Is it time to see a fertility specialist?
“Why isn’t it working?” “Is it time to move on?” You have tried everything, from the smiley-face ovulation kits to the fancy iPhone apps to track your menstrual cycle. You have had your partner “on call” to be available any time, any place to try to conceive. You thought you had it all figured out. You eat healthy (all those raw juices and green shakes!), you exercise, and everyone in your family has had no trouble making babies. So, what’s the issue?
First off, know that this is not at all uncommon, and you are not alone. Infertility affects 15 to 20% of couples — that’s 1 in 6 couples who are trying to conceive. It is a growing issue these days, especially with the large population of women (and men!) delaying fertility to pursue their professional careers and other endeavors. And the good thing is that everyone — the media, physicians and your peers — are willing to talk about it openly.
But when is truly the right time to move on and see a fertility specialist?
Infertility is defined as trying for 1 year with unprotected intercourse, with correct timing, and not achieving pregnancy. For women over 35, we shorten this interval to 6 months. If you have been trying to conceive consistently for 6 to 12 months with no positive results, this in and of itself is a good reason to move on. However, know that among patients under 35 years of age, up to 80% will conceive in the second year of trying. That being said, everyone has their own timeline, and many couples want more than one child, so there is no reason to wait beyond these recommended timelines to see a fertility specialist for a more thorough evaluation.
There are some signs and symptoms, as well as medical conditions and family history, that can prompt earlier referral:
1. Irregular cycles
If your cycles are all over the place and using the ovulation kits or apps seems like a waste of money because you never see a “surge” and know when to try, then an early referral is warranted. A fertility doctor can test you for ovulation and can monitor your cycles more closely to track ovulation and figure out if there are any causes for your irregular cycles (such as PCOS, a thyroid condition or high prolactin, to name a few).
2. Family history of early menopause
As any woman would, you naturally speak to your mom about your issues, and she mentions that she went into menopause early at 40. Menopause and ovarian aging have a hereditary component, and daughters of women with a history of early menopause may be at risk for early menopause themselves and, thus, would be candidates for early fertility evaluation and possibly more aggressive treatment. Some women with early menopause may have a genetic component causing this.
3. Family history of infertility
This holds for men and women. If you have family members who’ve experienced infertility or repeated miscarriages, or if men in the family have experienced reduced fertility, then early evaluation is also warranted.
4. History of exposure to reproductive toxins
Radiation, chemotherapy exposure or a current history of medications that can be toxic to eggs and sperm could cause early fertility loss. Patients who have current or prior exposure should see a fertility doctor and, ideally, prior to starting any “gonadotoxic” treatment to consider fertility preservation (egg or sperm freezing).
5. Genetic disorders
Many diseases can be propagated through generations. If you have a family history with multiple members affected by a certain genetic disease — for example, sickle cell or cystic fibrosis — and you are trying to conceive, then it is important to see a specialist and likely a geneticist and be tested for the gene for these disorders. Often, if one or both partners carry the gene, then the resulting pregnancy will be susceptible to the full disorder, and further treatment, such as IVF (in vitro fertilization) and genetic testing of the embryos (PGD/PGS), may be warranted.
6. Advanced reproductive age in men or women
In women definitively and increasingly in men, we know that fertility is age-related. For women over 35 and men over 40, early referral to a fertility doctor is reasonable.
Getting a referral is not hard. Speak to your family doctor about your personal situation, and they can refer you to a fertility specialist for a full evaluation.
Most of all, don’t worry: Your family doctor and we as fertility specialists are here to help, and we are lucky that we have so many tools to assist us in the evaluation and successful treatment of most infertility issues.