How Soon Should Couples Seek Fertility Treatment?

Snoopy is pretty smart
Charlie Brown had it down. And Snoopy did too. (Courtesy:

You’ve been trying to conceive but sparks just aren’t flying. You stopped using birth control pills (or pulled the IUD) and started having unprotected sex. With the help of an app, you figured out your most fertile time of the month and began timing sex to increase the odds. You switched to vegetable oils for lubricants and tried all sorts of positions, from missionary to doggie to cowgirl to kneeling lotus to quarter moon, full moon and even no moon, but still no luck. Maybe it’s time to get some help.

When To Seek Help?

Society guidelines define infertility as the inability to conceive after one year of trying. It’s that simple. How, when and where you have sex is all up to you, but if it doesn’t happen after 12 months, then infertility is present. The basis for this definition becomes apparent when you look at the trigonometry of trying: 30% get pregnant within the first month of trying, 60% get pregnant by 3 months, and 80% are pregnant by 6 months. After that another 5% of couples will conceive by 12 months and 15% will not have conceived.

So, the classic recommendation is to try for one year before seeking help. But, as a fertility specialist who sees infertile couples for a living, I would suggest that couples seek help whenever they get concerned about it. I say this because concern snowballs into stress and anxiety, and all of this can negatively impact the relationship, quality of life and fertility potential. Realizing that women’s fertility is known to decrease with age, I also recommend that couples seek help after 6 months if the female partner is older than 35 years. And, if either partner has a known medical history that might impact fertility, say like cancer treatment or surgery on their reproductive parts, then they should also consider seeking help even sooner than 6 months.

Who Goes First?

Society guidelines are clear on the issue of who gets evaluated once care is sought: Both partners. And at the same time.  However, what usually happens is that women make the first call to their gynecologists and the process begins. That evaluation should include a detailed medical and menstrual history, a physical examination and further blood and imaging studies as indicated. The male partner evaluation should also include a history, a proper physical examination, two semen analyses and blood and imaging studies as indicated. Importantly, since gynecologists do not typically take care of men, the male evaluation should be performed by a urologist with an interest or expertise in male infertility. In my practice, a thorough male infertility evaluation is completed in a single office visit, and one that I promise will not hurt.

Remember, although making babies is the most fun you might ever have without laughing (Woody Allen), behind the scenes there is a virtual symphony of precisely orchestrated biological events that must occur for its success.  The beauty and complexity of human conception is staggering if you really think about it. And getting professional help to tweak the process can mean all the difference in the world. Charlie Brown hit the nail on the head when he said: “Asking for help isn’t weak, it’s a great example of how to take care of yourself.”

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