By Carol Harbers

Sometimes the road to a baby bump can be bumpy. How do you know if you need fertility treatments or just more patience? Reproductive endocrinologist Thomas Price, MD, answers this question and more.

When is it time to see a fertility specialist?

If you are younger than 35, try for a year to get pregnant before considering fertility treatments. If you are 35 or older, try for six months.

Of course, these guidelines are for those who don’t have obvious problems, such as very irregular periods or a history of pelvic inflammatory disease.

As we all know, the older you get the lower your chances of pregnancy become. After age 40, chances of successful pregnancy are low. But I’ve heard of women having children well into their forties and even older.

Stories of older women, especially celebrities, having children in their late forties tend to get a lot of attention. The part of the story that doesn’t always come out is that they very likely became pregnant with the help of an egg donor.

Even with in vitro fertilization (IVF), the chances of a woman becoming pregnant after her early forties with her own eggs are very low. In fact, we typically don’t offer in vitro fertilization with a woman’s own eggs after age 44.

Are there still options after this age?

We offer treatment with an egg donor up to age 50.

Egg donation is extremely successful in our program. At our clinic, between 50 and 60 percent of couples will take home a baby on the first try with egg donation.

What are some of the most common causes of infertility?

In women, the most common causes of infertility are ovulation problems -- not making an egg. Again, this is something that becomes more challenging as a woman gets older.

Poorly functioning fallopian tubes can also be an issue. Tubes can be damaged or scarred by disease. Endometriosis or problems with the uterus also can cause infertility. Low sperm count or poor sperm quality in males can also make pregnancy difficult.

What treatments are available?

Some of the options include medications, surgery, and IVF. But there is no one best treatment. Every woman and couple is different.

How does IVF work?

We use hormones to stimulate the production of eggs in a woman’s ovaries.

The eggs are retrieved from the ovaries, fertilized in the lab, and then put back into a woman. Then, we hope that implantation occurs and the woman becomes pregnant.

IVF bypasses the fallopian tubes that might be damaged. It also increases fertilization rates when there are problems with low sperm count.

How important is the lab at a fertility center?

The lab is incredibly important. In fact, the lab may be the most important factor in a successful in vitro fertilization procedure.

There are no labs out there that are better than Duke’s. Our state-of-the-art air filtration unit is extremely important to the success of growing embryos.

Is there a resource that compares success rates of fertility centers?
Yes. The Society for Assisted Reproductive Technology publishes the IVF success rates of clinics nationally.

I’m afraid of learning that an expensive procedure is my only option for becoming pregnant.

This is a common misconception.

Many people have the impression that we only do the fancy stuff like IVF. The fact is many couples get pregnant with simple treatments that are not expensive. For example, simple ovulation problems can be treated with inexpensive oral medication.

My insurance does not cover IVF. How does Duke help put fertility treatment within my reach?

Duke is a member of Advanced Reproductive Care, a corporation that helps people finance fertility treatment. They offer all sorts of packages, financing options, and a 100 percent refund guarantee program.

I’m also very proud that through the Pay It Forward Fertility Foundation, Duke Fertility Center gives several grants a year to couples who cannot afford fertility treatments.

Even though it may be a few years before I’m ready to have a baby, are there things I could be doing now to prepare my body?

I’m glad you asked! All women should start taking folic acid a couple of months before becoming pregnant.

Also, make sure you have all your vaccinations up to date, quit smoking, seek treatment for any diseases, and optimize your weight. Being either under- or overweight can adversely affect your fertility