Traditionally, infertility has been defined as one year of unprotected intercourse without conception; this affects 10-15 percent of couples during their reproductive years. In normal couples without infertility issues, there is only a 30% chance of becoming pregnant with each ovulatory cycle. By one year, 85% of couples will attain pregnancy.
When should a couple seek medical intervention? If a woman is in her mid-30s or younger, has regular menstrual cycles, and her partner is healthy – I would usually allow one year before testing extensively. Reasonable early evaluations would be a semen analysis (35% of infertility involves a malefactor) and confirmation of ovulation (release of an egg) with each cycle. The latter can be done with over-the-counter urine tests, or by following a woman’s body temperature throughout the cycle (called basal body temperature [BBT] charting). Medications can be used to help a woman ovulate regularly, and depending on the malefactor – artificial insemination or other technologies can be used.
We know that female fertility decreases over time; in general, the older a woman is beyond age 35, the earlier I would rule out causes of infertility. This would include a semen analysis and BBT charting as well as a pelvic ultrasound. In some cases, we might consider a test to confirm that the fallopian tubes are open (called a hysterosalpingogram or HSG), and possibly laparoscopy (camera in the abdomen) to visually assess the ovaries and fallopian tubes.
Some primary care providers and nearly all OB/GYNs can provide more information about infertility and interventions that are appropriate for a couple’s particular circumstances. There are also infertility specialists (reproductive endocrinologists) that can help with more complicated situations or in vitro fertilization (IVF).
