When we’re growing up, we hear different stories on where babies come from. By the time we’re in High School, our health teacher typically educates on how to avoid getting pregnant but when it comes to when we genuinely want to conceive, you’d be surprised how many don’t know the basics. Particularly when you have been trying to get pregnant what feels like some time, you may wonder when it’s appropriate to consult a doctor or what are the first steps in fertility to uncover what may be causing any potential barriers to have a family. Wherever you are in your trying to conceive journey, we want to help inform you about your reproductive health and the first steps in fertility that can help you know what you need to do to have a healthy pregnancy and family!
First Steps in Fertility: How Does Age Impact Your Fertility?
In recent years, studies have shown that age can impact both men and women’s fertility. However, in the case of women, it’s more time-sensitive as she is born with approximately two million eggs that decrease in quantity and quality the older she gets. This is why if you’re a woman who is actively trying to conceive, some smart first steps in fertility is to schedule an appointment to see a reproductive endocrinologist and have a fertility assessment done to get an idea of your egg quality and quantity.
According to the American Society of Reproductive Medicine, women under 30 have about a 25% chance of getting pregnant, women over 30 have a 20% chance, and by the time a woman turns 40 the chance is only 5%. This is due to the egg decline over the years as it’s estimated that most women, by their mid-twenties, may only have 300,000 eggs. Every woman is different though and the best first steps in fertility is to learn more about your own ovarian reserve.
First Steps in Fertility: When to See A Doctor
In general, if the woman is under the age of 35, and the couple has been actively trying to conceive for at least one year; or if woman is over the age of 35 and the couple has been actively trying to conceive for at least six months without success, their first steps in fertility worth considering would be consulting a reproductive endocrinologist. Some other reasons you may want to consider making an appointment with a fertility specialist sooner are:
- Have been diagnosed with Polycystic Ovarian Syndrome (PCOS)
- Suspect or have been diagnosed with endometriosis or damage to your fallopian tubes
- You’ve been having missed or irregular periods
- Are concerned that you may not be ovulating, or you have not been able to pinpoint when you are ovulating
- Have had a history of pelvic infection, such as pelvic inflammatory disease (PID) pelvic pain
- Have had two or more miscarriages
Regarding miscarriages, if you’ve had two or more miscarriages, this is known as Recurrent Pregnancy Loss (RPL). In this case, you should mention this to your doctor. There are several factors that can cause a miscarriage and some first steps in fertility towards pregnancy loss would be to look at possible autoimmune issues, uterine anomalies or a possible genetic or chromosomal abnormality that may be causing these losses.
First Steps in Fertility: How Will My Fertility Be Assessed?
For women, the first steps in fertility will be blood work to look at various hormones and a transvaginal sonogram. The sonogram will evaluate your uterus and ovaries and look for any ovarian cysts, endometrial inflammation, etc. The blood work will evaluate your ovarian reserve, as we mentioned earlier. This is your egg quality and quantity. The primary hormones evaluated are your Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol and your Anti-Müllerian Hormone (AMH).
First Steps in Fertility: Having Your Doctor Advise You of Your Options
Here is where all of these first steps in fertility will pay off as your doctor will collect all of your health history, your family building goals, review the test results and then walk you through all of your options. These may include some simple lifestyle changes, to minor medical invention or even in vitro fertilization (IVF). Especially if you’ve experienced several miscarriages, IVF plus Preimplantation Genetic Testing for Aneuploidy (also known as PGS) can be invaluable. If you have had recurrent pregnancy losses, PGS can be helpful as it identifies if the correct number of chromosomes are present in embryos. Since approximately half of all first trimester pregnancy losses are due to chromosomal abnormalities, PGS can reduce the risk of pregnancy loss by providing your doctor with information to preferentially
transfer embryos that are identified as chromosomally normal.
In addition, If you have an autosomal dominant condition in your family history or you and your partner are both identified as a carrier of the same autosomal recessive disease such as Cystic Fibrosis or Tay-Sachs, your doctor may suggest something called Preimplantation Genetic Diagnosis (PGD) PGD plus IVF will help significantly decrease the chance of passing on this condition to your future children.
These first steps in fertility can be intimidating but the fact that you’re willing to take them can put you directly on the path to parenthood. Now, more than ever, there are so many developments in the reproductive field as well as resources. Along your journey, should your doctor identify you have a specific infertility issue or diagnosis, we hope you feel comfortable discussing some of the options mentioned above with your reproductive endocrinologist. Now that you know about these initial steps, we want you to feel ready to take the next steps you need to become a parent!