Infertility – When To Get Help and What to Expect

Struggling to conceive or know someone who is? You’re not alone. Infertility is a common issue but one many couples are hesitant to seek help for. Since infertility can be a time-sensitive situation, experts say it’s essential to understand when it is time to get help.

“You should start looking for treatment if you are under the age of 35, having regular periods, have tried for a year and still have not gotten pregnant,” advises Dr. Marguerite Shepard, a reproductive endocrinologist and the fertility specialist at Indiana University Health. “If you are over the age of 35, having regular periods and haven’t gotten pregnant within six months, then you should seek treatment. And, if you are over the age of 40, I suggest much earlier attention – no more than three months. Some would even say right away.”

Trying to get pregnant means having intercourse two to three times a week. For women who have regular periods, most will take approximately three to six months to conceive, and the odds do not change much within the next six months.

However, the decision to seek treatment can be a balance of time and money. Fertility testing and treatments can be expensive, and many insurance companies may not cover some or all of the costs. Evaluating the menstrual cycle, conducting x-rays of the uterus and fallopian tubes (called a hystersalpingogram or HSG) or uterine sonograms, and evaluating sperm counts are all common methods to determine the source of the problem.

There are also several other types of treatment, depending on the age and result of the tests. Dr. Shepard recommends that patients spend between three to six months – the average time it takes a couple to get pregnant naturally – on each treatment before moving on to the next one. At Indiana University Health’s Coleman Center for Women, the following treatments are available:

Oral Fertility Drugs:

Clomiphene and letrozole are the two prescription medications used. These pills work by either making the body believe it is not producing estrogen (clomiphene) or blocking estrogen production (letrozole) so the pituitary gland stimulates follicle growth. These medications tend to be inexpensive and both are available with a prescription. Because both of these drugs affect estrogen production, side effects may include hot flashes, headaches and ovarian cysts.

IUI (intrauterine insemination)

This procedure is often done if there is a low sperm count or if a woman’s cervical mucus is blocking sperm from reaching the uterus.  In an IUI, a thin catheter inserts sperm directly into a woman’s uterus, maximizing the number of sperm cells reaching the uterus to increase the possibility of pregnancy. While this option is less invasive and less expensive than in vitro fertilization, the pregnancy rates can also be lower.

IVF (in vitro fertilization)

During IVF, all mature eggs are harvested from a woman and are fertilized with the partner’s sperm. One healthy, fertilized egg – or two if the woman is over 35 years old – is placed back in the body five days later. Additional matured embryos may be frozen, if the woman has no objection. The cost of IVF can be a drawback, since most insurance companies do not cover this procedure.

To find a good fertility specialist, Dr. Shepard recommends seeking a doctor who asks appropriate questions, looks for a simple solution first and does not rush to recommend expensive treatments or tests. To locate one in your area, visit the website for the American Society for Reproductive Medicine (www.asrm.org).

-- By Gia Miller


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