If you and your partner are trying to conceive, every month that goes by without a positive pee stick can feel like an eternity. But you may not need to rush off to the doctor just yet. Here's our guide to help you know when it's time to get checked for possible fertility problems. (But remember: These are guidelines. Please consult your doctor if you're at all unsure.)
Wait a year. Believe it or not, it can take a normal young couple up to 12 months to get pregnant. "We usually recommend patients in their 20s and early 30s try to conceive or at least not use birth control for 12 months [before coming in to see us]," says Dr. William Schoolcraft, founder and medical director of the Colorado Center for Reproductive Medicine. Conception is a delicate dance of sperm and egg, so it's not a guarantee even if you're timing things right.
Wait six months. After 35, a woman is labeled "advanced maternal age." Even though that term makes us cringe—since when is 35 old???—the chances of conceiving start dipping around that age.
"A woman's egg supply decreases over time, particularly after age 35," says Dr. Marcy F. Maguire, MD, FACOG, Reproductive Medicine Associates of New Jersey. If you haven't conceived after half a year, see a fertility specialist called a reproductive endocrinologist (RE).
Right away. After 40, a woman's eggs drop in quality as well as quantity, so not only are the chances of conceiving fewer, but the risk for miscarriage is greater. "At the age of 40, about 50% of a woman's embryos contain an abnormal number of chromosomes," Dr. Maguire says. Women in their forties are more likely to need fertility treatments, so talk to an RE soon after you begin trying.
Before you start trying Your weight can impact the reproductive functions and the hormonal balance of your body.
"Women with a BMI [body mass index] under 18 or over 30 may be at higher risk for infertility and also complications during pregnancy," Dr. Maguire says. Check your BMI using this calculator: if you're underweight or overweight, it's worth talking to your doctor about how to achieve a better BMI for your overall health even before you try to conceive; although it may be possible for you to get pregnant if you're ovulating regularly.
Right away. Your thyroid is tied into your hormones, so if it's out of whack it may impact your chances of conceiving and having a healthy pregnancy. "Abnormal thyroid function may be associated with infertility, miscarriage, and abnormalities of fetal brain development," Dr. Maguire says. If you suspect thyroid issues, see a doctor right away; but if it's already being monitored and regulated with medications, it should be a nonissue.
Right away. "Women with known issues, such as polycystic ovary syndrome (PCOS) or endometriosis, should be evaluated as soon as they begin attempting pregnancy," Dr. Maguire says. Dr. Schoolcraft agrees: "Waiting 6 to 12 months is not always productive in such cases," he says.
Many women with PCOS don't ovulate, so you'll need medications to help jump-start it. Endometriosis is trickier—it could result in blocked fallopian tubes, diminished ovarian reserve or nothing at all depending on its severity, which a fertility checkup can determine.
Right away. An absence of periods, irregular cycles or pelvic pain could be an indication that you have an undiagnosed fertility issue. If you have any of these symptoms, see a specialist ASAP.
Men with fertility problems are best served by either a urologist or an andrologist. Urologists are trained in the evaluation and treatment of disorders of the kidneys, urinary tract, bladder, and male reproductive organs, and have at least two years of general surgical training. A urologist will usually perform a semen analysis, look for varicoceles (varicose veins in the scrotum), check hormone levels, and order lab tests to check on the quality of sperm.
An andrologist is either a medical doctor or laboratory specialist who may have earned a PhD in biochemistry, endocrinology, or physiology. These doctors focus on the physiologic, hormonal conditions that affect male infertility.
If a woman has fertility issues that can't be addressed by her primary physician, she can see a reproductive endocrinologist (RE) — a doctor specializing in the treatment of hormonal disorders that affect reproduction. REs have completed at least two years of training beyond their ob-gyn residency and have passed oral and written exams.
Depending on the nature of her problem, a woman might also need to see a reproductive surgeon. These ob-gyns are trained to treat anatomical problems, such as tubal obstruction, endometriosis, and uterine abnormalities, as well as other reproductive-organ disorders that require surgery.
Before locating a fertility specialist who can address your particular needs, you may need to do some groundwork. Here are a few ways to get started:
During your first visit (which both partners should attend), you'll want to get a sense of how the practice is run, what services the doctor provides, the hours of operation, and the fee structure or payment plan. Here are some general questions to ask: