Specialists use the term “fertility” to describe the ability to conceive a pregnancy, which is slightly different from the capacity to have a live birth, which is known as “fecundity.”
So how do you know if you’re fertile? Unfortunately, the short answer is, unless you just got pregnant, there’s no sure way to tell. However, if you’re a woman, the two most important clues that you may be fertile are your age (the odds are highest before age 35) and a history of regular periods. Your chances are also better if you have never smoked and have no history of a pelvic infection that could cause blocked fallopian tubes. But still, that’s no guarantee.
Why? For one thing, there are causes of infertility in women, such as poor thyroid function and low levels of progesterone, that often go undetected prior to a fertility workup because they don’t always cause obvious symptoms like irregular periods. And some women have perfectly normal test results but still aren’t getting pregnant. This is known as “unexplained infertility,” and it accounts for 20 percent of all cases of infertility, notes Basim Abu Rafea, a reproductive endocrinologist and infertility specialist and medical director of The Fertility Clinic at London Health Sciences Centre in London, Ontario. Without testing, you also won’t know if your partner is fertile because a man can have a low sperm count or poor sperm motility without having any other signs of trouble.
If you meet with a doctor and are diagnosed as infertile, that doesn’t necessarily mean that you will never get pregnant and go on to have a baby. In fact, that’s why some specialists are beginning to use the term “subfertile” because “infertility has a permanence to it,” notes Neal Mahutte, a reproductive endocrinologist and infertility specialist and director of The Montreal Fertility Center. While there are different definitions, Canadian fertility specialists describe a couple as “infertile or subfertile” if a woman is “under 35 and has been having unprotected regular sexual intercourse for a year and has not achieved pregnancy,” explains Abu Rafea. “If you’re 35 and above, it’s six months.”
These timelines were decided because your chances of getting pregnant actually decline the longer you try without success. Mahutte notes that in one study of healthy couples ages 23 to 37, 30 percent conceived in the first month of trying, 10 percent conceived by the seventh month and only about four percent conceived after a year.
If you haven’t seen results in a year (or six months if you’re over 35), that’s when you should head to your doctor to look into causes, advises Abu Rafea. That said, if either of you has something in your medical history that suggests you might have fertility issues, such as a family history of menopause before 40, prior abdominal or uterine surgery, irregular or very painful periods or a past sexually transmitted infection, talk to your doctor immediately.
If you’ve conceived but miscarried in the first trimester or very early in the second, your doctor will investigate after three consecutive losses, explains Abu Rafea. (Technically, this is a problem with fecundity rather than fertility that is known as recurrent pregnancy loss.) The above definitions apply both to couples who have never had a baby (primary infertility) and those who have (secondary infertility).
Being diagnosed as infertile isn’t an endpoint in your pursuit to expand your family, and it doesn’t mean that you have a zero percent chance of conceiving. Identifying any problems and getting the help of reproductive technologies to overcome barriers like blocked fallopian tubes and poor sperm motility can greatly improve your chances. Up to 90 percent of the time, simple treatments, such as medication, are sufficient.
“Very rarely do we tell a young, healthy couple that they can’t have children,” says Abu Rafea. “It’s just how you go about doing it.”