By Prati Sharma, M.D.
You have the iPhone menses tracker and have bought out the drugstores supply of ovulation predictor kits and pregnancy tests. Its now been over 6 months and still no two lines confirming that a baby carriage is in your future. All hope is not lost! The truth is, most couples that don’t conceive in the first year of trying will succeed in Year 2.
What comes next?
Preliminary testing: Ask your family doctor to obtain a few key tests: a semen analysis, day 3 FSH and Estradiol hormone tests and if possible a hysterosalpingogram (HSG) to evaluate the uterus and fallopian tubes (connect ovaries to uterus).
When do you need to see a “fertility specialist?”
Age: Age>35 warrants prompt evaluation and referral after 6 months of trying naturally. One of the basic tenets of reproduction is that loss of eggs (oocytes) accelerates over the age of 35 and particularly over 37, causing age-related infertility. A family history of early menopause especially below 40 is another reason to refer to a fertility specialist sooner as there is a hereditary component to age-related infertility. Asking mom when she went into menopause is an important question that can give insight into your future fertility potential. Any abnormalities in ovarian reserve tests regardless of age should prompt immediate referral.
Moderate to severe male factor infertility: An abnormal semen analysis showing low counts, motility, or morphology can require further treatment with urologic (male specialist) evaluation, intrauterine insemination (IUI: placing washed sperm in the uterus) or IVF with ICSI (fertilizing eggs and sperm in the laboratory).
Tubal abnormalities on HSG: Any evidence of tubal blockage may warrant surgical evaluation by laparoscopy or in vitro fertilization.
Recurrent miscarriage: Two or more first trimester miscarriages (in first 12 weeks) or one second trimester (after 13 weeks) miscarriage are reasons for further evaluation. There are certain genetic, immune and blood clotting disorders that can be tested for and treated to prevent future miscarriages.
History of genetic disorder: A strong family history of any genetic disorder (i.e. thalassemia, sickle cell anemia, familial breast cancer) can mean that the genes responsible can be passed on to children. With the advent of IVF with preimplantation genetic diagnosis (PGD), embryos can be created and tested for specific genes to avoid pregnancy with an embryo with the abnormal gene.
Pelvic pain/endometriosis/fibroids/irregular cycles: Menstrual cycle irregularities and pain can indicate the presence of PCOS, endometriosis, or fibroids, all of which can contribute to infertility.
Chronic medical problems: A significant medical history such as hypertension, obesity, diabetes, autoimmune conditions, or blood clotting disorders can lead to pregnancy complications and contribute to infertility. Referral to a high risk pregnancy specialist can ensure proper management of medical disorders prior to conception to avoid complications in pregnancy.
When initial evaluations (sperm, ovarian reserve, HSG) are performed in a timely fashion and prompt referral is made when abnormalities are found, for most infertile couples, the prognosis is very good.
And a baby carriage can certainly be in most couple’s futures.
*This article is for informational purposes only. Always seek the advice of your family doctor for personal medical advice and guidance.
More about Dr. Prati A. Sharma
Dr. Prati A. Sharma is an American Board Certified Reproductive Endocrinologist who practices at The Create Fertility Centre in Toronto, Ontario. She did her residency and fellowship training at Cornell and Columbia University in New York, NY. She specializes in Polycystic Ovary Syndrome, Advanced In vitro Fertilization procedures and Reproductive surgery. You can reach her at: www.createivf.com where she’s currently accepting patients.
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