Infertility affects 12-18% of U.S. couples with similar rates in other industrialized countries. Infertility is defined as the failure to conceive after 12 months of regular intercourse in the absence of contraception in a woman less than 35 years of age. The rates are certainly higher in older couples since the female fertility starts to decline each year after 30 and then plummets after 40.
The probability of successful conception is 95% at 2years however it doesn’t mean that you should wait 2 years before seeking care if you sense there is a problem. You should seek advice if you are less than 35 years of age and have had regular intercourse without success for 1 year. If you are over 35 you should seek care after 6 months and sooner if you are 40. Finally, you should seek care if there are any signs or symptoms that indicate a problem.
A comprehensive history of both you and your spouse should be taken. The history will include medical, surgical, family and gynecologic history. In depth questions about your menstrual cycles, history of pain or infections and coital activity will be asked. Depending on the results, the fertility doctor may suggest that your husband have a detailed physical examination by an Urologist. The gynecologist will then perform a detailed physical examination including a pelvic examination. Abnormalities maybe found that could indicate a cause for the infertility. For instance an enlarged thyroid might suggest an endocrine problem or a body mass index >30 might indicate insulin resistance. There are many other potential findings.
There are standard evaluations, which may be ordered depending on the findings of the history and physical examination. A semen analysis can provide valuable information about the sperm function. Laboratory tests for the woman may include a thyroid or prolactin check to see if there are endocrine problems which would affect ovulation. A progesterone level taken during the luteal phase of the cycle can confirm if ovulation is occurring. Day 3 follicle stimulating hormone, estradiol and an antimullerian hormone can indicate if there is a low ovarian reserve within the ovaries. Finally imaging such as an ultrasound or hysterosalpingogram can indicate if there is tubal obstruction or other uterine abnormalities. Finally a laparoscopy might be recommended to further evaluation the female reproductive tract.
Subfertility or infertility is a common problem in couples. A thorough evaluation is required if you want to identify and correct the problem. The tools are available, you must decide how much you are willing to undergo. In a small percentage of cases, a cause is not found. Despite this there are many examples of couples conceive spontaneously even after they have either undergone therapy, which has failed or have stopped actively trying.