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When to See a Fertility Specialist

Private: Elena Hesina Yanushpolsky, MD
Contributor Elena Hesina Yanushpolsky, MD

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.

Get a health checkup

It’s important for both partners to have a general health checkup 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 getting pregnant by using urine ovulation predictor kits which can be bought over the counter. Other ovulation detection methods, such as basal body temperature measurements and cervical mucous evaluations, can be used. However, they are less precise than urine ovulation predictor kits.

Age and pregnancy

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.

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 sex 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.

Personal health history

Certain conditions may significantly increase a couple’s risk of infertility. 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 get pregnant.

For females, infertility risk factors include:

  • Irregular menstrual cycles
  • History of pelvic infections
  • History of pelvic and/or abdominal surgery
  • Endometriosis

For men, the risk factors for infertility are:

  • History of undescended testes at birth
  • Genital infections and/or trauma
  • Use of illicit drugs, marijuana and anabolic steroids

When should you seek help?

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.

Private: Elena Hesina Yanushpolsky, MD
Elena Hesina Yanushpolsky, MD

Elena Yanushpolsky, MD, is an Infertility Specialist within the Center for Infertility and Reproductive Surgery at Brigham and Women's Hospital and Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

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