How to know if it’s taking too long to get pregnant

It begins as an idea. “Yes, a child might be nice someday.” Then you stop using birth control and wait. A month passes, maybe another. And you’re still not pregnant. Now, you’re starting to worry.

Not so fast.

“The rule of thumb is if you’ve been trying to get pregnant for 12 months and are under age 35, then it’s time to get a referral to a reproductive endocrinologist and infertility specialist,” says OB/GYN Rebecca Flyckt, MD, a fertility specialist at Cleveland Clinic. “If you’re 35 or older, we recommend seeing a specialist after six months of trying. Before that, there’s probably no cause for concern.”

The average couple has about a 20 to 25 percent chance of conceiving in any given month. Nearly two-thirds of couples will become pregnant in the first six months of trying. Women 35 or older may have more difficulties becoming pregnant because egg quality and quantity can change at this stage, Dr. Flyckt says.

You may want to ask a doctor to examine you sooner if you have any of these medical problems:

• Irregular or painful periods

• Pelvic pain

• Previous pelvic surgeries

• Diabetes and general health issues

If you are healthy and still trying to get pregnant after a year, then it’s time to have candid conversations to rule out the possible causes of infertility, including:

• Female infertility: About a third of the time women have trouble getting pregnant because they have problems such as blocked fallopian tubes, endometriosis or ovulation disorders.

• Male infertility: In another one-third of cases the man may produce too few or no sperm or the sperm may lack motility (ability to move toward the egg).

In the remaining 35 to 40 percent of cases, couples struggle to conceive because there is a combination of problems in both partners or there is no specific explanation for the problems.

Nicole Herbst and her husband, Rob, found themselves in that last category — unexplained infertility.

“We tried to get pregnant after our deployment to Iraq,” says Ms. Herbst, who, along with Rob, served in the U.S. Army Reserve. “Because of our ages – I was 35 and Rob was 39 – we decided to see a reproductive endocrinologist for infertility testing.”

The couple had already had pre-pregnancy physicals, but their infertility evaluations were more thorough. A doctor asked about their health history. Rob’s exam included a semen analysis.

A doctor ordered several tests for Nicole, including:

• Blood work to evaluate her hormone levels

• An X-ray dye test – called a hysterosalpingography – that checked her uterus and fallopian tubes

• A laparoscopy that used an endoscope – a slender fiber-optic scope attached to a video camera – to view her pelvic organs

Doctors diagnosed unexplained infertility. They devised a treatment plan that began with fertility drugs and intrauterine insemination (IUI). When this wasn’t successful, the couple started in vitro fertilization before finally conceiving and maintaining the pregnancy.

The couple learned a lot about different fertility treatments — and what those treatments would cost.

“Not all of the treatments are covered by insurance,” Ms. Herbst says. “At times, it’s been financially draining and emotionally exhausting, not only on me, but on our relationship.”

They ended their four-year pregnancy journey on a high note. Nicole delivered their daughter, Violet, by cesarean section on March 4 at Fairview Hospital.

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