Knowing when it’s time to seek medical help for conception

After deciding that they want to have children, many couples hope it happens quickly. However, when natural conception takes longer than expected, it can be difficult to know when it’s time to obtain medical help.

The natural pregnancy rate for couples who conceive within the first month of trying is 20% to 25%, notes reproductive endocrinologist Adam Fechner, MD, an infertility specialist at University Reproductive Associates (URA). That rate doubles to 50% after three months, rising to 75% after six months.

“The reason we define infertility as a year of trying without pregnancy is, if you extrapolate those numbers out, at the year mark about 90% of couples will be pregnant. If you're in the 10% that still hasn’t conceived, that's when we recommend getting checked out to see what's going on,” Dr. Fechner says.

Other obstacles to natural conception include such things as age and health conditions. If a woman is over age 35 and has been trying for six months without becoming pregnant, there may be a matter that a fertility specialist can identify, for example. Or, if she has polycystic ovary syndrome and experiences irregular or very few periods, trying for a year make not be advisable because the couple will need assistance in getting pregnant.

"If a partner has erectile dysfunction, and the couple says, ‘Look we can't have sex and actually try to get pregnant,’ there's no reason to wait six months or a year,” Dr. Fechner says. “Or, if a woman has had previous surgery to remove both of her fallopian tubes, we know she will ultimately need IVF, so there's no reason to wait to get checked out.”

Knowledge Is Power

While consulting a reproductive specialist is the first step in determining if there’s a problem that could be preventing a couple from conceiving, Dr. Fechner notes that many couples hesitate to obtain help because they fear being pushed into aggressive treatment. But having a consultation with a specialist for a consultation and undergoing routine testing doesn’t mean a couple is required to pursue treatment.

Adam Fechner, MD

“Get the information first, hear what the options are. I think some people are really anxious about what the testing will involve or what we’ll find,” says Dr. Fechner, who specializes in endometriosis, recurrent pregnancy loss, uterine fibroids, in vitro fertilization (IVF), polycystic ovary syndrome and minimally invasive reproductive surgery. “We get people who wait a long time and say, ‘I didn’t come in sooner because I really didn’t want to do IVF.’ Given how aggressive some clinics can be in pushing patients into IVF, I understand that feeling. But that fear shouldn’t keep you from at least undergoing testing and talking about the treatment options. It doesn't mean you have to jump right into something aggressive.”

For women, testing usually involves an ultrasound and blood work on the third day after a period begins. An X-ray of the fallopian tubes is taken usually a week later to confirm they are open and that the uterus is normal. Meanwhile, men provide a sperm sample, which they can produce at home. Within two weeks after that period, fertility specialists have the information they need. Once couples have the results, they can discuss their treatment options and decide if they want to move forward. Depending on the type of issue testing uncovers, couples can potentially start treatment as early as the next cycle.

“If a couple says, ‘We understand our results and treatment options and we don't want to do anything else,’ that's fine. But I much prefer couples to get the information and make an educated decision not to pursue treatment, versus delaying the evaluation for years, only to find out later there is a significant issue,” Dr. Fechner says. “We’ve had patients come into the office after five years of trying only to find out the guy has no sperm, or the women’s tubes are blocked. If we had known that earlier, they could have saved years of trying with little to no chance of success, and we could have initiated treatment when the woman was younger, which would have translated into a higher chance of success. Those cases are always upsetting to see, for a variety of reasons."

Believing they can’t afford fertility care, couples often wait to pursue it.

“Many people don't realize that, in many cases, insurance will cover some or all of their infertility treatment,” Dr. Fechner says. “That’s clearly another barrier to treatment, where people say, ‘We waited because we didn't think we could afford it,’ and we can thankfully tell them, ‘No, your insurance is going to cover a good portion of this.’”

With offices in Hasbrouck Heights, Hoboken and Wayne, URA’s board-certified OB/GYN and fertility specialist team believes that “knowledge is power.”

“Arm yourself with the information you need to make an informed decision, and if that decision is, ‘We’re not going to do anything else,’ that's OK,” Dr. Fechner says. “The worst thing that can happen is someone comes back, and they say, ‘If I had known this, I would’ve done something different.’ We want them to say, 'I got the information and I made an educated decision.’”