I tell my friends that there are several steps you can take with your OBGYN prior to visiting a fertility specialist. If you already know that you have an infertility factor, then visiting a fertility specialist sooner may improve your chances of having a family. Time is important when it comes to fertility, as a woman's age increases her fertility decreases. Women are most fertile between the ages of 20-28 and fertility really begins to decline after 35.
I always mention that if you do go to a fertility or IVF (In Vitro Fertilization) clinic, it doesn't mean you'll automatically be doing IVF. The majority of fertility specialists want to try lower tech and lower cost measures first before they recommend IVF. These other treatments may include clomid, diet and exercise, diagnostic testing and possibly surgery.
Each month a fertile couple (maternal age under 35) has about a 20-30% chance of conceiving, most couples believe that once the birth control goes out the window it should be closer to 70-80%! This is important to remember if you and your partner have tried for a couple of months without a positive pregnancy test.
This is the game plan I suggest to my friends if they have been trying for several months without luck.
1. Start charting your cycle. If you have been on hormone controlled birth control for a while, then your natural cycle may be very different from your 'medicated' cycle. Get to know what your natural cycle is like because it can be useful information if you end up at a fertility specialist. Plus it's important for women to know the handful of days each month when they are ovulating and can conceive. There are many websites that you can log onto, and even apps you can download to chart your cycle and tell your when your most fertile days should be. I used Pink Pad lite for my iphone, which was free and helped me to monitor my menstrual cycle when I first stopped taking birth control pills. Some women ovulate earlier than suggested and others later.
2. Using ovulation predictor kits can be helpful for some women to discover when/if they are ovulating in their cycle. Don't panic if you don't surge, I tried an ovulation predictor kit during the same cycle that I got pregnant with my daughter and it never surged for me. While there may be some value in using them they are not 100% accurate.
3. If it's been several months without success and you're charting a normal cycle and surging from the ovulation predictor kits then I advise that the male partner have a semen analysis done. It's a painless and relatively inexpensive test (average around $175-250) that will let you know if his sperm is up to standards.
4. Try acupuncture - this IS even for the needle phobic, which I was, until I tried acupuncture. They shouldn't call them needles because they don't hurt, and they are hair thin. If you do get pregnant you're going to have your blood drawn a lot, and acupuncture needles are nothing in comparison. I found the experience to be very relaxing and have had it done many times. The best way to track down an acupuncturist that has fertility experience is to call your local fertility specialist and see who they recommend. Many fertility centers work with acupuncturists to help improve their patient's experience and potentially their pregnancy rates. I love acupuncture because it is holistic and covered under some insurance plans, if not, you can use your flex spending account money toward acupuncture.
5. Talk to your OBGYN and find out how much experience they have with fertility diagnosis and treatment. Not all OBGYN's are equal when it comes to how knowledgeable they are at diagnosing and initially treating infertility. I would call your local fertility center and ask if there is an OBGYN they would recommend. Often times fertility centers will know which local physicians send them the best initial fertility work ups and those are the OBGYN's you would want to start with.
6. Your OBGYN may put you on clomid which is a pill that induces egg production and ovulation. It is important to not do too many clomid cycles because there have been studies that suggest that women who are on clomid for many cycles (12+) could have an increased risk of ovarian cancer. Additionally, if you're on clomid for close to a year it's likely that you should try a different approach including IVF. Many fertility specialists do a maximum of six cycles of clomid before moving on to the next treatment course.
7. Talk to your OB/GYN about having an AMH (Anti-Mullerian Hormone test) done, which is a test that can help to give you a better idea of the size of your remaining egg supply. This test doesn't give you the quality of your eggs, but rather an idea of the quantity of eggs that you have remaining. Result from this test may suggest that you need to see a specialist sooner rather than later.
8. Have your OB/GYN do a Hysterosalpingogram (HSG). This is a test that injects dye into your uterus and out through your fallopian tubes. This will let the physician know if you have any issues with your uterus or blocks in your fallopian tubes that could be causing problems. There have been studies that suggest a slight increase in fertility potential following this procedure.
These are just a few suggestions of what you can do prior to deciding it's time to move on to a fertility specialist. Educating yourself about your cycle and reading about fertility from reputable sources can help to alleviate some of the stress you may be feeling about going to a fertility specialist. Below are a few resources I feel are helpful to educate and empower and offer support.
http://www.asrm.org/patient_resources/
http://cnyfertility.com/
http://resolve.org/
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