Holy Name Medical Center Blog

What to Expect When You’re Not Expecting

Posted by Paula Barcia-Pena, MD
Holy Name Medical Partners on August 3, 2021
Paula Barcia-Pena, MD - Obstetrician-Gynecologist

You and your partner decided to start your family, but when months go by, you wonder when you should seek medical guidance. The answer depends on your age.

If you are younger than 35, it is considered normal to take up to a year to conceive. If you are 35 or older you should consider consulting your OB-GYN after six months of unprotected sex without pregnancy, since time is of the essence.

There are some exceptions to these general guidelines, as a medical exam and blood tests might be indicated earlier for women with irregular menstrual cycles or known risk factors for infertility, such as a history of pelvic inflammatory disease or endometriosis.

Worldwide, the percentage of couples having difficulty conceiving is as high as 15 percent. Both partners of an infertile couple should be medically evaluated. Overall, up to 40 percent of infertility cases stem from male reproductive issues, 35 percent from female reproductive issues, 10 percent from both partners, and up to 15 percent are attributable to unknown factors, according to the American Society for Reproductive Medicine (ASRM).

Fertility declines steadily with age for both men and women, but the decline is more marked for women as the quality and quantity of eggs decline. A woman’s most fertile years are in her 20s. Fertility wanes in the 30s, particularly after age 35. The incidence of having abnormal oocytes, the cells in the ovaries that may develop into eggs, is 60 percent after age 40. After age 42, that risk rises to 75 percent.

While sperm quality deteriorates somewhat as men age, it generally does not become a problem before a man is in his 60s.

Decreasing Odds

Each month that she tries, a healthy, fertile 30-year-old woman has a 20 percent chance of getting pregnant. By age 40, that drops to less than 5 percent per cycle, according to the ASRM. Although the average age for menopause is 51, most women are unable to have a successful pregnancy by their mid-40s.

Despite misconceptions in popular culture, those success rates hold for pregnancies resulting from fertility treatments as well as natural conception. Many different medical conditions and other factors can contribute to fertility problems.

Couples may also be under the impression that in vitro fertilization (IVF) is foolproof, but it’s not. IVF is a complicated process and generally works in less than half of cases. IVF can be an expensive and emotional journey that is generally considered when other methods, such as timed intercourse, fertility drugs, surgery and artificial insemination, haven’t worked.

Contributing Factors

For both men and women, extremes in weight – either too high or too low - can affect fertility. Sometimes a weight loss of only 5 percent can increase the odds of pregnancy.

Lifestyle factors such as smoking, drinking alcohol and stress can play a big role in fertility for both partners and can also affect the viability and health of a developing fetus. Tobacco can be toxic for the ovaries. And sometimes stress management is made more difficult as couples worry about infertility. The plethora of apps now on the market to track fertility are meant to be helpful but sometimes add to the stress.

Taking Steps

If you're seeking help with infertility, an OB-GYN or other primary care provider can do the initial assessment. Your doctor will first take a medical history and perform a basic physical exam to assess whether your weight, family history or lifestyle could be factors.

From there, a basic diagnostic workup for women would include a blood test and a baseline ultrasound of the uterus. These tests will help evaluate hormone levels and the quality of the egg supply. An HSG or hysterosalpingogram also would be used to check for blockages in the Fallopian tubes or buildup of tissue within the endometrial cavity. For males, a semen analysis assesses the quantity (sperm count) and quality of sperm.

Your doctor may recommend other tests based on your and your partner’s medical history and specific situation. Once these diagnostics are completed, your health care provider can steer you toward a fertility specialist who can offer the best treatment options.

Paula Barcia-Pena, MD, is a board-certified obstetrician-gynecologist with offices in Teaneck and Cliffside Park. She is fluent in English, Spanish, Italian, and Portuguese. To schedule an appointment: 201-833-7087 (Teaneck), 201-943-4884 (Cliffside Park), or HolyNameMedicalPartners.org.