When to Refer a Fertility Patient

When to Refer a Fertility Patient

  • On average, about one in every eight couples experience a delay in conception.
  • Chances of achieving a natural conception peak in the twenties, and thereafter are on a decline.
  • Likelihood of a successful natural conception decreases further as the maternal age compounds with the increasing number of cycles without successful conception, as shown below:

Rate of Conception per Cycle

Age (Years)Start6 Months12 Months

20's

30%

10%

2%

35

20%

5%

<1%

40

5%

<1%

<1%

  • Note the large decline in conception rates after 6 months of attempts.
  • A more proactive stance should be taken with any couple who is having difficulties with conceiving rather than continue to have patients try themselves over more cycles.
  • Using Advanced Reproduction Treatment (ART), we are able to give couples a better chance at conception despite the odds that stack against them.
  • Evaluation and treatment should be an option for anyone interested after six months of trying to conceive.
    • All women older than 30 should have an evaluation for ART after six months of trying.
    • Above age 40, all woman seeking to obtain a pregnancy should be referred for ART at the start.
  • Patients should be referred for ART if a couple cannot get a diagnosis on their infertility issues.
    • Based upon their age and prior success rates in conceiving, Clomid is not the best course of action.
    • According to the American Society for Reproductive Medicine (ASRM), an additional six months of intercourse alongside a prescribed Clomid, when compared to an additional six months with no treatment, demonstrated no significant difference in pregnancy rate (2013 Practice Committee Statement).
  • Also note that Clomid will have no impact on increasing the pregnancy rate if the male has undiagnosed mild infertility complications.
    • Male fertility screening may also be in order.
  • If tubal problems or uterine problems such as mild endometriosis are present, Clomid will have little effect on helping the couple conceive.
  • However Clomid will aid in achieving a pregnancy for women with ovulatory infertility issues.
    • Based on the diagnosis and treatment, the conception rates per cycle range from about 5-20% in these women with the assistance of Clomid.
  • Regardless of ovarian testing (for AMH, FSH, etc.), patients in all of these circumstances should be referred for ART, even if the IVF is as high as 70%.
When to Refer a Fertility Patient

IUI Treatment Outcomes According to Diagnosis, Age <38 Years, 2003-2006

DiagnosisCyclesPregnancies
(% per cycle)
MiscarriageLiveBirth/Ongoing
(% per cycle)

Unexplained

3690

546 (14.8%)

89

458 (12.4%)

Ovulation Disorder / PCO

2238

448 (20%)

74

374 (16.7%)

Male Factor

1154

173 (15%)

27

146 (12.6%)

Endometriosis

418

38 (9%)

3

35 (8.4%)

Tubal Factor

234

27 (11.5%)

3

24 (10.3%)

Uterine Factor

137

18 (13.1%)

4

14 (10.2%)

Diminished Ovarian Reserve

125

14 (11.2%)

3

11 (8.8%)

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When To See a Specialist?

When To See a Specialist?

Deciding when to see a fertility specialist can be complicated. We’ve created a short quiz to help.

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Question 1 / 6

Are you a heterosexual couple that has tried to conceive for over 6 months?

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Question 2 / 6

Are you a single person trying to conceive?

yesno
Question 3 / 6

Are you a same sex couple trying to conceive?

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Question 4 / 6

Do you have any genetic concerns?

yesno
Question 5 / 6

Do you have irregular menstrual cycles or ovulatory problems?

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Question 6 / 6

Are you a patient where male factor infertility is present?

yesno
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