When Should We Worry?
The process is obviously more complex than outlined here; these are, however, the basic steps in the process. The next question is "How well does this process normally work?" The answer is, "It depends."
Human reproduction is a tremendously age-sensitive event. For a couple in their early twenties with no fertility problems, their fecundity, or chances of becoming pregnant in any given month, may be as high as 20 to 25 percent. This results in a probability of conception within one year of about 90 percent. For a couple in their forties with no known problems, monthly fecundity may be as low as one to two percent. These are important numbers to know. Numerous studies have demonstrated a significant decline in human fertility beginning at about age 30 and progressing rather quickly thereafter.
Many couples worry that it may be taking them too long to conceive. This is a natural concern. In this modern world, we have become increasingly used to controlling anything and everything, and to making things happen when we want. We can heat an entire meal in minutes or cross the country in hours. But we can't make ourselves be pregnant when we want. Nature doesn't work that way. Nature requires patience, and some couples have more patience than others.
The real question is this: "How long should a couple be patient before they begin to seek some help and evaluation?" The answer again is that "it depends." There are very specific definitions for the duration of unprotected intercourse before a couple should be considered infertile. A couple that has never been pregnant before is defined as infertile if they have been attempting pregnancy for one year without success. If a couple has a previous pregnancy but now have been trying for six months to have another child, they too are infertile by definition.
These are, however, only definitions. They do not mean that any couple must wait a mandatory year before they begin to seek some evaluation and help. In fact, in many cases, this wait would be inappropriate. Women beyond the age of 35 certainly should not wait a year before beginning at least some preliminary testing. After age 40, a good case can be made for suggesting that a couple contact a physician as soon as they make the decision to attempt pregnancy.
As a guideline, when a couple becomes concerned about their ability to conceive, they should schedule some time with a physician and talk it over. Depending on the circumstances, it may be that some simple reassurance is all that is warranted. It is, however, inappropriate for any physician to tell a couple, "Just relax, it will happen." If a couple is worried, their concerns need to be addressed. Equally inappropriate is the response, "You need to try for a year before we can do anything." This simply is not true. While it may not be appropriate to become overly concerned and perform a lot of expensive and extensive testing, some simple evaluation may go a long way toward reassurance.
If a couple expresses fears and concerns, these emotions must be considered valid: To ignore or belittle them is not helpful or fair to anyone. So if you're worried, find a physician with an interest in fertility and schedule some time to talk to her or him. Just talking to someone about your concerns can't hurt. You may or may not decide to pursue further testing at that time, but at least you can make that decision in a more informed fashion.
John C. Jarrett II, M.D., is the co-author of The Fertility Guide: A Couples Handbook for When You Want to Have a Baby (More Than Anything Else).