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Saturday, May 25, 2013
Because it often takes months to achieve pregnancy, a couple is not formally diagnosed as having infertility until they have tried to achieve pregnancy unsuccessfully for more than a year. However, if good timing and good luck have not resulted in pregnancy within 6 months, many women will request a basic fertility evaluation from their obstetrician-gynecologist. Certainly, all couples who have not achieved pregnancy after a year of unprotected intercourse should undergo a thorough fertility evaluation.
Some couples have hints or clear indications that they might have a fertility problem and should come in sooner for evaluation.
Age - A common reason for early evaluation is the woman?s age, since fertility decreases fairly rapidly in the late 30?s. Women over 35 years of age should be evaluated after 6 months of attempting pregnancy without success. There is no reason to delay fertility evaluation and treatment for a year or more when the chances of becoming pregnant continue to decrease with age. After the age of 40, more than one in three couples will have difficult achieving pregnancy.
Absent or abnormal menstrual cycles - Another common reason to seek evaluation and treatment is abnormal or absent menstrual cycles. The monthly release of an egg, called ovulation, is most likely to occur in women with regular, monthly menstrual cycles. Therefore, fertility rates are best for women who have regular, monthly menstrual periods.
Certainly, women who have no periods, or have less than one menstrual period every 40 days, should come in to be evaluated without delay. Likewise, women with menstrual cycle length <22 or >40 days should be evaluated for ovulation problems.
Medical history - Another important reason for early evaluation is if either member of the couple has any history of reproductive organ problems.
Several types of health care providers can diagnose and treat fertility problems.
Gynecologist - The best place to start is the health care provider who takes care of your routine gynecologic care. He or she will either begin the basic evaluation or refer you to someone who does these kinds of evaluations.
General obstetrician-gynecologist - Most basic fertility evaluations are performed by general obstetrician-gynecologists who have a special interest in fertility treatment. Most of the routine diagnostic tests and basic treatments can be carried out without special equipment or additional training.
Reproductive endocrinologist - Many communities now have the services of a reproductive endocrinologist. This is an obstetrician-gynecologist with additional training in reproductive endocrinology and infertility. A large part of their practice is devoted to diagnosing and treating couples with infertility. They usually work in conjunction with a specialized laboratory that analyzes and prepares sperm for intra-uterine insemination (IUI) and handles the intricate process of fertilizing eggs and growing embryos for in vitro fertilization (IVF), as discussed below.
Prepared in partnership with Melina Dendrinos, MD, Class of 2008, Case Western Reserve University School of Medicine, 1st year resident in Obstetrics and Gynecology at University of Chicago.
This article is a NetWellness exclusive.
Last Reviewed: Jul 11, 2010
William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University