Infertility can be an emotionally draining, costly, and physically demanding condition for many couples. Thankfully, there are many treatments, reproductive specialists, and assisted options available today that can help you fulfill your dream of starting a family. Having an open dialogue with your physician is the key to identifying any problems that may exist and making a plan that feels right for you and your partner.

What is Infertility?

Conceiving can take time. Infertility is defined as being unable to get pregnant after having unprotected sex regularly for one year. But anyone who has ever waited months or years for a positive pregnancy test will tell you it can feel like forever.

Jamieson Greenwald, MD, an OB/GYN at Summit Health, helps guide her patients through this difficult process. “It is very hard for women to hear it can take that long to conceive, but everyone’s body is different,” she says. “I try to spell out a clear process, so they know exactly what to expect. If a patient is under 35 years old, I tell them it can take up to 12 cycles of actively trying. For those over age 35, I cut that to between six and eight cycles. After that period of time, if they are not pregnant, I tell them to come back and see me so we can figure out a plan.”

Nearly 10 percent of women in the U.S. have trouble getting pregnant. The older you are, the more likely you are to have issues with fertility. Around age 30, a woman’s ability to get pregnant slowly starts to decline and drops dramatically after they reach their 35th birthday.

“A lot of patients ask me if there is a test that I can run ahead of time to measure how fertile they are,” says Dr. Greenwald. “Unfortunately, there is nothing we can do proactively to determine how much success they are going to have.”

Identifying the Cause of Infertility

Finding the source of your infertility, if one exists, is the first step. Either the woman or the man can be the source—and sometimes there is simply no definitive reason that the doctor can point to. “Do not worry if it takes time to figure out the root of the issue,” says Dr. Greenwald. “The process can take time.”

If you have trouble getting pregnant, it is important to find out if you are ovulating regularly. Every month, around the middle of your menstrual cycle, the body releases an egg. This process is called ovulation and it means you have a fertile window when conception can occur.

Women should monitor ovulation at home. Dr. Greenwald advises patients to keep track of their menstrual cycle using an app on their phone and at-home ovulation predictor kits. Blood tests also provide important clues. For example, conditions like an over- or underactive thyroid can affect fertility. Since infertility can affect men too—your partner should have their sperm tested.

Ultrasounds help detect structural abnormalities that would prevent the egg from implanting in the uterus. Your physician will look for anatomical abnormalities and conditions like uterine fibroids or ovarian follicles. A special type of imaging test called a hysterosalpingography may also be used to evaluate the health of the reproductive system.

Polycystic Ovary Syndrome: A Treatable Cause of Infertility

Some patients who present with irregular or missed menstrual cycles suffer from a hormonal disorder called polycystic ovary syndrome (PCOS). The condition, which affects 1 in every 10 women, is one of the most common causes of infertility in women. Other symptoms include excess facial and body hair, acne, and weight gain.

“It is important to recognize the symptoms of PCOS, because it is a very treatable cause of infertility,” says Dr. Greenwald. “Most women have success when we use medications that induce ovulation.”

Bringing in a Fertility Specialist

Deciding when to consult an expert is different for every patient. “It really depends on how eager they are to take the next step. Some patients want to give it more time, while others feel better being more proactive,” says Dr. Greenwald. “When a woman is over 35 years old, I more strongly recommend a specialist because time is of the essence.”

Patients often worry that being referred to a fertility specialist means they will jump right to in vitro fertilization (IVF). But Dr. Greenwald explains many women have success with just the in-depth monitoring these experts provide. “Consulting a fertility specialist does not mean you will need the full-court press right away,” she says.

Fertility Treatment Options

Assisted reproductive technologies are medical procedures that are used to treat infertility. These techniques can help the sperm fertilize the egg or make it easier for the egg to implant into the uterine lining. Some of the most popular fertility treatments include:

• Intrauterine insemination (IUI) - Healthy sperm is retrieved and placed directly into the uterus using a long, flexible tube called a catheter.
• In Vitro Fertilization (IVF) - The woman’s eggs and man’s sperm are collected separately and put together in a laboratory dish for fertilization. After a few days, the embryo is then transferred back into the uterus. 
• Egg Freezing - Healthy eggs are harvested from your ovaries, frozen, and stored in a cryogenic freezer. They can be thawed and used years later.

Egg freezing is a proactive option for women who think they may want to get pregnant later in life. But Dr. Greenwald advises it is a safety net, not a guarantee. “The younger your eggs are when you freeze them,” she says, “the better chance you have of success.”

Clearing Up Infertility Myths

A common misconception Dr. Greenwald often hears is that taking the birth control pill can affect your fertility. “I hear this a lot from patients who have been on the pill for a long period of time and then have trouble conceiving,” she says. “The pill does not cause infertility. Stay on it until you are mentally and physically ready to conceive.”

However, it may be helpful to stop other medications since certain over-the-counter and prescription medications may affect fertility. If you are thinking about starting a family, make an appointment for a pre-pregnancy consultation with your gynecologist. Together, you can come up with a plan.

One lifestyle change that can affect fertility is weight loss. If you are a healthy weight, Dr. Greenwald explains, you are more likely to ovulate normally.
 

Summit Health does not provide fertility treatment or offer egg freezing. However, we are experts in the field of obstetrics and gynecology conditions as well as pregnancy planning. Our providers have the skills, tools, and expertise to provide full evaluation for those trying to conceive and can recommend next steps.