Getting started with fertility treatment

Infertility is typically defined as follows:

• Women under 35 with regular cycles, engaging in unprotected intercourse for 1 year without pregnancy.

• Women aged 35-39 with regular cycles, unprotected intercourse for 6 months without pregnancy.

• Women 40 or older with regular cycles should seek immediate evaluation and treatment.

This definition assumes a heterosexual partnership and regular menstrual cycles. However, you may want to consult a fertility specialist sooner if you experience:

• Irregular or absent periods

• A history of endometriosis or PCOS

• Two or more miscarriages

• Issues with ejaculation

• Prior surgeries or medical conditions (e.g., pelvic inflammatory disease, STIs)

• Known structural reproductive abnormalities

• Hormonal disorders (e.g., thyroid disease, pituitary tumors, hyperprolactinemia)

• A family history of genetic disorders

• You are a single woman, part of a gay or lesbian couple, or a transgender individual.

The success of any intervention is highly dependent on the quality of the egg. Therefore, the primary focus should be to get tested and initiate treatment with increasing urgency if the female partner is older than 35.

Other reasons to consult a fertility specialist:

• If you meet the definition of infertility (see above)

• When basic treatment, often clomiphene citrate (Clomid, Serophene), has not resulted in pregnancy after 6 months

• When severe male factor exists

Often, your obstetrician/gynecologist (OB/GYN) or urologist can conduct basic female and male diagnostic testing. Additionally, a reproductive endocrinologist or reproductive urologist may perform these assessments. The choice of where to begin is frequently dictated by insurance coverage.

A fertility specialist, or reproductive endocrinologist (RE), is a physician who has not only completed the rigorous educational requirements to become an OB/GYN but has also undergone advanced training and a fellowship specifically in reproductive endocrinology and infertility (REI). This additional training can take up to 10 years of postgraduate education.

Yes, men can have infertility. Nearly 40% of semen analyses show abnormal sperm, which can significantly contribute to infertility. Therefore, it is essential to test both the male and female partners when a couple experiences difficulties conceiving.

Infertility is often thought to be only a female problem, but that's incorrect. Men also play a significant role, as things like sperm quality and hormones affect fertility.

Yes. Being proactive and seeking early intervention can significantly enhance your chances of success. Look out for the following warning signs:

• A consistent absence of menstrual periods is often the primary indicator of potential issues.

• Women aged 35 and older are at a higher risk for infertility and should consider consulting a physician sooner rather than later.

• Men experiencing difficulties in achieving or maintaining an erection, or who struggle with ejaculation during intercourse, may be facing underlying issues.

• For individuals with complex medical conditions, it is advisable to seek counseling regarding the risks associated with pregnancy before attempting to conceive. While these conditions might not necessarily prevent pregnancy, discussions are important.

• A family history of genetic disorders in either partner can impact the couple's ability to conceive.

• Experiencing two or more miscarriages raises the possibility of a fertility problem that should be investigated.

• Couples in same-sex relationships, while not inherently infertile, should also pursue evaluations and may require support in their family-building journey.

Early warning signs of potential infertility can occur at any age. Women experiencing any of the following conditions should consider discussing them with a physician to understand their impact on fertility:

• Irregular menstrual cycles, which may indicate polycystic ovary syndrome (PCOS).

• Severely painful periods or the absence of regular monthly periods.

• A history of pelvic surgeries, including the removal of ovarian cysts, treatment for endometriosis, ectopic pregnancies, tubal surgeries, or surgeries related to a ruptured appendix.

• A diagnosis of endometriosis.

Women with any of these conditions who are facing challenges conceiving should seek an evaluation sooner than the typical recommendation.