Delayed conception requires fertility evaluation

Dear doctor,

My husband and I are both 32 years old. We have been dealing with infertility for the last five years. We don’t think anything is wrong with either of us. Should we wait longer or seek help?

Worried

Answer

Delayed conception isn’t an uncommon occurrence. For most, it’s usually a transient phenomenon, with spontaneous conception occurring in the course of time. However, there should never be any hesitation to be evaluated, especially when the delay is more than a year. Older couples beyond the mid-30s should be evaluated earlier, after around six months of trying to conceive.

Five years is too long for a young couple not to have conceived. In such cases, waiting longer isn’t advised. There should be an immediate evaluation for the man and the woman. Going for a consult with your regular gynaecologist is a good first step but you could also choose to go straight to a specialised fertility clinic.

The initial fertility consult will include a comprehensive review of your reproductive and sexual function. Both of you should attend the consult together. Clues about what the problem might be can sometimes be quickly evident during the first consultation. However, most couples require testing for various reproductive functions before a definite diagnosis can be made. Recommendations about the best treatment options can only be made once a thorough evaluation has been completed.

Most men only need to do a sperm test. If this turns out normal, additional testing isn’t usually necessary. Some men will, however, require more extensive testing if their sperm result is abnormal. Women often require several tests that include a check of the reproductive hormones, and imaging studies to assess the normality of reproductive organs. It may also be necessary to do additional specialised tests in women depending on what appears to be apparent.

Once your evaluation becomes conclusive, you will be advised on the most appropriate fertility treatment. Some will only require relevant advice and simple treatments. But those with complex fertility problems will likely require equally complex fertility treatments. Such treatments are quite demanding, and tend to be expensive. Success rates aren’t guaranteed either, some couples require repeated treatments before eventually conceiving.

In the face of delayed conception, seeking help sooner than later is the most practical thing to do. The stigma around infertility can sometimes hinder couples to act appropriately. This shouldn’t ever be the case. Infertility should always be viewed as a disease, like any other. Couples must be cautious about anecdotal treatments that don’t really work. Consulting the right specialist should be the norm. Once a comprehensive evaluation has been done, a specific diagnosis usually leads to successful conception for most couples.

- Dr Alfred Murage is a Consultant Gynaecologist and Fertility Specialist; [email protected]