A Guide to determining when to consult with a fertility specialist

You’ve been trying to get pregnant for six months or more. You may be considering the irony that after so many years of not wanting to get pregnant, when you are ready, it’s not happening. It seems like babies are everywhere, and you’ve even caught yourself staring at an expectant mother’s growing belly. You avoid discussing the issue with family and friends. Perhaps the hardest part is the first day of your period.

When should you seek medical advice for infertility?

• Most couples should try on their own for 12 months before seeking professional advice.
• Women over the age of 35 may consult their physicians after six months.
• Women who have irregular cycles or for whom there is a known or suspected risk factor for infertility should seek medical advice once they decide to start a family.

Are you having intercourse during the most fertile days of your cycle?

Women should record their menstrual cycles. Ovulation usually occurs about 14 days before the subsequent cycle starts. For example, in a 26-day cycle, ovulation usually occurs about day 12 (day one is the first day of flow). In a 34-day cycle, ovulation usually occurs around day 20. Over the course of several months, a woman will be able to predict the timing of ovulation and assure that intercourse occurs during the most fertile days of her cycle. Try to time intercourse for every other day from about day 10 to day 20. You may also use over-the-counter ovulation predictor kits such as Clear Plan Easy or First Response to focus on a 24- to 36-hour window.

Consult with your primary care physician or gynecologist before seeking the advice of a fertility specialist.

Couples should not assume that infertility is the result of a medical problem. Lifestyle choices may impact fertility, such as caffeine use, stress, exercise and diet. Your physician may recommend lifestyle changes to increase fertility. Both the male and female should be evaluated.

Once your primary care physician rules out disease and you’ve been having intercourse during your fertile days for at least one year, a fertility evaluation should be initiated. Her evaluation will include blood tests, ultrasonography and hysterosalpingography (HSG). His evaluation will include a semen analysis. Based on the results, your primary physician may recommend a treatment plan.

Women may be prescribed medications to induce ovulation. If pregnancy is not achieved after three cycles, women should be referred to a fertility specialist.

If test results indicate a blockage in the fallopian tubes, abnormal uterus, abnormal sperm or low sperm count, couples should consult with a fertility specialist immediately as they may be candidates for in vitro fertilization (IVF) or intrauterine insemination (IUI).

Who should consider IVF?

• Patients with blocked fallopian tubes
• Patients with endometriosis
• Patients with unexplained infertility
• Patients with severe male factor infertility
• Patients with ovulation disorders
• Prior to or following treatments that may otherwise result in temporary or permanent sterility
• Patients with a family history that puts them at risk for transmitting a particular genetic disorder to their offspring. Such couples are candidates for using preimplantation genetic diagnosis (PGD) to screen embryos prior to transfer.

Who should consider IUI?

• Patients with a low sperm count
• Patients with abnormalities of ejaculation (e.g., retrograde ejaculation, impotence, spinal cord injury)
• Patients with any condition of the cervix that prevents sperm from entering the uterus
• Patients using donor sperm

It is time to see a fertility specialist.

Call 404-778-3401 to make an appointment with an Emory fertility specialist as soon as possible. Before your appointment, we recommend the following:

• Attend one of our fertility and IVF seminars.
• Consider joining a support group like Resolve.
• Review CDC IVF Success Rates Data.
• Gather the results of all the blood tests and semen analysis.
• If you have undergone a hysterosalpingogram, obtain the actual film, not just the radiologist’s report.
• Research your employer’s fertility benefits and financing options.