When To See A Fertility Specialist: 11 Reasons To Book An Appointment

When you first start trying to conceive, it can come as a surprise when you don’t get pregnant after a few months. You may have heard something somewhere about trying for a year for a positive pregnancy test before you get concerned. Do you really have to wait that long though? Knowing when to see a fertility specialist is important when you’re TTC — getting in to see one at the right time can help you grow your family faster, and reduce your own stress and heartache. For some, that one-year timeline is appropriate; for others, fertility specialists will want to see you much sooner.

When to see a fertility specialist

You can be diagnosed with infertility after one year of having regular sexual intercourse and not getting pregnant, says The American College of Obstetricians and Gynecologists (ACOG). Since that’s the definition most people know, you might assume the one-year timeline automatically applies to you, too.

If you’re having trouble getting pregnant on your own, fertility specialists (also known as reproductive endocrinologists) want to help you. Exactly when in your journey of TTC you should make an appointment depends on so many factors. Romper spoke with two physicians who explained exactly when they want to see you in their offices.

When you’ve been TTC for one year or more

Experts expect about 85% of people to get pregnant within one year of trying, says Dr. Kimberly Keefe Smith, M.D., board-certified OB-GYN at Brigham and Women’s Hospital, as long as their reproductive health is normal. “Trying for a year [applies] when you’re under the age of 35, you have regular cycles and know when to expect your period, and you don’t really have any other symptoms.”

When you’re 35 or older & have been TTC for six months

That one-year timeline shortens by half once you reach age 35, says Keefe Smith, which is when the quality of your eggs begins to naturally decline.

“Women above the age of 35 should not hesitate to see a fertility specialist,” says Dr. Rachel Weinerman, M.D., associate professor at Case Western Reserve University School of Medicine, and an attending physician in reproductive endocrinology and infertility at University Hospitals. “Women who are interested in doing fertility preservation, conceiving on their own, or have tried for six months or more with their partner and have not conceived should consider getting an evaluation with an infertility physician.”

If you’re over the age of 40 and want to conceive

By age 40, Keefe Smith says egg quality and quantity are sharply declining, with most people over age 44 having only a 5% chance of conceiving with their own eggs. So, she says most reproductive endocrinologists will want to see you in office before you even start TTC.

If you have irregular or extremely painful periods

People who do not get regular menstrual periods should seek fertility care sooner than the one-year mark, Weinerman says, because it can be a sign you’re not ovulating normally, which will interfere with your ability to get pregnant.

“If they generally get periods more than 40 days apart, they should not try for more than three months,” Weinerman says. “Or, if they have been tracking their cycles regularly before trying and they do not get regular periods, or their periods really vary significantly, they do not need to wait. They can seek help right away.”

Keefe Smith adds that whether your periods are irregular or super predictable, if they’re painful or heavy enough that you have to stay home from work or change your plans, it’s a good idea to see a specialist “sooner rather than later.”

If you have anatomical abnormalities

Weinerman says people who have been told their fallopian tubes are missing or blocked should consult a fertility specialist early on while TTC. Same goes for those with a history of fibroids or concerns about the shape and structure of their uterus. Some conditions that put you at risk for a blocked fallopian tube include endometriosis, chlamydia, and pelvic infections or surgeries, Keefe Smith says. If you have any of these, bring them up with your OB-GYN and ask whether you should see a fertility specialist.

If you’re interested in fertility preservation options, like egg freezing

If you want to have children one day, but not now, you’ll need to work with a reproductive endocrinologist to do it. “If someone knows that they want to conceive at some point in their life but they’re not in a position to do so currently, then they can see a reproductive endocrinology and infertility physician to discuss fertility preservation such as egg or embryo freezing,” Weinerman says.

If you’re trying to conceive & not in a heterosexual relationship

Weinerman says she sees patients in same-sex relationships who are hoping to conceive, transgender patients hoping to grow their families or have a partner who is transgender, and single parents-to-be wanting to conceive without a partner.

If you or your partner has had chemotherapy or radiation

Cancer treatments are hard on the body, and can impact fertility in men and women. “For men, the only way to know if chemotherapy has affected their fertility is by getting a semen analysis. For women, regular menstruation can be a reassuring sign, but there still could be lower fertility. Women who had chemotherapy who are not getting regular periods should be assessed right away,” Weinerman says.

If your close family members went into menopause early

If you’re comfortable asking your mother, grandmothers, and aunts about when menopause began for them, it’s useful info to give your doctors. “The average age of menopause — when you run out of eggs — is around 50 to 51, but there’s a massive range of normal,” Keefe Smith says. “Obviously people aren’t clones of their family members, but the number of clues we can get upfront is really helpful, and family history is definitely one of them.”

If you’ve had more than one “chemical pregnancy”

If you’re having positive pregnancy tests but the embryos aren’t developing and “disappear,” as Keefe Smith says, it’s considered a chemical pregnancy (though those who have gone through them might just prefer the term miscarriage).

“If people are having pregnancies that they’re picking up on ultrasound and then they miscarry, you don’t need to have 12 ovulations where you’re actively trying. That time of being pregnant counts toward the one year,” Keefe Smith says. “It’s promising that egg and sperm were able to meet and the embryo’s implanting and starting to grow, but if this is consistently happening, especially two or more times, definitely come see an expert to see if there’s something we can jump in to help with to prevent a third.”

If you have PCOS or a thyroid condition

Keefe Smith says both of these diagnoses come up often as challenges her own patients face on their journey to conceiving.

Can you get tested for infertility?

If you’re trying and trying but not getting pregnant, of course you’re going to wonder if you can just get tested for infertility instead of worrying, waiting, and guessing. This means you’ll probably also be tempted by at-home fertility test kits (you know the ones). Unfortunately, Weinerman says there’s not really a perfect test to gauge whether or not you’re fertile.

“There really is no test to tell someone that they’re fertile. The only way to know is to actually try,” she says. “There may be things that we can do to help patients get pregnant in nontraditional ways or to preserve their fertility, but I can’t tell someone if they’re fertile or infertile based on the testing results.”

Finally, Weinerman says not to let fear of the cost of infertility treatment keep you from booking that first appointment. “Many people are hesitant to come to a fertility specialist because they’re concerned about the cost of treatment. There are many options that fertility physicians can offer depending on the specific situation, and some may not be as expensive as patients may think. Some fertility treatments are covered by insurance, especially dependent on what state the patient is living in and what insurance they have. It’s always worthwhile to get an assessment and have a discussion with your physician.

Experts:

Dr. Kimberly Keefe Smith, M.D., board-certified OB-GYN at Brigham and Women’s Hospital

Dr. Rachel Weinerman, M.D., associate professor at Case Western Reserve University School of Medicine, and an attending physician in reproductive endocrinology and infertility at University Hospitals