What is fertility or infertility? 8 common questions answered 

By Marta Wais MD | May 13, 2025

Part 1, Podium & Parenthood: Fertility & family planning webinar series

Whether you’re just starting to consider growing your family or have been trying for some time, understanding the basics of fertility is empowering. This conversation, inspired by a recent educational session hosted by Markham Fertility Centre and the Canadian Sport Institute Ontario, breaks down core fertility concepts in an accessible, compassionate way—starting from the most fundamental questions.

If you are interested in seeing a Reproductive Endocrinologist and Infertility Specialist at Markham Fertility Centre, please see our referrals page.

What is fertility and how does it work?

Fertility refers to the natural ability to conceive a child. For people with ovaries and a uterus, it involves a series of hormonal and physical changes known as the menstrual cycle. Each month, an egg is released (ovulation) and may be fertilized by sperm. If fertilization occurs, the embryo may implant into the uterus, resulting in pregnancy.

Key concepts include:

  • Ovulation: Typically occurs around Day 14 of a 28-day cycle.
  • Fertile window: The 5–6 days leading up to and including ovulation, when pregnancy is most likely to occur.
  • Sperm lifespan: Up to 5 days inside the female reproductive tract.
  • Egg lifespan: 12–24 hours after ovulation.

Timing intercourse during this fertile window is essential when trying to conceive.

What are the most common causes of infertility?

Infertility affects 1 in 6 Canadian couples, and it can be due to issues with the egg, sperm, uterus, fallopian tubes, or a combination of factors. Both partners should be assessed.

In people with ovaries:

  • Ovulatory disorders (e.g., PCOS)
  • Diminished ovarian reserve (fewer eggs, lower quality)
  • Endometriosis
  • Tubal factor infertility (e.g., blocked fallopian tubes)
  • Uterine abnormalities

In people with testes:

Other factors:

  • Age (fertility begins to decline after age 35)
  • Lifestyle (smoking, alcohol, excessive exercise, stress)
  • Medical conditions (e.g., thyroid dysfunction, diabetes)

Read about lifestyle factors that contribute to male fertility.

Read about lifestyle factors that contribute to female fertility.

Read about prenatal vitamins.

When should I see a fertility specialist?

It’s time to seek help if:

  • You’re under 35 and have been trying for 12 months without success.
  • You’re over 35 and have been trying for 6 months.
  • You have known reproductive issues (e.g., irregular periods, endometriosis, PCOS, history of STIs).
  • You’re a same-sex couple or single person needing assisted reproduction.
  • You’ve had two or more miscarriages.

Don’t wait. An initial consultation and testing can provide answers and peace of mind.

What does a fertility workup involve?

A fertility assessment includes:

  • Cycle tracking or monitoring: Bloodwork and ultrasound to determine ovulation patterns.
  • Blood tests: To check hormone levels (FSH, LH, AMH, thyroid).
  • Transvaginal ultrasound: To assess ovarian reserve and uterine structure.
  • Semen analysis: Evaluates sperm count, motility, and morphology.
  • Hysterosalpingogram (HSG): An X-ray to check if fallopian tubes are open.

These results help your fertility team develop a tailored plan.

What treatment options are available?

Fertility treatment is not one-size-fits-all. Options may include:

  1. Lifestyle Changes
    • Diet, weight management, stress reduction, quitting smoking
  2. Ovulation Induction
  3. Medications like Letrozole or Clomid stimulate ovulation
  4. Intrauterine Insemination (IUI)
  5. Washed sperm is placed directly into the uterus during ovulation
  6. In Vitro Fertilization (IVF)
  7. Eggs are retrieved, fertilized in a lab, and embryos are transferred to the uterus
  8. Fertility Preservation
  9. Egg, sperm, or embryo freezing for future use
  10. Third-party reproduction
  11. Includes donor sperm, donor eggs, surrogacy for those unable to carry a pregnancy

Every journey is unique, and your treatment will depend on your specific diagnosis, age, and goals.

How does age affect fertility?

Age has a significant impact on fertility—especially for women. Here’s a quick overview:

  • Before age 35: Monthly chance of pregnancy is ~20–25%
  • By age 40: That chance drops to ~5% per month
  • Egg quality and quantity decline with age, increasing miscarriage risk

For men, sperm quality also declines gradually, though the effect is less dramatic. However, older paternal age can contribute to lower pregnancy success rates and increased risk of genetic conditions.

What if everything looks “normal,” but I still can’t get pregnant?

This is called unexplained infertility—a diagnosis given when no obvious cause is found. It can be frustrating, but treatment is still effective. Your doctor may suggest a timed IUI cycle, or IVF if you’ve already tried less invasive approaches.

What emotional support is available during fertility care?

Fertility is more than just physical—it affects your emotional and mental health. Many clinics, including Markham Fertility Centre, offer:

You are not alone. Finding a community and support network can make a profound difference in how you navigate the journey.

Summary

Fertility may seem complex, but with the right information, support, and team beside you, you can move forward with clarity and confidence. Whether you’re exploring options or ready to begin treatment, knowledge is a powerful first step.

If you’re unsure where to begin, consider booking a fertility consultation to get the answers tailored to your situation.

Stay tuned for the next topic on our series!

To learn more about meeting with a Reproductive Endocrinologist and Infertility Specialist at Markham Fertility Centre, you can see our referrals page.

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