Time To Seek Fertility Help?
Difficulty conceiving can feel uncertain and stressful for many women and couples. In most cases, an initial evaluation begins with an OB/GYN appointment. The basics of conception will be reviewed, and standard bloodwork can be ordered. If a pregnancy has not occurred after 12 months of trying for couples under age 35, or 6 months of trying for couples over age 35, seeking care with a reproductive endocrinologist (RE) is often recommended. This specialist can assist with infertility diagnosis and treatment. Seeking care from a RE early can significantly increase the chances of a successful pregnancy.
Reasons for infertility
Approximately 9% of men and about 11% of women of reproductive age have experienced fertility problems. For some women, age is the primary concern, as fertility starts to decline gradually in the early 30s, followed by a more rapid decline after 35 years of age. In other cases, underlying health conditions such as endometriosis, uterine fibroids, or polyendocrine metabolic ovarian syndrome (PMOS) may be the cause. Male-factor concerns, such as low sperm count or motility, may be the reason a pregnancy has not occurred. Accurate diagnosis of the underlying cause is important so that treatment can be tailored to the individual patient.
When to seek specialized care
Several clinical features signal the need for prompt referral to a reproductive endocrinologist. The absence of menstrual periods or very irregular cycles may suggest ovulatory dysfunction. Recurrent pregnancy loss, defined as 2 or more miscarriages, also requires prompt evaluation. Pelvic pain or known endometriosis can impair fertility and merits specialist input. History of chemotherapy or radiation raises concern for diminished ovarian reserve. Male concerns such as erectile dysfunction (ED) or prior testicular injury also indicate evaluation. In many cases, failure to conceive after months of trying is the main reason for a referral.
Role of the RE
A reproductive endocrinologist is a physician with advanced training in fertility and hormone disorders. During an initial evaluation with the RE, a physical exam will be performed, and a detailed medical history will be collected. Extensive bloodwork, including Anti-Müllerian Hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol, will be completed. An ultrasound will be used to image the uterus and ovaries and count the number of follicles. In some patients, a procedure known as a hysterosalpingogram (HSG) will be ordered to visualize the tubes and ensure there are no blockages. For the male partner, a semen analysis (SA) is typically ordered to evaluate sperm count, motility, and morphology. Patients are encouraged to ask questions at every stage of the evaluation process.
Next steps
Once the RE makes a diagnosis, discussion about next steps can occur. In many cases, intrauterine insemination (IUI) or in vitro fertilization (IVF) will be recommended. The RE will work with the patient to create an individualized plan, often involving the use of fertility medications to stimulate egg growth. In more serious cases of infertility, discussions about egg or sperm donors, or the use of a surrogate may take place.
Moving forward with care
Seeking timely evaluation with a RE can clarify next steps and reduce uncertainty. Evidence-based treatments continue to advance and expand available options for couples facing infertility. If a concern has been identified, patients should seek expert care sooner rather than later. With a diagnosis and individualized treatment plan, reproductive options can be optimized.
