When should we come for fertility management?
This is possibly one of my most perplexing questions. Unlike many other things I do where there is a very black and white answer, many fertility questions are individual decisions that work for “this” couple only.
In this article, I’ll cover a few of the basics.
We only talk in female age as to monthly chances of getting pregnant, as the ovary or egg time clock is a very real entity. Women have much the same chance of falling pregnant per month until age 35 and then fertility starts to fall dramatically. If at all possible, your 20’s and early 30’s are the optimal time to fall pregnant and the latest to start a family should be between 35 and 40. After 40 things can sometimes be very difficult. I know its not fair but mens age is not nearly as important.
If there is an obvious known reason for not getting pregnant such as very few periods, a history of fallopian tube damage or a previous vasectomy, don’t wait to seek medical help. While in general investigations for fertility do not usually commence before a year has passed with no result, if in that time you only had two periods then early investigation and treatment would be warranted. This relatively easy to treat condition could commence treatment immediately. So if you believe there is an obvious reason for not getting pregnant, you should come straight away.
For all the others with no known reasons, it is worth an explanation as to why waiting approximately a year is a good time before getting serious about fertility investigations. In the under 35 year olds each month the chance of becoming pregnant is between 15 and 25%, so that means 85% of couples are spontaneously pregnant after 12 months. Couples often ask does this mean using special things like ovulation kits or concentrating on days to get pregnant. The answer is no, this means having a regular normal sex life and not concentrating or stressing on when to get pregnant.
The couples who do come after 12 months are a selected group and only 15% will fit this criteria. Now that they are not pregnant these couples have approximately 1% of getting pregnant a month with just over 90% pregnant in 2 years. After 12 months of trying this would be a good time to start the investigative process, as after this time without help or intervention the chances of spontaneous pregnancy are less likely.
Many people are surprised at how easy the initial investigations are and from there we can give many couples a good idea what the next steps are. A couple of blood tests on the women give a wealth of information as to how hormones are working and whether or not the all important function of ovulation is occurring. This is also a good time to start the urinary ovulation kits as well. Although just the mention of it makes men tense, a semen analysis is simple clear cut and instantly excludes many problems. The third common test is fallopian tubal assessment. The choice of which one would be best left until discussion with a fertility specialist. The information gathered from these three simple tests gives an excellent insight into what’s happening and what the options are from here, so there is no reason to be scared.
Of course, all this is bought forward if you are presenting after the age of 35. We try to get on top of things much quicker as time is now much more important and so we would do the same investigations after only 6 months instead of waiting for the usual 12 months.
Many have heard about a new test called AMH test. This is a good biological clock predictor and you should ask your GP to arrange for this test if there is any family history of premature menopause or there are known factors that may have affected your egg quantity or quality, or if you simply just require reassurance to leave things for the year.
Fertility and having a family is a very natural business except for the 10-15% who have real troubles. Knowing when to start investigating is an individual decision and one that should be discussed with your GP or specialist.
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