Fertility & Infertility

Fertility Care
Written By Jennifer Tang

Overview

Fertility describes the ability to conceive, while infertility refers to difficulty achieving pregnancy. Fertility challenges are common and can involve ovulation, sperm, the fallopian tubes or uterus, age-related changes, underlying medical conditions, or a combination of factors. Sometimes, standard testing does not identify a clear cause. Infertility affects approximately 1 in 6 people of reproductive age worldwide at some point in their lives.¹

At Tangible Health, we take an individualized, evidence-informed approach to fertility and preconception care. We look at your reproductive history alongside menstrual and ovulatory health, sperm health when relevant, nutrition, lifestyle, medications, metabolic health, existing medical conditions, and your fertility goals. Care can be provided before you begin trying to conceive or alongside your family doctor, fertility specialist, IUI, or IVF care.

What Is Fertility & Infertility?

Fertility depends on several steps working together. Ovulation needs to occur, sperm must be available and able to fertilize an egg, the reproductive tract needs to allow egg and sperm to meet, and the resulting embryo must be able to implant.¹ The World Health Organization defines infertility as a disease of the male or female reproductive system characterized by not achieving pregnancy after 12 months or more of regular, unprotected sexual intercourse.¹

That 12-month definition does not mean everyone should wait a full year before asking for help. In general, fertility evaluation is recommended:

  • After 12 months of trying when the female partner or person providing the eggs is under 35

  • After 6 months of trying at age 35 or older

  • More promptly after age 40

  • Earlier at any age when there is a known condition or history that may affect fertility²˒³

Fertility challenges are also not solely a female issue. Male reproductive factors contribute to a substantial proportion of infertility cases, which is why semen and male reproductive health should be assessed when relevant.¹˒⁵

Common Signs That Fertility May Need Assessment

Fertility challenges do not always cause noticeable symptoms. For some people, difficulty becoming pregnant is the only sign. Other reasons to consider fertility assessment may include:

Menstrual & ovulatory changes

  • Irregular menstrual cycles

  • Very long or very short cycles

  • Frequently missed or absent periods

  • Difficulty identifying ovulation

  • Significant changes in your usual menstrual pattern

Reproductive health concerns

  • Very painful periods, particularly when endometriosis is suspected

  • Known PMOS

  • Known endometriosis

  • Fibroids or other uterine conditions

  • Previous pelvic infections or surgery

  • Known or suspected fallopian-tube problems

  • Previous chemotherapy or radiation that may affect fertility

Sperm & male reproductive concerns

  • Abnormal semen-analysis results

  • Low sperm concentration or movement

  • Difficulty with ejaculation or sexual function

  • Previous testicular injury or surgery

  • Certain hormonal or reproductive conditions

Fertility history

  • Trying to conceive without success for the recommended period based on age

  • Previous fertility treatment

  • Repeated pregnancy loss

  • A known condition that may affect reproductive health

A fertility assessment can also be appropriate before trying to conceive, particularly if you have medical concerns, take medications that may affect pregnancy, or simply want guidance on preconception health.²˒⁶

Causes & Contributing Factors

There is rarely one universal explanation for fertility difficulties. Several different factors may be involved.

Ovulation & ovarian factors
Conditions that interfere with regular ovulation can make conception more difficult. These may include PMOS, certain endocrine conditions, primary ovarian insufficiency, and other disorders affecting ovarian or hormonal function.¹ Age is also an important factor. Female fertility declines with increasing reproductive age, with a more noticeable decline during the later reproductive years.²˒⁸

Fallopian tubes, uterus & pelvic health
Blocked or damaged fallopian tubes can prevent sperm and egg from meeting. Conditions involving the uterus or pelvis, including endometriosis, certain fibroids, congenital uterine differences, previous infections, or pelvic surgery, may also contribute to infertility in some people.¹

Sperm health
Male fertility can be affected by sperm concentration, movement, shape, sperm production, reproductive-tract obstruction, hormonal conditions, varicoceles, certain medications, medical treatments, and other reproductive-health concerns.¹˒⁵

Overall & preconception health
Health before pregnancy matters for both fertility and pregnancy. Factors such as smoking, certain substance exposures, nutrition, physical activity, medical conditions, medications, and overall health may influence reproductive health or pregnancy outcomes.⁴˒⁶

This does not mean fertility challenges can always be corrected through lifestyle changes. Many causes require medical investigation or fertility treatment, and some remain unexplained even after appropriate testing.

Unexplained infertility
Sometimes both partners undergo standard fertility testing, and no clear explanation is found. This is known as unexplained infertility. It does not mean that nothing is happening or that the difficulty is psychological; rather, currently available testing has not identified a specific cause.

Our Approach to Fertility

At Tangible Health, fertility care is centred around understanding where you are in your reproductive journey and identifying the areas where supportive care may be useful without delaying appropriate medical investigation or fertility treatment.

Your Reproductive Health
We look at your menstrual cycle, ovulation patterns, reproductive and pregnancy history, known conditions such as PMOS or endometriosis, previous fertility testing, and any current fertility treatment. When sperm is part of the fertility picture, male reproductive health and available semen-analysis results should also be considered rather than focusing only on the person trying to become pregnant.²˒⁵

Your Preconception Health
Preconception care looks beyond conception itself. We may assess areas such as nutrition, folate intake, sleep, movement, medications and supplements, smoking or substance exposure, metabolic health, and other medical concerns that could affect fertility, pregnancy, or overall health.⁶˒⁷

Your Fertility Plan
Some patients come to us before they begin trying to conceive. Others are already tracking ovulation, undergoing fertility testing, preparing for IUI or IVF, or working with a reproductive endocrinologist. We help you understand where supportive naturopathic care fits within your broader fertility plan and when referral or collaboration with another healthcare provider is appropriate.

Your Goals
Your goals may include preparing for pregnancy, better understanding your menstrual cycle, supporting overall preconception health, addressing a diagnosed condition that affects fertility, navigating fertility treatment, or simply feeling more informed and supported throughout the process. Your care plan is built around those priorities.

Treatments That May Be Included

Your fertility or preconception care plan may include:

  • Clinical nutrition to support nutritional adequacy, preconception health, metabolic health, and a healthy pregnancy

  • Lifestyle medicine to support sleep, movement, stress management, and sustainable health behaviours

  • Nutraceuticals & supplements when there is an individualized indication, including review of prenatal supplementation and folic acid

  • Botanical medicine when clinically appropriate, with careful consideration of fertility medications, pregnancy safety, and the available evidence

  • Acupuncture as a complementary component of fertility or preconception care when appropriate

  • Naturopathic counselling to support stress management, lifestyle changes, and the emotional demands of trying to conceive

  • Collaborative care with your family doctor, reproductive endocrinologist, fertility clinic, urologist, gynecologist, or other healthcare providers when needed⁴

What to Expect

Initial Assessment
We begin with a comprehensive review of your fertility goals, menstrual and ovulatory history, previous pregnancies or pregnancy losses, medical history, medications and supplements, nutrition, sleep, stress, lifestyle, and any previous fertility testing or treatment. When relevant, we also consider sperm health and your partner’s reproductive history.

Targeted Testing
Testing is recommended based on your individual history and where you are in your fertility journey. This may include reviewing or coordinating standard fertility investigations such as ovulation assessment, semen analysis, imaging of the uterus or fallopian tubes, or other testing recommended by your fertility team. Additional bloodwork may be considered when clinically appropriate to assess areas such as thyroid function, iron status, nutritional deficiencies, or metabolic health.

Personalized Plan
Your care plan is developed around your fertility goals, health history, clinical findings, and any existing fertility treatment. Recommendations may include nutrition, lifestyle medicine, targeted supplementation, acupuncture, or other supportive approaches, with careful consideration of pregnancy safety and any medications or fertility protocols you are using.

Ongoing Support
Fertility care can change as new test results, treatments, cycles, or pregnancy plans arise. Follow-up visits allow us to adjust your plan over time and coordinate care with your family doctor, fertility clinic, reproductive endocrinologist, or other healthcare providers when needed.

When to Seek Support for Fertility

You do not necessarily need to wait a full year before speaking with a healthcare provider. Consider seeking fertility assessment if:

  • You are under 35 and have been trying to conceive for 12 months

  • You are 35 or older and have been trying for 6 months

  • You are over 40 and are planning pregnancy

  • Your periods are very irregular or absent

  • You have known or suspected endometriosis

  • You have PMOS with irregular or absent ovulation

  • You have a history of pelvic infection, surgery, or known tubal disease

  • There is known or suspected sperm or male-factor infertility

  • You have experienced repeated pregnancy losses

  • You have received chemotherapy, radiation, or another treatment that may affect fertility

  • You are concerned about fertility because of an existing medical condition

  • You would like preconception guidance before beginning to try²˒³

Seeking support early does not mean something is necessarily wrong. It can simply help determine whether further investigation is appropriate and give you clearer information about your options.

Book An Appointment

Frequently Asked Questions

  • If you are under 35, fertility evaluation is generally recommended after 12 months of trying. If you are 35 or older, it is usually recommended after 6 months. You may want to seek support sooner if you have irregular periods or a known fertility concern.²˒³You also do not need to wait for these timelines if your periods are absent or very irregular or you already know about a reproductive-health concern.

  • Testing may include checking for ovulation, assessing the uterus and fallopian tubes, bloodwork, and a semen analysis when sperm is involved. The exact tests depend on your history and fertility goals.²

  • Not exactly. AMH (anti-Müllerian hormone) provides information about ovarian reserve, but it cannot tell you your exact chance of becoming pregnant naturally or directly measure egg quality.²˒⁸

  • Yes. Irregular or absent periods can sometimes mean that ovulation is not happening regularly, which may make conception more difficult.²

  • No. Fertility challenges can involve female factors, male factors, both partners, or sometimes no clear cause at all.¹˒⁵

  • Yes. Fertility generally declines with age, particularly for the person providing the eggs, with the decline becoming more noticeable in the later reproductive years.²˒⁸

  • Some nutrients are important for reproductive health, but many supplements marketed for “egg quality” or “sperm quality” have limited or uncertain evidence. Supplements should be chosen based on your individual needs.⁵

  • Yes. Naturopathic care can complement IUI or IVF by supporting nutrition, lifestyle, and overall health, while working alongside your fertility clinic and treatment plan.

 

Related Care

Fertility can overlap with several areas of health. You may also benefit from:

Jennifer Tang
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