Oh, Baby, This Is Harder Than I Thought! When To Seek Reproductive Help

Most couples think that getting pregnant when they're "ready" will be easy. The fact is, however, that an estimated one in 10 couples will experience infertility. If you're one of those 10 percent of couples, you may be asking, how long should we keep trying to get pregnant on our own, and when is it time to see a fertility specialist? The general rule is this:

• If you're younger than 35 and haven't become pregnant after one year of unprotected sex, it's time to talk to a fertility doctor. In fact, insurance won't cover this consultation until and unless you've tried to conceive for an entire year. If you have other associated problems, such as irregular menstrual cycles, then you may seek help earlier.
• If you're 35 or older, you shouldn't wait as long because getting pregnant can get more difficult as you approach age 40. In this case, you should see a specialist after six months of trying to conceive (and insurance will cover it).

Common Reasons for Not Being Able To Get Pregnant

There is a wide range of reasons women can't conceive:

• The largest group we see, 25 to 30 percent of patients, are women who don't ovulate (release an egg each month), usually due to irregular menstrual cycles, most often, as a result of polycystic ovarian syndrome (PCOS).
• Blockages affecting the fallopian tubes, the pair of tubes along which eggs travel from the ovaries to the uterus, are another fairly common cause of infertility that can result from scarring due to infection, previous pelvic surgeries, or sometimes due to endometriosis, a condition often associated with infertility. (Endometriosis is often associated with these types of blockages.)
• In a fairly large percentage of women who can't conceive, infertility is unexplained. All their tests are normal; they simply can't get pregnant.
• There is also a small percentage of women who have abnormally developed uterus or other uterine abnormalities like fibroids or polyps that make it difficult to conceive.
• And in other cases, male infertility is the culprit, usually due to a problem with either sperm production or sperm transport.

The good news is that in many of these cases, there are various medical and surgical treatment options available.

What Can Couples Do Before Seeing a Fertility Specialist?

There are certain commonsense things couples can do to improve their chances of conceiving before they see a fertility doctor. The advice I give patients includes:

• When both partners work and lead busy lives, they might only be having sex on weekends, which isn't necessarily when ovulation occurs. So I encourage couples to buy ovulation kits to determine when the woman is fertile so they can time sex to optimize conception. There are even fertility apps they can use on their phones.
• Some women may want to have pre-conceptual counseling with their regular gynecologist before they start trying.
• Stop smoking. This habit has been shown to compromise fertility in some women. Plus, some insurance companies won't cover in vitro fertilization if either partner smokes.
• Lose weight if you're overweight, obesity is associated with less-healthy embryos and delayed fertility.
• Take prenatal vitamins, folic acid helps aid conception, and normal vitamin D levels may also help (vitamin D deficiency is fairly common among adults).
• Too much alcohol intake (more than four glasses a week) may lower the ability to get pregnant.
• Marijuana use is controversial, some studies suggest pot use can lower sperm count in men and delay fertility in women, while others don't. Even though pot is now legal in Massachusetts, I urge couples trying to conceive to use it with caution.

Overall, the most important advice I would give a woman who is trying to get pregnant is to follow a healthy lifestyle, eat a balanced diet, exercise regularly and maintain a healthy weight. I also remind women that sometimes conception can be a difficult road, and they shouldn't expect miracles after just one or two cycles. At the same time, it's important to not get stressed out, because stress isn't good for them, either. But we're here to try to make it as easy as possible, with an array of approaches we can try, including in vitro fertilization. Our pregnancy success rate at UMass Memorial is very good and, as an academic medical center, we also can provide access to specialists for other conditions, like high blood pressure, that may affect a woman's health. Guest Blogger: Shaila Chauhan, MD, Chief, Reproductive Endocrinology/Infertility, UMass Memorial Health Care