for people who produce sperm also decreases with age, though more gradually. Age affects treatment choices and success rates.
What are the chances of success with treatments like IVF?
Success depends on age, diagnosis, and individual factors. Younger people typically have higher success rates. TidalHealth specialists provide up-to-date information tailored to your situation.
Are fertility tests painful or risky?
Most tests are simple and low-risk. Blood tests and semen analysis are minimally invasive. Ultrasounds are painless. Hysterosalpingography (HSG) may cause brief cramping. More involved procedures, like laparoscopy, carry some risks, which your care team will explain.
Will insurance cover fertility treatment?
Coverage varies by plan. Some treatments may be partially covered; others may not. TidalHealth can provide guidance on financial counseling and payment options.
What if no cause is found?
Unexplained infertility occurs when testing does not reveal a cause. Options may include timed intercourse, ovulation-induction medication, IUI, or IVF. Your TidalHealth specialist can guide you through the best approach.
How can we cope with the emotional impact?
Fertility challenges can be stressful. Counseling, support groups, and open communication with your partner and care team can help. TidalHealth offers resources to support emotional well-being during evaluation and treatment.
Next step
Reach out to a TidalHealth clinician or reproductive specialist to create a personalized plan.
