Photo: Hero Images/Getty
When you’re trying to get pregnant, you start to notice all the babies and pregnant women around you, the cute announcements on Facebook, the moms pushing strollers down the street, and the women with baby bumps at work or in line at the coffee shop. It can start to feel like everyone else is getting pregnant while you’ve been trying for months. It’s normal for it to take a while. But how do you know when it’s time to talk to a doctor about your fertility?
All women should see their doctor for a check-up even before they start trying to conceive to discuss possible issues, genetic testing and lifestyle habits that can give them a head start. If, at any point in the process, you have worries about your fertility, you can go ahead and make an appointment with your doctor, says Batya Grundland, a family physician with the Family Practice Health Centre at Women’s College Hospital. “If someone is concerned, they shouldn’t hesitate to talk to their doctor for reassurance, validation and small tweaks surrounding the timing of intercourse,” says Grundland.
Women who are under 35 and have no major medical conditions need to have unprotected sex for a year before they’re diagnosed as infertile and can move on to the next steps, like testing for issues. “That can feel like a really long time,” says Grundland, “but if you’re low risk, you have time.”
If you are under 35 and have any fertility red flags—like irregular or absent cycles or a history of ovarian cysts, sexually transmitted infections or miscarriages—it’s a good idea to talk to your doctor earlier, after about six months of trying, because all of these could interfere with conception.
Women who are over 35 should also see their doctors after six months, but that doesn’t mean something is wrong. “If someone is 37 and they haven’t conceived for six months, they’re actually not really an outlier,” says Ellen Greenblatt, head of the Mount Sinai Hospital Division of Reproductive Sciences. But since it becomes harder to conceive the older you get and you’re more likely to have fertility issues as you age, you’ll want to know as soon as possible if there are fertility issues so that you can address them.
When you see your doctor, they will talk to you about timing sex to when you’re ovulating and assess your lifestyle habits, such as smoking, alcohol intake and weight. They will also take a health history, asking about medical issues, sexually transmitted infections and previous miscarriages. It’s important to have your partner come to this appointment because half of fertility issues are traced back to men.
If you’ve been diagnosed as infertile, your doctor will likely request basic tests, which might include a sperm analysis and a blood test to look at your thyroid levels and other hormonal issues. If you have one of the most common issues for women—polycystic ovary syndrome, which makes you release eggs infrequently or not at all—they might talk to you about taking a drug called Letrozole to stimulate ovulation.
If your doctor doesn’t find a problem with these tests, you might be referred to a fertility specialist for more tests, such as an ultrasound (to look at your ovaries) and a sonohysterogram (in which fluid is injected into your uterus to make sure that your fallopian tubes are open). Depending on the results, your doctor might talk to you about fertility treatment options like intrauterine insemination (IUI), in vitro fertilization (IVF), surgery to increase sperm counts in men or a procedure to open blocked fallopian tubes in women.
Medical intervention might not be necessary at all—about 50 percent of couples get pregnant on their own in their second year of trying. If you do need it, know that getting medical help can be an emotional—and expensive—process, but it’s often very effective.
“When you’re trying to get pregnant, it can feel that every period and every month that passes is a disappointment,” says Grundland. “But in this day and age, with the technology we have, there are a ton of different options and ways to have a family.”