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The Fertility Waiting Game...How long is too long?

By Dr. Rinehart on February 29, 2012

Infertility is a word that is frequently used. However, the meaning of the word is like a chameleon in that the circumstances of its use will determine its meaning. For example, a young couple just married wonder if they will have problems getting pregnant. Never having tried to conceive, they have no idea if they will be labeled as infertile.  What about a 38 years woman, who has tried to conceive with her husband for the last six months without success.  They begin to wonder if they will ever have a child that is genetically theirs… are they infertile?  Consider a 47 year old woman, who has met the man of her dreams and wants to conceive their genetic child.  However, she has not had a period in 3 months and started having hot flashes about a year ago. Is she infertile or menopausal?

A  forty something woman, or for that matter, even a thirty something woman may not have a year of reproductive potential remaining.  She may benefit from treatment but only if it is initiated soon. A same-sex couple may never actually have the ability to try to conceive. A young woman without menses due to a condition called polycystic ovarian syndrome (PCOS), may also not benefit from a one year ‘waiting period’.  PCOS is very successfully treated through medical intervention, but the spontaneous pregnancy rates are quite low and the miscarriage rates if the cycles are not regulated with the help of fertility medications. Thus, the definition of infertility can help or hurt a person’s chance of having their own child.  And, so can a one year waiting period, whether it is insurance imposed or judgment call. 

The Definition of Infertility

The standard reply to the definition of infertility is attempting to conceive for greater than one year without success. The definition of infertility then can be either the failure to conceive at one year, as is used by the Illinois state law, or six months as is suggested for some couples by the American Society for Reproductive Medicine, or almost immediately for woman who never has regular menses.  The evidence remains that the longer a person/couple attempts to become pregnant without success, the lower the chance of conceiving on the next attempt and the more likely they are either sub-fertile or sterile.

 Knowledge about why a person has not conceived in their defined time frame can help predict what the future may hold for that person. For those people where the woman is young, waiting may be successful. For others, no amount of time or treatment will permit that person to genetically have their own child. For many couples, reasonable infertility treatments will permit them to have a child and move on with their lives.

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