Fertility & Infertility

Fertility Care
Written By Jennifer Tang

Overview

Fertility describes the ability to conceive, while infertility refers to difficulty achieving pregnancy. Fertility challenges can involve ovulation, sperm health, the uterus or fallopian tubes, age, underlying medical conditions, or a combination of factors. Sometimes, no clear cause is identified even after appropriate testing. Infertility affects approximately 1 in 6 people of reproductive age worldwide during their lifetime.¹

At Tangible Health, we take a comprehensive and individualized 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 and thyroid health, existing medical conditions, and your fertility goals. Care can begin before you start trying to conceive or be used 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 the egg and sperm to meet, and the resulting embryo needs to implant.¹

The World Health Organization defines infertility as a disease of the male or female reproductive system in which pregnancy has not been achieved after 12 months or more of regular, unprotected sexual intercourse.¹ This definition is separate from recommendations about when to begin a fertility evaluation.

In general, evaluation is recommended:

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

  • After 6 months 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

Fertility challenges are not solely a female issue. When sperm is part of the reproductive picture, both partners should generally be considered during fertility assessment.²˒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. Reasons to consider fertility assessment may include:

  • Irregular, infrequent, or absent periods

  • Very short or unusually long menstrual cycles

  • Difficulty identifying regular ovulation

  • Very painful periods or known endometriosis

  • PMOS or another condition that may affect ovulation

  • Known fibroids, tubal concerns, previous pelvic infection, or pelvic surgery

  • Abnormal semen-analysis results or other sperm-related concerns

  • Previous testicular injury, surgery, or reproductive conditions

  • Repeated pregnancy loss

  • Previous chemotherapy or radiation that may affect fertility

  • Trying to conceive without success for the recommended period based on age²˒⁵

You can also seek preconception care before you begin trying, particularly if you have an existing medical condition, take regular medications, have concerns about reproductive health, or simply want guidance on preparing for pregnancy.³

Causes & Contributing Factors

There is rarely one universal explanation for fertility difficulties. Several factors may be involved, and sometimes no clear cause is found.¹

Ovulation & Hormonal Health
Conditions that interfere with regular ovulation can make conception more difficult. These can include PMOS, primary ovarian insufficiency, thyroid or other endocrine conditions, and other disorders that affect ovarian or hormonal function.²

Fallopian Tubes, Uterus & Pelvic Health
Blocked or damaged fallopian tubes can prevent egg and sperm from meeting. Endometriosis, certain fibroids or uterine differences, previous infections, and pelvic surgery may also affect fertility.¹

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

Age & Overall Health
Age is an important factor in fertility, particularly when eggs are involved. Smoking, certain substances or environmental exposures, some medical conditions, medications, nutrition, and other health factors may also influence fertility or pregnancy health.¹˒³˒⁴

Lifestyle matters, but fertility difficulties cannot always be corrected through lifestyle changes. Many causes require medical investigation or fertility treatment.

Unexplained Infertility
Sometimes standard fertility testing does not identify a specific cause. This is known as unexplained infertility and does not mean that the difficulty is psychological or that nothing is happening; rather, available testing has not identified a clear explanation.²

Our Approach to Fertility

At Tangible Health, fertility care focuses on understanding where you are in your reproductive journey and identifying areas where supportive care may be useful without delaying appropriate fertility assessment or 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 treatment you are currently receiving. When sperm is part of the fertility picture, sperm and male reproductive health are considered as well.²˒⁵

Your Preconception & Overall Health
We may look at nutrition, prenatal and folate intake, sleep, movement, stress, medications and supplements, smoking or substance exposure, metabolic and thyroid health, and other medical concerns that may be relevant before pregnancy.³

Your Goals
Your priorities may include preparing for pregnancy, better understanding your cycle or ovulation, supporting sperm health, addressing a condition that may affect fertility, navigating IUI or IVF, or feeling more informed and supported throughout the fertility process. Your care plan is developed around those priorities.

Treatments That May Be Included

Your individualized fertility or preconception care plan may include:

  • Clinical Nutrition to support nutritional adequacy, preconception health, metabolic health, and sustainable eating habits

  • Lifestyle Medicine to support sleep, movement, stress management, smoking cessation, and other health behaviours relevant to preconception care³˒⁴

  • Nutraceuticals & Supplements when there is an individualized indication, including review of prenatal supplementation and folate

  • Botanical Medicine when clinically appropriate, with careful consideration of fertility medications, reproductive goals, and pregnancy safety

  • 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

When you are receiving fertility treatment, care can be coordinated with your family doctor, fertility clinic, reproductive endocrinologist, urologist, gynecologist, or other healthcare providers as appropriate.

What to Expect

Initial Assessment
We start 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.

Fertility Assessment & Testing
Depending on your history and where you are in your fertility journey, we may review existing investigations or discuss whether further assessment is appropriate. Standard fertility evaluation may include assessing ovulation, semen analysis, and the uterus and fallopian tubes, with additional testing selected according to your individual history.²˒⁵ Routine broad hormone, immune, inflammatory, or functional-medicine testing is not required for everyone.

Personalized Plan
You’ll receive a personalized care plan designed around your fertility goals, health history, test results, current treatment, and priorities. If you are preparing for IUI or IVF, recommendations are made with your fertility medications, treatment protocol, and pregnancy safety in mind.

Ongoing Support
Fertility care is a step-by-step process and may change as new test results, cycles, treatments, or pregnancy plans arise. Follow-up allows us to adjust your plan over time and coordinate with your fertility or medical team when needed.

When to Seek Support for Fertility

You do not necessarily need to wait a full year before talking 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 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 have an existing condition that may affect fertility or pregnancy²

  • You would like preconception guidance before beginning to try³

Current fertility guidance supports beginning assessment sooner when a known fertility concern is already present rather than waiting for an arbitrary timeline.

Book An Appointment

Frequently Asked Questions

  • If you are under 35, fertility evaluation is generally recommended after 12 months of trying. At age 35 or older, it is generally recommended after 6 months. Evaluation may be appropriate sooner if you have irregular periods or another known fertility concern.²

  • Assessment commonly looks at ovulation, the uterus and fallopian tubes, and semen when sperm is involved. Other tests are selected based on your medical and reproductive history.²˒⁵

  • Not exactly. AMH provides information about ovarian reserve, but it cannot tell you your exact chance of becoming pregnant naturally or directly measure egg quality.²

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

  • No. Fertility difficulties may involve female factors, male factors, both partners, or sometimes no identifiable cause.¹˒⁵

  • Some nutrients are important for reproductive health, but evidence for many products marketed specifically for “egg quality” or “sperm quality” is limited or uncertain. Supplement recommendations should be individualized and reviewed for safety.

  • There is no universal requirement to spend 3–6 months “optimizing” fertility before trying. Preconception care can begin whenever you are planning pregnancy, but age or an existing fertility concern should not be used as a reason to delay appropriate evaluation or treatment.³

 

Related Care

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

Jennifer Tang
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