Most childless couples with a female age under about 45 that are having problems getting pregnant are considered to be infertile but not sterile.
It is prudent to seek medical help for fertility issues without waiting for a year of trying on your own if you have a condition that is a known risk factor for fertility problems, such as irregular menstrual cycles, endometriosis, previous tubal pregnancy, PCOS – polycystic ovary syndrome, previous pelvic inflammatory disease (PID), etc.
The appropriate amount of time to try on your own can be longer, or shorter than one year. For example, if you are only 25 years old and feel that you want to give it more time to occur naturally – you might try on your own for another 6 months before seeing a doctor for help.
In 2008, ASRM published a revised definition of infertility that says:
“Infertility is a disease, defined by the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years.”
You do not need to have sex all the time in order to get pregnant. If you like it that way, then no problem – it doesn’t reduce a couple’s fertility potential either. The best fertility advice in terms of frequency of intercourse is – every day or every other day “around ovulation”.
The egg only lives about 12-24 hours, while the sperm (if normal) will live in the female’s reproductive tract for up to 2-5 days – while maintaining the ability to fertilize an egg.
The cause of infertility is investigated by performing fertility tests in a basic infertility evaluation. The tests can be completed during one menstrual cycle (one month).
This can be done in a variety of ways. About 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem, polycystic ovarian syndrome, is effectively treated with medications.
The semen analysis is a very important test and should be done early in the evaluation process. If a severe sperm defect is discovered, the testing on the female partner should be modified, and therapy can be immediately directed to the sperm problem.
Depending on the individual couple’s situation, various blood tests on either the female or the male may be needed. Blood tests that might be needed include day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), AMH, prolactin, testosterone (T), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH).
If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests.
Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages.
The hysterosalpingogram, or HSG is done in order to assess the anatomy of the endometrial cavity of the uterus and the fallopian tubes. The HSG is usually scheduled between days 6 and 13 of the cycle – after bleeding and before ovulation.