When Is The Best Time To See A Fertility Doctor?

Did you know a woman is born with about one million eggs? It sounds like a lot, but by the time she’s in her early 30s, only about half of her eggs remain. In addition, as a woman ages, her egg quality also declines. That’s why when it comes to trying to get pregnant, age is often the biggest barrier.

Marcy F. Maguire, MD, FACOG is a Reproductive Endocrinologist at Reproductive Medicine Associates of New Jersey. Here she provides insight on when to see an infertility specialist.

How long should you try to get pregnant before consulting a specialist in your 20s, in your 30s and in your 40s?

Women under 35 who have been trying to get pregnant for more than a year should see an infertility specialist. Women over the age of 35 should contact an infertility specialist after six months without success.

Earlier evaluation for infertility is recommended in special circumstances. For instance, if a woman has irregular menstrual cycles or a family history of early menopause, or either partner has a history of cancer, the couple should seek consultation as soon as they decide to have children.

What health issues could put you at risk for fertility problems?

In addition to age, there are a number of issues that increase a couple’s risk for infertility.

• Irregular menstrual cycles can lead to difficulties in getting pregnant. Irregular cycles can be a sign of polycystic ovary syndrome, premature ovarian failure, or insufficient stimulation of the ovaries by hormones from the brain. Because all of these issues are associated with health problems beyond fertility, it is very important that anyone with irregular menstrual cycles be evaluated by their OB/GYN.
• Abnormal thyroid function may be associated with infertility, miscarriage, and abnormalities of fetal brain development. Again, because abnormal thyroid function negatively affects not just fertility, but overall health, it is very important that any individuals with abnormal thyroid function be regularly monitored by their primary care physician or an endocrinologist.
• Extremes of body weight may also affect reproduction. Individuals with a BMI under 18 (underweight) or over 30 (obese) may be at higher risk for infertility and also complications during pregnancy. Individuals who are underweight or have morbid obesity (BMI >40) should seek expert consultation prior to attempting conception. All couples seeking pregnancy should aim for a healthy body weight prior to conception.
• Women with endometriosis are at increased risk for infertility and ectopic pregnancy. Endometriosis is a condition wherein endometrial tissue (which should be found only inside the uterus) occurs outside the uterus. Endometriosis can lead to scarring and damage of pelvic structures including the fallopian tubes and ovaries. It is typically associated with infertility and pelvic pain.
• Individuals with complicated medical histories, including history of cancer, inflammatory bowel disease, prior pelvic surgeries, or other health issues may benefit from an early fertility evaluation. Such diagnoses and procedures can be associated with diminished ovarian reserve (low egg count), blocked fallopian tubes, and complications occurring during pregnancy.

What if you already know you have a reproductive issue such as PCOS, endometriosis, pelvic inflammatory disease, scar tissue, etc.?

Women with known reproductive issues such as polycystic ovary syndrome (PCOS) or endometriosis should be evaluated by their gynecologist or a reproductive endocrinologist as soon as they begin attempting pregnancy. Women with PCOS often will need medication to induce ovulation in order to facilitate conception. Women with endometriosis should have their fallopian tubes evaluated to make sure that the endometriosis has not created scarring which increases their risk for ectopic pregnancy or completely obstructs their opportunity for conception.

Also, for couples in whom the male partner has a complicated medical history, prior exposure to chemotherapy, and/or testicular or endocrine abnormalities, early semen analysis may save the couple many months of fruitless efforts at conception.

What should you do if you’ve had more than one miscarriage?

Individuals with recurrent pregnancy loss (more than two miscarriages) should be evaluated by their gynecologist or a reproductive endocrinologist. There are several medical conditions associated with recurrent pregnancy loss, many of which can be corrected. Anatomic problems with the uterus such as a uterine septum, intrauterine scar tissue, and others can cause pregnancy loss. Abnormalities of thyroid function, exposure to environmental toxins, and issues related to blood clotting may also be linked with recurrent miscarriage. Sometimes one or both parents may harbor a chromosomal translocation (genetic issue) which can be addressed through advanced embryo screening techniques.

Stay positive! With 10 offices throughout New Jersey, RMANJ has been helping hopeful patients become parents for nearly 20 years. Visit RMANJ.COM to learn more.