Fertility: The silent struggle and when to see a doctor

It’s a question many people have heard before — “When are you having kids?”

While the question is often well-intentioned, the impact can cut deep for those struggling to conceive. Infertility impacts roughly 10 percent of people in the United States, regardless of age, ethnicity or socio-economic background.

“Many couples and individuals may be going through the struggles of infertility and not sharing that,” says Jaime Ellis, ARNP, obstetrics and gynecology provider at MultiCare Women’s Center — Auburn. “I encourage everyone to not put pressure on family and friends by frequently asking when they’re going to start a family or when is someone getting grandkids.”

Even when people do open up, it’s unfortunately hard to know what to say, says Lacey Marks, MD, FACOG, obstetrics and gynecology provider at MultiCare Rockwood Clinic.

But you can do one thing, she adds: Recognize how challenging the journey is — and how difficult holidays like Mother’s Day can be.

“There’s such a huge desire for motherhood, from both couples and single parents by choice, but sometimes there are challenges,” Ellis says. “There is help available. Procedures such as intrauterine inseminations are significantly less costly than IVP and are successful for many couples/individuals. I encourage anyone who is concerned about their ability to conceive to reach out to their health care provider for next steps.”

When to see a doctor

Infertility is defined as not achieving pregnancy after 12 months of consistently trying, says Dr. Marks. However, each person’s circumstances are different, and nobody will criticize you for seeking care sooner.

If you’re trying to conceive but having irregular or no periods, you shouldn’t wait 12 months, she says. If you’re over 35 and have regular periods, she advises seeing your provider at six months. And if you’re having regular periods and doing everything “right,” you’re still only 80 percent likely to conceive in the first four months, she adds.

Oftentimes, the biggest challenge is determining the cause of infertility, says Ellis. About one-third of cases are female-related, one-third male-related and the remaining are unknown, she says. Some of the more common complications include irregular or no ovulation (25 percent), fallopian tube or uterus abnormalities (35 percent) and male-related factors (30 percent).

Evaluation begins with an extensive look at your medical history, Dr. Marks explains. That includes whether you’ve been pregnant before, whether your partner has conceived before, as well as menstruation cycle, history of trauma to the pelvis or other pelvic conditions.

Next, hormone testing, semen analysis, X-rays and a pelvic exam/ultrasound are conducted.

“Some women may feel anger, guilt or self-conscious as they’re looking around at sisters and friends who are conceiving without problems.”

“Testing can be a lengthy and costly process, and a lot of insurance providers don’t cover it,” says Ellis. “[The patient] has to decide how much time and money they’re willing to put into this process.”

Sometimes, it can be an easy solution. But it’s important to set realistic expectations, be flexible and ensure both partners are on the same page, Dr. Marks says.

At-home tracking

Knowing that cost and access can be a challenge, many patients opt for at-home testing and fertility tracking to begin. Ellis and Dr. Marks say to take those results with a grain of salt and always consult your doctor before taking next steps.

With some at-home fertility tests, you don’t know exactly what you’re getting, Ellis says.  They can be a helpful supplement, adds Dr. Marks, but the type you use is important.

Dr. Marks recommends digital ovulation tests, which are more expensive, but give clearer results compared to analog kits, which can make it easier to miss the conception window.

Remember: Even if the test says you’re ovulating, it doesn’t mean the egg has been released. Ovulation tests track when your body has released the luteinizing hormone (LH), which tells the ovaries to release an egg, but in many cases it doesn’t do so for another 12 to 24 hours.

Tracking your cycle and temperature can be a more cost-effective at-home solution. Cycle tracking apps do a decent job telling you the best windows to conceive, but you have to be diligent in your tracking for an extended period of time.

Using a basal thermometer can make your tracking even more accurate when done correctly. Before even sitting up or checking your phone in the morning, take your temperature, Dr. Marks says. Even the smallest change in temperature is important to determining ovulation.

Once your temperature goes up (even if by a fraction of a number) and stays up, it means you’ve likely ovulated. The temperature will stay at those higher levels until you either start your next period or find out you’re pregnant.

Promoting fertility

A healthy lifestyle and caring for your overall well-being are key to promoting fertility.

Many lifestyle factors can play a role, Ellis says: being under- or overweight, smoking or having an untreated STI. She stresses a holistic approach to self-care for all patients, whether actively trying to conceive or planning to.

Exercise regularly, maintain a healthy diet, protect yourself from STIs and listen to your body. Additionally, make sure your body is getting adequate vitamins and nutrients, and supplement with prenatal vitamins if you’re trying to conceive.

If you’ve been on birth control, consult your doctor about stopping and what you should look for as your body re-regulates itself.

Specialty approaches such as acupuncture and infertility yoga can also improve your body’s natural balance and fertility, Dr. Marks adds.

Be sure to discuss with your provider any family history that could cause complications, such as blood clotting and uterine irregularities, or other health concerns like autoimmune diseases or thyroid imbalances that should be addressed before trying to conceive.

A long journey

Caring for yourself also includes mental health. Whether you’ve just started or are years into treatment, Dr. Marks says it can be hard to stay positive.

“Some women may feel anger, guilt or self-conscious as they’re looking around at sisters and friends who are conceiving without problems,” Ellis says. “Some people are embarrassed and think it’s their fault. I think the more information we can get out there, the more we can help.”

Sometimes medications used in treatment can alter your emotions and cause mood swings and other side effects, Ellis adds. Both partners should know what to expect and that there’s a support system available, including behavioral health access.

“The whole journey can be very difficult, emotional and stressful,” says Dr. Marks. “I encourage both partners to support and listen to one another. It can be easy to try passing blame, but it’s important to remember it’s not one person’s fault and no one is trying to cause it.”

To avoid communication breakdowns and find ways to support one another, Dr. Marks always encourages counseling for couples during the process.

“There’s going to be highs and lows, but it’s a team effort,” adds Ellis.