When to See a Fertility Specialist

As a couple, you’ve been trying to conceive for several months without success. Should you keep trying, or should you consult a fertility specialist?

The correct answer is that it depends, according to Elena Yanushpolsky, MD.

Dr. Yanushpolsky is a Mass General Brigham infertility specialist who cares for patients in the Infertility and Reproductive Surgery Program. Here, she shares some things that can help you determine how soon to see a fertility specialist.

Medical history and fertility tracking

It’s important for both partners to have a general health evaluation before seeking fertility evaluation and treatments like assisted reproductive technology (ART). Many conditions can have an impact on a couple’s fertility.

“I also recommend that my patients maximize their chances for conception by using urine ovulation predictor kits, which can be purchased over the counter,” says Dr. Yanushpolsky.

These kits help track ovulation, which is when you’re most likely to get pregnant. You ovulate when the ovary releases an egg that can be fertilized by sperm to create an embryo. Having sex up to 3 days before ovulation and 2 days after increases your chances of getting pregnant.

Other ovulation detection methods, such as basal body temperature measurements and cervical mucus evaluations, can be used, though Dr. Yanushpolsky notes they are less precise than urine ovulation predictor kits.

The American Society for Reproductive Medicine recommends a fertility evaluation if a woman or person assigned female at birth (AFAB) less than 35 years of age hasn’t become pregnant after 12 months of unprotected sex, and after 6 months for those 35 and older.

Fertility decreases with age.

For women and people AFAB, age is the main factor that affects the chances of achieving a successful pregnancy.

Fertility peaks between the ages of 20 to 30 years for women and people AFAB. Then fertility starts to slowly decline from 30 to 35 years of age, and once they turn 35, fertility begins to drop more rapidly. Over the age of 40, they have significantly lower chances of getting pregnant each month. The risk for miscarriage also increases.

A decline in fertility and an increase in miscarriage rates are related to different changes in the characteristics of eggs that happen as women and people AFAB get older. These changes mean the eggs are more likely to have genetic abnormalities. This may make the embryo less likely to implant successfully and may increase the chance of miscarriage.

A man or person assigned male at birth (AMAB)’s age may also affect a couple’s fertility. While men are known to have fathered children well into their 70s, changes in sperm characteristics and a drop in overall sperm counts occur as men get older, further reducing fertility.

Risk factors and possible causes of infertility

Certain conditions may significantly increase a couple’s risk of infertility.

For women and people AFAB, this includes (but is not limited to):

• Irregular periods
• History of pelvic infections
• History of pelvic and/or abdominal surgery
• Conditions that affect the reproductive system, like endometriosis or uterine fibroids
• Conditions that affect the ovaries, such as polyendocrine metabolic ovarian syndrome (formerly called polycystic ovary syndrome, or PCOS)

For men and people AMAB, risk factors for infertility include (but are not limited to):

• History of undescended testes at birth
• History of genital infections (such as a sexually transmitted infection) and/or trauma
• Use of illicit drugs, marijuana, and anabolic steroids
• Conditions that affect the testicles, ejaculation, or sperm quality or count

Other risk factors for either partner may include:

• Hormone disorders such as thyroid disease or elevated prolactin levels.
• Overweight or obesity, or extreme weight gain and loss
• Smoking
• Alcohol use

If either partner has any of these risk factors, they may need to consult a fertility specialist after only a few months of trying to conceive. Learn more about other signs and symptoms of infertility.

Talk to your PCP about a fertility evaluation.

It can be stressful when you’re not getting pregnant as quickly as you expect, and you may have uncertainty and questions about why this is happening. Remember that you’re not alone — talk to your PCP or OB/GYN about your concerns.

“If you’re still unsure about consulting a specialist, I advise seeing someone sooner rather than later, particularly if you or your partner is over 35 years old,” Dr. Yanushpolsky says. “Waiting can work against you due to age-related fertility declines and cause needless worry and anxiety.”

Your PCP or OB/GYN can evaluate if you should see a fertility specialist based on your overall health, age, and risk factors for infertility.