Rule of thumb: When you’re not getting pregnant after a year of unprotected intercourse on a regular basis – or when you’re getting frustrated.
You’ve decided. Emotionally, financially, you’re ready to have a baby.
But are you physically ready and able?
The American Society of Reproductive Medicine (ASRM) advises that failure to conceive after a year or more of unprotected intercourse on a regular basis is reason to consult a fertility specialist. In fact, 80 percent of women conceive within three months of unprotected intercourse and 98 percent of those that will be successful on their own over several years will have gotten pregnant within a year.
Though friends and family may not have problems conceiving or understand the issues, subfertility (reduced fertility without conception) is common. In the United States about 12 percent of women of reproductive age (15-44) have trouble conceiving or carrying a child, according to the Centers for Disease Control and Prevention. Infertility certainly is not just a female issue though, according to the National Institutes of Health, as roughly a third of infertility cases are due to the male, a third to the female and a third to both.
If you’re struggling to get pregnant and starting to get frustrated but aren’t quite ready to call a fertility specialist, there are some things both you and your partner can do to maximize your chances of getting pregnant such as timing intercourse with ovulation or reaching a healthy weight.
Who should consider seeing a fertility specialist
Many couples aren’t sure when they should reach out to a fertility specialist. They wonder, Have we tried long enough?” “Are we just being worrywarts? The reality is that if you’re asking these questions, most likely you have tried long enough and you’re having an appropriate level of anxiety. If you have not conceived within a year, some data suggests that your odds of successful spontaneous conception over the next several years are 5 to 1 against it happening. Also, getting perspective, even if you don’t pursue testing and therapy can at least make sure you’re on the right track.
If you’re having unprotected sex every three days around the middle of your cycle (whether you use LH predictor kits or not), have no known male or female reproductive problems, are under the age of 35 and you still aren’t conceiving, there may be fertility issues.
My patients often tell me, “We’ve been trying for a while.” But how do you define “a while?” The answer, “It depends” always seems to be right in medicine, but there are a few factors that can help say when to say when.
The age factor
A lot depends on a woman’s age. (Unfairly, men’s fertility isn’t as affected by time, though there are some subtle effects past the mid 30s.) The older the woman is, the harder it is to conceive and the longer it may take. The health of a woman’s eggs doesn’t mature with age, it declines.
Peak fertility is generally between the ages of 23 and 31. In one’s mid 20s, 80 percent of eggs are chromosomally normal, so most months a good egg can be found. However, by 35 as many as half of eggs can be abnormal and by 40 it can be 75 percent or more. As a result, one has to be more assertive about therapy as one gets past age 35, because sperm may have trouble finding normal eggs.
As a quick guide, a woman should come see us if she is:
- Under 35 and hasn’t conceived after one year
- 35 to 39 and hasn’t conceived after six months
- 40 or over and hasn’t become pregnant after three months.
Women who have irregular periods may not be ovulating normally – or at all. Painful periods also may be due to endometriosis, when the tissue that normally lines the uterus grows outside of the uterus. Endometriosis can cause infertility in 30-50 percent of women who have it. Tissue can block the fallopian tubes or impact fertility in other ways.
A fertility specialist can help you unravel why your periods are abnormal. We can recommend treatments for the endometriosis or medications to induce ovulation and get you back on track.
Infertility has as much to do with sustaining a pregnancy as it does with conception. Miscarriages can be caused by multiple issues, including hormonal problems, uterine abnormalities and infections. If you’ve had two or more miscarriages, it’s a good idea to see a fertility specialist.
Because the male partner is the sole cause or contributing cause of infertility in about a third of infertile couples, both partners should be evaluated. (It is amazing how many doctors will perform a tubal reversal on a woman, never check the male, and then find after the reversal that the male has no sperm!) Male infertility often relates to problems with how sperm are produced (low sperm count) or move to possibly reach the egg (low motility).
We can do a sperm analysis. If you’ve already had one, I can assess the severity of the problem and offer appropriate solutions to help you conceive.
Solutions may range from simple lifestyle changes – smoking, testosterone use and extra weight can affect sperm production and quality – to more complicated procedures such as intrauterine insemination (IUI), where semen is injected into the uterus at ovulation, or in vitro fertilization (IVF), in which the egg is fertilized in the lab with semen and the resulting embryo is implanted in the uterus.
Related information: Male Fertility Testing
Other physical problems
In order to conceive a baby and sustain a pregnancy, your body needs to hit just the right balance. A host of physical issues can throw off that balance. See a fertility specialist:
- If you or your partner have had cancer. Cancer treatments can cause fertility problems in both men and women.
- If you have had a sexually transmitted disease. Some sexually transmitted diseases may cause pelvic inflammatory disease (PID), which if left untreated can seriously affect female and male fertility. PID can cause scarring and permanent damage to reproductive organs.
- If you are underweight or overweight. Weight can be a problem for both genders. Underweight women often have irregular ovulation and periods, which makes it harder to conceive. Obese women also have a harder time getting pregnant and have poorer outcomes with reproductive treatments. Studies have shown that overweight men produce less sperm and lower quality sperm. Research has also shown that reaching a healthy weight can improve a couple’s chances of becoming pregnant.
Call the fertility specialist
Infertility could be the result of one or more of the above factors but it can also be treated. I always think it’s important to remind people that infertility is very common among men and women and we see fertility issues as very normal. Please don’t let shame or fear of a diagnosis keep you from your dream of expanding your family.
Fertility doctors are often reproductive endocrinologists, who specialize in treating hormonal and other disorders affecting reproduction (the endocrine system secretes and regulates hormones). Reproductive endocrinologists have three years of specialized training through fellowships beyond their four year OB/GYN residencies. Some fertility specialists, myself included, receive further training in all aspects of infertility and treatments and are board certified in reproductive endocrinology & infertility (REI).
An innovative evaluation technique
The first step of the infertility journey is a thorough examination of both partners. There are a number of tests available to women, including the Parryscope™ testing method, which I developed as a gentle, accurate, comprehensive and fast alternative to traditional testing options, which can be painful.
Related information: Female Fertility Testing
In 15 minutes, I can evaluate the health of a woman’s ovaries, fallopian tubes and uterus. We’ll know if her ovarian reserve, or the quantity of eggs in her ovaries, is adequate, if her fallopian tubes are blocked and therefore preventing fertilization or implantation, and if her womb is in good shape to accept the embryo and sustain the pregnancy. My Parryscope™ evaluation is remarkably efficient at pinpointing the female’s cause of infertility. Similarly, the Parryscope™ technique helps us quickly rule out possible causes of female infertility.
This allows me to quickly understand whether there are any meaningful factors making it hard to get pregnant and whether they can be fixed. In the same visit, I usually sit down with the woman and her partner if present to discuss the results so that we can help them find the best balance for a fast, affordable and successful path to being pregnant.
I know how much fertility can weigh upon you. My goal is to communicate clearly but gently the core things you need to know in order to maximize your chances of having a baby.
The next steps: Get our help sooner rather than later
These are broad guidelines about how to think about what matters and how to find out whether infertility issues affect you. If you have any of the above risks, make an appointment now. The sooner you reach out, the sooner we can help you get results.
Also, we understand that fertility can be as hard mentally as physically. People often want to know how much you care before they care how much you know. Though we have a very educated team, we also care deeply about our patients and treat them as family. We want to be there for you and share in your success!