3 Signs It’s Time to See a Fertility Specialist

The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.

When you want to have a baby, but it’s just not happening despite your best efforts, it can be heartbreaking and stressful. If the question “Why can’t I get pregnant?” runs through your mind often, it may be time to take a proactive step and seek answers from a fertility doctor.

According to the National Institutes of Health (NIH), infertility is defined as a person or couple not being able to get pregnant after one year of having regular, unprotected sex, or after six months if the woman is older than 35. 

The American Society of Reproductive Medicine (ASRM) has expanded the definition to “a disease, condition, or status characterized by any of the following:

• The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
• The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner.
• In patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at 6 months when the female partner is 35 years of age or older.

Nothing in this definition shall be used to deny or delay treatment to any individual, regardless of relationship status or sexual orientation.”

That’s the official word, but every person’s situation is unique. If you’re concerned about your reproductive health or fertility issues and want to educate yourself, you should be able to ask questions and explore your options.

You may already be working with your obstetrician or family doctor, but after months of trying, it is time to begin working with a fertility specialist.

What is a fertility specialist (or reproductive endocrinologist), and how are they different from an obstetrician/gynecologist (OB/GYN)?

A fertility specialist, also called a reproductive endocrinologist or RE, is a doctor who specializes in diagnosing and treating fertility problems.

Usually, an OB/GYN focuses on patient care during pre-conception, pregnancy, and childbirth under what might be considered “normal” circumstances or with initial fertility challenges. An OB/GYN may also be able to administer initial fertility treatments, such as intrauterine insemination (IUI). An RE is an OB/GYN who is specially trained to advise on and administer assisted reproductive technology (ART), such as in vitro fertilization (IVF), as well as diagnose and treat physical or genetic causes of infertility. 

When Should You See a Fertility Specialist?

The three key factors you should consider when deciding whether or when to see a fertility specialist are timing and your age, your personal health issues, and if you have a pattern of pregnancy loss. Here are some basics on each. 

Timing

If you’re under 35 and you’ve been actively trying to conceive for a year without success, or you’re over 35 and you’ve been trying for six months, it may be time to see a fertility specialist.

Fertility declines as we get older. A woman is born with all the eggs she will ever have, and that number decreases as she ages. Hormone levels also change as a woman ages. A man’s sperm quality can also decrease as he gets older, which can complicate the ability of sperm to reach and/or fertilize an egg. Men also produce fewer sperm as they age.

In general, it’s believed that a healthy 30-year-old woman has about a 25%-30% chance of getting pregnant naturally each month. A healthy 40-year-old woman has about a 10% or lower chance of getting pregnant every month. There are exceptions to every rule and statistic, but if you think your age may be a factor, it’s worth exploring, even if it’s to rule out this issue with a fertility evaluation (that may include a review of your medical history, along with blood tests and ultrasound) and/or semen analysis. 

Personal Health

If you’ve experienced or have been treated for menstrual cycle irregularities or pelvic disorders, or your male partner has experienced issues, it may be time to see a fertility specialist.

Sometimes a woman has experienced reproductive issues or abnormalities, such as irregular periods or problems with ovulation, that provide an early hint that something may not be quite right with her reproductive system. But whether you’ve had signs of trouble or not, if you’re having trouble conceiving, getting fertility testing done by an RE could help you understand what may be going on.

In addition to menstrual cycle issues and egg count and quality, the team at your fertility clinic may also explore issues like hormonal imbalances, thyroid disease, polycystic ovary syndrome (PCOS), endometriosis (uterine lining tissue found outside the uterus), uterine fibroid or polyp growths, or fallopian tube blockages.

An RE will also investigate if there are male-factor influences on fertility. Of all infertility cases, approximately 40%-50% are due to male-factor infertility—male influence alone or in addition to female infertility issues. As many as 2% of all men will test with below-optimal sperm conditions. Male infertility issues include: low sperm concentration, poor sperm motility, abnormal morphology (size and shape), or a combination.

Loss pattern 

If you’ve suffered loss in multiple pregnancies, it may be time to see a fertility specialist.

A pregnancy loss (which may be a miscarriage, the spontaneous loss of a fetus before 20 weeks, or a stillbirth which is a loss after 20 weeks) is always difficult to bear, though it’s more common than you may think. Nearly 1 in 4 pregnancies ends in loss. 

The most common causes may include genetic or chromosomal issues, or maternal health issues or infections. Often, though, there’s no known cause. A woman experiencing two or more losses (known as recurrent pregnancy loss) should consider investigating more closely. An RE can help explain and explore what the determining factors may be, as well as when to start trying to conceive again after a pregnancy loss.

An RE can guide you on your path to pregnancy

Though you may feel disappointed and saddened over your struggles to become parents, working with a fertility specialist who has experience and knowledge of the latest techniques and technology can help you overcome what may seem like insurmountable odds. You can discuss your treatment options with your RE and choose the best path for you.

If you haven’t already, find a fertility specialist who can help you decide what your next steps in your family-building plan should be. You can also connect with a fertility coach to help with guidance and support throughout your fertility journey.