Fertility 101: Stop birth control. Have sex. Get pregnant.

All of your friends, family members, and that random girl from high school you still follow on Instagram seem to have no problem getting pregnant, so it must be easy…right?Unfortunately, ask 1 in 6 women in the United States, and they will tell you it isn’t always that simple.

When should you start to worry?

How long does it really take to get pregnant, and when should you seek medical care?

I’m here to help answer those questions!

First, a little background. Every month, around the middle of your menstrual cycle, the ovary releases an egg. This process is called ovulation. In order for pregnancy to occur, sperm must meet that egg and fertilize it. While sperm can live inside the woman’s reproductive tract for 3–5 days, an egg can only survive for about 24 hours after it is released. If it is not fertilized during that time, pregnancy is very unlikely to occur that month.

If the egg is fertilized, it becomes an embryo and travels through the fallopian tube before implanting in the uterus. If any step in this process is disrupted, infertility can occur.

So you may now be asking: How long should this take? What is normal?

The ability to conceive is highest for women in their 20s. Even then, if everything is timed perfectly, there is only about a 20–25% chance of pregnancy each month. After age 35, that chance decreases to around 10% per month.

For healthy couples under the age of 30, about 70–80% will conceive within one year of trying. By age 40, that number decreases to about 44% of couples.

Because of this, the American Society for Reproductive Medicine (ASRM) recommends beginning an infertility evaluation:

• After 1 year of trying if the woman is under age 35

• After 6 months of trying if the woman is age 35 or older

• Immediately if the woman is age 40 or older

Of course, these recommendations assume you are otherwise part of a “healthy couple.” There are several situations where it makes sense to seek care sooner, including:

• Menstrual cycles that are routinely shorter than 21 days or longer than 35 days

• Cycles that vary by more than 5 days from month to month

• Severe pain with periods or intercourse

• A history of pelvic infection, including chlamydia or gonorrhea

• A partner with a history of testicular surgery or other fertility concerns

So what should you expect when you come to see us?

Most infertility evaluations begin with a thorough history, including your medical, surgical, and menstrual history. We will often recommend blood work and imaging—usually an ultrasound—to evaluate the uterus and ovaries. Sometimes additional testing is done to evaluate the fallopian tubes. For your partner, we typically recommend a semen analysis.

The common causes of infertility that we evaluate for include:

• Ovulatory disorders (not releasing an egg every month)

• Tubal factors (blocked or damaged fallopian tubes)

• Male factor infertility (low sperm count or poor motility)

• Age-related decline in egg quality

• Uterine factors (polyps, fibroids, or structural differences)

• Unexplained infertility

Approximately 30–40% of infertility is related to female factors, 30–40% to male factors, about 20% involves both partners, and 10–20% remains unexplained.

Once we’ve completed the evaluation and assessed both partners, we usually meet again to discuss next steps. In many cases, there are treatments we can offer right here in the clinic to help improve fertility. In other situations, we may recommend referral to a reproductive endocrinology and infertility specialist.

If that happens, the good news is that much of the initial evaluation has already been completed—so you’ll be able to hit the ground running when you meet with the fertility specialist.

Fertility can be complicated. And stressful. And as much as we would love for it to be as simple as “stop birth control, have sex, get pregnant,” for many people it just isn’t that easy.

We’re here to help you navigate this process. Whether you haven’t started trying yet and just want to talk about what to expect, you’ve been trying for a few months and aren’t sure whether you’re ovulating, or you’ve been trying for a while and want to discuss next steps—we’re here for you.

No question is too simple or too small. Most of us were never taught this information in school, and the internet can be a confusing place full of both good and not-so-good advice (like whether you really need that expensive hormone cycle tracker—spoiler: probably not, but we’re happy to talk about it!).

Infertility is deeply personal and can feel incredibly isolating. Many of us have struggled with it ourselves (🙋‍♀️), so we understand the emotional toll this process can take. Our goal is to support you every step of the way.

And the good news is that with the right evaluation and treatment, many couples will ultimately achieve pregnancy!

If you're interested in starting your new chapter with compassionate, evidence-based care, consider becoming a patient of Associated Physicians OB/GYN department. Our physicians are accepting new patients, and it's as easy as giving us a call at (608) 233-9746.

Dr. Amanda Schwartz, MD, OB/GYN