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Updated on September 15, 2023
From irregularly shaped sperm to blocked fallopian tubes, hormone imbalances to sexually transmitted infections, there are many factors that can affect your ability to get pregnant. If you’ve been trying to conceive for a year or more without becoming pregnant and you are younger than 35, or if you’re 35 and older and have been trying for six months, you’re not alone. Infertility affects up to 15 percent of couples. Talk to your healthcare provider (HCP) about being tested—and possibly treated—for fertility issues.
Many HCPs, including OBGYNs and primary care physicians, can perform a basic fertility evaluation, explains Gregory Starks, MD, a reproductive endocrinologist in Kansas City, Missouri. For further evaluation and options, ask your HCP for a referral to a fertility specialist. Here’s what you can expect, along with possible next steps:
Fertility testing and treatment
Typically, a fertility evaluation includes a medical history, a physical exam, and fertility testing. While the process for people assigned male at birth is usually non-invasive and focuses on semen analysis, the process for people assigned female at birth may be more involved.
"You can expect an extensive evaluation of your fertility history, a review of old records, a possible exam, further targeted testing, and protocol selection for future management,” says Dr. Starks. Your HCP may ask you to chart your body temperature to track your ovulation. They may also take blood samples and recommend a hysterosalpingogram (HSG), which looks for irregularities in the uterus and fallopian tubes.
It's useful to remember that infertility is the result of “male factors” (such as issues with sperm) in 40 to 50 percent of couples, according to the American College of Obstetricians and Gynecologists (ACOG). And in many cases, HCPs can’t find a cause for fertility issues. As many as 30 percent of all cases of infertility may be “unexplained.”
But just because there is no clear reason for your fertility challenges, there are still plenty of things you can do to increase your chances of conceiving.
Once you have been evaluated, your HCP will recommend which medications or procedures may have the best chance of boosting your fertility. Options include taking hormones to stimulate ovulation, intrauterine insemination, and in-vitro fertilization (IVF), during which eggs are fertilized in a lab and then implanted into the uterus.
“IVF is needed when there are unresolved male factors, occluded fallopian tubes, extensive endometriosis, age-related factors, and unresolved issues from traditional therapies,” says Starks. “This therapy resolves the vast majority of reproductive issues.”
Questions to ask a fertility specialist
Going through fertility testing and treatment can be an emotional and complicated process. You can take some control over it by staying informed and asking your HCP to walk you through all the options and information. Be sure to ask these questions:
- How will you find the cause of fertility issues? What kind of testing is involved?
- What fertility treatments are the best choices for me?
- How many of these treatments has your practice done before?
- How successful are these fertility treatments?
- Should I make any lifestyle changes to help with treatment?
- What risks, if any, do these fertility treatments have?
- Will my insurance cover fertility testing and procedures? How much do they cost?
As more questions occur to you, write them down and bring the list to appointments. Together, you and your HCP can make the best fertility decisions for you.
