Not Pregnant Yet? When to Seek Help

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.

“By definition, infertility is failure to conceive after one year of unprotected intercourse,” says infertility specialist Jeffrey M. Goldberg, MD. “If pregnancy hasn’t been achieved in one year, it’s time to consult an infertility specialist.”

Infertility affects about 15% (1 in every 6 or 7) of reproductive age couples.

When to see a doctor

While most couples should consult a doctor after a year of trying, Dr. Goldberg says some should see an infertility specialist sooner. Women who are 35 or older should be evaluated after trying for only six months since age-related decline in fertility is more rapid in the mid to late 30s and 40s. While a fertile 30-year-old woman has about a 20% chance of getting pregnant during each cycle, by age 40 those chances have dropped to about 5%.

Others who should see a doctor sooner than a year are:

• Women with irregular or absent menstrual cycles, which are signs that she’s not ovulating normally.
• Women with a history of endometriosis, pelvic adhesions (scar tissue) or pelvic infections.
• Women who have had a tubal ectopic pregnancy, pelvic infection or need to reverse a tubal ligation.
• Men with an abnormal semen analysis or erectile or ejaculatory problems.
• Men who need surgery to reverse a vasectomy or obtain sperm.
• Lesbian or single women requiring donor sperm.

Although not an infertility problem, women who have had two or more miscarriages should also seek help.

Finding solutions

Since infertility involves two patients, finding a potential cause(s) requires tests for both partners. These may include:

• Strategies for tracking the woman’s ovulation.
• Screening for anatomic problems like fibroids or blocked fallopian tubes.
• Obtaining a semen sample for a sperm count.

The infertility specialist uses these findings to recommend a path toward conception, which may include:

• Medications like Clomid® or letrozole that promote ovulation.
• Surgeries on either partner, such as a procedure to reverse a prior tubal ligation or vasectomy, remove fibroid tumors from the uterus or cysts from the ovaries or to treat endometriosis. 
• Procedures such as intrauterine insemination (also called IUI or artificial insemination) or assisted reproductive technology like in vitro fertilization.
• Discussions of lifestyle factors that can impair fertility, including smoking and excess weight.

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