More than a year of trying to conceive without a pregnancy is long enough for infertility to be diagnosed at any age, and it is past the year of trying that even couples with no apparent problem are advised to complete before seeing a health care provider. None of that advice sets a weight to reach first. If a doctor has given you a weight target before anyone looks into why you have not conceived, you can ask for an infertility evaluation of both of you now, from that doctor or from another health care provider.
How long you are supposed to try before anybody evaluates you
Couples are advised to try for at least one year before seeing a health care provider only when three things are true: the woman is under 35, her menstrual cycles are regular, and neither partner has an apparent health or fertility problem. With the same conditions and the woman 35 or older, couples should see a provider after 6 months of trying to conceive without success, and when the woman is older than 40, a couple should consider seeking more immediate evaluation and treatment. Fertility in women is known to decline steadily with age, and as a result some providers evaluate and treat women 35 or older after 6 months.
You can check whether your cycles count as regular. Regular, predictable periods that come every 21 to 35 days likely reflect ovulation, and a woman with irregular periods is likely not ovulating. If the woman's periods are irregular, or either of you has an apparent health or fertility problem, the one-year interval does not apply to you.
Infertility itself is defined by the same months: not becoming pregnant after having frequent, unprotected sex for one year or longer, and at 35 or older it can be diagnosed after six months. It also includes pregnancies that end in repeated miscarriage or stillbirth. Many couples who struggle with infertility do end up having children, sometimes with medical help.
Signs that mean you do not wait at all
If either of you has any of the signs below, do not delay seeing a health care provider, however few months you have been trying.
| For women | For men |
|---|---|
| Irregular periods or no menstrual periods | A history of testicular trauma |
| A history of endometriosis or very painful menstrual periods | Prior hernia surgery |
| A history of pelvic inflammatory disease | Prior use of chemotherapy |
| Known or suspected uterine or tubal disease | A history of infertility with another partner |
| A history of more than one miscarriage | Sexual dysfunction |
| Genetic or acquired conditions that can diminish ovarian reserve, the supply of eggs the ovaries have left |
For anything in either column, book that visit now, and name the sign when you ask for the appointment.
Periods that turn irregular or stop while you are losing weight are irregular or absent periods all the same. Weight loss, excessive exercise or stress, alone or together, can stop periods through a condition called functional hypothalamic amenorrhea, which can affect how the ovaries work.
Why nobody has examined your partner
An infertility evaluation is where your partner gets examined, and it takes in both of you: health care providers collect a thorough medical and sexual history from both partners. In men, infertility is typically evaluated by a semen analysis, a complete medical history and a physical examination, which together help show whether and how male factors are contributing. A semen analysis measures the number, movement and shape of sperm, a specialist evaluates the results, and a slightly abnormal result does not necessarily mean a man is infertile.
Feeling well does not take your partner out of the picture. Men are found to be the only cause or a contributing cause of infertility problems in couples in about 40% of cases. Problems in the male are just as likely as problems in the female, it is equally likely that the cause is a combination from both partners, and in many cases the exact cause remains unknown or unexplained, a situation called idiopathic infertility. An evaluation that looks at one of you can find a cause on one side and miss the rest.
Ask the doctor running the evaluation how your partner's history and semen analysis will be arranged, and whether the two of you can be seen together.
What an evaluation actually consists of
The evaluation begins with the two histories, and the tests that follow are chosen for you as a couple. Initial evaluation can include tests that are appropriate based on the couple's specific circumstances, and those may include a semen analysis, tubal evaluation and ovarian reserve testing. The three are examples, and your circumstances decide which of them, or which other tests, you have. Your provider will ask about your health history and may do a physical exam, and testing, which is different for women and men, may include blood tests and imaging tests as well as the semen analysis.
Women need functioning ovaries, fallopian tubes and a uterus to get pregnant, and a condition affecting any one of them can contribute to infertility, so there are tests for each of the three:
- No single test is a perfect predictor of fertility, but there are tests for common markers of ovarian function, including follicle-stimulating hormone (FSH), anti-müllerian hormone (AMH) and antral follicle count (AFC). Ovulation itself can be predicted with an ovulation test or a blood test.
- The fallopian tubes can be checked with a hysterosalpingogram, an X-ray of the uterus and tubes that shows whether dye moves freely through the tubes, which means they are open. Chromopertubation is a similar test done in the operating room during a laparoscopy, a keyhole operation on the belly.
- The uterus may be looked at with a transvaginal ultrasound, among other methods.
A reproductive endocrinologist is a health care provider who specializes in managing infertility, and individuals and couples who are unable to conceive a child should consider an appointment with one, so ask the doctor running the evaluation for a referral by that title.
Where weight belongs in the conversation
Weight belongs in the conversation because it bears on fertility in both partners. Female fertility is known to decline with overweight, obesity or low body weight, and with extreme weight gain or loss, and male fertility with overweight or obesity. Obesity is linked to lower sperm count and quality in men, and being underweight is linked to ovarian dysfunction and infertility in women.
Other factors bear on one or both of you as well, including these:
- Age, for both of you: fertility in women declines with age, and couples in which the male partner is 40 or older are more likely to report difficulty conceiving.
- Smoking and heavy drinking, among other substance use, which reduce fertility in both men and women.
- Excessive exercise, which is known to affect ovulation and fertility in women.
- Strenuous physical labor and taking multiple medications, which are known to reduce sperm count.
- High blood pressure, which changes the shape of sperm and so reduces fertility.
- Radiation therapy and chemotherapy, which can cause infertility in females and males.
Among women with obesity who have polycystic ovary syndrome (PCOS), losing a small percentage of body weight greatly improves the likelihood of ovulation and pregnancy. That applies to women with obesity who have PCOS, and an evaluation can tell you whether you have it. PCOS is the most common cause of infertility, and it causes women not to ovulate, or to ovulate irregularly (see Irregular periods are worth a PCOS check, even before weight care).
Keeping a healthy weight, quitting smoking and limiting alcohol are among the habits that may help lower the risk of infertility, though not all cases of infertility can be prevented. If a doctor has given you a weight target, ask that doctor what it rests on, such as a diagnosis like PCOS, and ask at the same visit for the evaluation of both of you.
Pain or bleeding when you might already be pregnant
A pregnancy you have not confirmed yet can be ectopic, meaning the fertilized egg grows in the wrong place outside the uterus, usually in a fallopian tube. An ectopic pregnancy can't end in a healthy pregnancy, and if it continues the tube can burst and cause internal bleeding, which can be a life-threatening emergency that needs immediate surgery. At first it may cause no noticeable symptoms.
Pelvic inflammatory disease, endometriosis, and earlier pelvic, abdominal or fallopian tube surgery are among the factors that may increase the risk of an ectopic pregnancy, along with certain sexually transmitted infections, smoking, being older than 35 and infertility treatments. Each of them is worth mentioning when your history is taken.
Early signs of an ectopic pregnancy may be light vaginal bleeding and pelvic pain, and an ectopic pregnancy can be a medical emergency. If your period is late or a pregnancy test is positive, and you have belly pain, shoulder pain, vaginal bleeding, or feel dizzy or faint, get medical care right away. For severe pain, heavy bleeding, fainting, or dizziness that does not go away, go to an emergency room or call 911; for a milder sign, phone a health care provider's office right away, since an office that is closed may forward your call to a provider on call.
Trying to conceive is part of your health history for NicoCares weight care too, so tell your care team in Spruce, the app where they write to you, along with any weight target a doctor has given you. How soon a reply comes there is not stated, so none of the pregnancy signs above should wait on one.
