Infertility is a challenge no couple wants to face. Nancy Sarmiento, DO, with Carolina Women's Physicians, shares what a couple can expect when dealing with infertility.
How long does it usually take for a woman to get pregnant?
The average couple trying to get pregnant with regular intercourse has a 25% chance of conceiving in the first month, a 70% chance after six months, and a 95% chance in 12 months.
How long should couples try to conceive independently before talking to a doctor?
Age factors into the decision. Age 35 is the magic number when many women get nervous about conceiving. If you are under 35 and have been trying to consistently for a year with no success, we recommend you get evaluated. If you are over 35, nearing 40, we recommend seeing a specialist if you have been trying for six months without conceiving.
How common is infertility?
Though women often don't like to talk about it, infertility is more common than you may think. One in six couples goes through infertility, and people need to know they are not alone.
What are the usual causes of infertility, and how do you evaluate them?
The major causes of infertility are:
- Ovulatory dysfunction (50%)
- Uterine or fallopian tube abnormalities (20%)
- Semen abnormalities (30%)
First, we obtain a thorough history and physical. We want to know if you have regular menstrual cycles to determine whether you ovulate monthly and release an egg. If you are using a period tracking app, we'll look at that data.
Next, we will do some lab tests to evaluate your hormone levels. Some of the hormones that impact fertility are:
- TSH (thyroid stimulating hormone) can significantly affect your menstrual cycle.
- FSH (follicle-stimulating hormone) causes follicles to release the eggs and grow; this tells us the age of your eggs and increases as you age.
- AMH (anti-mullerian hormone) tells us how many follicles or eggs you have available.
Next, we evaluate the uterus or fallopian tubes. We use a transvaginal ultrasound to look into your uterus and see if there are any abnormalities. You could have fibroids, polyps or uterine adhesions that prevent an embryo from implanting. Sometimes, infections can damage fallopian tubes, so we use an x-ray diet test called a hysterosalpingogram to evaluate the fallopian tubes.
Finally, we need to evaluate your partner and will order a semen analysis to rule out an issue there.
What tools may be available for women to track their peak fertility?
Many great apps, like Pre Mom or Flo, let you input the start and end of your cycle to track your ovulation. You can pair these apps with ovulation predictor kits to determine when you will release an egg to optimize the chance of conception. Eggs are only viable for about 24 hours, so it's important to time intercourse appropriately.
When do you refer a couple to a reproductive endocrinologist for infertility treatment?
If the woman is close to age 40, I immediately refer them to a specialist. If they are younger and I find abnormalities like polyps or fibroids that require surgery, a generalist OB/GYN like myself can take care of that.
If there are significant hormonal issues, like a very high FSH level indicating early menopause, I refer women to a reproductive endocrinologist. If there is an issue with the male's sperm, I will also direct the couple to an infertility specialist.
The good news is that many treatment options, including oral or injectable medications, intrauterine inseminations and in vitro fertilization, can help a couple conceive.
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