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Mother Nature vs. Infertility Treatment

Still not pregnant? When to seek infertility treatment and when to let nature take its course.

When to Get the Full Infertility Workup

After trying for one year, doctors may recommend a full infertility workup. They may opt to do this sooner if the couple is aged 35 or older, says Mindy Shaffran, MD, a reproductive specialist at East Coast Fertility in Plainview, N.Y.

"After the age of 35, it is recommended that couples try for six months instead of a year," she says. "The majority of couples will be successful in that time, and if you are not, there may be things that we want to catch sooner rather than later."

"Fertility declines rapidly after age 35 and sometimes it gets to the point where we can't really help," she says. "It behooves women in this age group to start the process earlier even if they would have gotten pregnant on their own so they know that there is not any particular problem that they need to overcome," she says.

There are many possible causes of infertility, and a full workup will try to identify exactly which is causing the problem. Doctors will examine potential causes of both male infertility and female infertility. The results will help dictate and guide infertility treatment.

The process starts by consulting an infertility specialist, like Shaffran. The full workup will entail a semen analysis for the man. In women, the infertility workup consists of blood testing to check levels of thyroid hormone and other hormones, a Pap test to check for changes in the cells of the cervix or infection, and a hysterosalpingogram (HSG), an X-ray procedure that makes sure that the fallopian tubes are open. The HSG can also detect any abnormalities in the uterus.

Sabanegh often suggests that men get tested first. "Routine semen analysis is quick and relatively inexpensive," he tells WebMD. "Before we put women through invasive, expensive, and painful tests, we better have a pretty good idea that those tests are necessary," he says.

For couples who want to complete the evaluation as rapidly as possible, Shaffran says she will initiate a workup on both partners simultaneously. "Many couples will often have more than one factor at the root of their infertility."

Troubleshooting Your Fertility Problem

If a problem is identified in terms of the ovulation process, the first-line infertility treatment is typically Clomid or Serophene, drugs that work by stimulating ovulation. "This is usually paired with intrauterine insemination (IUI)," Shaffran says. IUI is a fairly low-tech procedure in which sperm is injected directly into the uterus to meet - and hopefully fertilize -- a waiting egg.

"We try this for three to six months and if we are unsuccessful, then I may try an injectable and IUI," she says. Injectable drugs also stimulate ovulation, but are stronger than Clomid. As such, the use of injectables has an even greater risk of multiple pregnancies.

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