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Published on February 02, 2015

When to Seek Help for Fertility Issues

 After months of trying to get pregnant, Anna and Alex have grown more and more disheartened with every day that passes. They want to keep trying, but aren’t sure if and when they should see a professional.

Unfortunately, this hypothetical example is all too real for many couples that have trouble understanding when they should visit a fertility doctor. Considering it’s not a topic that’s frequently discussed, it’s important that you get the clarity you need.

According to Dr. Larry Barmat, an OB/GYN who specializes in reproductive endocrinology and infertility at Abington Reproductive Medicine, there are two reasons why a couple should visit a fertility specialist.

“One reason is that the couple has had difficulty conceiving,” he said. To get pregnant, Dr. Barmat said couples should have unprotected sex two to three times a week. “If a woman is 35 years old or older, she should visit a doctor six months to a year after trying to get pregnant. If under 35 years old, it is appropriate to wait up to one year.”

Another time to see a fertility doctor or to get fertility counseling is when a woman is considering delaying childbearing. Since age plays a significant role in a woman’s fertility, it’s important to see a specialist sooner rather than later if you plan on waiting until you’re older.

“Patients need to be educated about the significant impact age has on reproduction,” said Dr. Barmat. Today, it’s become more common for women to delay having children—whether due to career or personal issues—and many think it’s easy to do so, thanks largely to advances in reproductive medicine, such as egg freezing. However, it’s important to understand that having available eggs isn’t the only part of the equation that’s needed to get pregnant.

“I’ll see patients who are 35 or 40 years old, and they have been thinking of pregnancy for a while, but no one sat them down and said that your chance of pregnancy at age 25 is 25 percent per month, and at age 40, your chance is less than five percent per month,” said Dr. Barmat.

“One look at the stats, and it gets sobering quickly when you see the dramatic impact of age and fertility,” he added.

If delaying childbearing, another factor to take into consideration is how many children you want to have.

“If a 33 year-old wants a large family, that’s going to change your approach compared to a 33 year-old who only wants one child,” Dr. Barmat said.

As a result, it’s important to be as proactive as possible.

“Egg freezing is a potential option for women to preserve their reproductive potential,” said Dr. Barmat. “But the younger the age of the egg, the better the pregnancy chances.” If done when a woman is 28, for example, she’ll be able to utilize her much younger frozen eggs when she and her loved one try to conceive at age 40.  

For couples having trouble conceiving, Dr. Barmat said there are a few different tests that must be performed to identify the cause of the problem.

When meeting with couples, Dr. Barmat said he looks at the four main factors that go into making a baby: sperm, egg, fallopian tubes and uterus. Although individual tests are conducted to identify potential issues in each factor, patients have the option to say whether or not they want a specific test performed.  

Factors that can cause infertility in women include irregular ovulation, Polycystic Ovarian Syndrome, and blocked fallopian tubes. Among men, the most common cause of infertility is abnormality with the semen (e.g. reduced count, motility).

Whatever the reason, however, Dr. Barmat emphasized that it’s important to not put the blame on a single individual. “I always stress that the husband and wife are a single unit trying to make a baby,” he said. “In some cases, a woman with infertility issues might be with a man who has a low sperm count; the combination of those two can make it very difficult to get pregnant.”

Once the tests are complete and the issues are identified, patients must choose a treatment approach. Treatment options include in vitro fertilization, fertility injections, or clomid, an anti-estrogen drug that’s designed to stimulate the ovaries to produce eggs. 

Although couples might be eager to try any treatment, they should review every option and understand the statistics related to their chances of getting pregnant. “It’s important to empower the patient and ensure they make the choice that’s best for them.”

When going through fertility treatments, Dr. Barmat said the most important thing for the couple to know is that the medical team is there to support them. “Most patients come into the process scared, but if they’re in the right place when going through fertility treatments, they shouldn’t feel as bad as they anticipated.”

And if finally fulfilling your dream of having a baby is possible, then it’s certainly worth it.


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