Welcome to Her Fertility, the podcast for women navigating infertility who want to feel like themselves again while they do it. I'm your host, Jess Tims, researcher, educator, and somatic practitioner, and I've been exactly where you are. I know what it feels like to be in the waiting, in the not knowing, in the relentless hope and grief of this journey, and I know there is a way to move through it fully alive without losing yourself in the process.
Every week, I bring you honest conversations, real research, and the kind of support your clinic can't prescribe. This is Her Fertility. Come on in.
 Dear Jess, when should I see a fertility doctor? Whoever asked this might be in that really uncomfortable place between maybe we just need more time, or should I be doing something about this? And so I'm gonna answer, and so I'm gonna answer this question with guidance, with the fertility guidance that we have on when you should be seeing a fertility doctor, but I'm also gonna give you when you shouldn't follow that guidance.
So stay with me all the way to the end because regardless of whether you've been trying for a few months, maybe you're approaching a year of trying, maybe you're 35 years or older and you're wondering if your timeline is different, or maybe your medical history has given you some reason to wonder whether your timeline is different.
There is guidance that we can follow, and then there are times when you don't want to follow that guidance. So let's talk about the guidance. According to our current fertility guidelines provided by the American Society of Reproductive Medicine, um, if you are under 35 and you've been having regular unprotected intercourse and you are not pregnant, then a fertility evaluation is generally recommended after 12 months.
If you're older than 35, then it's recommended after six months. And if you're over 40, then a more immediate fertility evaluation would be appropriate Now, those are broad guidelines, um, but what I really wanna call out here is that those guidelines aren't rules that are saying that you're not allowed to ask questions before then.
And there are definitely circumstances where you should ask questions sooner. And so here-- And so if you find yourself in one of these categories or you have this experience, then definitely start asking questions sooner, and I'll, I'll walk you through, through that. But let's get clear around what and who a fertility doctor even is.
So when we say a fertility doctor, we're usually talking about a fertility specialist, and typically, that is a reproductive endocrinologist, sometimes called an RE or an REI. An REI is an OBGYN who's completed additional specialty training in reproductive endocrinology and infertility. So you most likely have an OBGYN or an OB, and those are two different things, but either of them can absolutely be a good starting point.
And so they can, you know, discuss, like, your cycle and your initial labs. They can also address other gynecological concerns, and they might be able to help you determine whether a referral to a specialist makes sense. if you meet the criteria for a fertility evaluation or you already know that you have a fertility issue, then you might wanna work directly with a reproductive endocrinologist sooner
If you already have a known condition or a medical history that would affect your fertility, it's worth talking to a specialist sooner. For example, that might include, like, irregular or absent menstrual cycles, maybe known or suspected endometriosis.
Maybe you have a history that raises concerns around, like, your fallopian tubes or the uterus itself. And we don't talk about the men enough, but maybe the male partner has concerns in his history, right? Like maybe there is a genetic condition or, you know, exposure to radiation or chemotherapy in the past.
And there are other medical circumstances where you might need to seek out a specialist sooner. And in general, if you just have a feeling, like, you know, we've been trying, it has not been twelve months yet, but I just wanna start asking questions, then listen to your intuition and start asking questions.
And, and you might be wondering what actually happens during a fertility evaluation. And I think that part of the fear around making that initial appointment is that it can really feel like if I see a fertility doctor, then I'm starting IVF. And those are not the same thing. Making an appointment doesn't commit you to IVF.
It doesn't commit you to medication or treatment. It starts within a fertility evaluation, and it starts with more specific testing that you might not be able to get anywhere else because this is, again, specific to your fertility for both male and female partners. And so in that evaluation, what you can expect is a full understanding of what brought you here.
So we wanna know your medical history. There's gonna be initial tests run. Typically, it's blood work around where your hormone levels are, where your AMH is. Um, they might look at your ovaries and estimate your ovarian reserve. They might evaluate your uterus and whether your fallopian tubes are open.
And they really wanna understand your medical and reproductive history. And then the same would be for the male partner. They might do a semen evaluation, um, which I hope that they do because that would be a full and complete, right, like, evaluation. We don't wanna forget that it takes two to make a baby.
and sometimes having this information from a full evaluation can give you way more data than you had before, and that can be helpful. So you don't need to wait until you are, like, desperate and exhausted from trying on your own. And that really ... And I think, and I think there's another emotional layer to this question because sometimes making an appointment with a fertility clinic really feels like admitting that something is wrong.
And maybe you don't feel ready to identify yourself as someone who's experiencing infertility s- and you might be w- thinking, like, surely next month will be the month, and it might be. And seeing a specialist doesn't mean that you've given up on conceiving without treatment. It means that you're gathering information.
So you are absolutely allowed to make an appointment and ask questions. You're allowed to learn what your options are. You're allowed to receive that information and then decide that you're not ready to do anything with it yet. Like, that's totally allowed. Information and intervention are not the same thing.
And more testing isn't always better either. And I think especially because we live in a world where you can order an enormous amount of fertility testing yourself, I don't always think that you need to run everything possible, right? Like, you don't need to do all of the fertility testing out there, like, the moment you decide you want a baby.
The companies that sell you those things probably disagree with me on that because they're trying to sell you their product. Um, but testing is useful only when we understand the question that we're trying to answer and when we want to use that information to evaluate what we would do differently because of the result.
And we talked a lot about this in our AMH episode here on the Her Fertility podcast. So if you've, you know, been given an AMH result that doesn't sit well with you, that you didn't expect, then go listen to that episode 'cause there's specific guidance on AMH in there. But in general, fertility testing can give you information.
And so in- instead of asking, like, should I test everything just in case, I would rather you have an appropriate evaluation based on your age, based on how long you've been trying, based on your cycles, your medical history, your partner's history, and any symptoms or diagnoses that you already know about, and that would be done with a fertility specialist
, And then you have data to work with within the context of an expert opinion who can guide you through that data. Now, you can always get a second opinion and get more guidance, right? But I, but I, but I, but I've seen where people order their own labs, and then they are just overwhelmed by the information because they don't really know what to do with it.
So getting clarity on what you're trying to test and then what you would do differently with that information is a really good guideline to work within on your own. Now, you might be thinking to yourself, "Well, Jess, I just have this feeling that something isn't right, so should I go see a specialist?" And this one is a little harder because it...
there is no guideline for intuition, and I don't wanna tell you that every fear means that something is medically wrong. And trying to conceive can really create a lot of anxiety and hyper-awareness, and I don't want you to feel like you need to ignore your intuition or your questions because you haven't reached, you know, the 12-month date on a calendar.
So if you find yourself there and you're like, "I just feel like there... you know, something in my intuition is telling me," then talk to your OB or your OBGYN and ask whether anything in your medical history warrants further evaluation. You can ask them, and write this down or come back to the episode and write this down.
You ask, "Based on my age, my cycles, my medical history, and how long I've been trying, when would you recommend that I come back if I'm not pregnant?" That is a completely reasonable conversation to have. And you don't have to diagnose yourself yet so you could still wait. Okay, pause Okay, play Come back to here reasonable conversation to have.
And if you're deciding whether to make the appointment or not, I want you to ask yourself these questions first. First ask, how old am I and how long have I actually been trying? And then use the guidelines as a starting point to work within. Then ask, are my cycles regular? If they aren't, right, like if they're irregular, short, absent, super long, if you have concerning symptoms, like definitely go talk to your doctor, meaning like your physician, rather than assuming you need to wait because your body is trying to tell you something.
And then third, do I have any un- do I have any known medical or reproductive history that could affect my fertility? Because that could change your timeline. And then ask two more questions. If I'm trying with a male partner, has anyone considered his reproductive health too?
And then finally, what am I hoping to learn from the appointment? Because sometimes the next step isn't treatment. Sometimes it's simply information. And then if you do make that appointment, I want you to remember something that I so wish more women understood before they walked into a fertility clinic.
You are still allowed to make decisions. Your physician and the doctor on the other side of the door can give you recommendations. They can explain timelines. They can recommend additional testing and treatment, and those recommendations can absolutely be incredibly valuable. But you can ask, "Why are you making these recommendations?
What information are you basing that recommendation on? What are my options?" And also ask, "What happens if we wait?" Would ... Also ask, "What would change your recommendation?" You don't need to walk into the appointment already knowing everything. That's why you're going. So when you ask, dear Jess, when should I see a fertility doctor? Generally speaking, if you're under 35, it's after 12 months, and if you're over 35, it's after six months. And if you're after, if you're over 40, then see a fertility specialist sooner to start testing your fertility sooner.
And all of that lives within the bigger context of your unique body and your unique experiences in that body. And so if there's some reason, medically speaking, that you should see somebody sooner, then you absolutely need to consider that. Or if you have this overwhelming intuition telling you, "I wanna go get more information sooner," then go get that information.
 Thank you for being here today. If you would like to submit an anonymous question for Dear Jess, please see the show notes for the link. I would love to support you with answering your question. And if you're ready to go deeper,
you can find everything at www.herfertility.support. And if today was your first time here, welcome. Come back. There's more where this came from. Until next time, give yourself love. You are doing more than you know.
