When a couple is eager to have a baby and isn’t getting pregnant right away, time seems to stand still. The first place to start is figuring out if there is a problem. Infertility is defined as not getting pregnant after 12 months (or more) of regular unprotected sex. Ninety percent of couples get pregnant during this timeframe.
If there is trouble conceiving, experts have recommendations on how soon to consult a fertility specialist based on a woman’s age and past reproductive history. Guidelines suggest a woman under the age of 35 should seek help after 12 months, which drops to six months for women aged 35 to 39. And women aged 40 and over should seek fertility assistance after trying to get pregnant for three months without success. If the woman has a known reproductive problem such as irregular cycles, hormone problems, history of pelvic surgery or if the man has a history of problems that might affect sperm production, then they should seek medical help right away.
Whenever you decide the time is right to seek help, the first step is to find the right fertility specialist – a reproductive endocrinologist – and clinic. Your doctor will begin by performing a complete evaluation of both partners. Causes of infertility lie primarily with the woman about 40% of the time, only the man 25%, both partners 25%, and undetermined 10% (“unexplained infertility”).
A single problem or multiple factors may be affecting your ability to get pregnant; these range from weight or hormonal problems to genetics and even medications you may be taking.
Your evaluation will include a comprehensive physical exam and complete medical history. In general, a doctor will check a woman’s hormone system, ovarian reserve, plus pelvis, vagina, cervix and uterus. A man’s sperm quality—count and motility—is also measured.
A number of simple diagnostic tools can help identify the specific cause of the problem in both men and women. Your doctor will recommend the appropriate diagnostic tests based on the evaluation.
Once a diagnosis is made, or even if a specific cause can’t be identified, your doctor will discuss the treatment options most likely to be effective for your situation, including any risks. This should include what is best clinically, and also what will work for your lifestyle and financial situation.