Infertility is defined as a failure to conceive after 12 months of unprotected sexual intercourse. However, there are many factors that can cause infertility, some of which should be evaluated and treated earlier than that. If you think you might be infertile, it is important to seek help from a health care professional.

Here are some signs that you may be dealing with infertility:

Age

If you are over 35, it is generally accepted that 6 months is an adequate time to try, and waiting longer may reduce the chances that medical help will be effective. Fertility rapidly declines in women over 35 with half of the women over 40 being infertile just based on age. Both numbers of eggs and quality of eggs decline with age.

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Ovarian reserve testing may identify women with low egg numbers. These include AMH (antimullerian hormone) testing and ultrasound examination of the ovaries to count visible follicles (where the eggs develop).

Low numbers of eggs, called decreased ovarian reserve, may reduce the chances of conceiving. Also, as a result of aging, the quality of the eggs diminishes and the percentage of abnormal embryos conceived increases, which results in difficulties in conceiving and higher miscarriage rates.

Ovulation

There are other reasons to seek attention before the 1-year mark, or even immediately. If you have very irregular menses, with cycle lengths over 35 days, then you may not be ovulating or may be ovulating infrequently. Conception is difficult with infrequent ovulation, and will not occur in the absence of ovulation. Women with ovulation problems need to be evaluated. Medical treatments to induce ovulation can be very successful, so there is no reason to wait to seek help.

Medical History

If you have a medical history that indicates a higher risk for infertility for you or your partner, you should seek assistance sooner than you would otherwise. This includes a history of previous pelvic infection (pelvic inflammatory disease or PID) which can damage the fallopian tubes or a history of endometriosis or surgery to remove cysts from the ovaries.

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Women who have had previous abdominal surgery that may have affected the pelvic organs (like a ruptured appendix, for instance) are at higher risk for pelvic adhesions (scarring around the fallopian tubes) which may impair fertility. Men who are at higher risk for infertility should be evaluated with a semen analysis right away. This includes men who have had previous surgeries for testicular torsion or for undescended testicles.

Health and Lifestyle

There are a few ways to improve your fertility even before you try to conceive. It is important to be in the best health possible. If you have any medical problems, like diabetes or hypertension, these should be optimally treated and controlled prior to conceiving. In addition, avoiding nicotine products and marijuana, limiting alcohol and caffeine, achieving and maintaining healthy body weight by eating a healthy diet (including fruits, vegetables, and a daily multivitamin) and exercising regularly, are all important in preparing to get pregnant.

Once you decide you need help, what should you do?

You should speak to your gynecologist about any suspected issues and start an evaluation which typically includes a semen analysis and hysterosalpingogram (HSG, an X-ray of the fallopian tubes to confirm they are not blocked).

Depending on your doctor’s experience with such an evaluation, you may also decide to seek out a reproductive endocrinologist, who is specifically trained in reproductive problems including infertility and its treatment.

Although many couples require advanced fertility treatments, like IVF, some will only need some guidance or some minor medical treatments (for thyroid problems, for instance) or ovulation-inducing medications, so don’t jump to the conclusion that you need expensive or risky procedures.

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Barry Witt, M.D. is the Medical Director of WINFertility and Greenwich Fertility. He is a board-certified reproductive endocrinologist who has been offering reproductive care for more than 25 years.