When To Seek Infertility Treatment

Most couples will achieve pregnancy within a year of trying. Infertility is defined as not being able to get pregnant after one year or longer of regular unprotected sex and not being able to maintain a pregnancy.

About 9% of men and 11% of women of reproductive age in the United States have experienced fertility problems, according to the National Institutes of Health (NIH).

Fertility decreases with age in both men and women, but the effects of age are much greater in women.

In their 30s, women are about half as fertile as they are in their early 20s. Women’s chance of conception declines significantly after 35.

In general, a couple doesn’t need to seek medical help for infertility until they’ve tried to conceive for one year or have an obvious problem or a condition that is interfering with conception.

Since a woman’s age can affect her fertility, women over the of age 35 should have an evaluation if they’ve been trying to conceive for over six months. For women over 40 years old, they should be seen immediately.

“A woman may wish to see a fertility specialist sooner if she has a history of irregular menstrual cycles, miscarriage, pelvic inflammatory disease, endometriosis, polycystic ovarian syndrome, uterine fibroids or other gynecological problems,“ says Brooke Friedman, MD, an OB-GYN and fertility specialist at Scripps Memorial Hospital La Jolla.

Infertility in women is also affected by other factors, including:

• Smoking
• Excessive alcohol use
• Extreme weight gain or loss
• Excessive physical or emotional trauma

Infertility may be due to a single factor in either the male or the female. It may also be due to a combination of factors involving both partners.

“The first step toward a solution is to get a fertility evaluation,” says Dr. Friedman. “Through diagnostic testing, a fertility specialist can help create a personalized treatment plan that’s right for you.”

In one third of infertile couples, the problem is with the man. In one third, the problem is with the woman. In one third, the problem can’t be identified or is with both the man and the woman.

Infertility in men is often due to a problem with sperm production or sperm delivery. “A semen analysis can help identify any problems with the male reproductive system,” Dr. Friedman says.

Infertility in men can be caused by different factors, including:

• Disruption of testicular or ejaculatory function due to trauma to the testes
• Excessive alcohol or drug use
• Being overweight or obese
• Smoking
• Certain cancer treatments
• Medical conditions, such as diabetes
• Hormonal and genetic disorders

Women need a healthy and functioning reproductive system to get pregnant. Infertility in women is often due to problems with ovulation.

Not ovulating can result from several causes, including:

• Ovarian or gynecological conditions, such as polycystic ovary syndrome (PCOS)
• Aging
• Endocrine disorders, such as thyroid disease
• Lifestyle and environmental factors (obesity, being underweight, smoking tobacco, heavy drinking)
• Problems in menstrual cycle
• Structural problems of reproductive system (blocked fallopian tubes due to endometriosis or other conditions, and physical problems with the uterus, including uterine fibroids and polyps)
• Infections (including sexually transmitted diseases)
• Autoimmune disorders

“Your physician may need to perform multiple tests to determine the exact cause of the problem,” Dr. Friedman says.

These tests may include:

• Hormone blood tests
• Pelvic ultrasound
• Hysterosalpingogram, an X-ray test that checks to see if the fallopian tubes are open

Infertility treatment options include:

• Medications to induce ovulation
• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)

Your options will vary based on the cause of the problem.

Fertility drugs may be prescribed to help induce ovulation if the problem is hormonal in nature.

Drugs can be used with other infertility treatments, such as IUI, a procedure where sperm is directly inserted through a woman’s cervix and placed near the top of the uterus. It is also called artificial insemination. The goal is to increase the number of sperm that can reach the egg targets.

IVF is the most effective fertility treatment available that uses assisted reproductive technology (ART). ART refers to fertility treatments in which both eggs and embryos are handled outside the body. About 2% of all infants born in the U.S. every year are conceived using ART, according to the Centers for Disease Control and Prevention (CDC).

With IVF, eggs are removed from a woman’s ovaries in an outpatient procedure under anesthesia and fertilized with sperm in a lab setting. The fertilized eggs, or embryos, are allowed to grow and develop for 5-6 days in the IVF lab. Generally, one embryo is then transferred back into the uterus to achieve pregnancy via the vagina. Your physician may suggest a variation of IVF based on the cause of infertility.

“Success can vary depending on factors, such as the woman’s age,” Dr. Schmidt says. “As a woman ages, the rate of success declines.”

IVF can sometimes be a lengthy and emotionally challenging process. It’s important to get support. IVF can be costly also, especially if the woman has to go through more than one cycle.

IVF sometimes involves the use of donor eggs, donor sperm or previously frozen embryos. A gestational carrier or surrogate may also be involved.

Women today are often waiting until they’re in their 30s and 40s to have children. Single women or couples delaying childbearing have an advantage. They can turn to egg freezing to try to preserve their fertility and increase the chances of conceiving when they’re ready.

For some conditions, surgery may be recommended. For women, procedures may include:

• Hysteroscopy to treat fibroids, adhesions or uterine septum.
• Myomectomy, including robotic myomectomy, to remove uterine fibroids
• Laparoscopy to treat endometriosis, including robot-assisted surgery

Endometriosis causes the uterine lining to grow outside the uterus causing pain, irregular bleeding and sometimes infertility.

“This is an exciting time in reproductive medicine and new developments in research and technology promise even more advancements in achieving safe, healthy pregnancies,” Dr. Schmidt says.

To learn more about this topic, watch the San Diego Health video on fertility issues and miscarriage.

To learn more about this topic, you may also listen to the San Diego Health podcast on what causes infertility in women and men.