Like buying a home or finding your dream job, getting pregnant can be a more complicated and lengthy process than you ever imagined. If conception has been a challenge for you, there are plenty of resources to help you get you where you want to be. You just need to know when to access them.
First off, there are some women who should see a fertility specialist even before they start trying. You're one of them if:
-- You have irregular periods and you've been off hormonal birth control for at least three months.
-- You've been diagnosed with a disorder such as polycystic ovarian syndrome (PCOS) or endometriosis.
-- You have had a sexually transmitted infection (STI). If you have been previously diagnosed with a STI, you may be at risk for tubal factor infertility and you have a greater chance of an ectopic pregnancy.
-- You have an autoimmune disease such as lupus; a bleeding or clotting disorder (including heavy menstrual bleeding); or a medical condition that requires long-term use of medication (for example, diabetes, epilepsy or severe depression). You might be at a higher risk for complications during pregnancy, so it's best to work with your doctor to manage treatment before you conceive.
-- You're a past or present smoker. "History of tobacco exposure can have an irreversible impact on a woman's fertility window," says David Ryley, M.D., a reproductive endocrinologist at Boston IVF fertility clinic in Boston and clinical instructor at Harvard Medical School. "Any woman who might be trying to have a family, even she if stopped smoking in distant past, should see someone to have her fertility assessed."
-- Your partner has a known fertility issue.
If you don't fit into any of those camps, you have regular periods, and you're under 35, you don't need to see a doctor until you've been trying to conceive for one year without success. "Some doctors are starting to rethink when it is time to be concerned. It may be worthwhile to come in for some testing if you haven't conceived after six months, since 70 to 80 percent of pregnancies are achieved in the time frame," says Steven R. Bayer, M.D., reproductive endocrinologist at Boston IVF fertility clinic in Boston. "At the very least, undergo testing to check your fallopian tubes and have your partner do a semen analysis."
Doctors recommend that women age 35 to 40 consult a specialist after they've been trying for six months with no luck. If you're 40 or older, that window is halved -- you should seek help when you've been trying for just three months.
But let's define "trying." It's not simply two sex sessions a month or whenever you've had one too many margaritas on date nights. "You need to be having unprotected intercourse every other day in the five days leading up to ovulation and the day you start ovulating," says Angela Chaudhari, M.D., a gynecologic surgeon and assistant professor in the Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine in Chicago. Some docs recommend having sex two to three times per week for an even bigger range (say, days 7 to 20) in your cycle.
Once you have passed the recommended window for trying, see your ob-gyn. "He or she can do a blood workup to determine if there are any hormonal issues and refer you to a reproductive endocrinologist if necessary," Dr. Chaudhari says. If all's well on your side, your guy should consult a urologist, who can look into his sperm count, motility, morphology, and shape, and determine if his health is a factor. Many problems are easily address by lifestyle changes. And even if infertility is an issue, assisted reproductive technologies such as fertility drugs, intrauterine insemination (IUI), and in vitro fertilization (IVF) have higher success rates than ever.
If any doc shoos you away or blows off your concerns, don't hesitate to find a specialist who takes you seriously. "I'd much rather work with someone who is proactive about [her] health, Dr. Ryley says, "than a person who ignores issues until they're too late to fix."
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