So you are ready to build your family. You have stopped using contraceptives of all kinds and stocked up on a few home pregnancy tests. A few months go by and nothing happens. You start to worry. Your doctor reassures you that you are young enough and healthy enough “so just relax.” You might even ask your mother for advice, and she might remind you that everything is in God’s hands. Nevertheless, you are starting to wonder whether or not you need an expert. But when do you make the call?
Most guidelines recommend an investigation for infertility if a woman who is under age 35 has had unprotected intercourse for 12 months or longer and has not become pregnant. Women 35 and older are recommended to wait only six months before seeking help. Some authorities advise that women over 30 should start investigating after six months (I tend to agree).
There are a few states that define infertility for insurance purposes as two years of failed attempts at pregnancy in women under age 35. However, sometimes these recommendations just don’t matter because you already know or suspect that a problem exists. How might you know?
I have developed an acronym to help organize how we think and discuss infertility in my practice and guide conversations with patients about potential tests and options we can try.
The acronym is SEMS:
S – Sperm
E – Eggs
M – Can they Meet?
S – Can they Stick and not miscarry?
If you suspect there may be a prior or existing problem in one of these categories then it is time to contact a physician who has focused their practice on helping people get pregnant. Below, I have outlined some examples of what each of these categories might include.
The reason a couple may struggle to get pregnant can sometimes be linked to problems with the sperm. Do any historical facts raise concerns about the man’s sperm quality? Perhaps there is a history of trauma or surgery on the testicles, or a history of major illness such as a cancer that required powerful medications. Even a history of aggressive exercising, especially weight lifting, or very competitive sports can hint at an issue with the sperm count.
A semen analysis is a simple test that can be obtained without even consulting a fertility doctor, although you may need one to interpret the results. We provide this testing in our office in a private and secure environment designed to put the men at ease.
It is an important first step because 20-30% of all untested couples that walk into the door of my clinic have a “male factor” as the primary cause of their difficulties, and it costs under one hundred dollars in our office.
Are you ovulating? If your periods are not at all regular you may not be ovulalimg on your own. Ovulation predictor kits and temperature charting may provide some evidence that an egg is being released. But the only way to actually know you ovulate is if you get pregnant.
Could you have an issue with egg supply or ovarian reserve? The life span of your ovaries may be concerning either because of age, a family history of early menopause, or illness that could affect your egg reserve, such as treatment for an earlier cancer. A fertility specialist will address these issues on the first visit.
Can they Meet?
Sperm and eggs meet in the Fallopian tubes. The sperm swim up through the uterus to the tubes while the ovary sit near the other end of a tube so that the eggs can drift into the tube’s octopus-like-ending called fimbria. There are various causes of “plumbing” problems and clues include a history of pelvic infection (especially chlamydia), prior abdominal surgery, painful periods, pain during sex, heavy bleeding and clotting during menstrual periods.
A fertility doctor will focus on these clues while a generalist physician might just brush them off and start you on clomiphene; a fertility drug that can cause more harm than good and certainly won’t help if your tubes are blocked.
Can they Stick?
Miscarriage can occur without the woman even knowing and so when an infertile couple is evaluated by a fertility specialist the possibility that the couple is in fact dealing with recurrent pregnancy loss is usually addressed.
You may suspect this is happening to you if you have had several months where your cycle was different, had sore breasts, bleeding was late, early, heavier or lighter. You may have experienced a couple of documented miscarriages but been assured there is nothing to worry about. Perhaps you or a family member has an autoimmune disease such as Lupus or Rheumatoid Arthritis or has a history of a blood clot in the leg or in the lung.
If so, there are tests that can be done to identify if any of these factors may be influencing your fertility. Once identified, a doctor who focuses on helping women conceive will chart out a course of action to improve your odds of success.
Remember, on average a healthy couple will spend 5 months trying to conceive. But if you are concerned because of a SEMS issue, you do not have to wait- just make the call to a fertility specialist