Still Trying? It May Be Time for Fertility Testing

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Why does pregnancy come easy for some and not for others? High school biology class would have us believe that the union of egg and sperm is an easy feat. Intercourse leads to pregnancy, right?  

“In reality, for a fertile couple in their 20’s, there is about a 25% chance of pregnancy occurring each month. Within a year, 85% of those couples will achieve an ongoing pregnancy” says Jeremy Groll, MD, SpringCreek Fertility. This monthly fertility rate starts to decline as a woman ages. By age 40 there is about a 5 percent chance of pregnancy occurring each month.

Is There a Right Time for Infertility Evaluation?

Most women 35 and under do achieve pregnancy within a year of trying. For the remaining couples and for couples with fertility risk factors, then fertility testing may be appropriate.

The definition of infertility and when to seek fertility testing and evaluation changes with age.

Infertility has traditionally been defined as an inability to conceive, or become pregnant, after one year of regular, unprotected intercourse. So as a general rule, you should seek fertility testing after a year of trying to become pregnant. But there are situations where you may want to seek evaluation sooner.

“If a woman is over the age of 35, then an evaluation should be performed after six months of attempting pregnancy and after three months if she is over 40,” says Dr. Groll.

About 50 percent of the time, a male factor contributes to a couple’s inability to conceive, according to the American Society for Reproductive Medicine. Male fertility testing should therefore be part of any infertility evaluation.

“We’re now saying the definition of infertility changes to six months for women ages 36 to 39 and to three months by the time a women is 40,” Dr. Lindheim notes.

How Does Fertility Testing Work?

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Fertility testing can be targeted or comprehensive, Dr. Groll explains. 

Some OB/GYNs will perform targeted evaluations through blood tests if there is a known or suspected risk factor. Blood tests can shed light on such fertility issues as ovulation disordersthyroid problems and ovarian reserve (production and quality of your eggs). 

Infertility specialists, called reproductive endocrinologists, perform more comprehensive testing that can uncover a broader range of infertility causes.  

“Instead of one test and then another, infertility specialists perform comprehensive evaluations where we do many tests and then put it all together so we can expeditiously move patients through treatment,” Dr. Groll says. 

Female Fertility Testing 

After a physical exam and review of your health history, reproductive endocrinologists first focus on the least invasive fertility tests to uncover the most common causes of infertility. They pursue a variety of female fertility tests on a case by case basis, taking into account patient preferences, age and the duration of infertility. 

Besides blood tests, your doctor also may order imaging tests for a closer, more detailed look at your reproductive organs to uncover such problems as fibroids and ovarian cysts.

Ovarian reserve testing is typically performed for women over 30 and may include ultrasound.

Male Fertility Testing

Sperm need to be plentiful and healthy for the long journey through a woman’s reproductive tract to both reach and fertilize an egg. If the sperm quantity is too low, or if sperm are not shaped properly and do not move well, pregnancy is less likely. A semen analysis will study all these factors to provide a snapshot of male fertility.

If semen analysis results are abnormal, advanced testing may be needed to take a closer look at sperm characteristics or to identify infection.

Things to Consider Before Fertility Testing

Talk to your doctor about lifestyle risk factors, such as smoking, stress or being overweight. Improve what you can before trying to become pregnant. In addition, aim for a healthy diet, regular exercise, limited alcohol intake and no illicit drug use.

Jeremy Groll, MD

Jeremy Groll, MD

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