My husband and I have been trying to get pregnant for the past six months without luck. When should we seek medical help for infertility?

Approximately fifteen percent of couples in the United States struggle with infertility and are unable to get pregnant. Typically, infertility is diagnosed after twelve months of trying to conceive without the use of birth control. I would encourage you and your spouse to keep trying. If you aren’t pregnant after six more months, you may want to see a doctor and have an infertility evaluation. Tests can be done to find the cause of Infertility after which you can discuss treatment options if necessary.

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What is infertility?

Infertility is usually defined as not being able to get pregnant after trying for at least one year. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile. Infertility is a problem for one of every six couples. It can be caused by problems in a man’s or woman’s reproductive system. Problems in the woman’s body are responsible for about half of the cases of infertility. Often the reason for infertility in a woman is that her ovaries are not releasing eggs. For example, when a woman gets older, the ability of the ovaries to release healthy eggs declines, especially after the age of 35. Other things that may affect the eggs and the release of eggs (ovulation) are: hormone problems, overweight or underweight, smoking, too much stress, unhealthy diet, ovarian tumors or cysts, intense exercise, abuse of alcohol or drugs, tumors in the pituitary gland, chronic illness, such as diabetes and some medicines. A woman who is not ovulating normally may have irregular or missed menstrual periods. An abnormal or damaged fallopian tube or uterus can be another cause of infertility. When an egg is released, it must pass through a fallopian tube to the uterus. A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must then attach to the inside of the uterus. A fallopian tube or uterus may be damaged by an infection, such as a sexually transmitted disease, a birth defect in the female organs, growths in the uterus, such as polyps or fibroids, scar tissue from surgery (called adhesions), endometriosis which is tissue from the uterus growing outside the uterus, DES syndrome, which you may have if your mother took the medicine DES when she was pregnant with you. You may have problems with your cervix that make it hard for the sperm to reach and fertilize the egg, such as cervical stenosis (a cervix that is very narrow or closed), abnormal cervical mucous, cervicitis, which is inflammation or infection of the cervix. In rare cases, a woman’s body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility. Thirty percent of infertility cases have no known cause.

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How is infertility diagnosed?

You and your partner will have thorough exams. You will be asked about: your sexual history, including previous pregnancy, miscarriage, or abortion, your medical and family history, your diet and exercise habits, stress, your use of drugs, alcohol and tobacco, your sexual intercourse practices, such as how often you have sex and whether you use lubricants. You may need to find out if you are ovulating each month. Your healthcare provider can tell you how to take and chart your body temperature each morning. Your temperature will rise after ovulation. You can buy kits at the drugstore that can help predict ovulation. Blood test and an ultrasound of the ovaries can also be used to see if you are ovulating. Other tests that may be done are: urine and blood test to check for infections and a hormone imbalance, test of samples of cervical mucus and tissue from the lining of your uterus, tests of your partner’s semen to check the number and quality of sperm in the semen. You may have the following procedures to check for a blockage in your tubes or uterus, scar tissue, or endometriosis: hysteroscopy, laparoscopy, hysterosalpingogram.

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