Many women spend years trying not to get pregnant only to find that when they are ready to start their family, nature has other plans for them. According to the Centers for Disease Control and Prevention, infertility affects about 12 percent of married women attempting to get pregnant. That’s about 1 in 8 American couples.

Every woman has unique fertility circumstances and challenges in conceiving a baby. There is no one right answer when it comes to fertility and the ability to conceive. If you have tried for some time to conceive without success, you may be wondering when might be the right time to move on from watching your diet, tracking your menstrual cycle and having timed intercourse on your most fertile days?

Rashmi Bolinjkar, M.D., an OB/GYN on the medical staff at Texas Health Allen and Texas Health Women’s Care – Allen, a Texas Health Physicians Group practice, offers these guidelines for possible signs of infertility that may spur you to have a conversation with your OB/GYN:

• As a woman, the inability to get pregnant after 12 months of unprotected intercourse at an age younger than 35 or after 6 months of trying over the age of 35.
• A history of multiple miscarriages, endometriosis, pelvic inflammatory disease or irregular ovulation.
• Unexplained infertility.

“We consider the first year of trying for women of child-bearing age to be fairly normal, but if a woman has a reason to suspect an underlying problem, she should seek care earlier,” Dr. Bolinjkar says. “What’s important for the start of conception is for the woman to be in good health and near her ideal body weight. Additionally, medical problems such as diabetes or hypertension should be well-controlled on medications that are deemed safe in pregnancy.”

The good news, according to Dr. Bolinjkar, is that advances in fertility testing and assisted reproductive technology have made it possible for the majority of women and couples who experience challenges in conceiving to go on to fulfill their dreams of parenthood.

OB/GYN or Fertility Specialist?

If you decide to schedule an appointment with your OB/GYN, your visit will likely consist of a thorough assessment of your medical history to rule out other possible problems, such as thyroid disease, hypertension or diabetes, which can play a role in infertility. Your menstrual history will also be evaluated and your doctor will want to ensure you are caught up on Pap tests and screenings for sexually transmitted infections (STIs).

For her patients who still experience conception issues, Dr. Bolinjkar says she will typically recommend comprehensive reproductive testing at this stage. A pelvic ultrasound may be done to evaluate the pelvic anatomy, labs will be ordered for a set cycle day to assess ovarian reserve (an estimate of a woman’s supply of remaining eggs) and immediately following the end of the menstrual flow, a hysterosalpingogram (HSG)?or dye study?will be done to evaluate the uterine cavity and fallopian tubes. The cycle-day 21 progesterone level will be assessed to determine if a woman experiences ovulation and a male semen analysis may be ordered for the woman’s partner to evaluate sperm count, motility (movement) or morphology (structure).

“This may sound a little extensive, but the unique nature of fertility warrants a comprehensive approach to evaluation,” Dr. Bolinjkar explains. “The information I receive from these tests and assessments will allow me to determine if I can I develop a viable treatment plan or the need exists to refer a woman on to a reproductive endocrinologist.”

Generalist OB/GYNs may use medications such as Clomid or Femara as an initial step to stimulate ovulation. These medications are an option if a woman has tried to conceive on her own, has normal tubal patency, her partner has a normal semen analysis and there are no other contraindications to pregnancy. Dr. Bolinjkar points out that side effects such as multiple gestations (generally twins rather than triplets) and ovarian hyperstimulation, or large ovarian cysts, are relatively rare with these medications.

Beyond the use of oral fertility medications, other approaches to assisted reproduction usually fall within the expertise of a fertility specialist. Such a specialist is trained in more advanced approaches to conception, including intrauterine insemination, in vitro fertilization and preimplantation genetic screening. Approximately 85 to 90 percent of infertility cases are treated with drug therapy or procedures other than in vitro fertilization, according to the American Society for Reproductive Medicine.

Find the Right Family-Building Option for You

Many women put off talking to their OB/GYN about fertility concerns because of the perceived “waiting game” that can come with the conception process, but Dr. Bolinjkar suggests women take a more active approach to growing their family.

“You know your body better than anyone,” she suggests. “When nature isn’t cooperating despite your best efforts to manage your health and your use of available technology such as ovulation calculators or cycle trackers isn’t successful, it’s not a sign of failure to reach out to a medical professional. It’s my job to help you in your journey to building your family.”

To find an OB/GYN, or to learn about women’s health and fertility services available through Texas Health Resources, visit Women’s Health.