How Long Is Too Long? When Is It Time to Come in for a Fertility Evaluation?

As native New Yorkers, we don’t like waiting more than two minutes for our coffee, more than three minutes for a cab, and more than four minutes for the subway. We are as impatient as the next gal trying to get to and from work, home, and our workout class. Despite the unexpected (ugh, why did I have to get stuck behind the garbage truck? I’ll never make it!), we pretty much know how much time to allot to almost all of our daily tasks: one minute to make your coffee, 10 minutes to walk to the subway, 15 minutes to walk to the gym, and 20 minutes to walk the dog.

But while we have these routines down to the minute, what we often don’t know is when to seek medical advice for our bodies. Am I overreacting; will it just go away? Am I a hypochondriac? Maybe that pain is normal. And if something is really wrong, can it be fixed? The fear of the unknown, of what might be wrong, and what might need to be done to fix it can frighten even the strongest individuals.

For most of us, it’s hard to imagine that we won’t just pull the goalie (aka stop using contraception), have unprotected sex, and two weeks later see pregnant on the stick. The months of not pregnant, despite valid efforts, can become emotionally and physically exhausting. However, it’s confusing to know when it’s time to call the natural way quits and seek medical advice. Your mom will tell you “Relax, and it will happen.” Your friends will tell you, “It happened for me the first try!” and the Internet will tell you almost everything and anything. Whom do you believe?! A credible and comforting source in this process can be extremely hard to come by. Let us at Truly, MD, do our best to be your voice of reason.

Traditionally, infertility was defined as one year of unprotected intercourse. It didn’t matter if you were 24, 34, or 44 when trying to get pregnant—your OB/GYN generally did not refer you for further evaluation until you hit that one-year mark. Thankfully, this is no longer the case. Our current guidelines factor in the age of the female partner for when it’s time to call a time out from trying on your own. So get out your calendars, and start counting because here’s the latest advice: For women who are equal to or less than 35 years old, you can continue to follow the traditional recommendation and wait a year before seeking evaluation/treatment. Women who are older than 35 should, by the new guidelines, get the ball rolling after six months of trying. And lastly, women who are older than 40 should seek immediate evaluation/treatment. Come right to your fertility specialist.

And remember, while these recommendations are in place to guide the general population, there are certain situations where we would want to see a 32-year-old after trying for three months and a 35-year-old after trying for one. It’s super important that you share your medical, gynecologic, and family history with your OB/GYN. If your mom had menopause young, you might have it even younger! There are certain red flags, like this, that will prompt a referral to a fertility doctor before any alarm has even gone off.

So why are we lighting the fire under you? It’s not to scare you, rush you, or make a nerve-wracking situation even worse—we promise. It’s because, in this case, we sort of know how the story might end if you wait too long. We have shaken that Magic 8 ball (Will my mom let me stay out past curfew? Decidedly not!), and we know that female age is one of the most important factors when trying to conceive. Every month that passes, from the moment we are born, we are losing eggs. The rate or the slope (Algebra 101: y = mx + b!) of this line of loss is fairly gradual until we hit about 32. It picks up, or gets steeper, at about 37 and then nosedives at 40.

You’re not just losing quantity but also quality. The older the egg, the more likely it is to make an abnormal embryo (medically defined as an aneuploid embryo). And while abnormal or aneuploid embryos may get you pregnant, in most cases, they lead to a miscarriage.

There is a classic study that was done in France (They gave us more than just good wine and French Fries) that is mentioned frequently in the world of fertility medicine. Pourquoi?(That’s why, for all of you non-French speakers) The answer is because the women in the study all had partners with no sperm (medical term = azoospermia) and needed donor sperm insemination to get pregnant. Therefore, who got pregnant and who didn’t became all about female age (All donors were young, so male age went out the window, and the inseminations were timed so the appropriate time of intercourse became no big deal).

And voila, the results are as follows: As women aged, the pregnancy rates decreased significantly. The pregnancy rate after 12 insemination cycles was 74% for women less than 31 years old, 62% for women aged 31 to 35 years, and 54% for women older than 35. Bottom line: female age REALLY matters. The story ends pretty much the same way when we look at IVF success rates; pregnancy rates decline significantly as the age of the female partner rises. Translation…tick, tock, tick, tock…please make that clock stop!

While we can’t refuel your egg supply (when the gauge reads empty, you are truly on empty), we can help bring you in for gas before you hit that point. Unfortunately, we will all run out at some point. It’s part of being female. And while some cars lose gas faster than others, if you are aware of what makes them run low and seek evaluation and treatment earlier, your journey will be smoother, and you will reach your destination faster.