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 under the age of 35 has not become pregnant after 12 months of unprotected intercourse. Women over 35 are advised to wait only six months before seeking help.
Some fertility specialists advise that women over 30 should start investigating after six months (I tend to agree). For insurance purposes, some states define infertility for 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?
One of the region’s leading fertility clinics, Fertility Partnership, developed an acronym to help organize how we think and discuss infertility. It guides our 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 an 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 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, secure environment designed to put the men at ease. It is an important first step because 20-30% of all untested couples who walk into Fertility Partnership have a “male factor” as the primary cause of their difficulties, and it costs under $100 in our office.
Are you ovulating? If your periods are not regular, you may not be ovulating 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 lifespan 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.
Sperm and eggs meet in the Fallopian tubes. The sperm swims up through the uterus to the tubes while the ovary sits 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.
Miscarriage can occur without the woman even knowing, 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 documented miscarriages, but have 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 identify whether 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.