For most people, trying for a baby begins with a lot of excitement. You might find yourself shopping for baby clothes, planning to take parental leave, and wondering what pregnancy will be like -- for you or your partner. Working with an infertility specialist is probably the farthest thing from your mind. It might feel like something other people do.
Then the first month passes without a positive test. You might spend hours reading message boards to learn about early pregnancy signs, or scour the Internet to learn about ways to optimize your fertility. You go into the second month even more hopeful than ever. Another negative test. Months go by and you may begin to worry that something is wrong. You also know that it’s common for pregnancy to take up to a year, and even to have a miscarriage.
So when should you see an infertility specialist? Here’s what you need to know about making the decision.
Why You Need an Infertility Specialist
If you had an infectious disease, you’d see an infectious disease specialist. If you had cancer, you’d want a cancer doctor, and wouldn’t expect your general practitioner to treat it. Yet all too often, people think they don’t need an infertility specialist. They think their obstetrician or primary care physician can treat their infertility. Or they avoid treatment altogether.
Infertility specialists are more equipped to treat infertility than your family doctor. Infertility is a complex medical issue with many potential causes. Even if you already have a diagnosis, that diagnosis might not be the sole reason for your infertility. So getting a comprehensive workup from someone who knows fertility medicine is key.
Some people with fertility issues see an appointment with an infertility specialist as giving up. They worry that by seeking treatment, they’re admitting a problem, and that somehow doing so will make the problem worse. Don’t fall for this line of thinking. If you’ve tried for a long time to get pregnant and it hasn’t worked, something is wrong. The sooner you find out, the sooner you can become a parent. Infertility is treatable, but prompt treatment can mean the difference between becoming a parent and continuing to struggle.
The benefits of choosing an infertility specialist include:
- Not wasting time. Everyone only has a certain number of fertile years. That means that the sooner you get help, the more time you will have to get pregnant.
- Using only treatments that work. Fertility medicine is rapidly changing. What your OB or GP learned in medical school may be outdated, and even harmful.
- Testing for both partners. Many couples make the mistake of assuming infertility is a woman’s issue. A fertility specialist can treat you both, and will also assess whether there’s an issue in the way your bodies interact -- such as when a woman’s body reacts to a man’s sperm like it’s an invader.
- Saving money. Many people avoid fertility treatment because they’re afraid it will be prohibitively expensive. The reality is that a fertility specialist can actually save you money. Your fertility doctor is an expert at getting people pregnant, and will only try proven methods. That means that you may spend less in the long run.
- The possibility of insurance coverage. In some cases, fertility issues are due to a medical condition that insurance should cover treatment for. A fertility specialist knows which issues to test for, and how to properly code the billing to maximize the insurance coverage to which you are entitled.
When to See an Infertility Specialist
So when should you see an infertility specialist? We recommend seeking help in the following situations:
- The woman is under the age of 35, and the couple has tried for longer than a year to get pregnant. This is because the chances of pregnancy with well-timed intercourse is about 1 in 4 each month. A year offers plenty of time for healthy couples to get pregnant.
- The woman is over the age of 35, and the couple has tried for longer than six months to get pregnant. Six months is enough time for most people to get pregnant. After 35, it can take a little longer. However, waiting too long can run out your fertility clock. Fertility begins gradually declining after 35, and dramatically declining after 40. So every month you spend waiting is a month of lost fertility potential.
- The woman is over the age of 40, and planning to try to become pregnant.
- You’ve been able to get pregnant, but have had a miscarriage, and have then tried for another six months without a successful pregnancy.
You’ll notice that each of these scenarios look at the woman’s age, not the man’s. While male fertility does decline with age, women are born with as many eggs as they will ever have. So women’s fertility declines more rapidly, and eventually ends altogether. Some women also have a condition that causes premature egg death, significantly reducing the chances of fertility. Ultimately, the woman’s age is far more important than the man’s. When the man is over 45, however, we recommend fertility counseling before trying to get pregnant.
Trying for a long period to get pregnant without success is the most common reason people seek help for infertility. Some other reasons to seek help include:
- There’s reason to believe the woman is not regularly ovulating. If you take ovulation tests and never get a positive result, or if you get positive results at several different times during the month, this can mean there’s a problem. Ovulation tests don’t measure actual ovulation. They just show production of luteinizing hormone, a hormone related to ovulation. So multiple positive tests may actually mean the body is repeatedly trying to ovulate but is unable to do so. Another sign that there may be an issue with ovulation is that a woman has a very long menstrual cycle -- longer than 35 days.
- Issues with the woman’s period. A menstrual cycle shorter than 21 days may mean that the luteal period -- the phase of the cycle during which the egg implants in the uterine wall -- is too short for a woman to successfully become pregnant. Very irregular periods can also point to a problem. If a woman’s period length varies greatly, or a woman regularly misses periods, this may signal an issue.
- A serious medical issue in either partner. Some health problems, including diabetes, hypertension, polycystic ovary syndrome, and many metabolic and endocrine disorders can compromise fertility. If you know you have a health problem, talk to your doctor about how it might affect fertility and how you can best control symptoms.
- Using medications that can affect fertility. Ask your doctor about any drugs you take. If any are linked to birth defects, see a fertility specialist for advice on alternatives.
- Having undergone chemotherapy, using immunosuppressants, or undergoing an organ transplant.
- A history of ejaculatory problems in the man. A man who cannot get or sustain an erection, or who cannot ejaculate inside of his partner will be unable to get her pregnant.
- Trying to get pregnant without a partner. If you’re single or hoping to use donor sperm or eggs, work with a fertility specialist, not on your own or with a general practitioner.
- You are trying for a second baby after a history of fertility issues with your first.
- You have had three or more consecutive miscarriages -- miscarriages in a row without a healthy pregnancy in between.
- You have had two or more second trimester miscarriages.
- You have a structural abnormality, such as a swollen testicle or only one ovary.
- You have endometriosis.
- You are very overweight, very underweight, or have a history of eating disorders.
- You monitor your basal body temperature, and it does not follow a normal pattern or does not indicate clearly that you are ovulating.
Sometimes, even in spite of no clear evidence of a problem your gut tells you something’s not right. We often talk to couples who tell us that they just knew they’d one day be sitting in our office, or they were sure it would take more than a year to get pregnant. Don’t let anxiety get the best of you. But listen to your intuition. If you can’t shake the feeling that something might be wrong, see an infertility specialist. There’s no harm in getting help early.
Is it Ever Too Early to See an Infertility Specialist?
If you’re worried that there might be something wrong, but can’t point to any clear evidence of a problem, is there any harm in seeing an infertility specialist early?
Absolutely not! In fact, seeing an infertility specialist before you begin trying to get pregnant can make the process a lot smoother. Particularly if you’re prone to anxiety, support from a skilled doctor can ease your mind, help you make sound reproductive choices, and result in a fertility journey that’s less painful.
Some of the benefits of seeing an infertility specialist early include:An education on how babies are made. You might think you know, but most people never learn the basics. Do you know what a luteal phase is, how important implantation is, or why sex after ovulation is less likely to get you pregnant? What about how long an egg can live? Can you explain how basal body temperature correlates with fertility, or why a positive ovulation test doesn’t necessarily mean you’re ovulating? If you can’t answer these questions, you might need to brush up on your fertility education.
- Basic testing for common fertility issues. A fertility specialist can help you determine if you're at risk for fertility issues, tell you which signs to watch for, and offer basic testing for common fertility issues.
- Counseling on lifestyle strategies that might improve fertility. There’s no magic pill, but a healthy weight, a healthy diet, good stress management, and sound overall health can increase the odds of a healthy pregnancy.
So if you’re considering seeking help, don’t delay. It’s never too early. And if there’s a problem, the earlier you know about it the quicker you can fix it.
Why Some People Are Reluctant to Seek Help
We hear three myths about fertility specialists from our clients. Here’s what they are -- and how they can undermine fertility:
- Myth: Fertility specialists only offer IVF, which is expensive and painful.
Fact: Fertility specialists offer a wide range of treatments, many of which are affordable and some of which are even covered by insurance. Most infertile couples don’t need IVF, and many opt not to try it.
- Myth: Most fertility issues are hard to treat, and seeing a fertility specialist means you’ll probably never get pregnant.
Fact: Seeing a fertility specialist is the fastest route to pregnancy. These doctors are experts at getting you pregnant and ensuring the baby is healthy. Many fertility issues are easily treated, but only with the help of an expert. Wasting time with a generalist may mean wasting months or years of fertility on strategies that don’t work.
- Myth: If we keep trying, we’ll eventually get pregnant.
Fact: Most couples who try longer than a year will not get pregnant without help. Even if you’re among the lucky ones, do you really want to waste more time wondering if you’ll get pregnant and agonizing over your fertility?
There’s a clear solution to infertility issues. It’s not supplements, posting on message boards, anxiety, or fighting with your spouse. A skilled fertility specialist really can help.
What to Expect From Your Appointment
A fertility appointment begins with a comprehensive medical history. Based on your history, the doctor will probably recommend further testing, including a physical exam and blood tests. Your provider will discuss your values and budget with you, so that they can recommend only the treatments that will work for your lifestyle and needs.
At the Center of Reproductive Medicine we also ask important questions about how you’re coping. We understand that infertility can affect your relationship, your mental health, and your sense of yourself. We ask how you’re doing, and we refer you to resources that can help. We listen compassionately and without judgment.
We know it’s hard -- unbearable even. We’re also confident we can help. So give us a call today. You have nothing to lose but your pain. And you have everything to gain.