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Fertility Journey

Starting the journey

Patients often first receive fertility care from their primary care doctor, who may perform initial tests or start medical therapies. Providers may then refer patients to a specialist in reproductive endocrinology and infertility. On average, appointments tend to be scheduled after six months of unsuccessful attempts to conceive.

You are not alone

Infertility affects more than 15% of couples trying to get pregnant. It is defined as the inability to conceive within one year despite having unprotected sexual intercourse. For average fertile couples trying to have a baby, the chance of succeeding in any given month is approximately 20%.

Infertility affects both men and women. Problems with sperm account for almost 40% of infertility. Problems affecting women include ovulatory dysfunction, blocked or damaged fallopian tubes, and endometriosis.

Age and infertility

In both sexes, fertility declines with age, but age-related fertility problems are far more likely in women. In men, fertility declines after age 50, but for women, fertility begins to decline at age 30.

Only 4% of women ages 15–24 have fertility problems. That number more than triples to 13% between the ages of 24–34. By age 40, more than a third of women experience fertility problems. 87% of women are infertile by age 45.

If you are having difficulty conceiving and any of the below apply to you, you may want to seek help earlier than after one year of trying:

  • A history of sexually transmitted diseases for you or your partner
  • Previous surgery or damage to reproductive organs
  • A history of serious illness, such as cancer
  • Hormonal problems
  • Exposure to radiation or toxins

Getting started

A thorough evaluation of an infertile couple begins with a history and physical exam. Before treatment, there is a certain amount of testing that is required for both the male and female partners. For the male, we recommend a semen analysis be done early in the process since up to 40% of infertility may be due to problems with sperm count or motility.

For most couples, other tests will include:

  • Hormone testing to check for certain conditions associated with infertility
  • Assessment of uterine cavity and fallopian tube patency
  • Assessment of ovulation

Advanced testing might also include laparoscopy and hysteroscopy or the use of ultrasound to evaluate pelvic structures for various defects or endometriosis.

What is included in a fertility evaluation?

Evaluation of female partner

Evaluation of male partner