Your TTC Strategy 11: Know Your Options--Infertility Evaluation and Treatments

From a purely medical perspective, infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse or the inability to carry a pregnancy to live birth. However, for most couples, infertility is more than just a physical condition—it represents a seemingly unsolvable problem that affects them physically, financially, and emotionally.

Considering the precision and intricacy with which the human reproductive system functions, it seems a miracle that babies are conceived and born to the majority of couples. However, any change in this complicated sequence of events can result in infertility.

Your regular gynecologist may perform the initial fertility evaluation and treatment, or you may choose to be evaluated by a fertility specialist, who has two years additional training in infertility evaluation and treatment. It is important to find a doctor who you trust and with whom you feel comfortable.

If you start treatment with your OB-GYN, it is important to know when to seek care from a fertility expert:

• You are concerned that something is wrong.
• You are 35 years of age or older and have been trying for six months.
• You have irregular periods or don't have periods at all.
• You have been attempting pregnancy for more than two years.
• You have been undergoing medical treatment for one year and have not conceived.
• You have a history of abdominal or pelvic surgery.
• You have a history of pelvic infections, hormonal problems, endometriosis, fibroids, DES exposure, excessive facial or body hair, or a sperm problem that has been identified.
• You have had several pregnancy losses or a prior ectopic pregnancy.
• You are considering having a laparoscopy or hysteroscopy.
• You have been on clomiphene for more than three months with no success and there is no proposed change for your treatment in the months to come.
• You report pelvic pain, heavy periods, and/or bladder or bowel symptoms around the time of menstruation and the doctor does not suggest having a hysterosalpingogram or laparoscopy to determine the cause of the symptoms.
• A fibroid or tubal damage has been noted on a hysterosalpingogram.