40w LaterGuide

Q. When should I see a fertility specialist?

Infertility is generally defined as not achieving a pregnancy after 12 months of regular, unprotected sex. An evaluation is generally recommended after 6 months if the person trying to become pregnant is 35 or older, and more promptly after age 40.

You do not necessarily need to wait this long if you have very irregular or absent periods, a condition that may affect fertility, a history of pelvic disease or surgery, known sperm-related concerns, or another reason to be concerned about fertility.

Q. When is the best time to have sex if we are trying to conceive?

The fertile window includes the several days leading up to ovulation and the day of ovulation. Sperm can survive in the reproductive tract for several days, while the egg can be fertilized for a much shorter time after ovulation.

Rather than trying to identify one exact moment, having sex regularly during the fertile window can increase the chance that sperm are already present when ovulation occurs. Cycle tracking, ovulation predictor kits, and other methods can help estimate this window, but none can predict the exact moment of ovulation every time.

Q. What if my partner cannot be present when fertility treatment is scheduled?

In some situations, a semen sample can be collected and frozen in advance for future fertility treatment. Whether this is appropriate and how many samples should be stored depend on semen quality, the planned treatment, clinic procedures, and local regulations. Discuss this with your fertility clinic ahead of time.

Q. Can I start IUI or IVF whenever I want?

Usually, a fertility evaluation is performed first to understand possible causes of infertility and determine which treatment is appropriate. This may include evaluation of ovulation, the uterus and fallopian tubes, ovarian reserve in selected cases, and semen analysis.

Not everyone needs the same tests, and IUI or IVF is not automatically the first treatment. The recommended approach depends on age, medical history, fertility diagnosis, how long you have been trying to conceive, and your reproductive goals. Access requirements and insurance or public funding also vary by country.

Q. Does fertility treatment increase the chance of twins?

It can. With ovulation induction or IUI, multiple pregnancy can occur if more than one follicle develops and more than one egg is fertilized.

With IVF, the risk of twins is strongly influenced by the number of embryos transferred. For this reason, single embryo transfer is preferred in many situations when appropriate, helping reduce the risk of multiple pregnancy while maintaining a good chance of having a healthy baby.

Q. Is a test to check whether the fallopian tubes are open painful?

Tests such as hysterosalpingography (HSG) use contrast material to evaluate whether the fallopian tubes are open. Some people experience mild to moderate cramping, while others experience more discomfort.

In some settings, ultrasound-based tests such as hysterosalpingo-contrast sonography (HyCoSy) may be available as an alternative. The most appropriate test depends on your medical history and the services available where you receive care. If you are worried about pain, ask your healthcare provider about what to expect and available pain-relief options.

Q. Is fresh or frozen embryo transfer more successful?

There is no single answer that applies to everyone. A frozen embryo transfer is not automatically more successful than a fresh transfer, and a fresh transfer is not always better either.

The best approach depends on factors such as your ovarian response, risk of OHSS, embryo development, uterine lining, treatment protocol, and individual circumstances. In some cycles, freezing all suitable embryos and transferring later may be recommended for medical reasons.

Q. Does a low percentage of normally shaped sperm mean a higher risk of birth defects?

No. Sperm morphology describes the shape and structure of sperm seen under a microscope. A low percentage of sperm with normal morphology may be considered as part of an overall fertility assessment, but it does not mean that a baby conceived with that sperm will have a corresponding risk of physical abnormalities.

Semen analysis should be interpreted together with sperm concentration, motility, and other clinical information rather than morphology alone.

Q. Does IVF use up my eggs and cause earlier menopause?

Current evidence does not suggest that ovarian stimulation for IVF causes earlier menopause by simply “using up” eggs.

During each menstrual cycle, a group of follicles begins developing, but usually only one becomes dominant and ovulates while the others stop developing. Ovarian stimulation allows more follicles from that group to continue developing so that multiple eggs may be collected.

IVF does not create new eggs or prevent the natural age-related decline in ovarian reserve, but fertility treatment itself is not considered to accelerate menopause in this way.

Q. Does taking birth control pills for a long time cause infertility?

For most people, using oral contraceptive pills does not cause long-term infertility. Fertility generally returns after stopping them, although the time until ovulation and regular menstrual cycles resume can vary between individuals and contraceptive methods.

If your periods do not return as expected after stopping contraception or you have other concerns about fertility, consult a healthcare professional.