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)||Start||6 Months||12 Months|
- 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%.
IUI Treatment Outcomes According to Diagnosis, Age <38 Years, 2003-2006
(% per cycle)
(% per cycle)
Ovulation Disorder / PCO
Diminished Ovarian Reserve