What Is Normal Fertility And When Does It Become Infertility?
What is Infertility?
Most people will have the strong desire to conceive a child at some point during their lifetime.
Understanding what defines normal fertility is crucial to helping a person or couple know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months.
Only an additional 7% of couples will conceive in the second year. As a result, infertility has come to be defined as the inability to conceive within 12 months. This diagnosis is therefore shared by 15% of couples attempting to conceive.
We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.
These include:
Infrequent menstrual periods: When a woman has regular menstrual periods, defined as regular cycles occurring every 21 to 35 days, this almost always indicates that she ovulates regularly.
Ovulation of the egg occurs approximately 2 weeks before the start of the next period. If a woman has cycles at intervals of greater than 35 days, it may indicate that she is not ovulating an egg predictably, or even at all. Ovulation of the egg is essential for pregnancy.
Therefore, we recommend an evaluation if menstrual cycles are infrequent or irregular in a couple attempting pregnancy.
Women aged 35 years or older: For unclear reasons, egg numbers decrease at a rapid rate as women age. Furthermore, as aging occurs, egg quality —the likelihood of an egg being genetically normal —decreases.
Therefore, we recommend a fertility evaluation if a couple has been attempting pregnancy for 6 months or more when the woman is 35 years of age or older.
A history of pelvic infections or sexually transmitted diseases: Sexually transmitted infections, such as chlamydia or gonorrhea, can cause inflammation and permanent scarring of the fallopian tubes.
The presence of open tubes is essential for natural conception, as sperm must traverse the tubes to reach and fertilize the ovulated egg.
We recommend immediate evaluation for a couple attempting pregnancy when the woman has a prior history of pelvic infection.
As part of the fertility evaluation, we will perform an HSG, a test designed to evaluate if the fallopian tubes are open.
Known uterine fibroids or endometrial polyps: Uterine abnormalities, such as fibroids that indent the endometrial cavity and endometrial polyps, can impair how the endometrium (the lining of the uterus) and embryo interact to lower implantation and pregnancy rates.
These abnormalities can also cause irregular bleeding between menstrual cycles. Evaluation should be pursued by 6 months of attempted pregnancy in women with a known history of these abnormalities or a history of bleeding between menstrual cycles.
The main approach to correcting or removing these uterine abnormalities is by hysteroscopy, a surgical method by which a narrow scope with a camera is placed within the uterine cavity.
Instruments can be introduced through the hysteroscope, allowing the surgeon to remove or correct any anatomic abnormalities.
Known male factor semen abnormalities: If a male partner has a history of infertility with a prior partner, or if there are abnormalities on his semen analysis, then we advise earlier fertility evaluation, ideally within 6 months of attempting pregnancy.
What is Involved in the Fertility Evaluation?
Infertility Tests
History and physical examination – First and foremost, your fertility physician will take a very thorough medical and fertility history.
Your doctor may ask you many of the following questions:
How long have you been trying to get pregnant? How often are you having intercourse? Do you have pain with menstrual periods or intercourse?
Have you been pregnant before? What happened with your prior pregnancies? Have you had any sexually transmitted infections or abnormal pap smears?
How often do you have menstrual cycles? Do you have any medical problems or prior surgeries? Do you have a family history of medical problems?
These and many other questions will help your physician design a specific evaluation and potential treatment for you. In addition to a careful history, a physical evaluation may also be performed.