Fertility can be a tricky topic to discuss. Fraught with uncertainty and uncomfortable conversation, the topic of infertility can be even messier as it can be complicated and there is a lot of misinformation out there. When a woman has difficulty getting pregnant, it’s important she has all the facts. To get the scoop on what to consider before seeking out a fertility specialist, we consulted Divya Shah, MD, MME at Penn Fertility Care. Here, she explains when and why someone should consult a fertility specialist, and what goes down during that initial doctor visit.
Let’s start with the most pressing: when should women see a fertility specialist? What are the criteria?
Infertility is, technically speaking, when a couple has attempted intercourse for one year without successful achievement of pregnancy. Any couple who would meet the criteria for infertility by that definition would be somebody to whom I would say, “Yes, you should probably see a fertility specialist.” Now, the caveat to that is there are lots of situations in which that definition doesn’t really apply. Suppose a woman is single and interested in parenting by herself, or same sex couples for that matter. Someone who has infrequent menstrual periods or a medical condition that has a known negative impact on their fertility may also want to be seen earlier. Many people also worry about [the impact of age on fertility. So, for example, if somebody were in their late 30s or early 40s, we probably wouldn’t want them to wait a whole year, [but might] prefer to see them around six months.
I think the important thing to know is that not everyone needs to rush in right off the bat. If you’re trying for three months and haven’t gotten pregnant yet, that’s too soon to see a specialist [unless] there are scenarios like the ones I mentioned or others where someone knows there’s something that’s preventing them from becoming pregnant.
Is visiting a fertility specialist something women should do on their own or in tandem with their partners?
So that can be confusing—when to go to male fertility specialist or female. [The] screening for male fertility is pretty straightforward — a semen analysis — versus the screening for female fertility, which can be comprised of lots of different tests or historical factors. For that reason, if the couple doesn’t have any history or medical treatments that they can pinpoint as an identifiable cause for infertility, I would start by seeing a GYN infertility specialist. If we identify [a male factor based on] the semen analysis or history, we work very closely with male fertility specialists to seek additional information as needed.
Of course, we always love it when we can see couples together because we’re able to get a full history from both partners and get everybody on the same page. However, we also recognize it’s tough to get out of work, so we frequently see female partners alone.
That initial meeting seems daunting. What typically occurs during the first visit to a fertility specialist?
This is a good question because I think a lot of women are really nervous and don’t know what to [expect]. To be honest with you, the first visit is a lot of talking. What I usually tell people is that your first encounter with a fertility specialist is [typically] the “information gathering visit.”
The typical fertility evaluation would include a semen analysis for the man, and for the woman, some combination of blood work, pelvic ultrasounds to look at the ovaries and uterus, and a dye study done in radiology called a hysterosalpingogram, or HSG, to look at the fallopian tubes and make sure they’re open. Based on what we find or historical factors, we might expand that for any given couple.
Are there preventative measures to improve one’s fertility?
I don’t know that I’ve ever explicitly thought of it this way, but that’s probably one of the biggest sources of frustration in my line of work—people feel very out of control. It’s not like heart disease where you can say, “Make these three lifestyle changes and it can have a profound impact on your likelihood of having a heart attack.” That’s not to say there aren’t any lifestyle changes that can contribute to fertility problems, but compared to other fields of medicine, the impact is relatively modest.
However, some things can be quite significant. Body weight is a big one — being underweight or overweight. Neither, it turns out, is very good for ovulatory fertility. There are other [modifiable] habits [such as] heavy alcohol use, drug use (prescription or otherwise) and smoking, that can [also] have a negative impact on fertility.
The hardest one of all is probably age. I hate to say this is a preventative [measure] because it’s not modifiable, but if a couple is thinking “Should we have kids at 32 or 42?” and they’re ambivalent between those ages, then sure, we’d rather they have a child at 32. If they were to have trouble, it’s a lot easier for us to intervene at age 35 than at age 43.
If someone reading this is struggling with infertility, what’s the next step?
This can differ a bit based on a person’s individual insurance, and that’s one of the tough parts. Many insurers will have much more limited coverage for fertility than they would for other services, so I think it’s important to be educated and informed about [your coverage]. Here at Penn, we can assist with this; we have financial services representatives for people to meet with or talk to when they call to make an appointment. I would say, on average, most people who come to see me—unless there’s a known [risk] factor right off the bat—have usually at least [discuss fertility with] their general OB/GYN or primary care provider beforehand. But there are many people have not. We’re happy to see people either way. We have locations in Washington Square, Market Street in University City, and Radnor, so people can get in at the location that makes the most sense for them.
This interview has been condensed and edited for length.
For more information about Penn Fertility Care, click here.