It’s common for me to see women (or hopefully, couples!) after they have been trying to conceive for a few months, nothing has happened yet and they are wondering if they should do something or what they can do to speed the process along.
Every person and couple is unique. Sometimes a little guidance, reassurance and stress reducing acupuncture is enough to get them back on track and other times, additional investigation is necessary. My recommendation is always to have an evaluation from a qualified Chinese Medicine doctor who has experience in fertility, as well as a Medical Doctor. We will talk about what an initial visit with a CM doc looks like another day. Today I want to focus on what to do and what to expect with your MD.
If you are under age 35: BOTH partners can and should be evaluated by a qualified doctor if they have not been able to conceive after 1 year of regular unprotected intercourse. This doesn't necessarily mean that something is wrong, but my belief is that more information is always a good thing and it’s important to get a clear picture of both partner’s health.
If you are over age 35: BOTH partners would be evaluated by a qualified doctor if they have not been able to conceive after 6 months of regular unprotected intercourse. Again, this does not necessarily mean that something is wrong but it is important to get evaluated and gather information so that we get the complete picture and appropriate treatment and recommendation can be made.
Sometimes patients just have a sense that something might be wrong or they have only been trying for a few months but having some testing to rule out significant problems can give them peace of mind. In either of these cases, I encourage you to advocate for your health and ask for testing even if it’s earlier than the guidelines advise.
There are some at home fertility testing options for both men and women like Modern Fertility and Fellow. At-home tests like these are more helpful with the advice and context from a professional so be sure to discuss results with your doctor or fertility acupuncturist!
Who should you see?
Most often this workup is done by a board certified Reproductive Endocrinologist and Infertility Specialist. These are specialty trained doctors who are experts in fertility. If there is no one with this credential in your area, a board certified OB/GYN will be fine. Look for REI (reproductive endocrinology and infertility) as part of their training/credentials for the former and for credentialing with the ACOG (American College of Obstetrics and Gynecology) for the later.
So, now you know where/who to go see, so what’s next?
The initial workout will involve a few tests for each partner. I cannot emphasize enough that the male partner needs to be tested, perhaps even first! Male factor subfertility is extremely treatable with simple, natural interventions. And remember, up to 50% of couples who have difficulty conceiving, it is due, in part, to the male.
Get your man tested.
For the woman, a workup will include a blood test for certain hormones that give us a picture of your reproductive health. These hormones include:
LH (Luteinizing hormone)
FSH (Follicle stimulating hormone)
Estradiol (Estrogen)
AMH (Anti-mullerian hormone)
Prolactin
TSH (thyroid stimulating hormone), other thyroid hormones/antibodies and progesterone are often included in the initial workup as well. There may be additional tests based on your history and physical exam.
It is also recommended that you have a test called a hysterosalpingogram or HSG. This is actually an x-ray to assess whether the fallopian tubes are open and the uterus is the proper shape and size.
Your doctor may recommend a pelvic ultrasound to assess something called your Antral Follicle Count. This number, combined with your other tests, health history and age will give you and your doctor an idea of your ovarian reserve, or an approximation of how many eggs you have.
All these tests will give both your MD and Chinese Medicine doc an idea of whether there is a significant factor interfering with conception that requires surgery, or Assisted Reproductive Tech (IUI/IVF) or if natural treatment will suffice to increase the likelihood of conceiving. Sometimes a combination of both is the best treatment option!
If you need help determining the best course of action for you or interpreting test results, please reach out!
Hugs,
Dr. Emily