Understanding your fertility and knowing when to seek support can make a meaningful difference in your path to becoming a parent—especially for women of color who may face unique challenges along the way
One of the most common questions I hear as a reproductive endocrinologist is When should I see a fertility doctor?
Infertility is defined as not being able to conceive within at least a year of having regular unprotected intercourse for women younger than 35 years old, and within six months for those 35 years or older. However, I have had many couples or individuals come in for an evaluation before those time periods because they want to know if there is anything contributing to them not being able to conceive.
I have seen patients before they try to start to conceive, as well as after three months, and even after many years of trying. My recommendation is simple—see a fertility specialist as soon as you would like to be pregnant and are experiencing difficulties. Or better, women who want to know their fertility status can see a specialist to learn about their reproductive health before they attempt to conceive and have a fertility evaluation or discuss egg freezing among other options.
Time is precious when it comes to fertility, especially as women get into their mid to late 30s.
For Black women in particular, there are important considerations that cannot be overlooked when it comes to fertility. Black women experience what I call the “Fertility Paradox.” Federal statistics show that Black women have a higher total fertility rate compared to other races in the fertile population. However, among those with infertility, Black women have about twice the infertility rate compared to White women.
Much of this disparity is linked to higher rates of fibroids and tubal disease but equally important is the fact that Black women are less likely and often take longer to engage with a fertility specialist, typically about 1.5 to 2 years later than other groups. That delay matters. There can be a significant reduction in egg quality even after a year.
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Before pursuing assisted reproductive treatments, there are several evidence-based lifestyle factors that can support a woman’s fertility.
If you decide to see a fertility specialist, it helps to know what to expect. More people than you might imagine experience fertility challenges—one in six—so the first step can be as simple as asking friends or family for recommendations or researching clinics online to see what services they offer.
At the first fertility appointment at RMA, we spend a significant portion of time discussing your fertility journey, your health history, and what your ideal family may be. And, because half of infertility cases involve the male partner, we typically recommend diagnostic testing for both partners to identify any underlying causes of infertility. This is also the time when individuals and couples can discuss donor eggs or sperm and fertility preservation with the physician.
Success rates depend on several factors, including the type of infertility, the ages of the individuals involved, and the treatment approach.
After a full evaluation, your doctor will discuss treatment options. They can range from surgical interventions to fertility treatments such as intrauterine insemination (IUI) or in vitro fertility (IVF). Timelines vary widely. Treatment can take as little as a month after your initial visit or extend to a year or more, depending on the underlying causes.
Costs also vary, but many states have mandates requiring insurance companies to cover infertility care.
Choosing the right clinic and provider is an essential part of the process. All fellow-trained and board-certified fertility specialists have undergone extensive education—four years of medical school, four years of OB/GYN residency, three years of fertility-specific fellowship training and continued education to maintain board certification. It’s important to verify that your provider has this background and is offering evidence-based care.
Unfortunately, I have seen many patients who were previously told—often by someone without specialized fertility training—that they didn’t need a certain treatment. As a result, they lost valuable time and money and were still not able to conceive. When evaluating a clinic, consider both the range of treatments offered and how comfortable you feel with the provider. Trust matters and you should feel it from your very first visit.
Fertility is deeply personal, but you don’t need to navigate it alone. Taking that first step—early, informed, and empowered—can make all the difference.
Dr. Simone Elder is a board-certified OB/GYN and reproductive endocrinologist practicing at Conceptions in Colorado, an IVI RMA North America affiliate, where she helps women better understand and take control of their reproductive health. She earned her medical degree from Weill Cornell Medical College, completed her residency at New York Presbyterian/Weill Cornell, and her fellowship in reproductive endocrinology at the University of Colorado.
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