Earlier evaluation for infertility is merited in special circumstances. For instance, if a woman has irregular menstrual cycles or a family history of early menopause, or either partner has a history of cancer, the couple should seek consultation as soon as they decide to have children. Some women in these circumstances will seek evaluation even before deciding to have children.
This is a critical issue today as individuals plan to start their families later in life. Our recent Infertility in America 2017 survey found that, on average, Millennials are planning to wait until after they are in their mid-30s to start their families. This means that they should speak to their gynecologist to learn more about their options to help ensure they are able to have healthy children later on.
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. Because all of these issues are associated with health problems beyond fertility, it is very important that anyone with irregular menstrual cycles be evaluated by their gynecologist. Indeed, irregular cycles can sometimes be the first sign of insulin resistance or diabetes, malnutrition, endometrial hyperplasia or cancer, or even (very rarely) brain tumors.
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 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.
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.
Of course, as with any complicated medical conditions, unexpected or atypical situations can occur. Women with polycystic ovary syndrome can occasionally ovulate spontaneously and conceive on their own. Women with endometriosis can also have spontaneous conceptions, though extra precaution is merited to ensure that they do not have an ectopic pregnancy. Women of advanced reproductive age can sometimes have spontaneous, healthy conceptions. However, these scenarios are less common and thorough early evaluation of women with complex reproductive issues will help the majority of those individuals to be better prepared to plan for and achieve pregnancy.
BELLEVUE, WA – March 13, 2024 – Reproductive Medicine Associates (RMA), one of the nation's…
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