Underlying causes

Endometriosis

“Endometriosis affects approximately 1 million people in Canada - 1 in 10 women and unmeasured numbers of transgender and gender nonconforming people.”

EndoAct Canada

Endometriosis is a chronic and often painful condition that affects women of reproductive age. It occurs when the tissue that normally lines the inside of your uterus grows outside of it, on other organs and tissues within your pelvis. This tissue, called endometrial tissue, acts just like the lining of the uterus, thickening and breaking down each month with the menstrual cycle. However, unlike the lining of the uterus, this tissue has no way to exit the body, leading to inflammation, pain, and the formation of scar tissue.

Signs & symptoms

Endometriosis symptoms can vary widely, but common signs include pelvic pain, particularly during your period, pain during intercourse, and heavy or irregular menstrual periods. Other symptoms may include bloating, fatigue, and infertility. While the exact cause of endometriosis is not known, there are several theories, including the retrograde menstruation theory, where menstrual blood flows backwards into the fallopian tubes and onto other organs in the pelvis.

Diagnosis

Diagnosis of endometriosis can be difficult as the symptoms often overlap with other conditions. Your doctor may perform a physical exam, pelvic ultrasound, or laparoscopy to confirm the diagnosis.

Treatment

While endometriosis can be a challenging condition, many women are able to manage their symptoms and achieve pregnancy with the help of medical interventions. Treatment options may include medications to manage pain and regulate hormones, surgery to remove endometrial tissue, and assisted reproductive technologies such as in vitro fertilization (IVF).

Impact on fertility

Endometriosis can have a significant impact on a woman’s ability to conceive and carry a pregnancy to term. Endometrial tissue that grows outside the uterus can cause inflammation and the formation of scar tissue, which can interfere with the normal function of the reproductive organs. This can result in a variety of fertility issues, including:

• Impaired implantation: The endometrial tissue can obstruct or damage the fallopian tubes, making it difficult for a fertilized egg to reach the uterus and implant.
• Ovarian endometriomas: Ovarian cysts filled with endometrial tissue can form as a result of endometriosis, which can affect the production and release of eggs.
• Abnormal hormonal levels: Endometriosis can disrupt the normal balance of hormones involved in the menstrual cycle and fertility, affecting ovulation and the luteal phase.
• Pelvic adhesions: Scar tissue caused by endometriosis can bind organs together, making it difficult for sperm to reach the egg or for a fertilized egg to implant in the uterus.

Living with endometriosis can be challenging, but there are many support groups and resources available to help you manage your symptoms and improve your quality of life. It is important to work closely with your healthcare provider to find a treatment plan that works for you, and to keep an open line of communication about any changes or concerns.

Luteal phase defect

Luteal Phase Defect (LPD) is a condition that affects a woman’s menstrual cycle. It occurs when the luteal phase, the time between ovulation and the start of a woman’s period, is shorter than normal. This can result in a decrease in the levels of progesterone, a hormone that helps prepare the uterus for pregnancy.

Luteal Phase Defect is often associated with infertility, as a shorter luteal phase can make it difficult for a fertilized egg to implant in the uterus.

Signs & symptoms

Symptoms of LPD can include irregular periods, light or spotty bleeding, and PMS-like symptoms such as bloating, mood swings, and headaches.

Diagnosis

Diagnosing Luteal Phase Defect can be done through various tests, including basal body temperature monitoring, ultrasound, or a blood test to measure hormone levels. If LPD is diagnosed.

Treatment

Treatment options may include hormone therapy to increase progesterone levels, or lifestyle changes such as exercise and stress management to improve overall menstrual cycle health.

Impact on fertility

When the luteal phase is shorter than normal, the level of progesterone may be insufficient to support a pregnancy. This can result in infertility or early pregnancy loss. Some of the ways that Luteal Phase Defect can impact fertility include:

• Impaired implantation: A shorter luteal phase may not provide enough time for a fertilized egg to implant in the uterus and establish a pregnancy.
• Irregular cycles: Women with LPD may experience irregular menstrual cycles, making it difficult to predict ovulation and conceive.
• Hormonal imbalances: Low progesterone levels associated with LPD can disrupt the delicate balance of hormones involved in the menstrual cycle and fertility.

It is important to talk to your doctor if you have concerns about your menstrual cycle and to keep track of any changes or symptoms. By working together with your healthcare provider, you can find the best treatment plan to address your Luteal Phase Defect and improve your chances of conception.

Male factor

Male factor infertility refers to a situation where a male’s reproductive health plays a role in the couple’s inability to conceive a pregnancy. It is a common issue, with male infertility accounting for approximately 30% of all infertility cases.

There are many factors that can contribute to male factor infertility, including problems with sperm production or function, genetic conditions, infections, and lifestyle factors such as smoking, alcohol use, and exposure to toxins.

Signs & symptoms

Some common symptoms of male infertility can include a low sperm count, decreased sperm motility, or the presence of abnormal sperm.

Diagnosis

Diagnosis of male factor infertility typically involves a semen analysis, which evaluates the quantity and quality of a man’s sperm. Other tests may also be performed, such as a physical exam, blood tests, or genetic testing.

If you think you have male factor fertility issues, speak with your doctor for a referral to a urologist or fertility specialist.

Treatment

Treatment options for male factor infertility can range from lifestyle changes, such as improving diet and reducing exposure to toxins, to medical interventions like medication or surgery. In some cases, assisted reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may be necessary.

Impact on fertility

It is important for men to discuss any concerns about their reproductive health with their doctor. With the right diagnosis and treatment, many couples can overcome male factor infertility and achieve their goal of starting a family.

Recurrent miscarriage or pregnancy loss

Recurrent Miscarriage, also known as recurrent pregnancy loss or repeat pregnancy loss, is a heartbreaking and difficult experience for couples trying to start a family. It is defined as the loss of two or more consecutive pregnancies before 20 weeks gestation.

The causes of recurrent miscarriage are not always clear, but can be related to factors such as chromosomal abnormalities, hormonal imbalances, uterine or cervical abnormalities, autoimmune disorders, or underlying health conditions such as diabetes or thyroid disease. In some cases, the cause of recurrent miscarriage may not be determined.

Signs & symptoms

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Diagnosis

Diagnosing the underlying cause of recurrent miscarriage can be challenging and may involve a range of tests and evaluations, such as blood tests, imaging studies, and a physical examination.

Treatment

Treatment options for recurrent miscarriage depend on the underlying cause and may include lifestyle changes, medications, or surgery. In some cases, assisted reproductive technologies such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may be recommended.

Impact on fertility

Recurrent Miscarriage can have a significant impact on infertility, as it can reduce a couple’s chances of having a successful pregnancy and starting a family. Each miscarriage can be physically and emotionally traumatic, and the experience of repeated loss can be especially difficult to cope with.

The impact of recurrent miscarriage on infertility can be complex, as the underlying causes of recurrent pregnancy loss can vary from one couple to another. For example, if the cause of the recurrent miscarriage is related to chromosomal abnormalities, it may be more difficult for a couple to conceive and carry a pregnancy to term. In some cases, recurrent miscarriage can also lead to physical complications, such as uterine scarring, that can affect fertility.

It is important to work closely with a healthcare provider to diagnose and treat the underlying cause of recurrent miscarriage, as this can improve the chances of a successful pregnancy. This may involve a range of tests and evaluations, such as blood tests, imaging studies, and a physical examination, as well as medical or surgical interventions.

Experiencing recurrent miscarriage can be emotionally devastating and it is important to seek support from friends, family, or a mental health professional.

Seeking support

The impact of a miscarriage can be far-reaching, affecting not only physical health, but also emotional well-being. Some of the ways that experiencing a miscarriage can impact a person include:

• Grief and sadness: Miscarriage can be a profound loss and can trigger feelings of grief, sadness, and anger. This can be especially difficult if the couple has been trying to conceive for a long time.
• Physical recovery: A miscarriage can also result in physical symptoms, such as heavy bleeding, cramping, and pain. It is important to allow time for physical recovery and to seek medical attention if needed.
• Emotional distress: Experiencing a miscarriage can also have a significant impact on mental health, causing feelings of anxiety, depression, and stress.
• Impact on relationships: A miscarriage can also affect relationships with partners, family, and friends. It is important to seek support from loved ones and to talk about your feelings with a mental health professional if needed.
• Future fertility: In some cases, a miscarriage can also impact future fertility, particularly if it is recurrent or is caused by underlying health conditions. It is important to work with a healthcare provider to address any potential fertility issues.

While the impact of a miscarriage can be significant, it is important to remember that many couples can conceive and have healthy pregnancies after experiencing a loss. With the right support and medical care, it is possible to overcome the impact of a miscarriage and move forward with hope and determination.

Polycystic ovary syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It is characterized by the presence of multiple cysts on the ovaries, which can result in hormonal imbalances and ovulation problems.

PCOS is caused by a combination of genetic and environmental factors, and its symptoms can vary widely from one woman to another.

Signs & symptoms

Some of the most common symptoms of PCOS include:

• Irregular periods: Women with PCOS may experience irregular or absent menstrual cycles, which can make it more difficult to conceive.
• Excess hair growth: PCOS can cause excess hair growth on the face, chest, and back, a condition known as hirsutism.
• Acne and oily skin: PCOS can also cause acne and oily skin.
• Weight gain: Women with PCOS are also more likely to experience weight gain, particularly around the waist.
• Infertility: PCOS can make it more difficult to conceive, as it interferes with ovulation and causes hormonal imbalances.

Diagnosis

Diagnosing PCOS involves a range of tests and evaluations, including a physical examination, blood tests, and imaging studies.

Treatment

Treatment options for PCOS depend on the severity of symptoms and may include lifestyle changes, such as changes in diet and regular exercise, medications, or fertility treatments. These treatment options do not cure PCOS; however, they can help to improve symptoms.

If you are experiencing symptoms of PCOS, it is important to work with a healthcare provider to develop a personalized treatment plan. With the right care and support, it is possible to manage the symptoms of PCOS and improve your chances of starting a family.

Premature ovarian insufficiency

Premature Ovarian Insufficiency (POI) is a condition that affects women of reproductive age, causing their ovaries to stop working before the age of 40. This means that the ovaries are no longer producing eggs and the woman’s estrogen levels are reduced, leading to a range of symptoms and difficulties.

If you have POI, you may experience irregular periods, hot flashes, and night sweats, among other symptoms. This can be a difficult and confusing time, but it’s important to know that you are not alone and that there are treatments available to help manage your symptoms and achieve your personal goals.

The causes of POI can vary and may be due to genetic factors or acquired causes such as autoimmune disorders, chemotherapy, radiation therapy, or surgery. Your healthcare provider can work with you to determine the cause of your POI and create a personalized treatment plan.

Treatment

Treatment options for POI may include hormone replacement therapy to relieve symptoms and maintain bone health, as well as fertility treatments such as in vitro fertilization (IVF) if you wish to have a child. Your healthcare provider can help you determine the best course of treatment based on your individual needs and goals.

Impact on fertility

Premature Ovarian Insufficiency (POI) can have a significant impact on a woman’s ability to conceive and have a child. This is because POI involves the cessation of egg production by the ovaries, which is necessary for conception to occur. Without a regular supply of eggs, women with POI may experience infertility.

In addition to the reduced production of eggs, POI can also lead to changes in a woman’s hormone levels, which can further impact her ability to conceive. For example, reduced levels of estrogen can cause changes to the endometrial lining of the uterus, making it more difficult for a fertilized egg to implant and develop.

Women with POI who wish to have children may need to explore fertility treatments, such as in vitro fertilization (IVF), to achieve pregnancy. In IVF, eggs are retrieved from the ovaries and fertilized with sperm outside of the body, and the resulting embryos are then implanted into the uterus.

If you have been diagnosed with POI, it is important to take an active role in your healthcare and work closely with your provider to manage your symptoms and maintain your overall health. An early diagnosis can be important to your future fertility and family-building plans.

Unexplained infertility

Unexplained infertility is a condition in which couples have been unable to conceive after trying for a period of time, but there is no clear medical explanation for their infertility. This can be a frustrating and confusing situation for couples who are trying to start a family. Unexplained infertility affects approximately 30% of Canadians who are unable to conceive.

Diagnosis

Unexplained infertility is diagnosed when all standard fertility tests and evaluations, such as assessments of the male partner’s sperm count and motility, and the female partner’s ovulation and fallopian tubes, come back normal. Despite these normal results, the couple is still unable to conceive.

If you have been diagnosed with unexplained infertility, it is important to remember that you are not alone and that there are treatments available to help you conceive. Your healthcare provider may recommend fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF) to increase your chances of getting pregnant.

It is also important to consider lifestyle factors that may be impacting your fertility, such as stress, diet, and exercise. Your healthcare provider can provide guidance on these factors and help you develop a plan to optimize your overall health and fertility.

You may also consider seeking a second opinion from another fertility specialist.

Support

If you have been struggling with unexplained infertility, it is important to take an active role in your healthcare and seek support from your healthcare provider and a fertility specialist. It can also helpful for you to seek support from a Reproductive Counsellor or in a Support Group.

Secondary infertility

Secondary infertility is a condition in which a couple has been able to conceive a child in the past but is unable to do so again. This can be a challenging and emotional experience, especially for couples who previously had no trouble getting pregnant.

Secondary infertility can be caused by a range of factors, including changes in the health of either partner, age-related fertility decline, and changes in the woman’s menstrual cycle. Conditions such as endometriosis, polycystic ovary syndrome (PCOS), and male infertility can also contribute to secondary infertility.

If you have been diagnosed with secondary infertility, it is important to take an active role in your healthcare and seek support from your healthcare provider and a fertility specialist. They can help you determine the cause of your infertility and develop a personalized treatment plan.

Treatment options for secondary infertility may include fertility medications, intrauterine insemination (IUI), or in vitro fertilization (IVF). Your healthcare provider can help you determine the best course of action for your individual needs and goals.

In addition to seeking medical treatment, it may also be helpful to address any lifestyle factors that may be impacting your fertility, such as stress, diet, and exercise. Your healthcare provider can provide guidance on these factors and help you develop a plan to improve your overall health and fertility.

If you are struggling with secondary infertility, it is important to remember that you are not alone and that there is hope for building your family. With the right support and treatment, many couples with secondary infertility can conceive and have healthy pregnancies.

Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) can have a significant impact on a person’s ability to conceive and have a healthy pregnancy. STIs can cause damage to the reproductive organs, leading to infertility. Here’s a detailed explanation of how STIs can impact infertility:

• Chlamydia and gonorrhea: These are two of the most common STIs and can cause pelvic inflammatory disease (PID). PID can damage the fallopian tubes, uterus, and other reproductive organs, making it difficult for the sperm and egg to meet.
• Human papillomavirus (HPV): Certain strains of HPV can cause genital warts and cervical cancer. HPV can also lead to the formation of abnormal tissue growth in the cervix and other reproductive organs, making it difficult for the egg to implant in the uterus.
• Herpes: Herpes can cause painful outbreaks in the genital area, leading to scarring and damage to the reproductive organs. In severe cases, it can lead to issues conceiving.
• Syphilis: This STI can cause damage to the fallopian tubes, uterus, and other reproductive organs. If left untreated, syphilis can also lead to damage to the brain and other organs.
• HIV/AIDS: HIV and AIDS can weaken the immune system, making it difficult for the body to fight off other infections. In severe cases, HIV can lead to infertility.

It is important to note that early detection and treatment of STIs can prevent or minimize damage to the reproductive organs and reduce the risk of fertility issues. If you have concerns about STIs and their impact on fertility, it is recommended that you speak with your healthcare provider for further evaluation or treatment options.

Fibroids

Fibroids are noncancerous growths that develop in the uterus and can impact fertility. If you have been diagnosed with fibroids, you may consider speaking to your primary care provider about your future fertility and family-building plans.

Symptoms

Fibroids can cause heavy menstrual bleeding, pelvic pain, and bloating. These symptoms can impact fertility by causing anemia, making intercourse painful, and affecting ovulation.

Treatment

Treatment options for fibroids include medication, surgery, and minimally invasive procedures. If you have concerns about fibroids and their impact on fertility, it is recommended that you speak with your healthcare provider for further evaluation and treatment options.

Impact on fertility

There are several ways fibroids may impact your ability to conceive:

• Location: If fibroids are located near the opening of the fallopian tubes, they can obstruct the tubes and prevent the sperm from reaching the egg. If fibroids are located in the uterus, they can prevent the implantation of a fertilized egg or cause early miscarriage.
• Size: Large fibroids can change the shape of the uterus and cause problems with implantation or miscarriage.
• Number: Multiple fibroids can cause problems with implantation or miscarriage.

It is important to note that not all people with fibroids will experience issues with fertility.

Ovulatory disorders

Ovulatory disorders refer to problems with the release of an egg from the ovary, which can impact fertility. Ovulatory disorders are one of the most common causes of fertility issues for people with ovaries.

• Anovulation: Anovulation refers to the absence of ovulation, which means that an egg is not released from the ovary. Without ovulation, pregnancy cannot occur.
• Irregular ovulation: Irregular ovulation refers to an inconsistent pattern of egg release from the ovary. This can make it difficult to predict when ovulation will occur, making it harder to conceive.
• Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that can cause ovulatory disorders. Women with PCOS may not ovulate regularly or at all, which can impact fertility.
• Premature ovarian failure: Premature ovarian failure refers to the loss of normal function of the ovaries before age 40. This can cause infertility by preventing the release of eggs from the ovary.

It is important to note that there are treatment options available for ovulatory disorders, including medication and surgery. If you have concerns about ovulatory disorders and their impact on fertility, it is recommended that you speak with your healthcare provider for further evaluation and treatment options.