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When to See a Fertility Specialist

As a couple, you’ve been trying to conceive for several months without success. Should you keep trying or should you consult a fertility specialist? The correct answer is that it depends. Here are some things that can help you determine how soon to see a specialist.

Getting Ready

It’s important for both partners to have a general health evaluation with a primary care doctor before seeking fertility evaluation and treatments. Many illnesses can have an impact on a couple’s fertility.

I also recommend that my patients maximize their chances for conception by using urine ovulation predictor kits which can be purchased over the counter. Other ovulation detection methods, such as basal body temperature measurements and cervical mucous evaluations can be used, though they are less precise than urine ovulation predictor kits.

Age Considerations

A woman’s age is the main factor affecting a couple’s chances of achieving a successful pregnancy. A woman’s fertility peaks between the ages of 20 to 30 years. From 30 to 35 years of age, female fertility starts to slowly decline. Once a woman turns 35, her fertility begins to drop more rapidly. Over the age of 40, women have significantly lower chances for conception each month. The risk for miscarriage also increases.

A decline in fertility and an increase in miscarriage rates are related to changes in the genetic, chromosomal, and metabolic characteristics of eggs that occur as women get older. These changes mean eggs are less likely to be fertilized by sperm. If fertilization does occur, the embryos also are less likely to implant successfully in the uterus, resulting in increased miscarriages.

   

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A man’s age may also affect a couple’s fertility. While men are known to have fathered children well into their seventies, changes in sperm characteristics and a drop in overall sperm counts occur as men get older, further reducing fertility.

As a result of these changes, evaluation by an infertility specialist should be considered if a couple has been unable to achieve a successful pregnancy after one year of unprotected sexual intercourse when the woman is younger than 35 years old, or after six months if a woman is older than 35 years; a man’s age should also be a consideration in whether to consult an infertility specialist.

Health History

Certain conditions may significantly increase a couple’s risk of infertility. For females, this includes irregular menstrual cycles, history of pelvic infections, history of pelvic and/or abdominal surgery, and endometriosis. For men, the risk factors for infertility are histories of undescended testes at birth, genital infections and/or trauma, and use of illicit drugs, marijuana, and anabolic steroids. If either partner has any of these risk factors, a fertility specialist may need to be consulted after only a few months of trying to conceive.

If you’re still unsure about consulting a specialist, I advise seeing someone sooner rather than later, particularly if you or your partner is over 40 years old. Waiting can work against you due to age-related fertility declines and cause needless worry and anxiety. 

Learn more about the evaluation and diagnosis of infertility in both men and women.

 

In this video, Mark D. Hornstein, MD, Director of the Center for Infertility and Reproductive Surgery at Brigham and Women's Hospital, discusses in vitro fertilization (IVF).