When to Hit the Panic Button Series: Recognizing When Trying to Conceive Needs Expert Help

Is it time to worry about your fertility? In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down when to hit the panic button if you're trying to conceive without success. From understanding when to consult an OB-GYN or a reproductive specialist to identifying red flags like family history, prior unprotected relationships, and the limits of methods like ‘pulling out,’ this episode gives you the roadmap to know when it’s time for professional guidance. Whether you're actively trying or just considering your future fertility, tune in to learn the signs that mean it’s time to take the next step on your path to parenthood.

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Transcript

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Today we talk about when to hit the panic button on your path to parenthood, how to know when it's time to get some help. I'm, Dr. Mark Amels and this is Taco about Fertility Tuesday. Today we're going to focus on when to hit the panel panic button while you're trying to conceive. If you've been wondering if it's time to consult an OB GYN or maybe a reproductive specialist, or factors like your family history or past experiences without getting pregnant should raise concerns, this is going to be a great episode for you. We'll dive into the signs that indicate it might be time to seek professional help on your fertility journey. I'm sure most of you are pretty familiar with the basic definition of infertility, meaning if you are under 35 and you have no other major issues after 12 months of trying, if you are not pregnant, then we call it infertility. If you're over 35, then after six months, we call it infertility. But what does it mean to try to get pregnant? I mean, clearly, if you are having intercourse every other day for six months different than someone who is having intercourse once a week or maybe once a month for one year, and the answer is, yeah, it does make a difference, but unfortunately that's not teased out. So does that mean if you're having intercourse like rabbits, that you need to worry sooner? No. But what it does mean is that if you are not having intercourse at least twice a week, your chances of success is going to go down. Unless you're using some type of ovulation kit to verify when you're ovulating and know that you're having intercourse during that time on the same notion. If you're one of those people who are checking ovulation kits and making your partner take eight different pills, then I would suspect that your chances are going to be better than someone who's just having intercourse every once in a while. Because in some ways you are actually giving a better chance because you're making sure when your ovulation is occurring. Now, I think it's important to understand that you don't have to try to get pregnant just having intercourse and not using protection. You do have a chance of getting pregnant. But there clearly is a difference between someone who is checking ovulation kits versus someone who is just having intercourse every once in a while. And the same thing of frequency. If you're having an intercourse every other day versus someone twice a month, you're going to have a higher chance of hitting the nail on the head more times. Even age has a part in this. If you're under 30 years of age, you have around somewhere between a 75 to 85% chance of conceiving within a year. But if you're age 35, it drops down to about 66%, which in a year. And once you get to age 40 now, it drops down to 44% chance of, conceiving within a year. And by the time you get to age 45, you're down to about 12% chance of, conceiving within one year. So as you can imagine, you can't look at someone and say it's the same for everybody because everybody is different. But although every person's journey is different, there are general guidelines that will help you know when to hit that pack button. I would define trying to conceive, essentially anyone who is having intercourse unprotected and having intercourse at least two to three times a week, or people who are doing timed intercourse by doing ovulation tracking or basal body temperature. So using that definition, let's start with the group under age 35. If you are under age 35 and you have absolutely no family history of infertility, you have regular menstrual cycles, you have no disorders such as endometriosis, polycystic ovarian syndrome, history of pelvic surgeries, a history of a sexually transmitted disease like gonorrhea, chlamydia, or a prior history of infertility with another partner, then it's not unreasonable to wait one year before seeking help. I wouldn't even hit the panic button because at that point that's pretty traditional. If it hasn't worked by then, then you need to get things figured out. Whereas in that same situation, if you're over 35, then by six months you need to be seeing a OB GYN or a reproductive doctor. So what are some of the concerning things that you should be looking for? Well, if you have irregular cycles, such as polycystic ovarian syndrome, if you have severely painful periods or a family history of endometriosis, or you've been diagnosed with endometriosis, if you've ever had a sexually transmitted disease, especially pelvic inflammatory disease, or maybe your partner has a problem getting erections or ejaculating, all of these specific conditions, you may want to even skip the OGN and go straight to the reproductive doctor. If you've already been trying for a year or six months. If you're over 35, personally, if you have conditions that would prevent pregnancy such as the ones I said. I would even make the argument that six months is enough to go see the reproductive doctor. And for women over 35, I'd say even after three to four months, it's not unreasonable to start talking to a reproductive doctor. But I want to talk about things that might make you worry even though you haven't been trying for a year. So let's start first with the pull up method, coitus interruptus. There are some people on earth who think they're the best pull routers in the world and how they prevented getting pregnant in so many relationships. To be honest, I believed that too until we found out we had infertility. Cortis interruptus, also called the pull up method, has about 25% yearly failure rate. So I would tell you that if you've been in a relationship for at least two years and you've been using the pull out method and you didn't get pregnant, even if it's not the same relationship, you might be concerned there might be something wrong. Either a sperm problem or there's a female issue that is causing some problems. So even though you weren't trying, you should be maybe hitting that panic button when you're about to try, because that would be unusual after two years, even with the pull up method of not having a single accident. Another area where I may hit the pack button a little earlier is family history. If you have a family history of early menopause, like premature ovarian failure or a, ah, family history with multiple multiple miscarriages, not miscarriages like someone has two, but I mean repetitive miscarriages over and over again. Maybe all the women in your family have endometriosis. These are things that could repeat. And for that reason, if you are under 35, I would say after six months, if you are not pregnant, you need to see someone. And if you're over 35, three to four months and you need to start seeing somebody, these are absolute red flags, especially early menopause. Essentially, if someone in your family on the female side has early menopause, I would say at least 10 years prior to when they had menopause, you should be getting evaluated for your ovarian reserve to find out if there's any issues. You may even want to think about freezing your eggs. The next area I would go to is unprotected intercourse in prior relationships. And what I mean by that is I've had patients who will come in for infertility with a partner and they said, oh, we've only been trying for about a year. But then I talk about prior relationships and they say, oh, I was in it for three years and we never got pregnant, but we weren't trying. But they weren't even using protection, not even using the ultimate pull out method. And a lot of times I would ask them, well, did that person that you were in the relationship ever have a kid? And they say, oh yeah, right away when they met someone else. It always surprises me that a light bulb doesn't go off at that moment. My point is if your partner or if you have been in prior relationships for a period of time where you didn't get pregnant, we're talking six months to one year and you weren't using the pull up method and you just didn't get pregnant, that is a concerning sign because that is a prior history of infertility. Now you don't think of it that way because you weren't even trying to get pregnant. But technically, as long as you're having intercourse twice a week for that period of time, you really should have become pregnant. And that is a sign that's concerning. And you should probably hit the panic button early on in your current relationship if you're not getting pregnant. Age is also another factor. Everybody knows as you get more mature, age becomes a bigger factor when it comes to fertility. But there is any factor to hit the pack button on more than another, it's going to be age. And that is because that, is the one thing you cannot reverse. If your tubes are blocked, you can bypass them. If sperm is low, you can do things like IVF and inject the sperm in. But if your egg quality is severely poor, there is not much you can do. And so any woman who is between 30 and 35 needs to start thinking about their fertility. And I would say for everyone by age 35, if you've been with your partner and maybe you weren't trying, but you've been thinking about kids and you kind of feel that, well, if it happens, it happens type of thing, which a lot of people do at age 35, you need to start hitting that panic button because if you're not pregnant by then, and you've been kind of a, little sloppy with preventing pregnancy, but you're also kind of like, if it happens, it happens. That's concerning because at 35, that's when your ovarian reserve can drop significantly. It's not like everyone does at 35, but there is definitely at 35, that is the ridge where a lot of people can drop off. And so that's why you need to worry at that moment. If you're already past that time, then the next number you have to worry about is 38. There's another significant drop after age 38. Personally, I would tell any woman who is age 40 or above, 3, 4 months at the most, and if you are not pregnant, you need to see a fertility doctor. Don't even waste your time with the OB gyn. It's not that they're not good, it's just any time wasted with them is lowering your chance of having success. As I mentioned, by age 42, your chances of getting pregnant on your own per year drops down to about 25%. And by age 45, it's down to 12% over a year. So every month wasted lowers your chances. And you definitely want to hit that panic button if you're not getting pregnant and you were after 40. Now, my goal here is not to worry people again. If you are young and you have any other problems, even if, let's say, you do have issues, but you're like, hey, if it happens, it happens, we're not that worried, then you still have time because you're young. But if you are more mature, as we talked about age 40, and you're kind of like, I want it to happen, but if it happens, it happens, the problem is you don't have time to waste at that point. You need to be proactive. Even if you don't care if it ever ends up working. Being proactive at least gives you the chance of being able to get pregnant in the future. But when you're younger, you can be a little bit more patient because of the fact that you have more room, because your window of opportunity is much bigger. But as you get past, As I said, 38 and especially 40, that window of opportunity is closing so fast that eventually even a fertility doctor won't be able to help you much overall. What I can tell you is no one has ever said, wow, I wish I didn't go to that fertility doctor so soon. I really wish I would have waited longer. That isn't a thing. What is a thing is that most people won't worry about it, will just kind of say what happened when it happens. And everyone tells them that they're just too stressed out, which isn't true. And then when they're finally ready to get pregnant, they come to the fertility doctor and they say, I wish I would have came here sooner. I would liken going to a fertility doctor early, similar to how my friend used to say, when it comes to dressing for an event, no one ever gets upset if you overdress to an event. You only look bad when you underdress. Well, in the same token, it's never going to be bad to be proactive and see a fertility doctor early, but the consequences of not seeing a fertility doctor early is tremendous. I hope this podcast was helpful for you. Maybe you're thinking about going to get pregnant and so this gave you a little bit of a timeline or let you know when to hit that pack button. Maybe you have a friend who's going through this and this is a great podcast to send to them so that way they kind of know when they need to start worrying. Even if they're not trying to have kids. This may be very helpful because at least we'll give them some type of guidelines. As always, I greatly appreciate everyone listens to this podcast. I appreciate all the great reviews and if you love us, tell your friends about us. Give us a five star review on your favorite medium. As I always say, please keep coming back. I look forward to talking to you again next week on Talk About Fertility Tuesday.