Proactive Fertility Assessment Makes Sense

There's just no reason to sit around and wait to get pregnant.

Assisted reproductive technology has existed in numerous forms, from basic guidance to high-tech procedures, for decades now. Clinical and laboratory specialists have worked to improve their techniques and skills to the point that pregnancy is a very real option for most people seeking treatment.

Sure, no reputable doctor will tell you to head straight for fertility treatment before you've even tried to conceive -- unless you and yours fall into a few specific categories.

But experts like Dr. Jeanne O'Brien of Shady Grove Fertility Center want everyone to know, "Seeking early consultation for fertility assessment is being proactive about your family's health care."

Early assessment does not equal needing treatment

It's common for prospective patients to worry that by virtue of seeking fertility assessment, they're going to be expected to eagerly submit to fertility treatment. The fact is that while virtually everyone might be able to benefit from such treatment, most people succeed eventually in getting pregnant without more than some guidance and, sometimes, clarification about the conception process.

Of the patients who decide that their situation would be better served by enlisting the help of specialists, most are able to get pregnant with less expensive, lower tech treatments like artificial insemination (AI). It's actually only a small percentage of patients who determine with their fertility specialist that in vitro fertilization (IVF) is their best route to pregnancy. Because IVF is so very successful in facilitating conception with most forms of infertility, it's easy to understand why the high-tech ART is recommended.

Time's the thing

"The first question to be answered," Dr. O'Brien states plainly, "is when to seek treatment."

Many variables go into the equation that add up to answer the question of "when" -- each person's body, medical history, and present health status is different. There are some averages, though, that have been arrived at through years of observation and research.

Here's what Dr. Brad Miller of Reproductive Medicine Associates of Michigan offers as a guideline:

"We recommend that women who are younger than 35 years old and who have been trying to conceive for a year should call their Ob/Gyn for an appointment to have a basic evaluation performed. If they are not pregnant within four to six more months, they then should be seen by a reproductive endocrinologist for further treatment."

One tricky specific note about the "trying to conceive" phase: don't keep it a secret from your Ob/Gyn, or you could find yourself further delayed later. According to Eileen Katzman, Executive Director of Sales & Marketing for Integramed America, "In some states with infertility insurance mandates, documentation of a year of 'trying' is now being required, prior to approval for fertility treatment being granted. That means that if a couple is 'trying but not telling' their OB/GYN, it doesn't count, and the patient is being forced to invest yet another year in the effort, or pay for treatment out-of-pocket. So, the impact can become a real financial burden and the clock ticking becomes all the more problematic."

The components of a basic fertility evaluation can (and sometimes must, depending on health insurance requirements) be performed by Ob/Gyns. Basic fertility testing includes blood tests and a hysterosalpingogram (HSG) to assess the woman's fertility and a semen analysis for the man. You can find out more about infertility tests on this page.

According to Dr. Arthur Wisot of Reproductive Partners Medical Group, only 15 percent of couples who try to get pregnant will not after a year of trying. This does not mean, though, that they can't get pregnant!

Dr. Wisot explains that, "For a young couple in which both partners have normal fertility levels, having intercourse at or around the time of ovulation will result in pregnancy about 20 to 25 percent of the time."

"If you're trying to conceive," Dr. O'Brien elaborates, "you need to be aware of the impact of time. A woman's age and the length of time that's passed since first trying to get pregnant are both indicators of when to seek fertility treatment."

Moving along

Dr. Miller describes another age group and their treatment-timing considerations: "Women who are 35 to 40 and have been trying to conceive for a total of six months should be seen by a reproductive endocrinologist."

The main reason for not recommending women in their late 30's try any longer than six months is because fertility, even in women who have no infertility factors, starts to decrease rapidly within these years. The more time passes, the less likely are her chances that natural, unassisted conception will occur.

Also, even the best treatment is more successful with younger women. Waiting longer than six months to seek reproductive assistance could be the difference between successful conception or never getting pregnant for women in their late 30's.

Dr. Miller continues, "Finally, those women more than 40 years of age and desiring future fertility should be seen by a reproductive endocrinologist immediately. Also, for women of any age with a cycle day 3 FSH [follicle stimulating hormone] level greater than 10, we would recommend an immediate evaluation by a reproductive endocrinologist." FSH is one of the hormones that can be tested by Ob/Gyns or specialists. It's performed by drawing blood on the third day of a woman's menstrual cycle and is used to indicate how sufficient her ovarian reserve may be to help her be fertile.

Again, the reason for recommending that women older than 40 years consider fertility testing immediately is not necessarily based on an assumption that they will need treatment. Rather, the chances are statistically increased simply due to nature that women in their 40's are far less fertile than younger women. If a fertility assessment turns up an issue that is resolvable by treatment, the patient will have time on her side toward her efforts at getting pregnant.

Another group that needs to consider immediate fertility assessment are those with identified risk factors, including:

  • history of irregular menstrual periods or absence of periods
  • previous abdominal or gynecological surgery
  • pelvic inflammatory disease (PID) or other sexually transmitted disease
  • known structural abnormalities of the uterus or other reproductive organ
  • endocrine (hormonal) disorders such as thyroid disease
  • pituitary tumors or hyperprolactinemia

How consumers view their role in health care has changed drastically in recent decades. The amount of health and medical information available is phenomenally different now than even just several years ago. When it comes to getting pregnant, health consumers are more savvy and know that infertility is more common than previously realized. With all the available avenues for getting reproductive assistance, finding out one's individual level of fertility, even before it appears to be a problem, just makes sense.