How to Start a Family When You Have Fertility Challenges

For one in eight (or 7.4 million!) women of reproductive age, fertility challenges are a reality. Despite this staggering number, there are still many who don’t know where or how to begin their journey to parenthood. In this post, we will explore some of the basics of beginning your fertility journey! The good news is that many, many families are successful with fertility treatment, but it is important to consider that the journey may look different than what you expected when you began.

The American Society for Reproductive Medicine (ASRM) has provided guidelines to help assist women in determining when to move forward with looking into fertility care. Women should consider seeking fertility care after one year of trying to conceive when under the age of 35, and after six months of trying to conceive if between the ages of 35-39. It is considered reasonable for women over 40 to have their fertility evaluated before starting to try to conceive. While you may choose to try on your own at first, it is useful to understand where your body sits in its reproductive function. These guidelines, however, do not preclude you from being evaluated earlier if you have concerns about your own fertility. For example, what if you aren’t having a spontaneous period? What if you are single, but wanting to have a child? In cases such as these, waiting doesn’t make sense and you should be evaluated as soon as you are ready to start your family.

So, where do you start your journey through fertility treatment? It is a myth that patients have to wait for a referral to be evaluated for their fertility challenges, but starting with your OB/GYN is not necessarily a bad thing. Many OB/GYNs are very skilled at ordering the lab tests that will be a part of your initial work up. However, your OB/GYN is not a fertility specialist, so they may or may not be equipped to provide information about the results. Referrals are often dependent on the type of insurance you have. If you have a PPO, you likely don’t need a referral and if you have an HMO, the reality is that you likely don’t have coverage for fertility services. That last point is worth vetting with your insurance company, because if you do have coverage, it is important to follow the steps that allow you to access your care. So in short, most patients are able to self refer to a fertility specialist because their insurance either allows it, or doesn’t cover the service anyway. The biggest risk to your fertility as a woman is time. So self-advocating for what you need is important!

Once you have found a provider to work with you, you should expect to undergo some basic tests to determine if there are concerns with you or your partner. Regardless of your family structure, both partners are often involved in your family plan and both partners should be evaluated. For women, this typically involves a medical history and blood work to determine your ovarian reserve (AMH, FSH, Estradiol), a transvaginal ultrasound to evaluate your ovaries (antral follicle count), and uterus (rule out fibroids, and other anatomic anomalies), possibly a fallopian tube evaluation depending on how you wish to conceive. For men, typically the workup involves a medical history and a semen analysis. As mentioned above, most physicians are capable of ordering this, but please ensure that your results are reviewed by someone who understands fertility and can put them in the context of your desire to get pregnant.

After your evaluation is complete, you should expect to receive a treatment plan. As mentioned above, this treatment plan should come from a fertility specialist that is well-versed in administering the proper fertility medication for your case and trained to conduct the monitoring necessary for a successful cycle. Once there is a treatment plan in place, it is often found that patients have not anticipated the cost of care that is not covered by insurance. While this can be a shock, there are programs that exist to decrease the cost of medications and defray the cost of services.

Most fertility clinics should be able to direct you to these programs. For example, we work with programs such as Compassionate Care and United Medical Credit. We also work with patients to find the lowest pharmacy for cash pay medications that might include using services such as GoodRx. If you are finding the cost of fertility unexpected, don’t give up without considering some of these resources. They can often be the difference between undergoing treatment or not.

A few examples of what initial treatments can be are things as simple as taking some oral medications to assist with ovulation and using an ultrasound or some ovulation predictor kits to assist in determining your body’s response, which may be all you need. Sometimes, diet and exercise recommendations can suffice. For male factor problems, maybe an intrauterine insemination will solve the problem. It is important to note, however, that there are times when these are not sufficient and treatment with advanced reproductive technologies, such as in vitro fertilization or embryo biopsy, are appropriate to begin with. Remember each person's journey is different because each of our bodies is different.

Finally, what if the initial treatment that you have planned doesn’t work? This is not uncommon. Many times patients and providers select the least aggressive form of treatment first. So don’t get dismayed. Come back and regroup to determine the next best step. This should occur every few months. It is important for both your time and resources to not spend too much time on solutions that are not going to be successful. ove on to those that will! Finally, remember that there are so many ways to approach family building and that looks different for everyone.

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