Not Pregnant Yet? When to Get Help

Not all couples should wait a year to get fertility help

couple looking at pregnancy test

Trying to have a baby can bring feelings of joy and anticipation about expanding your family. But when conception doesn’t happen right away, it’s easy to start worrying about infertility.

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“By definition, infertility is failure to conceive after one year of unprotected intercourse,” says OB/GYN Jeffrey Goldberg, MD, and Section Head, Cleveland Clinic Obstetrics and Gynecology. “If it hasn’t happened in one year, it’s time to see a fertility specialist.”

Infertility affects about 15 percent of the population, or one out of every six or seven couples. In many cases, it’s possible to identify the cause of the problem — whether it’s him, her or a combination of both — and take action to solve it.

When to see a doctor

While most couples should consult a doctor after a year of trying, Dr. Goldberg says some should see a fertility specialist sooner. For example:

  1. Women who are 35 or older, when fertility declines precipitously in most women. While a healthy 30-year-old woman has about a 20 percent chance of getting pregnant during each cycle, by age 40 those chances have dropped to about five percent.
  2. Women with irregular or absent menstrual cycles, which are signs that she’s not ovulating normally.
  3. Women with a history of endometriosis, pelvic adhesions (scar tissue) or pelvic infections.
  4. Women who need to reverse a tubal ligation or have tubal diseases.
  5. Men with an abnormal semen analysis or erectile or ejaculatory problems.
  6. Men who need surgery to remove blocked tubes, including the vas deferens or epididymis.
  7. Men who need microsurgery to reverse a vasectomy or obtain sperm.
  8. Lesbian or single women requiring donor sperm.

Finding solutions

With two people involved and so many fertility-impacting factors, achieving conception can take some detective work.

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It starts with physical exams of both partners and a discussion of health and sexual histories to begin to uncover the causes of the couple’s fertility problems. These may include:

  • Strategies for tracking the woman’s ovulation
  • Screening for fertility-inhibiting conditions in a woman like polycystic ovary syndrome or endometriosis
  • Testing a man’s semen for sperm count and evaluation for possible sexual dysfunctions
  • Discussion of lifestyle factors that can inhibit fertility, including smoking, excess weight and poor diet

Like any good detective, a fertility specialist uses these findings to recommend a path toward conception, which may include:

  • Medications like Clomid that promote ovulation
  • Surgeries on either partner, such as a procedure to repair her blocked fallopian tubes or his varicocele, an enlargement of the veins in the scrotum that can cause low sperm production
  • Procedures such as intrauterine insemination (also called ‘artificial’ insemination) or assisted reproductive technology like in vitro fertilization

Your doctor can help you decide the best way to proceed with your plan to have a baby.

More information

Infertility Treatment: When Nature Needs a Helping Hand

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