The ability to conceive is a life event that most couples take for granted. It can be one of the most frustrating and devastating of life’s detours when it doesn’t just happen as expected. So, how do you know if you need fertility treatment? Dr. David Walmer has a few guiding principles to help you decide when and how to get started.
Step #1: Consider preconception counseling
Preconception counseling is a planning step that can help you identify and anticipate potential issues that could impact your pregnancy. It usually consists of a physical exam and questions about both partners’ medical history and lifestyle.
“Pregnancy is one of the most rewarding things women can do and planning for it is wise,” says Dr. Walmer. “Screening tests can help you ward off or anticipate potential problems in pregnancy. It’s not a bad idea to document that you are immune to German measles (Rubella) and Chicken Pox (Varicella).”
Knowing your blood type and having an antibody screen can help your doctor manage your pregnancy. Many autosomal recessive genetic disorders can be predicted and eliminated through screening.“Start by having a conversation with your primary care provider,” says Dr. Walmer. “Your provider can help you to optimize your reproductive strategy, identify general health problems that might complicate pregnancy and help you assess your fertility potential, which may help you decide when to seek help.”
Factors that delay conception or potentially harm a pregnancy include:
- Delayed childbearing (age of the woman)
- Medical problems (diabetes, hypertension, etc.)
- Former surgeries in the abdomen or pelvis
- A genetic condition that is known to affect fertility
- You have irregular periods, endometriosis, or PCOS
- Intake of alcohol, caffeine, tobacco, prescription medications or other drugs
In addition, the psychological benefit of a preconception counseling appointment that allows you to talk about these issues can make the decision regarding any potential fertility treatment easier.
Step #2: Get help immediately if you know or suspect you have a problem
If you know that your menstrual cycles are irregular or you have been already diagnosed with an issue that might impact your fertility, there’s no reason to wait before being evaluated to find out if you’re a suitable candidate for assisted reproductive technology. Especially in cases where there is a known genetic condition that affects fertility in your family history or if you have suffered multiple miscarriages. Having two or more miscarriages in a row may indicate trouble with staying pregnant.
Don’t wait to seek professional help if any of these conditions pertain to you— the risk of infertility only increases with age.
Step #3: Seek help in 6-12 months if infertility remains unexplained
If there are no apparent reproductive problems, the American Society for Reproductive Medicine (ASRM) recommends that younger couples seek professional advice if they and have still not achieved pregnancy after one year of having unprotected sex.
The age of the female partner is more important than the age of the male in determining when to seek help. For women older than 35 years of age, it’s a good idea to start an evaluation for fertility treatment after trying to conceive for six months. By age 40, a woman’s chance of getting pregnant drops to less than 10 percent per menstrual cycle, according to the American College of Obstetricians and Gynecologists. A man’s fertility also declines with age, but not as predictably.
Step #4: Fertility Screening
In order to try to figure out when you need fertility treatment, your provider may want to do tests to help identify if there are sperm and eggs, whether they can find each other, and if the uterus looks like it will be able to house and nurture a growing baby. These tests may include a:
- Semen analysis
- Ovarian reserve testing (Ultrasound, AMH, FSH, Estradiol, Antral follicle count)
- Uterine cavity evaluation (HSG or saline ultrasound)
- Fallopian Tube Testing (HSG or FemVue)
- Endocrine testing (progesterone, thyroid, prolactin)
Once you have the results of the testing, you can begin to discuss options for enhancing your fertility. The options will vary with regard to probabilities of success, risks and cost. Some couples will want to do the least invasive, least expensive option first, even if it has the lowest probability of success while others will want to invest in a fertility treatment like IVF, which is able to fix more problems all at once.