Receiving a Diagnosis of Infertility

When It's Given, Who Gives It, What Happens Next

Couple talks to their doctor about infertility diagnosis
Receiving a diagnosis of infertility can be heartbreaking. But remember, it is also the first step in getting help.. Tetra Images / Getty Images

Receiving a diagnosis of infertility can be both emotionally difficult and a relief. Getting a name for what you're going through can help you seek out the help you need. At the same time, admitting that something is wrong isn't easy.

A diagnosis of infertility is usually given when a couple, after a year of trying to conceive, does not become pregnant. If a couple is trying to have their first child, the diagnosis given is primary infertility.

If they are trying to have a subsequent child, a diagnosis of secondary infertility is given.

A couple who suffers from recurrent miscarriages (usually after three successive losses) is also given a diagnosis of infertility.

Couples with infertility may or may not have obvious symptoms besides having difficulty getting pregnant.

Is the Year Wait Necessary for an Infertility Diagnosis?

“Try for a year, and afterwards, come back if you’re not pregnant,” is the most common answer given to couples who are trying to conceive, especially those under the age of 35.

But a year is a long time to wait. Do you have to try for a year before seeking help?

Not always.

  • Consider charting: Another way to speed up diagnosis is to consider charting your cycles. Charting your cycles involves, at the most basic level, recording your morning temperature, and watching for specific patterns within your cycle.​
  • If you’ve been charting your cycles for six months, and can document to your doctor that you’ve had sexual intercourse around the time of ovulation those six months, and still are not pregnant, they may be more likely to run some tests before your “year” of waiting is up.
  • If you're 35 or older, don't wait more than six months: If you’re over the age of 35, you shouldn’t wait any longer than six months before seeing a doctor. Because your fertility naturally decreases as you age (starting at the age of 25 for men, and at age 30 in women), time is of the essence once you pass age 35.

Who Makes the Infertility Diagnosis?

Usually, your regular gynecologist will make the first diagnosis of infertility.

However, that’s not always the case. An endocrinologist or your regular family doctor may alert you to the possibility of fertility problems, if you have health problems that can lead to infertility, like thyroid issues, diabetes, or PCOS.

After the initial diagnosis of infertility, your regular gynecologist may treat you, or you may be referred to a reproductive endocrinologist. Reproductive endocrinologists (RE) specialize in treating infertility in couples.

What Causes Infertility?

A diagnosis of infertility often comes in two stages, the first stage being the general infertility diagnosis, and the second stage being a diagnosis of the specific cause of the infertility. Infertility is almost a symptom itself. To treat infertility in the best possible way, finding the cause is helpful.

According to the American Society of Reproductive Medicine, one-third of infertility cases are caused by a problem on the woman’s side, one-third are from the man’s side, and the remaining third involve problems on both sides, or unexplained causes. In fact, in 20% of infertility cases, the cause for the infertility remains unknown.

Two of the most common causes of female factor infertility include:

  • Ovulatory Disorders: accounting for 18% to 30% of infertility in women.
  • Anatomical Disorders: like blocked fallopian tubes, often the result of infections or inflammations, like endometriosis or pelvic inflammatory disease.

More about causes of female infertility:

The two most common causes of male factor infertility include:

  • Low Sperm Production: Medically referred to as azoospermia (complete lack of sperm cells) or oligospermia (few sperm cell are produced), this is the most common cause of male factor infertility.
  • Sperm Malformations: Even if the amount of sperm is within the normal range, malformed sperm, as well as the ability of the sperm to make it to the egg before dying, can be a cause of infertility.

More about male infertility:

What Happens After an Infertility Diagnosis?

The next step is usually fertility testing, to determine the cause for the trouble. Figuring out what's wrong can help your doctor come up with the best treatment plan for you.

In some cases, your doctor won't be able to determine why you can't get pregnant. This is known as unexplained or idiopathic infertility. It occurs up to 30% of the time.

In this case, your doctor will likely suggest trying the lowest tech fertility treatment first (like clomid), and then work up the ladder if treatments are unsuccessful. 

Whatever the cause is for your infertility, you should know there is reason for hope.

According to the American Society of Reproductive Medicine, 85% to 90% of infertility cases can be treated using conventional treatments, like medication or surgical repair. Less than 3% of infertility patients require advanced treatments, like in vitro fertilization.

Sources

Who's Infertile? Us?. American Fertility Association. Accessed January 21, 2008. http://www.theafa.org/conceive/whosinfertile.html

Frequently Asked Questions About Infertility. American Society of Reproductive Medicine. Accessed January 21, 2008. http://asrm.org/awards/index.aspx?id=3012

Changes to Diet and Lifestyle May Help Prevent Infertility from Ovulatory Disorders. Harvard School of Public Health, Press Release. Accessed January 21, 2008. http://www.hsph.harvard.edu/news/press-releases/2007-releases/press10312007.html

General Infertility FAQ. InterNational Council on Infertility Information Dissemination. Accessed January 21, 2008. http://www.inciid.org/faq.php?cat=infertility101&id=1

Weschler, T. (2002). Taking Charge of Your Fertility (Revised Edition). United States of America: HarperCollins Publishers Inc.

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