Trying to get pregnant? When to see an infertility specialist

Infertility or having difficulty becoming pregnant is common. In the U.S., about 9 percent of men and 11 percent of women have experienced infertility. For couples who struggle with infertility, it may seem like everyone around them is able to have children, but them. Infertility means lots of waiting, and is often accompanied by feelings of disappointment, worry, confusion, impatience, stress, and/or frustration.

Jade Elliott spoke with Jessie Dorais, MD, Intermountain Healthcare, about trying to get pregnant.

“Many people are surprised when I tell them some average pregnancy statistics,” said Dr. Jessie Dorais, a reproductive endocrinologist affiliated with Intermountain Healthcare.

“There is a 20 to 25 percent probability of getting pregnant of the first couple of tries. And 85 percent of couples will conceive within 12 months. So, that means 15 percent won’t get pregnant right away. And after a couple has tried and failed to achieve a pregnancy for 12-14 months, the monthly probability goes down to 2 to 4 percent,” she adds.

Possible causes of infertility

Infertility is commonly caused by complexities with ovulation or sperm production or function. There are a combination of factors that may prevent pregnancy. In the United States, 10 to 15 percent of couples are infertile.

Female factors, male factors or both may contribute to infertility. The Association for Reproductive Medicine reports that female infertility accounts for about 35 percent of infertility, and male infertility accounts for about 35 percent of infertility, and the remaining percentages are either a combination of both or are unexplained. Some causes may be due to a combination of male or female factors, and some causes of infertility cannot be explained.

Often, tests may be performed on both partners to help determine if there’s a root cause to not being able to conceive naturally. A thorough fertility evaluation will include a complete medical history, and physical health assessment for the female and male partner. After pinpointing some contributing barriers, the fertility specialist will explain some possible fertility treatments.

Some factors that can affect fertility are:

• Maternal age
• A history of Sexually Transmitted Diseases
• Body Mass Index (BMI)
• Reproductive problems such as Endometriosis

However, it’s vital to recognize that every couple is different and has unique situations, so there is not a one-size fits all scenario when it comes to infertility. It’s helpful for women and their partner to discuss any underlying medical conditions with their primary care provider, obstetrician or midwife prior to trying to conceive.

Couples in their 20s or early 30s don’t struggle with infertility as much as those in their 30s and older, due to age affecting reproductive outcomes. Generally, miscarriage rates are about 20 percent for women who are in their 20s and increase to a 35 to 40 percent likelihood for those in their 40s. And genetic mistakes or chromosomal abnormalities (such as down syndrome) in babies also tend to be more common in older women.

Couples may experience primary or secondary infertility

Infertility (or primary infertility), refers to couples who have not been able to become pregnant after twelve months of trying without the use of birth control. This is typically common with first time parents to be.

Secondary infertility applies to couples who have been able to have a child or children in the past but are now unable to conceive. Sometimes, medications that are used to treat medical conditions as well as age in women can contribute to the infertility.

Increasing the chance of getting pregnant before seeing a fertility specialist

Couples who can’t get pregnant easily within a few months, may want to take some steps at home to increase the likelihood of getting pregnant. Women can track their menstrual cycle and ovulation. There are many apps available on smartphones to help with this. Pregnancy is most likely to happen if intercourse occurs within the six days prior to ovulation day. To help track ovulation, there are urinary ovulation predictor kits that may be purchased at drugstores. Women can try using the basal body temperature method to help identify when they’re ovulating, but women are generally most fertile two to three days prior to ovulation, so this method is not very effective for promoting or preventing pregnancy.

When to see a fertility specialist

How long to wait to see a fertility specialist depends on how old a woman is. For women less than 35 years old, it’s recommended to try to conceive naturally for 12 months.

“Consider seeing a specialist 12 months after trying naturally, if menstrual cycles are regular. For women with irregular cycles, they can be seen sooner than 12 months,” said Dr. Dorais. “For women in the 35 to 40-year age range, it’s recommended to see a specialist after trying to conceive naturally for six months without a positive pregnancy test. If women are 40 years of age or older they may want to see a specialist even sooner after trying to conceive.”

What to do before starting infertility treatments

Try to reach an ideal body mass index (BMI) prior to beginning infertility treatments, so don’t be too much over or under the recommended weight for your height and age. Getting adequate exercise, eating a balanced diet, and living a healthy lifestyle are best. That includes not smoking, drinking alcohol or using illegal drugs. These types of lifestyle choices may have an impact on fertility and the baby.

Women who are taking prescription medication will want to consult with their provider about whether it’s safe to continue their medications while trying to become pregnant. Women can begin taking prenatal vitamin supplements prior to conceiving.

“Infertility treatments depend on what's causing the infertility, how long a woman has been infertile, her age and her partner's age, and personal preferences. Everything that can be done is a bit elective. There’s a lot of room for personal preference,” said Dr. Dorais.

Some fertility treatment options include:

• Fertility drugs
• Artificial insemination (AI) and intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Donor eggs
• Egg freezing
• Surrogacy
• Fertility preservation for cancer patients.

It’s vital to recognize that infertility treatment may take time and have high costs. Many insurance plans don’t cover infertility treatments and it’s important to look into costs and plans to cover treatment.

For more information or to find a doctor, visit: https://intermountainhealthcare.org/services/womens-health/reproductive-medicine/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.

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