Typical vs. Equitable TTC Timeline

The benefits of integrated couples care.

People who want a baby don’t start the Trying To Conceive (TTC) journey thinking, “I hope it takes a really long time to get pregnant!” Most couples often spend so much time trying not to conceive that they think it will happen quickly. While most females begin with a preconception consult and a plan to monitor their ovulation, most males are not as proactive. Very few couples are aware that male factors are the cause of infertility 50% of the time and this contributes to why the majority of males do not have a reproductive health evaluation. Our mission is to help couples avoid preventable delays and missteps by encouraging the simultaneous evaluation of both partners and advocating for equitable awareness of and access to male reproductive care.

According to the American College of Obstetricians and Gynecologists (ACOG) and The American Society for Reproductive Medicine (ASRM), anyone trying to conceive a pregnancy within the next year should have a reproductive health evaluation. This recommendation is inclusive of all individuals heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender-nonconforming people trying to conceive.

The benefits of a male seeking a pre-pregnancy evaluation at the same time as the female partner include:

  • Couples report feeling less overwhelmed and more emotionally connected with each when they approach fertility equitably. The female shoulders less of the physical and mental load alone and the male has access to qualified medical expertise that helps to calm nerves and dispel societal myths about male fertility.
  • Among couples with male factor infertility, about 10% have underlying health issues. A full evaluation by a male fertility specialist can identify fertility-hindering issues that may be treatable and or completely reversible.
  • It takes about 72 days to regenerate all new sperm. A semen analysis makes it possible to develop a treatment plan to improve sperm health. Evaluating the male early in the TTC process optimizes sperm health and helps improve odds of success.

Below are two TTC timelines. The one on the left is what we typically see unfold for most couples struggling with infertility. The timeline on the right is what we want to see more often and reflects an equitable, integrated couples care model.

If you’re excited about becoming a parent and hope it happens sooner rather than later, we encourage you and your partner to follow the Equitable TTC Timeline steps to avoid losing months or years to undiagnosed male factor infertility.

Typical TTC Timeline
Equitable TTC Timeline
Month 1:

Female stops using birth control or contraception. Has a preconception consult with her OB/GYN. Receives information about her reproductive anatomy, how to use an ovulation predictor kit, and counsel on diet, nutrition, and supplements to improve fertility and conception odds.

Month 1:

Female stops using birth control or contraception. Schedules a preconception visit with her OB/GYN.
Male has a semen analysis and schedules a baseline assessment consult with a Male Fertility Specialist.
Both partners receive care concurrently from qualified providers.

Months 2-12:

Female has been peeing in cups and on sticks, taking temperatures and vitamins. If she had been taking hormonal birth control that stopped or regulated her cycle, her body will be adjusting to a natural ovulation cycle.

Months 2+:

Female is learning to track her ovulation cycle.
Male is taking steps to improve his sperm health.
Both partners have active roles in the TTC process. If the first SA indicated poor sperm health, follow up SAs can check for improvements.
Both partners consult with their providers and escalate the interventions depending on what is known about the female and male factors. IUI, IVF and other treatments can be considered earlier in the TTC timeline when the male factor is evaluated from the beginning.

Bottom line: Concurrent evaluation of both partners ensures appropriate actions are taken at the start of the TTC journey to improve chances of conceiving.

Month 13:

Female schedules a follow up with an OB/GYN and receives Diagnosis of Infertility. Provider likely prescribes clomid or something similar to help stimulate ovulation.

 
Month 17:

Female has a follow up with OB/GYN who orders an AMH test and a semen analysis for the Male partner.

 
Month 18:

Male receives Semen Analysis report and learns he has poor sperm health. He consults with a urologist, who most likely does not have expertise in Male Fertility.

Most couples wait 18 months before investigating if the male factor is contributing to their infertility. This would be like your car having a flat tire so you replace the two front tires and hope you fixed the flat.

 

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