The American Society for Reproductive Medicine (ASRM) defines infertility as a condition “defined by the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse.” Although 85 to 90% of healthy, young couples will conceive within one year of trying, this still leaves 10 to 15% who experience difficulty. Infertility is not uncommon, and should be no more embarrassing than any other medical condition.
The risk of having infertility has not changed much over the last several decades. What has changed, in the U.S., is the fertility rate and birth rate. The decreased rates of both are due, in part, to delayed childbearing for professional reasons (e.g., career, education) and personal reasons (e.g., marrying later in life).
A woman’s fertility peaks at about 20-24 years of age, decreases very little between 30-32, decreases progressively after that until 40, and then rapidly after 40. As fertility decreases, the risk for miscarriage increases. Both decreased fertility and an increasing risk of miscarriage appear to be due to decreasing follicle numbers in the ovaries and increasing abnormalities in the remaining aging eggs (i.e., diminished ovarian reserve or DOR). Risk factors for DOR include:
- Family history of early menopause
- Previous ovarian surgery, radiation therapy or chemotherapy
- Poor response to fertility treatments in the past
- Age 35, or older
While a fertility evaluation and treatment are recommended after one year of infertility, ASRM states, “Earlier evaluation and treatment…is warranted after 6 months for women over age 35.” An immediate fertility evaluation is also warranted at any reproductive age if a problem is suspected.
The many causes of infertility include ovulation problems, egg quality problems, anatomical problems such as blocked fallopian tubes or pelvic scarring/adhesions, male problems, and unexplained issues. The first step toward understanding the cause of your particular difficulties is to call our office at 516-605-2626 to arrange an initial interview during which we will review your history and recommend any necessary tests and evaluations.