When Should I See a Fertility Specialist?

972.506.9986 Irving, TX 817.701.1290 Arlington, TX

After 6-8 months of trying to conceive without pregnancy, many couples begin to wonder whether they should seek professional help.

While the answer to this question depends mostly on the woman’s age- a definite YES if the female partner is 35 or older- there are other factors that should prompt a couple to seek help sooner. At IVFMD we encourage our patients to take a proactive path in diagnosing the causes of their infertility by paying attention to their menstrual cycle and medical history.

So let’s go through the interview:

1. How long have you been trying to conceive?

If the answer is 3 years or longer, and especially if your menses are regular, the cause of your infertility is probably serious.

Severe male factor, tubal damage, pelvic adhesions, and advanced endometriosis are often involved in chronic infertility, and these conditions require the most aggressive treatment such as IVF.


As can be seen in the graph above, most couples (93%) will achieve pregnancy after 2 years of trying. There is only a minimal increase in pregnancy rate (to 95%) when trying on your own for another year.

Inportant Note: After 3 years of infertility, you should seek professional help.

2. What is the duration of your menstrual cycle?

The length of the cycle is measured from the first day of normal flow (not just spotting) to the first day of the next menses. The normal cycle length is 28-30 days.

A history of long cycles (32 days or longer) can mean that your follicle is developing too slowly. Stress (physical or mental) can impair the release of FSH (follicle stimulating hormone) from the pituitary gland. FSH is important for follicle growth and low FSH release can result in a follicle with insufficient support cells to nourish the egg and to produce progesterone after ovulation to prepare the uterine lining for implantation.


A history of short cycles, on the other hand, is more worrisome because it can suggest a low egg reserve. Short cycles (26 days or shorter) occur when the ovaries receive strong stimulation from a high level of FSH, which in turn hastens follicular maturation. Ovulation tends to occur earlier- on day 9-10 instead of the usual day 12-13. The presence of hot flashes is particularly worrisome as it reflects a state of low estrogen as often seen during the early phase of menopause.

Important note: Women who smoke tend to have lower egg reserve.

3. Do you have milky breast discharge or excessive hair on the face and abdomen that requires weekly removal?

Milky discharge can be a sign of excessive prolactin secretion. Prolactin is a pituitary hormone that acts on the breast to produce milk for lactation. High level of Prolactin can suppress the release of FSH and cause delay in follicle growth. Occasionally, a pituitary tumor can lead to excessive production of Prolactin. Thyroid conditions can also lead to excessive secretion of prolactin.
Excessive hair on the face and abdomen that require removal of at least once a week can be a sign of excessive male hormone production, which can inhibit follicle growth.

Polycystic ovary syndrome (PCOS) is a common condition that is associated with elevated production of testosterone and poor ovulation.

4. Have you been diagnosed with hypothyroidism or polycystic ovary syndrome?

Patients with thyroid conditions or PCOS can have delayed follicle growth or suboptimal ovulation and would benefit from taking ovulation induction medications to ovulate better.

5. Have you ever had abdominal surgery?

Myomectomy (surgery to remove fibroids) nearly always result in pelvic adhesions that can impair the ability of the tubes to find or pickup the egg after it is released from the ovulating follicle. Tubal surgery for ectopic pregnancy or for tubal adhesions implies existing tubal damage and co-existing pelvic adhesions. Bowel surgery for appendicitis or other conditions can result in significant pelvic adhesions.

6. Have you ever been treated for any STD (Chlamydia, Gonorrhea, HIV, HPV, herpes, syphilis)?

Gonorrhea and Chlamydia are well known to cause infertility by damaging the tubes and causing pelvic adhesions. Chlamydia is a STD that can cause infertility without symptom; thus, its treatment is often delayed due to late detection.
HPV can cause abnormal changes on the cervical cells that may necessitate surgical treatment of the cervix such as LEEP or cryosurgery, which in turn can lead to cervical stenosis (constriction of the cervical opening), impairing the movement of sperm into the uterus.

7. Do you have painful intercourse or severe pain with menstruation?

Deep pain with intercourse is very suggestive of endometriosis, a condition in which implants of the endometrium grow in the pelvic cavity. Endometriosis can cause pelvic adhesions and impair the fertilization process. While most women experience cramps during menstruation, severe menstrual pain can suggest endometriosis or uterine fibroids.

8. Have you had 2 or more miscarriages?

Most miscarriages that occur during the first 12 weeks are caused by sub optimal ovulation and abnormal embryos. Occasionally, thrombophilia (tendency to form clots) or abnormality in the chromosome of the parent(s) such as translocations can be the cause of recurrent early miscarriages. Miscarriages that occur after the 12th week can be caused by structural abnormalities such as fibroids, uterine septum, and other malformations of the uterus.

9. Does the male partner have the following?

  • Male surgery- vasectomy reversal, varicocele repair, or testicular surgery can suggest sperm problems (low count and low motility). Surgery can also lead to formation of sperm antibodies that can impair fertilization.
  • Previous infection of the male organs (prostatitis, epididymitis) can impair sperm motility and survival and cause formation of sperm antibodies that can bind to the tail to slow down the sperm or to the head to prevent fertilization.
  • Heavy smoking can result in damage of sperm DNA that can lead to formation of an abnormal embryo.
  • Low semen volume or watery semen can suggest retrograde ejaculation in which semen flows back into the bladder as a result of a weak sphincter at the bladder neck.
  • Testosterone supplement, a popular treatment nowadays for low male libido, can lead to complete suppression of sperm production in a short time. Many men who took just 2-3 months testosterone have been shown to have no sperm in their semen.
  • Hair loss medications such as Propecia can decrease the semen volume and sperm concentration. Medications that affect calcium ion action (calcium channel blockers for hypertension) can impair the fertilization potential of the sperm.

The table below lists the symptoms and their associated causes of infertility. If you have any of these symptoms, you should consider seeking help to save time and improve your chance of success.

  • Symptoms or  History
  •  Possible Infertility Factors
  •  Recommendations
  • Long cycles (32 days or longer)
  • Suboptimal follicle growth or delayed LH release
  • Thyroid problem
  • Polycystic ovary syndrome
  • Hormone testing
  • Ovulation induction
  • Thyroid supplement
  • Acupuncture, relaxation
  • Short cycles (26 days or shorter)
  •  Low egg reserve
  • Seek help ASAP
  • Aggressive treatment
  • Spotting for 2-3 days before menses
  • Insufficient progesterone effect
  • Thyroid problem
  • Ovulation induction
  • Progesterone supplement
  • Spotting before ovulation or randomly
  • Uterine polyp
  • Uterine infection
  • Hysteroscopic polypectomy
  • Antibiotics
  • Heavy menses with clots
  •  Intrauterine lesions such as fibroids or hyperplasia
  • Hysteroscopy
  • Endometrial biopsy
  • Surgery if necessary
  •  Excessive facial and body hair
  • High male hormone production causing sub optimal ovulation 
  • PCOS
  • Hormone testing
  • Ovulation induction
  •  Milky breast discharge
  • Increased secretion of prolactin from pituitary glands
  • Thyroid problem
  • Hormone testing
  • Medical treatment
  • Ovulation induction
  • Previous abdominal surgery
  • Pelvic adhesions impairing egg pickup
  • HSG to check tubes
  • Laparoscopy to evaluate the pelvis
  •  Previous STD
  • Pelvic adhesions or tubal damage impairing egg pickup
  • HSG
  • Laparoscopy
  • Previous cervical LEEP or cryosurgery
  • Constriction of cervical opening by scars (cervical stenosis)
  •  IUI
  •  Painful intercourse
  •  Endometriosis
  •  Laparoscopy
  •  Severe pain with menstruation
  •  Endometriosis
  • Uterine fibroids
  • Pelvic sonogram
  • Laparoscopy
  • Miscarriages before 12 weeksSuboptimal ovulation
  • Abnormal embryo
  • Chromosome translocation
  • Clotting disorders (rare)
  • Unknown
  • Thyroid, progesterone check
  • HSG
  • Thrombophilia screen
  • Treat underlying causes
  • Miscarriages after 12 week
  • Abnormal uterus
  • Abnormal embryo
  • Chromosome translocation
  • Clotting disorders (rare)
  • Unknown
  • HSG
  • Chromosome analysis
  • Thrombophilia screen
  • Treat underlying causes
  • Previous male surgery
  • Low sperm count, motility, and quality
  • Sperm antibody
  • Semen analysis with sperm antibody screen
  • Previous male infection
  • Low sperm count, motility, and quality
  • Sperm antibodies
  • Semen analysis with sperm antibody screen
  • Low semen volume (< 1 ml)
  • Retrograde ejaculation
  • side effect of medications
  •  Semen analysis
  • IUI or IVF if confirmed
  • On medications for low libido or hair loss
  • Low sperm count and motility by testosterone supplement
  • Low semen volume and sperm quality by certain hair loss medications
  • Semen analysis
  • Stop testosterone
  • IUI
  • Infertility of 3 years or more
  • Severe male or female factor
  • Seek help ASAP
  • IVF may be necessary

IVFMD serves the Dallas Fort Worth metroplex from its 2 fully equipped IVF centers in Irving and Arlington with results-driven, affordable and individualized fertility care.

Year after year, our experienced team has continued to celebrate successes alongside our IVFMD families. Our fertility team would like nothing more than to share that experience with you.

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