I’m 35. When Can I See a Fertility Doctor?

Is there anything you can do at six months TTC if you’re under 35? The thought of waiting another six months to not be pregnant feels frustrating. Are there things a doctor would be willing to try, such as progesterone supplements or other options, before IVF?

—Tired of Waiting

This question brings up a few things.

First, it is important to mention that there is an overall trend of women delaying childbirth. In 2022 –– the latest year for which we have data –– the average age of a mother at first birth was 27.4 years old, up from 21.4 in the 1970s. Increasingly, more women are giving birth to their first child at age 35 or older. There have also been remarkable increases in the availability and success of fertility treatments over this time. Because of how age affects a woman’s chances of conceiving, these trends mean that more women are seeking guidance, testing, and treatment for fertility even before they are attempting to become pregnant.

Second, human reproduction is incredibly inefficient. During a typical menstrual cycle, there are just six days when sex can result in a pregnancy: the five days before ovulation and the day of ovulation. But before that, the sperm has to make its way to the egg and successfully fertilize that egg, and the resulting embryo needs to travel to the uterus and successfully implant. That’s to say nothing of the genetics of the egg, sperm, and resulting embryo. All of this means that even under ideal conditions, fecundability –– the chances of conceiving within a given menstrual cycle –– are likely no higher than 38%. So it does take some time to conceive. But it is also true that about 80% of couples will conceive within the first six months of trying.

However, the guidelines of waiting 12 months of trying to conceive (in women under 35 without any red flags) prior to testing are just that — guidelines. While they are intended to provide data-driven recommendations and prevent unnecessary testing and anxiety, they are also reflective of very real-world limitations, like demand for fertility services.

If you are seeking guidance, it’s worth bringing it up to a fertility provider even if it seems premature according to the guidelines. Depending on you or your partner’s specific medical history, risk factors, and goals, your doctor may consider anything from starting a workup now to starting treatment. Keep in mind that these guidelines inform definitions of infertility that impact insurance coverage for testing, so this may mean paying out of pocket.