When to See a Fertility Specialist
If a couple is struggling to get pregnant, when should they seek treatment from a fertility specialist and when is it best to be patient and keep trying? A few key factors should play into this decision. These include:
- The woman’s age.
- Underlying conditions known to affect fertility, such as endometriosis.
- Medical history.
While female fertility is affected by age to a significantly larger degree than male fertility, it is important to remember that male infertility is a very common cause of a couple’s inability to get pregnant. According to the American Society for Reproductive Medicine (ASRM), male issues are identified in approximately 40 percent of diagnosed infertility cases – either as the sole cause or a contributing factor. This underscores the importance of thoroughly testing both partners once infertility is suspected.
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For healthy women under 35
For cases in which the female partner is younger than 35 years old and has no known reproductive health issues, the couple is advised to seek help from a fertility specialist after one year of regular, unprotected intercourse. Approximately 80 percent of women under the age of 35 will become pregnant within one year of trying.
After the one-year mark, couples who’ve not yet achieved pregnancy should seek evaluation from a fertility specialist.
For healthy women 35 and over
A woman’s fertility begins to decline in her early 30s, and the decline accelerates as she approaches her mid to late 30s. This results in decreased egg quality as well as a greater risk of miscarriage and birth defects. For this reason, the American College of Obstetricians and Gynecologists recommends that women over the age of 35 seek help from a fertility specialist after six months of regular, unprotected intercourse without pregnancy.
Women over the age of 40 are advised to consult a fertility specialist right away if they are actively seeking to get pregnant.
Other conditions and factors to consider
Female reproductive disorders
Women with a history of disorders known to cause infertility or make pregnancy more difficult should speak to their OB-GYN provider before trying to get pregnant. Depending on the severity of the disorder, the OB-GYN may refer the patient to a fertility specialist for further evaluation or to help her conceive. These disorders include:
- Polycystic ovary syndrome (PCOS).
- Fibroids, polyps and other uterine abnormalities.
- Diminished ovarian reserve.
- Chronic pelvic pain.
- Anovulation or irregular periods.
Male reproductive disorders
Most males do not experience symptoms when their fertility has been compromised. However, some men may be aware of underlying conditions that may make it more difficult for them to achieve pregnancy with a partner. If this is the case, they should speak with a fertility specialist and pursue further testing. These conditions include:
- Erectile dysfunction.
- History of undescended testicle, with or without repair.
- Previous injury to the testicles.
High or low female BMI
ASRM estimates that approximately 12 percent of all infertility cases are caused by the woman being overweight or underweight. Weight can directly impact fertility because it can alter the balance of important reproductive hormones that regulate ovulation.
One quick way to estimate if weight might be a factor for concern is calculating body mass index (BMI). This simple formula is based on the relationship between an individual’s height and weight.
If a woman’s BMI is well outside the normal range, she should consult a fertility specialist to determine if her weight may be affecting her ability to conceive. The specialist can also tell her what lifestyle changes might be implemented to help her gain or lose weight as needed. Oftentimes infertility caused by high or low body weight can be corrected when the recommended lifestyle changes are adopted.
History of recurrent miscarriage
Women with a history of recurrent miscarriages (two or more) should see a fertility specialist for further testing and evaluation. Miscarriages occur in 15 to 20 percent of pregnancies, and are most often the result of the genetic abnormalities passed on to the fetus. Recurrent miscarriages are much less common, and may indicate an underlying condition or anatomic abnormality.