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Infertility expert answers common questions

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It’s a condition that affects millions of couples, and can happen because of many different reasons. According to the United States Department of Health and Human Services, about 12 out of every 100 couples experience infertility.

Infertility is defined as being unable to get pregnant within a year of having regular intercourse without birth control methods or within six months for women over age 35. Indiana University School of Medicine Department of Obstetrics and Gynecology professor emeritus and reproductive endocrinology and infertility specialist Marguerite Shepard, MD answers questions about the causes and treatments of infertility and offers some advice for couples trying to get pregnant.

How do you diagnose infertility?

We diagnose infertility as one year of unprotected, regular intercourse without conception. If the average couple is having intercourse two to three times a week, well-spaced, they should get pregnant within three menstrual cycles of trying. The data suggest if you take a hundred couples who are trying to get pregnant, about 66 percent will have achieved a pregnancy within three months and up to 75 percent will conceive within six months.

By the end of a year, 80 percent will achieve a pregnancy and 20 percent will not. Of those 20 percent, 5 percent will achieve a pregnancy within the second year of trying without any treatment, but we don’t want to make people wait two years. So the recommendation is to try for a year if the woman is under the age of 35, but between 35 and 40, we suggest trying no more than six months without seeking treatment. For a couple over 40, it wouldn’t be a bad idea to get an evaluation almost right away if you’re trying for pregnancy.

What can cause infertility?

Infertility could happen as a result of another condition, such as polycystic ovary syndrome (PCOS) or endometriosis. PCOS is a hormonal disorder that keeps women from regularly ovulating. Endometriosis occurs when the uterine lining forms outside the uterus, which can cause irregular menstrual cycles as well.

There are still a lot of women who have regular menstrual cycles and are not getting pregnant, and that is when we have “unexplained” infertility that is caused by something else, such as their partner having a low sperm count.

What are the treatment options for couples experiencing infertility?

For the average patient who has regular menstrual periods and, as far as we know, her husband doesn’t have any problems, we say try for a year. If they are young and she is having regular periods and there is no reason to suspect a problem with his sperm count, then we can wait a year. If they are over 35, we wait six months. However, if we have identified a problem like PCOS or endometriosis, we wouldn’t make them wait a whole year, because we can begin treating those conditions. We can treat various ovulation disorders with medication to try to get the woman to ovulate more regularly. We’ll measure progesterone about a week after ovulation and see when her next period begins. We may also do a semen analysis on the man.

If we’ve tried reasonable treatments, then we might suggest in vitro fertilization (IVF). We also will use IVF if tubal disease is likely, because IVF is more effective. It bypasses the fallopian tubes damaged by disease.

What’s your advice for couples trying to get pregnant or experiencing infertility?

People can be tempted to do a lot of things that are going to make them worry. For example, I tell patients not to buy an ovulation kit, because that can cause a lot of stress. We use ovulation kits to monitor response to fertility drugs or other treatments, not to say “this is when you should have sex.” I try to tell people if you’re having intercourse two to three times a week, well-spaced, and nothing is wrong, you should get pregnant.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Christina Griffiths

Christina is the media relations specialist for the IU School of Medicine Dean's Office of Strategic Communications.