When to look for help?

Receiving assessment at an appropriate time and with the correct professionals is critical in the possibility of getting pregnant.  Therefore if you are looking forward to having a baby, we recommend a preconception consultation with an OBGYN specialized medical institution.

Even more, if any answer to the following questions is positive for you or your couple, we recommend a thorough evaluation by a fertility specialist:

  • ¿Have you been having unprotected sexual intercourse for 1 year or more without getting pregnant?
  • ¿Are you a women over 35 years old and have been having unprotected sexual intercourse for 6 months or more without getting pregnant?
  • ¿Have you been diagnosed with endometriosis any time in your life?
  • ¿Does your period comes with intense menstrual pain?
  • ¿Have you been diagnosed with Polycystic Ovarian Syndrome or ovulation dysfunction any time in your life?
  • ¿Do you have irregular menstrual periods, increased body hair, acne, oily skin or abnormal vaginal bleeding?
  • ¿Have you been through pelvic surgeries or have had sexually transmitted diseases, pelvic infections or complicated appendicitis?
  • ¿Have you been diagnosed with uterine fibroids or congenital uterine malformations?
  • ¿Are you a women who suffers of intense pain during penetration (vaginism)?
  • ¿Have you had any testicular disease such as traumas, abnormal testicular descent, testicular compromise by mumps, varicocele or sexually transmitted disease?
  • ¿Are you a male with a difficulty in having an erection, orgasm or ejaculation, that interferes with a periodical and normal sexual intercourse?

For your Information

During the first year of unprotected sexual intercourse, couples have a monthly pregnancy chance of approximately 15%. By the end of the first year 85% of them will be pregnant.

If a pregnancy isn’t achieved during the first year, the monthly pregnancy chance diminishes to 3-5%, and therefore an infertility diagnosis is established and a specialized diagnostic workup and treatment is indicated.

It is true that...

Is true that anxiety causes infertility?

What is certain is that anxiety is an effect of infertility rather than a cause.  It is estimated that only 1 to 2 per cent of infertility cases are solely and exclusively caused by a very obvious state of anxiety.  There is anxiety in almost every couple with infertility. However this is rather an effect than a cause of infertility.

Is it true that oral contraceptives used for long periods of time can lead to infertility problems?

This is not true because conversely, contraceptives are protective of female fertility. This is due to the fact that they decrease the frequency of pelvic infections, ovarian cysts and it may decrease the aggressiveness of diseases such as endometriosis, which affect the fertile potential of women.

Is it true that most ot the couples’ infertiliity problems are caused by women’s disorders?

Many men do not go to the doctor’s appointment and leave the responsibility to search for solutions in their partners’ hands. However, statistics show that 40% of infertility cases are associated with disorders of the semen or in other words, they are caused by a male factor.

Is that true that fertility treatments are very expensive?

This is not true, since the 80% of couples with infertility may be treated with low-complexity fertility treatments and at low cost, such as the induction of ovulation and artificial insemination.

How do i know that i have a fertility problem?

Human reproduction is an inefficient process.  During the first year, a couple’s monthly probability of pregnancy is just 20 %.  This means that if during the current month, a hundred of couples expect to become pregnant only twenty of them will succeed.  The remaining eighty will have to try again the following month, or so on forth.  Consequently, a couple who has been trying to get pregnant only for one, two or three months without success should not think that there is a problem.

Then: how long do we have to wait?

Although the chance of pregnancy per month is low, the long-term probability of pregnancy is good.  If the same hundred couples who seek for pregnancy, pursue their search for a year, at the end of this year, at least eighty of them will have been pregnant.  The scenario is not as good for the remaining twenty couples who after a year of trying to become pregnant do not achieve it.  In their case, the monthly percentage of pregnancy during the second year falls to 5 %.  This is the time when these couples need to seek for professional help.


If after having intercourse during a year, without using any contraceptive method, pregnancy has not been achieved, consultation with a fertility specialist should be done.

Older couples are an exception to this recommendation. Fertility begins to decline over the years. This is true for both men and women. Unfortunately, it occurs sooner for women than for men. In the case of women, the decrease of fertility begins to be noticeable after the age of 35 years and the process accelerates itself after the 39 years of age. In the case of men, a similar process occurs but to an older age.

For couples where the woman is older than 35 years or the man is older than 55 years, the recommendation is to consult after 6 months of fruitless search of the gestation.

In some cases, couples may suspect that they are having trouble getting pregnant, due to their medical history and they are advised to consult as soon as possible.

 Some of these cases are:

  • Pregnancy was not achieved in a previous relationship despite that it was not avoided.
  • There is a metabolic disease like diabetes, or thyroid disease.
  • The patient has had previous abdominal surgeries, for example, due to appendicitis, peritonitis, ectopic pregnancy or ovarian cysts. In these cases there may be blockage of the tubes (Fallopian tubes).
  • The woman has irregular menstrual cycles. This may be a sign of ovulation problems.
  • The woman has milk output without having had a recent childbirth. This means that there is a disorder of the lactation hormone (prolactin) which in turn causes ovulation problems.
  • An Intrauterine Device has been used, which increases the risk of blockage of the Fallopian tubes.
  • The man has had testicular trauma or varicose veins, which may affect sperm production.
  • There is no ejaculation.
  • There is overweight or under weight. Both ends

If none of the above conditions exist, but couples have a deep concern for their reproductive future, it is worth consulting anyway. A specialist can conduct some simple test, which clarify the situation and reassure the couple.



The basic fertility tests are three:

  • Spermiogram. Semen test to describe the quantity and quality men´s sperm.
  • Detection of ovulation to know if the woman produces mature oocytes each month. Measurement of hormones (progesterone) in the blood the 21st day of the cycle.
  • Examination of the Fallopian tubes. To detect obstruction or adhesions in the reproductive system of women. May be carried out using an x- ray with contrast or by laparoscopy.

Once the results of these tests are available, it may be possible to plan which is the best treatment to achieve pregnancy.

After having a child, can i have fertility problems?

Yes. This condition is called secondary infertility. After childbirth, the woman becomes refractory to a new pregnancy for a variable time, which essentially depends on the duration of breastfeeding. The reason for this is the priority of the body survival. Both pregnancy and lactation demand a lot from the body metabolically, so nature prevents the two situations to occur simultaneously.

During lactation, the ovulatory process is usually inhibited and this is evidenced by the absence of the menstrual period.

If there is no breastfeeding or if this is partial (i.e., breastfeeding combined with bottles with milk other than maternal) the ovulatory process can return a month after birth at the earliest. If there is breastfeeding only, menstruation and ovulation may be delayed up to six months postpartum. This does not occur on a one hundred percent of the occasions and individuals who wish to avoid pregnancy cannot be entrusted solely on breastfeeding, but they must combine it with another contraceptive method.

On the contrary, couples who are searching for a second pregnancy should bear in mind that pregnancy may be difficult during these first few postpartum months and it may be necessary to wait between six to twelve months to achieve pregnancy. If after a year or longer, of searching for the pregnancy without the use of any contraceptive methods (this includes natural methods such as abstinence on fertile days or intercourse interruption before ejaculation) and not being breast feeding, pregnancy is not achieved, one should think that there is a problem, and consultation with a specialist must be sought.

In some cases, in which it is expected that there is a problem, it is advisable to consult before this time.

These cases are:

  1. An infected cesarean section.  Future fertility is not usually at risk when there is a c-section done. However, if there is an infection, there is a risk that the infection causes a blockage of the Fallopian tubes and infertility. We say that there is an infected cesarean section when pus is collected in the surgical wound or there is fever and bad smell of vaginal discharge.
  2. Puerperal fever (postpartum endometritis). This is the occurrence of infection after a vaginal birth. Usually it is evidenced by a high fever in the postpartum along with purulent vaginal discharge and abdominal pain. Similarly to the item mentioned above, the risk is the obstruction of the Fallopian tubes.
  3. Use of intrauterine device.  It is common to use this contraceptive method in the postpartum period. The device may cause infertility by acting as a bridge for infectious agents to rise from the vagina to the Fallopian tubes. There is a very low risk with modern devices.
  4. Irregular periods. The absence of menstruation (amenorrhea) is normal to happen up to six months postpartum, but if this persists or periods are very irregular, this means that there are problems with the ovulation process.
  5. Milk secretion persists.  In some women, despite suspending breastfeeding, the secretion of milk persists. This is due to a hormonal disorder called hyperprolactinemia.  Hyperprolactinemia may cause difficulties to achieve pregnancy, since it causes ovulatory disorders.
  6. Sex problems.  The birth of a baby alters the couple’s sex life due to difficulties with schedules and fatigue and lack of sleep during the first few months.  This may cause distancing of the couple, and if it continues to happen, it may require assistance from a professional sexologist.
  7. Sexually transmitted diseases.  Either in men or in women, an obstruction of the vas deferens (man) or of the Fallopian tubes (women) may be caused, despite appropriate antibiotic therapy.
  8. Surgeries or trauma.  If during the elapsed time after childbirth, there are any surgeries such as appendicitis or cysts in women or hernias or testicle surgeries in men, or shock and trauma to the genital organs or lower abdomen, there is a chance of abnormalities of the reproductive system.

In these cases of secondary infertility is important to resort to suitably qualified professionals who can assess the importance of this disorder.

How is the diagnosis process done?

The study of a couple with a fertility disorder should be initiated at the right time, because the woman’s age plays an essential role in the probability of achieving a successful treatment that will lead to the birth of a healthy baby.

The diagnostic process of a couple with infertility should be complete, concise, and quick. In a term of 30 to 45 days this couple must be fully studied, the causes of the difficulty in achieving pregnancy and the treatment options must be identified.

This study focuses on four main aspects:

  1. The function of the ovaries: generally the medical history, the ultrasound and the hormonal measurements in blood let us know if the woman’s ovarian function is adequate and if the quantity and quality of eggs in her ovaries is sufficient to achieve pregnancy.
  2. The role of the fallopian tubes: examinations, such as laparoscopy and hysterosalpingography allow you to define if they are in the right conditions to allow the pregnancy
  3. The conditions of the uterus: little complex tests such as ultrasound, hysteroscopy, sonohysterogram or hysterosalpingography allow to detect uterine alterations that compromise the possibility of achieving pregnancy.
  4. The characteristics of sperm: the spermiogram (examination of the semen) is the key test in the evaluation of the men’s fertile capacity.

The cause of infertility will be detected in 90% of couples with the study of these four aspects. The cause of infertility is not detected only in 10% of couples. They undergo an unexplained infertility diagnosis, for which there are effective treatment methods.

Each one of the causes of infertility is susceptible to be treated and the chance of success increases day by day thanks to the dizzying scientific development in the area of human reproduction, and the experience of our doctors and biologists.

Which treatment do i need?

If you are a woman under the age of 35, with regular menstrual cycles (every 25 to 35 days) and you have less than 1 year of being searching for pregnancy, you probably will not need any treatment. You just need to give yourself the opportunity to have a spontaneous pregnancy trying it for 12 months, with the support of Inser through the preconception counseling..

On the contrary, if you have been trying to get pregnant over a year, or if you are 35 years of age or older and you have unsuccessfully tried to get pregnant for six months, we recommend you to see a human reproduction specialist by attending the First Time Appointment. It is also advisable to seek advice when your cycles are irregular or unusually painful, if you have had abdominal surgery, or if you have been diagnosed with endometriosis.

Likewise, men who have had history of inflammation or blows to the testicles, testicle surgery, undescended testicle or a sexually transmitted disease should also see a doctor. Also, if there is little amount of ejaculate (less than 1 milliliter) or the ejaculate has a color different than pearly white.

For your information, below you will find a list of common problems and their treatment options:

  • Ovulation problems or irregular menstrual cycles:
    There are medicines to stimulate the ovary and induce ovulation. These drugs can be tablets or much more powerful injections.
  • Problems with sperm:
    Initially, efforts should be made to find the underlying cause of the problem and treat it (urological & andrological evaluation). After this, Artificial Insemination may be used [to make link with this treatment] for mild problems or In Vitro Fertilization and ICSI if there are severe problems.
  • Blockage of the fallopian tubes:
    There are two alternatives:
    To perform a surgery to correct the problem.
    To carry out treatment of In Vitro Fertilization, in which the eggs are removed from the ovary and fertilized in the laboratory with the husband’s sperm. The fertilized eggs are then transferred to the uterus through the vagina, preventing the passage of sperm, egg and embryo through the fallopian tubes.
  • Unexplained Infertility:
    This happens when pregnancy cannot be achieved although all tests are normal. Artificial insemination has been shown to be effective in many of these cases.