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When is Enough Enough?

Many patients struggling to become pregnant wonder when it is time to quit. Just when is “enough enough”? It is important to realize that if the physicians at Texas Fertility Center can utilize all of the options available to us, probably 85-88% of patients will be able to have a baby. But that does not mean that there aren’t times during the treatment process when “enough is enough”.
Although the definition of infertility is one year of unprotected intercourse, it is highly recommended that couples (when the woman becomes 35 years old) be evaluated after 6 months of unprotected intercourse. When the woman is in her mid 30s, the chance of conceiving declines rapidly. Time is very important. So, when is enough enough for trying on your own? Enough is when the couple desires to be evaluated and/or meets the classic definitions of infertility. At that point, it is time for the couple to schedule an appointment for an evaluation. There are guidelines for the number of times couples should try a particular fertility procedure to improve their chances of becoming pregnant. In general, 85% of women usually conceive within 4-6 cycles with whatever fertility treatment they are undergoing. Unfortunately, it is not uncommon to hear of patients who have been on Clomid for years without success. After 4-6 cycles of this treatment, the couple should be progressing to another treatment. Enough is 4-6 months.
This guideline applies to intrauterine insemination (IUI), as well. If IUI is going to be successful, it almost always works within 4-6 cycles. Also, it is important for patients who undergo IUIs to be told the results of the semen analysis of the sperm brought to the office for the procedure. However, it is really important to know the results from the sperm prep to learn how many moving sperm are available for their IUI. If this information is not available, either ask your physician to provide the data or consider consulting a Reproductive Endocrinologist with a full-service Andrology laboratory.
If the sperm prep repeatedly produces less than 10 million moving sperm, the IUI is unlikely to work. At that point, the man should revisit his urologist to see if something can be recommended to increase his sperm production or the couple needs to be offered a higher level of technology to become pregnant – specifically, in vitro fertilization (IVF). Enough is 4-6 cycles of IUI with adequate sperm and 1 or 2 cycles with inadequate sperm. At that point, it is time to move along to the next level. Enough is not enough if the couple has not been offered the options available for them.
Sometimes couples are hesitant to move to the next level of treatment. Their concerns may include the cost, the stress, and/or the time requirement for the next procedure. These concerns may delay a couple from moving along. These concerns are understandable.  Despite the frustration of undergoing some of the treatments and not becoming pregnant, remember that the majority of couples will be successful if they continue their evaluation and treatment. However, it is important for couples to move along when “enough has become enough” for any particular procedure.

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