When to consult a fertility doctor?

Many men and women have grown up with the illusion that pregnancy will occur instantly if the necessary precautions are not taken during intercourse.

During sex education lessons in secondary schools, more time is spent listing contraceptive methods than talking about affectivity, the physiology of their bodies and the concept of fertility.

In this way the belief creeps in that pregnancy is an easy goal to achieve. And instead more and more couples eager to have a child, collide with a very different reality, full of obstacles and disappointments.

By having intercourse on the most fertile days, even young (twenty-year-old) and healthy couples have a probability of pregnancy that does not exceed 25-30% per menstrual cycle.

No certainty, therefore, but only a probability that drastically decreases after the woman’s 40 years of age, even if its decline already begins around 35 years of age.

Couple infertility

Couple infertility is defined as when pregnancy does not occur after a year of targeted attempts without conception.

Usually about 85% of couples manage to achieve pregnancy within 12 months.

For this reason, couples with women under the age of 36 are asked to try a year in peace before investigating their fertility.

At this juncture the choice to use ovulation tests , basal temperature graphs , etc. it remains a personal choice of knowledge of one’s cycles and one’s body but it is not necessary especially if it is a source of stress.

It is also true that if pregnancy does not occur after 3-5 months of trying, the woman is inclined by nature to understand if something is wrong.

Waiting another 6-7 months without knowing anything can be difficult, while  monitoring menstrual cycles with ovulation graphs and tests can make the aspiring mother clearly understand whether she ovulates regularly or not and therefore also if she has intercourse on the right days to stay pregnant .

When is it time to speed up checks?

Below are 4 situations that require you to anticipate checks before the year of failed attempts.

Over the age of 35

Age-related infertility accounts for a good portion of the causes of infertility in couples.

Today’s society, which has made women more independent, professionally committed, free to make their own decisions also on reproductive matters thanks to the help of contraceptive methods, has meant that the search for the first pregnancy comes later and later.

A woman is born with all her baggage of egg cells which gradually decrease in quantity and quality . Delaying pregnancy after age 35 can make it more difficult to achieve pregnancy as well as carrying more than double the risk of miscarriage (after 40, the risk triples). For this reason, women over the age of 35 should consult a gynecologist experienced in reproductive health after 6 months of unsuccessful attempts.

Male factor

Taken individually, male infertility is among the most common causes of infertility  [2].

One is led to think that, given that men renew their sperm park every three months, their fertility is always optimal

Instead it is not so.

While sperm cells don’t experience the same decline as female reproductive cells do with age, there are still many factors to consider.

It is important to go and evaluate the number (concentration), movement (motility) and shape (morphology) of the spermatozoa with a spermiogram.

Many men can have sperm abnormalities without having other health problems.

Trauma, infection, undescended testicles, varicocele, erectile dysfunction, the use of anabolic steroids (particularly testosterone) or exposure to radiation all affect male fertility.

Therefore, if the pregnancy is late in arriving, one of the first checks to do is a spermiogram.

Irregular menstrual cycles

A regular menstrual cycle usually means that you ovulate on time each month.

A normal menstrual cycle lasts between 21 and 35 days. When the ovaries fail to produce a good dominant follicle each month, the arrival of menstruation can become unpredictable. This makes it difficult to target intercourse at the end of pregnancy.

One of the most common causes of irregularities is polycystic ovary syndrome (PCOS) . Women with this syndrome usually have cycles longer than 35 days which can go hand in hand with the presence of acne, weight gain and excess facial hair.

If your cycles are regular but you notice spotting between menstruation (spotting = small blood losses) it is important to talk to your gynecologist. These losses can have various meanings including hormonal imbalances, the presence of fibroids, polyps or abnormal cells in the cervix.

Closed tubes

A patency of the fallopian tubes is essential for being able to conceive naturally. The extremities in contact with the ovaries have fimbriae which act as small fingers which grasp the egg cell once it has been ejected after the bursting of the dominant follicle.

Sperm swim from the vagina to the cervix, through the uterus, and into the fallopian tubes. Fertilization (that is, the encounter between the sperm and the egg cell) takes place inside the tubes: the zygote and its first stages of transformation live in the tubes for the first 5 days and then arrive in the uterus where implantation takes place .

Infections such as chlamydia, gonorrhea, appendicitis, even if they occurred many years earlier, may have caused adhesions to the tubes which alter their function.

Endometriosis (a disease in which the lining of the uterus grows outside the uterus) can cause scarring and also damage to the ovaries and fallopian tubes .

It is possible to check the patency of the fallopian tubes with specific tests such as hysterosalpingography. If the tubes are closed and it is not possible to make them patent, assisted reproduction treatment is necessary in order to become pregnant.