Four important factors must be taken into account:
- The age of the woman
- The time that you have been trying to get pregnant
- Any conditions that you may have been diagnosed with
- The method that you are planning to use to get pregnant
The age is the single most important factors to look at when you are trying to get pregnant. Indeed fertility declines rapidly for women, generally after the age of 30-35. Men on the other hand have a much slower decline of their fertility and can therefore father children at a much later age. The reason why your chances decline with age is that the number of eggs in the ovaries reduces with age. The quality of the eggs also tend to decrease as the body will select the best ones to use first. The age of the ovaries can be assessed by an ovarian reserve test, this can be done by a simple AMH blood test.
After female age, the next most important factor determining your chances of getting pregnant is how long you have already been trying. This is because most normally fertile women get pregnant within a few months of trying, meaning that if you have been trying for a long time then the chances of you having an undiagnosed fertility problem is much higher. About half of all women who try to get pregnant will do so within 4 months of trying to conceive. However, if you are still trying after six months, then there is a 50/50 chance that you will still be trying after a year – which is when your doctor will probably diagnose “infertility”.
Most couples will get pregnant within the first year, and this is why your doctor may recommend that you try for a bit longer if you have not yet been trying for a year. It is important to know that if you are over 35 years old, your doctor may decide to start the basic fertility tests earlier (after 6 months of trying for example). Of the couples who have been trying for more than a year to get pregnant naturally, about half will get pregnant in the second year. And of those who are trying for a third year, about one in ten will get pregnant in that year.
However, it is important to understand that a diagnosis of “infertility” without also a diagnosis of the cause of infertility should not cause too much worry. After a diagnosis of “infertility” from trying for a baby for 1 year, half of couples will fall pregnant over the next year. Over this next year you should expect your doctor to make every effort to identify any cause for your infertility, as invasive and often expensive treatments without an identified cause can be of limited use.
Some factors are known to affect fertility, for example hormonal imbalance (PCOS, thyroid dysfunction...), it is therefore important that you speak to your doctor when you are starting to try to conceive as they may want to do a few tests to check that everything is working fine. Some conditions which affect your fertility will not be detected unless you are doing specialised fertility tests. Your doctor may want to check that your tubes are working well and not blocked, but as these tests are expensive and invasive they are not done unless you have been trying for more than one year. If both of your tubes are locked, you are very unlikely to get pregnant naturally and you would therefore benefit from assisted reproductive technology.
If at the end of two years of trying to conceive, your doctor has still not identified an underlying cause, which often is called a diagnosis of “unexplained infertility”, you should certainly consider some kind of help to get pregnant. This is because only about one-in-ten couples who have been trying for two years, will get pregnant over the next year. This, combined with the impact of advancing female age on fertility discussed above, means that the chances of an unaided pregnancy drop rapidly.
There are several treatments that have been shown to help with unexplained infertility, ranging in cost and invasiveness from simple home testing through to complex medical procedures like drug stimulated artificial insemination, all the way through to in-vitro fertilization (IVF) which is a procedure where the woman’s eggs are physically removed from her body and fertilized with her partner’s sperm, before the growing embryos are surgically implanted into her uterus.
If you have an identified cause for your fertility, you should certainly consult your doctor as to the most effective method to achieve pregnancy in your specific circumstances. However, the following numbers give you some indication of the effectiveness of each of the common ways to help couples who have been trying for two or more years and with no underlying diagnosis for the cause of infertility (so-called “unexplained infertility”):
