You’ve been trying to build your family, but nothing is working. When should you see a specialist? Here are 10 sure signs you should see a fertility doctor now.
The textbook definition of infertility is the inability to conceive after 12 months of trying. However, there are certain groups of patients that are at higher risk for fertility issues and shouldn’t wait a full year before seeing a Fertility Specialist. So, what exactly does a Fertility Specialist do? What makes them different from an Ob/Gyn or primary care doctor? How do you know if you need to see one?
A Fertility Specialist is someone trained in all aspects of reproductive biology and has spent years studying fertility in women and men. While your Ob/Gyn can certainly help address some of your basic questions about fertility and may even do some basic testing and treatment, a Fertility Specialist lives and breathes fertility and will be well-versed in the latest research and techniques to help patients conceive successfully.
Being more informed about your reproductive health allows you to make better choices about what is right for you and your family. So, when should you see a Fertility Specialist? Here are 10 sure signs you should make an appointment.
1. You are under age 35 and have been trying to conceive for a year without success.
This is the classic definition of infertility. If you take a young, fertile couple without any fertility issues, they have about a 20-25% chance of successfully conceiving each month they try. With time, fertile couples will eventually achieve success. After 3 months of trying to conceive, 57% of couples will be pregnant. After 6 months, 72% will be pregnant. After 12 months, 85% of couples will be pregnant. If you haven’t successfully conceived after a year of trying, it’s usually a sign that there’s a fertility problem and it’s my job as a Fertility Specialist to figure out what that problem is and how we can fix it or work around it to help you succeed.
2. You are over age 35 and have been trying to conceive for 6 months without success.
As women get older, the likelihood of getting pregnant goes down largely because egg quality declines with time. Egg quality and therefore fertility potential begin declining much more quickly after age 35. This is why we recommend only 6 months of trying for women older than 35 before they consider seeing a Fertility Specialist. Women over the age of 40 should see a Fertility Specialist right away. Fertility drops off pretty quickly after age 40 and women are at higher risk of not just having infertility, but they are also at higher risk of having a miscarriage if they do get pregnant.
3. You have suffered 2 or more miscarriages.
One in 4 women will experience a miscarriage during their reproductive years. But just because they are common doesn’t mean they are insignificant. Miscarriages are incredibly difficult emotionally, physically, and psychologically and they can be a heavy burden on women trying to conceive. Women who have experienced 2 or more miscarriages have what’s known as recurrent pregnancy loss (RPL). There are several well-known causes and risk factors for recurrent miscarriages. A Fertility Specialist can review these causes with you, perform testing to see if you have any risk factors, and counsel you about strategies to reduce the risk of having a miscarriage in the future.
4. You have tried 3 or more clomid cycles without success.
Clomid is a medication that is sometimes prescribed by an Ob/Gyn to help patients ovulate. If you have tried 2 or 3 rounds of clomid with your doctor and either didn’t respond to the medication, didn’t ovulate, or didn’t get pregnant, it’s time to see an expert. We can think about using the same medication in different ways or try different strategies altogether that may help improve your chances of success.
5. You have irregular periods or don’t ovulate regularly.
If you are someone who experiences infrequent or irregular menstrual cycles or if you have been told you have polycystic ovary syndrome (PCOS), it’s important to consider seeing a Fertility Specialist right away. An irregular period may indicate that you are not ovulating or releasing a mature egg during your cycle, which is a necessary step to get pregnant naturally. PCOS is the most common cause of ovulatory problems. A Fertility Specialist can help figure out why your cycles are irregular and then offer some strategies to get your body back on track to help you get pregnant.
6. You have problems with your uterus.
The uterus is the home for a pregnancy and there can be problems with the uterus that can prevent you from successfully conceiving or even increase your risk of miscarriage. If you have been told or you know that you have fibroids, polyps, scar tissue, or some other issue with your uterus, talk to a Fertility Specialist right away. If you have had previous surgeries on your uterus like a D&C, fibroid removal (myomectomy), or C-section, this is also worth discussing with a Specialist because these procedures can cause scarring inside your uterus. The good news about uterine problems is that in the majority of cases they can be fixed by a Fertility Specialist or gynecologic surgeon.
7. You have endometriosis.
Endometriosis is a disease characterized by painful periods, irregular bleeding, pain during sex, and infertility. Endometriosis can contribute to infertility in several different ways. It can cause scarring which distorts your reproductive anatomy making it difficult for eggs and sperm to meet. Endometriomas, which are endometriotic cysts in the ovaries, can destroy healthy ovarian tissue and eggs. Endometriosis can even affect the lining of the uterus, which can impair implantation. Patients with endometriosis are at high risk of having infertility and should speak with a Fertility Specialist right away.
8. Your tubes are blocked or damaged.
The fallopian tubes are responsible for catching the egg once it’s released by the ovary. If one or both of your fallopian tubes are blocked this can decrease your chances of getting pregnant naturally. If both of your tubes are blocked, in vitro fertilization (IVF) should be considered. A Fertility Specialist can help determine if you have risk factors for tubal blockage and discuss the different ways you can make sure your tubes are open.
9. Your partner has a problem with his sperm.
With all this talk about eggs, we don’t want to forget about the importance of healthy sperm. In about 30% of the infertility cases we see, male factor is the primary issue. If your partner has had a semen analysis, review the results with a Fertility Specialist. There can often be clues in the semen analysis that explain why you may be having trouble conceiving. If your partner hasn’t had any testing, a Fertility Specialist can order testing that may be necessary to make sure there aren’t issues with the sperm.
10. You want to learn more about your fertility potential and family building options.
You don’t have to have a fertility problem to see a Fertility Specialist. In fact, I see many patients who just want to know where their fertility stands. Egg freezing for women who aren’t quite ready to start a family is becoming more and more common and takes less than 2 weeks complete. If you are in a same sex relationship and want to use donor eggs, donor sperm, or a gestational carrier, or if you are single and want to start your family a Fertility Specialist can help you understand all your options and walk you through the process.
Whether you are having trouble getting pregnant or if you just want to learn more about your fertility potential and options, talking to a Fertility Specialist can be really helpful. We will meet you where you are and be your partner on your journey.
Dr. Ghazal is a double board certified Fertility Specialist, a Southern California native, and an award-winning Top Doctor and Rising Star in the field. She specializes in all aspects of female and male infertility, IVF, egg freezing, LGBTQ+ family building, miscarriage & pregnancy loss, PCOS, ovulatory disorders, intrauterine insemination, fertility preservation for cancer patients, endometriosis, and preimplantation genetic testing. Her research has covered a wide variety of topics in the field of reproductive medicine including assisted reproductive techniques, embryo culture, fertility preservation, endometriosis, implantation, and IVF outcomes. She has authored numerous book chapters and articles that have been published in top journals and she has been invited to present her research at national meetings.