This is a question we hear a lot, sometimes from patients who are not even thinking about pregnancy in the near future, and other times from those who have been trying for a while without success. There is not one test that can tell if we have problems which may be a barrier to fertility, and evaluating a couple’s fertility is complex and takes several visits and a number of studies. A good thing to remember is that 85% of couples conceive relatively easily (within a year of trying). So only 15% of couples have difficulty, and very few of these are unable to conceive after all modern techniques are employed to help.
In a perfect world if everything is working optimally we have a 1:3 chance of conception in any given month, which means that trying for 3-6 months is certainly within the range of normal probability. Even trying for up to a year could be within the range of normal probability, especially if there are factors making the situation less than perfect (such as maternal age over 35, travel or timing issues making intercourse during the fertile window difficult each month etc). So generally if you are under 35 and have regular cycles (indicating that you are releasing an egg monthly) and are having regular intercourse, we recommend trying for 6 months or more before seeking help.
Sometimes it just takes time. After about 6 tries if you have not been successful, even though there still may be nothing at all wrong, we may suggest doing some simple testing such as a semen analysis and checking some blood hormone levels to ensure that ovulation (egg release) is occurring. If you are over 35 or are not having regular cycles we recommend evaluation earlier, since the chance of having an ovulation a problem is higher.
If there is a problem, the most likely problems causing a barrier to conception are ovulation disorders ( for example if the egg is not being released or is being released infrequently or with poor hormone production), and male factor issues (low sperm count , abnormal sperm shape or mobility). If we can rule out these two things that will rule out most causes of delayed fertility. Less common causes of fertility problems include damage or blockage of the fallopian tubes, which can be evaluated with a dye test called an HSG (hysterosalpingogram). The HSG is done by a radiologist and introduces a catheter through the cervix through which a dye is pushed under pressure, and if the tubes are open the dye can be seen flowing out through the tubes on the radiologic picture.
Other issues such as endometriosis, which is a condition causing pain and abnormal bleeding, can cause inflammation around the tubes which can cause scarring or abnormal transport of the egg into the tube, and occasionally is evaluated with a minor surgery called laparoscopy. Often fertility issues are related to maternal age, as our eggs become harder to fertilize as we get older. It usually takes more time to conceive as we age and the risk of early miscarriage is higher as well. For our patients in their mid to late thirties we may order a test called Anti Mullerian Hormone or AMH which evaluates the ovarian reserve, and may identify a patient who needs to move faster towards assisted reproductive techniques if she is running out of time.
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