When you want to have a baby, but it’s just not happening despite your best efforts, it can be heartbreaking and stressful.
If the question “Why can’t I get pregnant?” runs through your mind way too often, it may be time to seek answers.
According to the National Institutes of Health (NIH), infertility is defined as a person or couple not being able to get pregnant after one year of having regular, unprotected intercourse, or after six months if the woman is older than 35.
That’s the official word, but every person’s situation is unique. If you’re concerned about your fertility challenges and want to educate yourself, you should be able to ask questions and explore your options.
You may already be working with your obstetrician or family doctor, but after months of trying, it is time to begin working with a fertility specialist.
What is a fertility specialist (or reproductive endocrinologist), and how are they different from an obstetrician/gynecologist (OB/GYN)?
A fertility specialist, also called a reproductive endocrinologist or RE, is a doctor who specializes in diagnosing and treating fertility challenges.
Usually, an OB/GYN focuses on patient care during pre-conception, pregnancy, and childbirth under what might be considered “normal” circumstances or with initial fertility challenges. An RE is an OB/GYN who is specially trained to advise on and administer assisted reproductive technology (ART), such as in vitro fertilization (IVF), as well as diagnose and treat physical or genetic fertility challenges.
A fertility specialist’s office can usually also offer counseling and, if needed, make expert referrals to male and female reproductive surgeons.
When it comes to tackling fertility challenges, new discoveries are being made every year, and your RE can discuss these choices with you.
When should you see a fertility specialist?
The three key factors you should consider when deciding whether or when to see a fertility specialist are timing and your age, your personal health issues, and if you have a pattern of pregnancy loss. Here are some basics on each.
The three key factors you should consider when deciding whether or when to see a fertility specialist are timing and your age, your personal health issues, and if you have a pattern of pregnancy loss.
Timing: You’re under 35 and you’ve been actively trying to conceive for a year without success, or you’re over 35 and you’ve been trying for six months.
Fertility declines as we get older. A woman is born with all the eggs she will ever have, and that number decreases as she ages. Hormone levels also change as a woman ages. A man’s sperm quality can also decrease as he gets older, which can complicate the ability of sperm to reach and/or fertilize an egg. Men also produce fewer sperm as they age.
In general, it’s believed that a healthy 30-year-old woman has about a 25%–30% chance of getting pregnant naturally each month. A healthy 40-year-old woman has about a 10% or lower chance of getting pregnant every month. There are exceptions to every rule and statistic, but if you think your age may be a factor, it’s worth exploring, even if it’s to rule out this issue.
Personal health: You’ve experienced or have been treated for menstrual cycle irregularities or pelvic disorders, or your male partner has experienced issues.
Sometimes a woman has experienced reproductive issues, such as irregular periods, that provide an early hint that something may not be quite right with her reproductive system. But whether you’ve had signs of trouble or not, if you’re concerned about your ability to conceive, getting thoroughly tested by an RE could help you understand what may be going on.
In addition to menstrual cycle issues and egg count and quality, your fertility team may also explore issues like hormonal imbalances, polycystic ovary syndrome (PCOS), endometriosis (uterine lining tissue found outside the uterus), fibroid or polyp growths, or blocked fallopian tubes.
An RE will also investigate if there are male-factor influences on fertility. Of all infertility cases, approximately 40%–50% are due to male-factor infertility—male influence alone or in addition to female fertility issues. As many as 2% of all men will test with below-optimal sperm conditions. Male-factor issues include: low sperm concentration, poor sperm motility, abnormal morphology (size and shape), or a combination.
If you’re concerned about your ability to conceive, getting thoroughly tested by an RE could help you understand what may be going on.
Loss pattern: You’ve suffered loss in multiple pregnancies.
A pregnancy loss (the spontaneous loss of a fetus before 20 weeks) is always difficult to bear, though it is more common than you may think. Nearly 1 in 4 pregnancies ends in loss.
Causes may include genetic or chromosomal issues, or maternal health issues or infections. Often, though, there’s no known cause. A woman experiencing two or more losses should consider investigating more closely. An RE can help explain and explore what the determining factors may be, as well as when to start trying to conceive again after a pregnancy loss.
An RE can guide you on your path to pregnancy.
Though you may feel disappointed and saddened over your struggle to become parents, working with a fertility specialist who has experience and knowledge of the latest techniques and technology can help you overcome what may seem like insurmountable odds. You can discuss your options with your RE and choose the best path for you.
If you haven’t already, find a fertility specialist who can help you decide what your next steps should be.