Is It Time to See a Fertility Specialist?

How long should you try to get pregnant before speaking with a fertility specialist?

Typically, women under age 35 should attempt pregnancy for about 1 year prior to scheduling an appointment with an infertility specialist. Women older than 35 should be evaluated after attempting pregnancy for 6 months without success. This is because a woman’s egg supply decreases with age, particularly after age 35.

A woman may want to speak a fertility specialist earlier if:

  • A woman has irregular menstrual cycles or a family history of early menopause
  • Either partner has a history of cancer

This is a critical issue today as individuals plan to start their families later in life.

 

What medical issues could put you at a higher risk for fertility problems?

There are a number of issues that increase a couple’s risk for infertility:

  • Advanced age, particularly age >35 is the risk factor most strongly associated with infertility
  • Women over the age of 35 who have been having unprotected intercourse for 6 months or longer without pregnancy should be evaluated by their gynecologist or a reproductive endocrinologist
  • Irregular menstrual cycles can also lead to difficulties with conception
  • Irregular cycles can be a sign of polycystic ovary syndrome, premature ovarian failure, or insufficient stimulation of the ovaries by hormones from the brain.
  • Abnormal thyroid function may be associated with infertility, miscarriage, and abnormalities of fetal brain development. Again, because abnormal thyroid function negatively affects not just fertility, but overall health, it is very important that any individuals with abnormal thyroid function be regularly monitored by their primary care physician or an endocrinologist.
  • Extremes of body weight may also affect reproduction. Individuals with a BMI under 18 (underweight) or over 30 (obese) may be at higher risk for infertility and also complications during pregnancy.
  • Individuals who are underweight or have morbid obesity (BMI >40) should seek expert consultation prior to attempting conception. All couples seeking pregnancy should aim for a healthy body weight prior to conception.
  • Women with endometriosis are at increased risk for infertility and ectopic pregnancy. Endometriosis is a condition wherein endometrial tissue (which should be found only inside the uterus) occurs outside the uterus. Endometriosis can lead to scarring and damage of pelvic structures including the fallopian tubes and ovaries. It is typically associated with infertility and pelvic pain.
  • Individuals with complicated medical histories, including the history of cancer, inflammatory bowel disease, prior pelvic surgeries, or other health issues may benefit from an early fertility evaluation. Such diagnoses and procedures can be associated with diminished ovarian reserve (low egg count), blocked fallopian tubes, and complications occurring during pregnancy.

What if you already know you have reproductive issues?

Women with known reproductive issues such as polycystic ovary syndrome (PCOS) or endometriosis should be evaluated by their gynecologist or a reproductive endocrinologist as soon as they begin attempting pregnancy.

Women with PCOS often will need medication to induce ovulation in order to facilitate conception. Women with endometriosis should have their fallopian tubes evaluated to make sure that the endometriosis has not created scarring which increases their risk for ectopic pregnancy or completely obstructs their opportunity for conception.

Women with a history of pelvic inflammatory disease or multiple prior abdominal/pelvic surgeries should likewise be evaluated for anatomical changes/ scar tissue that would obstruct pregnancy.

Also, for couples in whom the male partner has a complicated medical history, prior exposure to chemotherapy, and/or testicular or endocrine abnormalities, early semen analysis may save the couple many months of fruitless efforts at conception.

 

What should you do if you’ve had more than one miscarriage?

Individuals with recurrent pregnancy loss (more than two miscarriages) should be evaluated by their gynecologist or a reproductive endocrinologist. There are several medical conditions associated with recurrent pregnancy loss, many of which can be corrected.

Anatomic problems with the uterus such as a uterine septum, intrauterine scar tissue, and others can cause pregnancy loss. Abnormalities of thyroid function, exposure to environmental toxins, and issues related to blood clotting may also be linked with recurrent miscarriage. Sometimes one or both parents may harbor a chromosomal translocation (genetic issue) which can be addressed through advanced embryo screening techniques.

 

Once you decide to see a specialist, what can you expect?

  • Before you visit a fertility specialist, make sure to bring your insurance documents, any relevant test results or medical history documents, and your partner, if possible
  • Budget about an hour for your initial consult
  • Once checked in, you’ll meet with your reproductive endocrinologist, who will ask you about your history and your partner’s history and learn how long you’ve been trying
  • The doctor will review your gynecological and pregnancy history
  • He will also review your medical history to see if you have any preexisting medical conditions which could affect your ability to get pregnant or maintain a healthy pregnancy
  • Then, he’ll go over any surgeries you’ve had and ask whether you are on any medications, have allergies, or regularly smoke cigarettes, drink alcohol or use drugs
  • Next comes a discussion about family history and genetic disorders
  • Then, the doctor will perform a pelvic exam and vaginal ultrasound to take a look at the shape of your uterus and ovaries
  • He will let you know what he found during the exam, review your history and answer any questions you may have
  • Finally, he will tell you about the testing you may need to do during a follow-up visit, including blood work, a hysterosalpingogram (HSG), a semen analysis, and genetic testing
  • At this point, you’ll leave the doctor’s office and see a nurse who has been chosen for you and will be part of your care team during your treatment
  • That nurse will answer any other questions you have and schedule you for your blood work
  • After all that, you can go home. If you decide to pursue testing, you can get that done first and then meet with your doctor again to design a plan to help you get what you came for: a healthy baby

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