Hopeful Expectations

Couples in their mid-thirties and older trying to conceive are often anxious to get results. Couples that want more than one child can go into super overdrive. This excitement about starting a family, coupled with the all of the dire statistics about declining fertility, can really set the biological clock ticking fast! It can also obscure the facts about how long it takes to conceive.

You have probably heard that you should be pregnant within one year of regular, unprotected sex (2-3 times per week). This will occur for 82% of couples aged 35-39. After two years, 90% couples will conceive on their own. This is great news if you are in the 90%. What about the other 10%? According to a German study, another 5% will conceive within 36 months of trying. That leaves only 5% without a baby after 3 years of trying, and the authors felt that it was doubtful that those couples would ever conceive unassisted. However, a British study found that only 1% of the population trying to conceive truly is sterile (could never have a child without intervention). The authors were clear to mention, though, that probability does decline with age.

So, if the overwhelming majority of us can get pregnant on our own, why do we know so many women undergoing fertility treatments? The answers are varied and complicated. Many couples are not willing to wait the full two years, particularly couples who want more than one child and feel that time is running out.  Some people believe, if the technology exists, why not take advantage of it? For others, their patience wears out before their eggs and sperm can get together.

In the United States, the protocol for couples over 35 who have not conceived after 6 months of unprotected sex is to be evaluated for infertility. Some insurance plans will pay for this evaluation. This may be a bit confusing, or lead couples to believe that you are actually supposed to be pregnant after 6 months of trying, when only approximately 60% of couples over 35 conceive within six months.

Some women resist going for a fertility workup because they think it is admitting failure, or they mistakenly believe that it is committing them to fertility treatments. Neither is the case. Think of it as a preventive health exam. It’s not assuming anything is wrong. It’s ensuring everything is ok and potentially saving you a lot of wasted time and heartache if something, in fact, is wrong.

At the initial fertility workup, the doctor will evaluate your and your partner’s sexual and health history, family history of infertility, order blood work that tests hormones and a semen analysis.  Many people start with their gynecologist, but we strongly recommend going to a reproductive endocrinologist. They receive advanced training in the nuances of the complicated hormonal cascades that control our fertility. A good fertility clinic will have flexible hours, knowledgeable staff, offer an array of services and supports. They definitely will not recommend an intervention until you are fully evaluated. Statistically speaking, there is a good chance nothing is wrong with you or your husband, and that can be very encouraging. Either way, you will be empowered with knowledge to help you make informed decisions.


This post initially appeared on Psychology Today

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