When my husband and I started trying to make a baby, we were halfway through a round-the-world trip and having plenty of sex. Yet, we returned home not pregnant. I began using ovulation-predictor kits, and our lovemaking became less spontaneous, more "we-need-to-do-it-today," especially since my 35th birthday was looming.
Like many women who are hoping to conceive, I had heard the standard advice: If you have regular (every 26-32 days) periods and are younger than 35, you should wait a year before consulting a doctor; if you're older than 35, wait just six months. Sound rationale backs up this advice, as half of couples trying to conceive will be pregnant by the end of six months, and 80 percent will be pregnant by the end of a year, according to Mary Jane Minkin, M.D., an OB-GYN in New Haven, Conn., and a clinical professor of obstetrics and gynecology at Yale University School of Medicine. "The odds are in your favor," Minkin says. Knowing exactly when you ovulate can boost those odds.
When to Take the Next Step
If you're still not pregnant after six months to a year of properly timed intercourse, see your gynecologist, who can perform or recommend several simple tests, including hormone- level blood tests for you and a semen analysis for your husband. "A sperm count is a non-invasive, easy and relatively inexpensive test. It tells when the problem lies with the guy, not the gal; 40 percent of infertility is what's known as 'male factor,'" says Minkin, who is co-author of A Woman's Guide to Sexual Health (Yale University Press).
Another common, relatively non-invasive test, a hysterosalpingogram (HSG), occasionally has an unexpected upside: While it's used to determine if there's a blockage in one or both of the fallopian tubes (thus preventing egg and sperm from meeting), there's a slightly increased conception rate afterward, as the procedure itself sometimes clears small blockages. Your gynecologist also may prescribe the oral ovulation-stimulating drug Clomid.
If these steps don't help you get pregnant, your next one should be a consultation with a fertility specialist, or reproductive endocrinologist (R.E.). Most patients get recommendations from their gynecologist, but you also want to make sure the R.E. is a member of the American Society of Reproductive Medicine (asrm.org). These physicians can perform more specialized tests and procedures.
When to Act Immediately
While six months to a year is the standard time to wait before seeing a doctor about fertility issues, here are some circumstances in which you shouldn't wait, according to Bill Meyer, M.D., a reproductive endocrinologist with Carolina Conceptions in Raleigh, N.C.:
• Negative ovulation-predictor kit test results for two consecutive months.
• Signs of hormonal fluctuations, such as experiencing nighttime hot flashes or irregular intervals between periods.
• Symptoms of polycystic ovary syndrome (PCOS), such as excess facial hair, light periods, thinning hair, acne, irregular cycles or steady weight gain.
• A family or personal history of endometriosis, which is linked to infertility.
• A short luteal phase, indicated by getting your period 13 days or less after a positive result on a urine ovulation kit.
As for my husband and me, after six months of unsuccessful attempts to conceive, I saw my doctor for blood tests, and my husband had a semen analysis. No problems were detected. I also underwent an HSG—and a few days later, we conceived our first child.