Subfertility, or infertility, is usually defined as a lack of conception after 12 months of unprotected, regular (twice weekly) sexual relations. For patients over 35 years old, subfertility is no conception after 6 months of unprotected sex. Special circumstances would warrant earlier intervention, such as irregular menses (no ovulation), or a low sperm count. It is not unreasonable to monitor for ovulation with daily urine ovulation tests (LH tests) days 10 - 20 of the cycle. (Cycle day 1 is the first day of bleeding). Ovulation can be further confirmed with a blood test (serum progesterone > 10 ng/ ml) drawn 7 - 8 days after the urinary LH surge). The progesterone test is available at our office on-demand without a prescription for $80. Semen analysis is available on-demand by the patient at our office for $150.
Women lose fertility quicker than men. There is a biological clock that causes many eggs released after age 34 to be genetically abnormal. At 30 years old, 25 % of the eggs are genetically abnormal. At 38 years old, 50 % of the eggs are genetically abnormal. And at 42 years old, 75 % of eggs are genetically abnormal. The uterus ages more slowly than the ovaries. Women are able to carry healthy pregnancies into their 40's and 50's, but they will usually require donor eggs from a younger patient.