When to see a fertility specialist
Medically reviewed on February 17, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
If you’ve made the decision to have a baby, the initial excitement of becoming pregnant can begin to wear off if you find yourself struggling to conceive right away. While becoming pregnant can take longer than anticipated, how do you know when it’s taking too long? Put differently, how do you know when you should see a fertility specialist?
According to the American College of Obstetricians and Gynecologists, if you’ve been off birth control for a year without successfully conceiving, or if you’re over 35 and it’s been six months of trying, you might need to visit a specialist [1].
There are also other situations in which you may want to see a specialist. Seeking fertility care from a specialist, as well as seeking ovarian reserve testing, can be a crucial step. In this guide, we’ll outline when to see a fertility specialist and what to expect when you do. (To learn more about your fertility-related hormones, consider taking the at-home Women's Fertility Test.)
Reasons to make a fertility specialist appointment
Even if it’s been less than six months to a year since you have begun trying to conceive, there are other reasons to make a fertility specialist appointment. Existing medical conditions or other problems can interfere with the ability to get pregnant.
A fertility specialist can provide advice and treatment options based on your unique situation. Let’s discuss the 5 most common reasons to see a fertility specialist.
1. There are known reproductive issues
Many people assigned female at birth have trouble getting pregnant because of an existing issue. Some of these potential issues include [2]:
- Primary ovarian insufficiency (POI) – When a person’s ovaries stop functioning normally before the natural onset of menopause, it may be due to POI. If you have POI, conceiving without medical assistance is unlikely.
- Endometriosis – Endometriosis is a painful condition that occurs when the tissue that should normally grow inside of the uterus grows elsewhere—for instance, in the fallopian tubes, ovaries, or pelvic area. This condition can lead to infertility if the excess tissue blocks the passage of the eggs through the fallopian tubes.
- Polycystic ovary syndrome (PCOS) – PCOS is a condition in which a person’s body produces more androgen hormones than is typical for females. This can cause irregular ovulation and/or abnormal menstrual periods—symptoms that can both lead to problems conceiving.
- Uterine fibroids – These non-cancerous tumors in the uterus can lead to back aches, heavy periods, and/or pain during sex. They can also interfere with the ability to get pregnant or carry a baby to term.
Because the symptoms of these reproductive issues can mirror the symptoms of more serious problems, such as gynecologic cancers, it’s important to see a healthcare provider if you’re experiencing any of them. Not to mention, all these reproductive issues require diagnosis by a healthcare professional.
If you’re diagnosed with a reproductive condition that interferes with the ability to get pregnant, there’s still hope for your dreams of having a baby. Fertility treatments can help in many situations.
2. A partner has known reproductive issues
Individuals assigned male at birth can also have reproductive issues that can result in infertility. There are typically three main causes of male infertility [3]:
- Sperm disorders
- Hormone imbalances
- Blockages in the reproductive organs
Of these three, the most common causes of fertility problems are sperm related. These include:
- An insufficient number of sperm
- Immature sperm
- Abnormally shaped sperm
- No sperm at all
If a fertility specialist determines that one of these issues is causing an inability to conceive, you’ll want to consider options such as artificial insemination, medication, or surgery.
3. There are menstrual irregularities
If periods are heavy, irregular, or non-existent, you might have trouble conceiving.
This is because many of the same problems that cause heavy periods can also negatively impact fertility—uterine fibroids, hormone imbalances, and/or certain cancers can cause you to have heavy bleeding during periods.
Other menstrual irregularities can also affect the ability to conceive. A study discussed in the “Annals of Epidemiology” looked at the menstrual cycles of over 2000 women between the ages of 21–45 [4]. The study found that women with shorter cycles of between 25–26 days had reduced fertility. This suggests a potential link between short menstrual cycles and infertility.
Finally, people who have infrequent or irregular periods often suffer from infertility because they don’t ovulate normally. If you're concerned you might not be ovulating regularly, you may benefit from virtual ovulation support.
There may be problems with the frequency of periods due to [5]:
- Rapid weight loss
- Low body weight
- Pituitary gland problems
- Eating disorders
- Stress
- Kidney disease
- Smoking
- Thyroid problems
- Health conditions, such as PCOS and POI
4. There have been multiple miscarriages
Miscarriages in early pregnancy are common. In fact, about 10-20% of pregnancies end in a miscarriage during the early stages [6]. However, individuals who have had multiple miscarriages should consult with a fertility specialist.
When a person has had repeated miscarriages, there are usually other causes, such as [7]:
- Egg or sperm with abnormal chromosomes
- Uterine scarring
- Autoimmune disorders
- A septate (divided) uterus
- PCOS
A fertility specialist may help determine the cause of miscarriages and the viability of a full pregnancy.
5. Over the age of 35
Women who are 35 and older are at an increased risk of [8]:
- Fewer or poor-quality eggs – People with uteruses are born with a fixed number of eggs in the ovaries. As you get older, the number of eggs decreases. Plus, the remaining eggs have a higher likelihood of damage. This means it is more likely to give birth to a baby with missing, extra, or damaged chromosomes (resulting in issues such as Down syndrome). You can learn more about how many eggs a woman has to get a better understanding of the factors that impact female fertility.
- Pregnancy complications – Older people who do get pregnant are more susceptible to complications during pregnancy. Preeclampsia, gestational diabetes, and premature births are all more common in individuals over age 35.
- Health conditions that can impact fertility – As you get older, it is more likely to have health problems that can lower the ability to conceive. Conditions such as high blood pressure, diabetes, and certain cancers can make it difficult to get pregnant.
So if you’re over 35 and want to start a family, it’s a good idea to see a fertility specialist before trying to conceive.
What can a fertility specialist provide?
If you decide that a fertility specialist is the next step, there are a few things you need to know. First, the fertility specialist will conduct an infertility evaluation [1]. During this evaluation period, you and your partner will need to answer questions about medical history and health status. These questions will likely cover:
- Current medications
- Birth control methods previously used
- STD and other sexual history information
- Alcohol, tobacco, and drug use
- Family health history
Then, you’ll undergo several tests, including:
- Basic gynecological exam
- STD test
- Blood tests to check your hormone levels
- Ultrasound to confirm ovulation and that there are no ovarian cysts
If you have a partner, there are additional tests they may need, such as:
- Semen analysis
- Urological exam
- STD testing
- Hormone level tests
Depending on the results of these tests, you may receive a diagnosis or may need further examination. It’s also important to keep in mind that, in some cases, fertility specialists are unable to find an exact cause for infertility. But whether or not a fertility specialist is able to determine a cause, they may recommend methods and treatments to help support conception.
What methods might help promote pregnancy?
There are several other methods a fertility specialist might use to help you and your partner conceive [9]. Among the most common are:
- Lifestyle changes – An infertility specialist might first recommend improving your overall health and wellness. A better diet, weight optimization, and elimination of alcohol and/or substance use may increase the chance of conceiving. Lifestyle changes are also the most cost-effective option.
- Medications – Sometimes, hormonal therapy can help regulate the body’s functions and your hormone levels. This might make it possible for you to conceive. However, it’s important to note that hormonal therapy can come with some unpleasant side effects, such as mood swings and anxiety.
- Surgery – In some cases, surgery is necessary to remove fibroids, unblock fallopian tubes, or treat endometriosis. For individuals assigned male at birth, swollen scrotal veins might also require surgery.
- In vitro fertilization (IVF) – IVF involves combining the sperm and egg in a laboratory setting and then implanting the resulting embryo in the uterus. IVF is usually used in cases in which other methods won’t work.
Another option for female infertility treatment can include freezing the eggs, which can be stored for later use.
How much will treatment cost?
As you can imagine, the cost of fertility treatment is often quite high. For example, medication alone may cost $1,000 or more [10], and IVF can cost $25,000 and up (depending on the number of attempts needed).
To further complicate matters, most insurance plans won’t help cover these expenses.
Evaluate your hormone levels with Everlywell
If you’re over the age of 35, have menstrual irregularities, or have reproductive concerns, a fertility specialist could help support conception efforts. In addition, consider testing the hormones that influence your ovarian function with the Everlywell Women’s Fertility Test. Our simple, convenient, and affordable at-home test can give you insight into whether your hormones are causing your fertility issues and help guide your decision-making process.
Related content
What is secondary infertility?
Can irregular periods cause infertility?
References
1. Evaluating Infertility. American College of Obstetricians and Gynecologists. URL. Accessed February 17, 2022.
2. Common Reproductive Health Concerns for Women. Centers for Disease Control and Prevention. URL. Accessed February 17, 2022.
3. How Common is Male Infertility and What Are its Causes? National Institutes of Health. URL. Accessed February 17, 2022.
4. Wesselink AK, Wise LA, Hatch EE, Rothman KJ, Mikkelsen EM, Stanford JB, McKinnon CJ, Mahalingaiah S. Menstrual cycle characteristics and fecundability in a North American preconception cohort. Ann Epidemiol. 2016 Jul;26(7):482-487.e1. Epub 2016 May 31. PMID: 27449569; PMCID: PMC4964792.
5. Amenorrhea: Absence of Periods. American College of Obstetricians and Gynecologists. URL. Accessed February 17, 2022.
6. Early Pregnancy Loss. American College of Obstetricians and Gynecologists. URL. Accessed February 17, 2022.
7. Repeated Miscarriages. American College of Obstetricians and Gynecologists. URL. Accessed February 17, 2022.
8. Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy. American College of Obstetricians and Gynecologists. URL. Accessed February 17, 2022.
9. Treating Infertility. American College of Obstetricians and Gynecologists. URL. Accessed February 17, 2022.
10. Cost of Infertility Treatment. American Society for Reproductive Medicine. URL. Accessed February 17, 2022.