Pregnancy and Childbirth How to Talk to Your Doctor About Fertility By UPMC Magee-Womens Hospital, April 4, 2017 If pregnancy isn’t occurring as quickly as you expected, you may begin to wonder if you have an infertility issue. When is it time to see a doctor? Discussing family planning can be difficult, but couples should keep an open line of communication with their doctor to address issues early. “It can start with your primary care physician or your gynecologist,” said Marie Menke, MD, MPH, a specialist in reproductive endocrinology and infertility at the Center for Fertility and Reproductive Endocrinology at Magee-Womens Hospital of UPMC. “You can start the conversation by saying, ‘I’ve been trying for this long. What do you think I should do next?’” Signs You Should Talk to Your Doctor About Infertility Couples who have been trying to become pregnant for more than a year should speak to a doctor about the possibility of fertility testing. Likewise, if you are older than 35 and have been trying for more than six months, speak to a doctor. RELATED: When Should I Seek Out a Fertility Specialist? “The decline in fertility does become a little more rapid in the 30s, so we want to intervene early if we can for those couples,” Dr. Menke said. You should also begin a conversation with your doctor if you have a history of: Irregular or frequently missed periods Uterine fibroids Endometriosis Gonorrhea, chlamydia, and other sexually transmitted diseases Types of Fertility Testing Your doctor will perform several tests to determine your level of fertility. To do this, they must look at two factors: Your ability to conceive as well as your ability to carry a healthy pregnancy. A physical and pelvic exam, as well as an in-depth look at your medical history An assessment of your ovarian reserve as an estimate of egg quality Testing to confirm ovulation is still occurring An evaluation of the uterus, ovaries, and fallopian tubes Hormonal testing Doctors typically only turn to in vitro fertilization as a last resort, Menke said. “There could be a variety of underlying reasons for infertility,” Dr. Menke said. “The treatment we turn to often depends on the cause. There are oral medications that can help you ovulate. If it’s something tubal, sometimes the issue can be repaired surgically.” Fertility Issues in Men All men, regardless of age, should undergo a semen analysis. “I tell most of my patients that there could be a problem with either of them — men should also be evaluated,” Dr. Menke said. “About 40 percent of the time, there is a contributing factor from the male partner.” RELATED: New Solutions for Male Infertility Lifestyle Changes and Fertility For couples looking to conceive after going off contraception, there is no “magic timeline,” Dr. Menke said. In some cases, conception after ending birth control may take several months. You should talk to your doctor about your family planning needs. Several lifestyle factors can spell fertility troubles, including smoking, being overweight, or suffering chronic anxiety. The Center for Fertility and Reproductive Endocrinology at Magee-Womens Hospital offers state-of-the-art infertility services for men and women. Visit the center’s website or call 412-641-1600 for more information. Smoking “Smoking is detrimental to your egg quality,” Dr. Menke said. Men who smoke are more likely to have damaged DNA in their sperm, and regular tobacco use can affect hormone production, according to the Centers for Disease Control and Prevention. Obesity Being overweight or obese can cause hormonal imbalances, irregular periods, and ovulation problems, according to the CDC. Obese women may have trouble conceiving even if they are ovulatory. But Dr. Menke cautions that women who are underweight or who regularly exercise excessively may also have difficulty conceiving. Stress “We know stress plays a big role in infertility, but it’s difficult to quantify,” Dr. Menke said. “There are a lot of studies that show stress is present in many cases of infertility, but we don’t know if it’s a chicken or egg.” Couples should talk to their doctor about the emotional toll of infertility. Dr. Menke said Magee-Womens Hospital has a social worker on staff to help patients work through the stress associated with fertility procedures. “There are a lot of support groups out there too — RESOLVE is a really great national group that focuses on infertility issues,” Menke said.