When to Visit an Infertility Specialist or Fertility Doctor?

A couple should be aware of when to visit an Infertility Specialist. If you and your partner are trying to conceive, without any luck, then to seek the help of an Infertility Specialist is suggested. However, some guidelines are needed to be followed before rushing off to a Fertility Doctor.

WHEN TO VISIT AN INFERTILITY SPECIALIST OR A FERTILITY DOCTOR

Every month a negative urine pregnancy test may make you feel that it has been ages that you have been trying to conceive. However, in reality, you need to wait a year before coming to any conclusion. In general, it is seen that 30% of couples get pregnant within the first cycle (about one month), 60% of couples will conceive within three cycles (about three months), and 80% will conceive within six cycles (about six months). While trying to conceive tracking your ovulation will help improve your odds of getting pregnant.

Please go through our blog that will help you to understand, who needs a fertility treatment and when is the right time to get checked for possible fertility problems. The general factors that should prompt you to visit an infertility specialist are:

  • Age & fertility: Female fertility starts to decline after the age of 35; the quality and quantity of egg deteriorate. A woman who is under 35 years and has been unable to get pregnant after one year of regular, unprotected intercourse then she should visit an infertility doctor.

    After 35 years women are labelled as advanced maternal age, and if you are 35 and above and haven’t been able to get pregnant for over six months, then it’s time to see a specialist who can guide you about possible treatment option for infertility, and if you are 40 and above then you should visit an infertility specialist immediately.

  • Irregular menstrual cycles: Missed periods, irregular periods or pelvic pain could be an indication that you have an undiagnosed fertility issue. Please read the signs, and if you have any of these symptoms, see a fertility specialist immediately.

  • Body weight: Weight can impact the reproductive functions and the hormonal balance of your body. Women with a BMI under 18 or over 30 may be at higher risk for infertility and also complications during pregnancy. If you are underweight or overweight, then please visit a specialist and discuss how to achieve a better BMI for your health before conceiving.

  • Uncontrolled thyroid hormones: Abnormal thyroid function can be associated with infertility, miscarriage, and may cause abnormal foetal brain development. If a thyroid problem is suspected then it is better to see a doctor; but if you are already monitoring and having medications to regulate it, and still not able to conceive, seek a consultation with a fertility specialist.

  • Recurrent miscarriage: A woman who has had a history of recurrent/multiple miscarriages that is three or more miscarriages should visit a fertility specialist.

  • Surgery: A woman needs surgery or treatment for endometriosis or a blockage or scarring in her fallopian tubes should visit for her fertility screening with IVF consultant

  • Ovulation problem: A woman who has ovulation problems that is, she ovulates irregularly or does not ovulate at all and has not responded to ovulation induction previously.

  • Pelvic inflammatory disease: A couple who has a known risk factor, such as a history of genital infections or pelvic inflammatory disease.

  • History of early menopause: A family history of early menopause (premature ovarian failure), before the age of 40 years, in your mother or sister may indicate that your fertility may also decline at an early age than expected.
  • Complicated medical history: If a woman has chronic medical conditions like hypertension, diabetes, heart or kidney disease then she should see a fertility specialist sooner to discuss her chance of pregnancy and to plan a safe pregnancy after that.

  • Abnormal semen analysis report: An abnormal semen analysis report in male showing either a low sperm count, poor motility (movement), or poor morphology (structure) needs to visit a fertility doctor.

  • Unexplained infertility: A couple who has unexplained infertility that is the necessary tests, or basic infertility workup are normal, but they are not able to conceive.

  • Male factor infertility: In case of ejaculation problems, undescended testicles or abnormal semen analysis report, you should visit a specialist.

  • IVF indications: A couple who is considering assisted reproductive technologies, such as in vitro fertilization (IVF) because the indications suggest so.

WHAT ARE THE INDICATIONS TO OPT FOR IVF TREATMENT?

IVF is the most effective treatment for most of the infertile cases, but usually not the first line of treatment. So many a times patients think that why the doctor has suggested them IVF treatment when there are other options like IUI (intrauterine insemination) and other fertility drugs to enhance fertility or some microsurgery that can improve their chances to conceive.

To this, our Senior IVF consultant Dr Richa Sharma said (Medicover Fertility – IVF Centre in Gurgaon)

“Many patients who come to me for consultation have many queries as to why IVF only so here are the reasons as to when your clinician will advise you IVF when other options won’t work or prone to fail as per individualised treatment protocol IVF is advised based on the following clinical scenario or indications only:”

  • Blocked Fallopian tube: A blocked fallopian tube detected by HSG test would always not indicate an IVF. The IVF specialist will decide considering the level of the blockage that is how complicated it is, the age of the female, how many years they have been married and how many years they are trying to conceive.

    • If tubal surgery is not possible, if there might be a risk of ectopic pregnancy, then IVF may be suggested.
    • If the woman has had a tubal surgery, but the problem continues, and she has not been able to conceive, then IVF is indicated.
  • Endometriosis: Endometriosis and infertility are closely related terms. Research says 30 to 50% of women with endometriosis have trouble in conceiving: a woman with untreated endometriosis and who is trying to get pregnant, her chance of conceiving each month is only between 2-10%. In this case, women affected with mild to moderate endometriosis should be treated as a case of unexplained infertility. In severe cases of endometriosis, the fallopian tubes can be affected, causing blockage, and the ovaries can be affected causing cysts, the pelvis may be affected causing toxicity in the pelvic environment from endometriotic deposits. In these cases, IVF is the best treatment plan suggested to patients battling infertility due to endometriosis.

  • Hormonal imbalance: A hormonal imbalance like in cases of PCOS where after multiple ovulation induction, a patient has failed to get pregnant, then, in that case, IVF is indicated. The number of ovulation induction cycles will depend on a woman’s age and is recommended not to exceed cycles.

  • Unexplained Infertility: Unexplained infertility is idiopathic, which means the cause of the disease remains unknown even after a thorough infertility investigation. Diagnosis of unexplained infertility can be the most frustrating condition for the couples and adds to stress. It contributes to 10-15% of all infertility cases. IVF is indicated in this case if the duration of infertility is three years or more. However, If the woman is older than 36 years, IVF may be considered earlier after 1 year.

  • Male factor infertility: Male factor infertility can be detected from an abnormal semen analysis report. It can be due to low sperm count, poor motility or poor morphology. In case a man has an abnormal semen analysis report, there can be two options: Either go for donor sperm or go for IVF-ICSI as per the Sperm count.

    Another option is surgical sperm retrieval in case of azoospermia (nil sperm count) or severe oligospermia (low sperm count), but the doctor should have the expertise to do the same. In a semen analysis report, we usually focus on the Total Motile Sperm Count. If the total motile sperm count is less than 1 million: the first line of treatment ideally should be ICSI. If the total motile count is more than 1 million but less than 10 million, then IVF can be performed. If the total motile count is more than 10 million, then it should be treated as a case of unexplained infertility. Also, in severe cases of poor sperm morphology, ICSI is suggested.

  • Immunological infertility: Is defined as the presence of an anti-sperm immune reaction in one or both the partners, which is capable of interfering with fertility. However, it has been seen that in about 8–10% of these couples, the immunological aspect is on the male side, causing male immunological infertility. In this case, after an infertility duration of 1 year, IVF is indicated.

CONCLUSION

The thought of being infertile can be daunting, and most people would instead not go down that road. The truth is that the longer you delay, the harder it gets. Age is the worst enemy of fertility, and especially female age decides a lot. With age, couples find it increasingly difficult to conceive even with fertility treatment. Besides that, the generation gap will happen between parents and prospective child, which makes child-raising more challenging. In that case, you have to opt for third-party reproduction like IVF donor programmes. The sooner you visit a fertility specialist and find out if there is something wrong with your fertility, the sooner you can start treatment, just in case you need it. Read your body, your fertility signs, if you find it deviating from its normal course then it is the right time to consult an Infertility Specialist.