Sometimes it just takes more time for a woman to get pregnant. The average healthy couple may try for 6-12 months before nature takes its course. The most important thing to remember if you are having difficulty conceiving is to not take this struggle personally.
According to the American College of Obstetricians and Gynecologists, up to 15 percent of couples suffer from infertility. But thanks to advances in fertility testing and assisted reproductive technology, the vast majority of women and couples who experience challenges in conceiving fulfill their dreams of having a family.
When to Talk with Your Doctor
How do you know when it is the right time to move on from lifestyle modifications, tracking your menstrual cycle, ovulation predictor kits and having well-timed intercourse? Molly McStravick, M.D., an obstetrician/gynecologist on the medical staff at Texas Health Rockwall and Texas Health Women’s Care, a Texas Health Physicians Group practice, offers these guidelines that may prompt you to start a conversation with your OB/GYN:
- Failure to get pregnant after 12 months of unprotected, regular intercourse at an age younger than 35 or after 6 months over the age of 35. Sooner evaluation may be warranted in women 40 or older.
- You have a history of multiple miscarriages, endometriosis, pelvic inflammatory disease or irregular ovulation.
- You or your partner have a known infertility problem.
“Very fertile women may conceive within four months, but we consider that first year of trying for women of child-bearing age to be fairly normal,” McStravick explains. “Many women assume the inability to get or stay pregnant is due to a medical problem. But in reality, hanging on to unhealthy lifestyle habits can affect a woman’s fertility as well.
In addition to giving up smoking, drug use and heavy drinking, a woman should aim to eat a healthy diet, exercise in moderation, try to get her weight into a healthy range and ease up on caffeine. Being in good health and near ideal body weight is a perfect combination for conception.”
The good news is infertility is not inevitable if a woman is older or has a chronic health condition. When ovulation calculators, cycle trackers or other available technology don’t lead to success, it may be time to engage a medical professional in the family planning efforts.
“A woman knows her body better than anyone. But when nature isn’t cooperating despite her best efforts to manage her health and any medical issues, it’s my job to help,” McStravick adds.
OB/GYN or Fertility Specialist?
A woman’s OB/GYN is her first resource for anything related to female reproductive health. McStravick encourages women to schedule a pre-conception counseling visit with their OB/GYN, especially if they have any chronic medical conditions. This ensures that a woman is in her optimal state of health to achieve pregnancy and may reduce the risk of fertility struggles.
Once a patient warrants or desires an evaluation due to infertility, McStravick starts by assessing the woman’s medical history, to rule out possible problems such as thyroid disease, hypertension or diabetes — which can play a role in infertility. She also evaluates the woman’s menstrual history, Pap tests and screenings for sexually transmitted infections (STIs).
A patient always has the choice to see a reproductive endocrinologist, which is a physician who specializes in infertility. A specialist may be recommended after the assessment is completed. In 40 to 50 percent of infertility cases, a male factor is involved. For this reason, McStravick suggests any initial assessment of an infertile couple should involve taking a history and evaluating the male partner as well. In certain cases, it may be recommended for a male partner to see a urologist.
“The unique nature of fertility warrants a collaborative and comprehensive approach. Together, we can gain a sense of what we’re dealing with before a treatment plan is developed,” she adds.
Generalist OB/GYNs may use medication as an initial step to stimulate ovulation. Medications such as Clomid or Femara 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. 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.
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 accompany the conception process, but McStravick encourages women to take an active approach to family building.