When to Seek a Specialist

When should I make an appointment to see a fertility specialist?

Insurance companies often define infertility as one year of unprotected intercourse without conceiving. However, this is a general rule that has many exceptions.

So, when should you be concerned? You should be concerned and make an appointment to see either a gynecologist or a reproductive endocrinologist anytime you suspect that you have a fertility problem. There is no reason to wait if you know or suspect that you have a problem.

One of the most common problems that is readily apparent to couples is a problem with ovulation, i.e. releasing eggs. You should be suspicious if you do not have “normal” menstrual cycles. Normal cycles have these characteristics:

  1. They are regular and predictable
  2. They occur at a frequency of between 27 to -35 days
  3. They vary month to month by no more than +/-  one day and
  4. They are associated with an LH surge 14 days before each menstrual period. You can contactmeasure your LH surge by purchasing an ovulation predictor kit from a local drugstore.

Many women with normal cycles will notice an increase in a clear slippery vaginal discharge just before their LH surge. If you are trying to get pregnant, it is a good idea to keep a menstrual calendar and record your LH surges and when you have intercourse. You should try to have intercourse at least once in the three-day window before your LH surge.

Below is a list of other situations that might indicate an existing fertility problem.

  • History of pelvic inflammatory disease
    • Positive test for gonorrhea or Chlamydia
  • History of an ectopic pregnancy
  • Known pelvic adhesions
  • Fertility problems in a previous relationship, etc.

Age as a Factor

If you don’t suspect a specific problem but it seems to be taking longer to get pregnant than you expect, then the age of the female is an important factor in the decision-making process.

Women in their 20s who are sexually active and not using contraception will miss a period and have a positive pregnancy test about every four months. Therefore if young couple doesn’t get pregnant within a year, it is very likely that they have an unsuspected problem.

Couples in the United States today frequently delay childbearing and end up seeking help because of the natural age-related decline in fertility about the age of 35. It is important to know that delayed childbearing is the #1 cause of infertility in the United States and some women who wait until after the age of 40 will not be able to have children without either adoption or the use of donor eggs. Therefore the closer women are to 40 the sooner they should seek help.

Again, it is okay to make an appointment anytime that us you are concerned. You don’t have to prove that you have infertility. Your initial appointment is preconception counseling.