Guidelines for when to see a fertility specialist & why people with infertility often don’t seek medical assistance
Infertility is a sensitive topic for many, which can make it difficult for couples and individuals to bring it up when they are not having success trying to conceive. It’s understandable that many people don’t know when to see a fertility specialist.
No one is more aware of this than the fertility specialists at Conceive NJ. Although some still feel there is a stigma around infertility, it is actually a very common diagnosis that affects 1 in 6 people of reproductive age.
The following information sets out guidelines for when to seek help, how to feel comfortable doing so, and what to expect in a first visit to explore a possible diagnosis of infertility.
Length of time trying to conceive & infertility risk factors
These are the two key concepts in determining when to see a fertility doctor. The American Society for Reproductive Medicine states that infertility may be the case if a couple has unsuccessfully been trying to get pregnant for a year of having intercourse, without the use of birth control. If the woman is older than age 35, six months of no success can indicate infertility. It is often recommended that women over age 40 seek a specialist’s evaluation as soon as possible. Finally, if a diagnosis in either a female or male partner is already known, then there may not be a need to wait until being seen by a specialist.
If one of the above is the case with a couple or person, they should seek a specialist’s evaluation. The age range difference is due to the fact that infertility increases with age, considerably more so in women than in men. Because of the age factor, getting help from a specialist as soon as possible is important. This is particularly important for those with the time frame issues above AND one of the risk factors below.
Risk factors for infertility
Infertility can be an issue for couples and for individuals. For instance, a female who wishes to be a single parent will require donor sperm and either intrauterine insemination (IUI) or in vitro fertilization (IVF) to have a child. The same is true for LGBTQIA+ couples and individuals, who may also need the reproductive assistance of fertility treatments to have children of their own.
Considerations for male infertility & infertility in women
The following situations are risk factors for male infertility, female infertility or shared infertility. These can indicate that the couple/person seek a fertility evaluation before waiting one year of trying to conceive.
- The woman has conditions affecting reproduction such as polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids or polyps, irregular periods, or any ovulation problems including low ovarian reserve.
- Women who have experienced recurrent miscarriage, which is two or more pregnancy losses.
- Women with a history of ectopic pregnancies or blocked fallopian tubes.
- Men with low sperm count or quality as identified in a semen analysis.
- Men with issues affecting fertilization, such as erectile dysfunction or abnormalities causing ineffective ejaculation.
- Men who have varicoceles, a history of undescended testicles or testicular problems or injury. Also noteworthy is a history of repair of groin hernias, especially in infancy or childhood.
- Men and women with obesity or having low body weight that may affect fertility.
- Those with a family history of infertility issues, either due to health conditions or genetic issues.
- Men or women who have undergone cancer treatments.
- Men or women with a history of sexually transmitted disease.
Some of the above issues can be initially evaluated by a woman’s OB-GYN or a man’s primary care doctor or urologist. But beyond that, seeing a specialist certified in reproductive endocrinology and infertility (REI) is the best option for advanced diagnosis and treatment.
Reasons people who may know when to see a fertility specialist choose not to
Studies have shown that just over a half of people who experienced infertility sought treatment (57% for women 53% for men). Some of this is due to unawareness about infertility or even how long it normally takes to get pregnant.
At Conceive NJ, people often share other issues that caused them to delay seeing a specialist who could help them have a family. We have found these issues frequently prevent others from seeing a specialist as well.
Financial concerns about testing and treatment can be a major obstacle. We want people to know that the majority of fertility patients do not use the more expensive treatments like IVF that can prevent people from even considering a consultation. And if they do need IVF, we work with them on affordable IVF options, insurance coverage and other financial assistance options.
People are embarrassed to talk about infertility – even partners in a couple can avoid discussing it. Consider that many people are too shy to talk about sex, much less the problem of infertility associated with it. This can be due to a lack of understanding about what it takes to get pregnant (it is not an easy occurrence: in the best of circumstances the chances are about 20% each month).
Some are wary of being at fault for the infertility or blaming their partner. The reality is that infertility is an equally shared condition, with about one-third of cases caused by female infertility, one-third by male infertility and one-third by a combination of the two partners. Just discussing infertility or its prospect can cause arguments and relationship difficulties that make seeking help more difficult. We encourage everyone to be as open and honest as possible in these conversations. In many cases, family counseling can help people move beyond their reluctance to take the steps needed to have children of their own.
What to expect at the first fertility consultation
Knowing what to expect at the initial fertility consultation can make people more comfortable with taking that step. We encourage people to have an open mind and come prepared to ask any questions they have. This enables the specialist and the patients to get to know each other and begin to build a trusting relationship so everything goes as smoothly as possible from the start. Consultations will vary as we treat heterosexual couples, LGBTQIA+ couples and those wishing to be single mothers; but we have broken down the general concept of what most patients will experience.
Detailed medical history
Dr. Isaac Glatstein will take a comprehensive medical history from both partners. Because infertility is as likely to be due to either partner or both, it is always best to have both partners present at the first visit, if possible.
We will discuss reproductive health, general medical history including chronic conditions, surgeries, sexual history, family genetic issues and any previous pregnancy outcomes including live births or miscarriages. We will also talk about lifestyle issues such as weight, smoking or vaping, alcohol consumption or drug use.
Fertility tests
Testing generally includes the following items:
- A set of consult bloodwork on both partners to assess general health status and evaluate the reproductive system.
- Several ultrasound exams on the female partner to assess her reproductive system at various timepoints during her cycle.
- Ovulation testing or ovarian reserve testing for the woman.
- Imaging tests such as the hysterosalpingography that checks for open fallopian tubes, which is where fertilization normally takes place.
- A semen analysis for the male partner.
At the end of the first consultation, Dr. Glatstein will review what he is able to identify as potential causes of infertility in the couple or individuals. Most often this will not be a complete assessment, as tests will not yet have been completed.
Working toward a fertility treatment plan
Even so, he will likely be able to suggest what the treatment plan might entail, as well as a schedule for proceeding. Treatments can range from lifestyle steps the patient can do on their own to medications, surgery to correct conditions or anatomical issues, and assisted reproductive technologies such as ovulation medications, IUI or IVF.
He will also discuss a possible time frame for the treatment, and chances of a successful pregnancy, though this can change as additional testing occurs. Dr. Glatstein may discuss counseling options for coping with infertility stress.
Our financial counseling team is available and ready to assist as needed. They will verify patents’ insurance benefits if applicable and also discuss the fertility benefits under their specific plan. They can also discuss treatment costs and set expectations.