This is probably not a question you’ve ever thought to ask yourself, but the answer might surprise you – especially if you’re a little bit older or if you’re dealing with any genetic polymorphisms that affect hormone levels like MTHFR or COMT.

What is Infertility?

Infertility is a complex disorder with significant medical, psychosocial, and economic aspects.

It is defined as inability of a couple to conceive after 12 months of regular intercourse without use of contraception in women less than 35 years of age; and after six months of regular intercourse without use of contraception in women 35 years and older.  The timing and definition are the same for women using sperm donors.  

Also, please understand we are using the term “women” but this also applies to trans men and non-binary people who have ovaries and a uterus.

Statistically, females aged 20 to 24 years had the lowest rates of infertility while those aged 35 to 39 years had the highest rates.

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The brief windows for infertility pass very quickly. Are you taking appropriate action?

Words related to fertility

  • Subfertility is both Dr. Amy and Dr. Kate’s preferred term because “infertility” sounds too final and sub fertility more adequately reflects that there is typically hope in the situation.
  • Fertility is the ability to have a clinical pregnancy (but this may not result in a live birth so you could be “fertile” but unable to have a baby.
  • Fecundity is clinically defined as the capacity to have a live birth – this is the actual goal of baby in arms.
  • Fecundability is the probability of achieving a pregnancy in a single menstrual cycle with adequate sperm exposure and no contraception that results in a live birth.
  • Sterility is a permanent state of infertility this could be a hormonal or a structural situation for women, for example a woman post hysterectomy, or it could be a zero sperm count for men.

When Should You Be Evaluated By A Professional?

The general consensus among infertility experts is that infertility evaluation should be undertaken:

  • For couples who have not been able to conceive after 12 months of unprotected and frequent intercourse if they are under 35 years old.
  • Earlier evaluation should be undertaken based on medical history and physical findings, and in women over 35 years of age
  • After two miscarriages.
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Gene SNPs and Fertility

There are a number of overt genetic disorders that complicate pregnancy, but even simple polymorphisms can pose a problem.

MTHFR is a known issue with fertility, being implicated in repeat miscarriages, neural tube defects, and also in low sperm count in men.

COMT mutations are also an issue because with COMT mutations there is a much higher risk of high estrogen disease like uterine fibroids or endometriosis as well as a risk of low relative progesterone.

There are other gene SNPs that can cause complications as well, but these are two we’ve talked about before. Most practitioners or fertility groups won’t evaluate your genes as a first step, so if you suspect these issues then talk with your practitioners to request appropriate testing.

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