AGE ISN’T EVERYTHING: Reasons for a 20-something year old to see a fertility specialist

Most people assume the patients I see are typically 35 and older – but that is so *not true*! Yes, age is a major factor that impacts fertility but there can be many fertility related issues that can impact even patients in their 20s and early 30s. 

Here is a list of common reasons I see young patients:

PCOS – Irregular or absent ovulation can make it very difficult to know when to try to conceive. If you aren’t ovulating, you aren’t ‘in the game’. We often use letrozole to kick start ovulation and monitor the cycle with ultrasound +/- blood work to ensure the medication worked and that the response is not too aggressive (aka: minimize the risk of twins).

Blocked Fallopian Tubes – The fallopian tubes are the meeting place for sperm and eggs. The tubes can be blocked on one or both sides due to conditions like endometriosis (see next bullet point), STIs or pelvic inflammatory disease, history of ruptured appendix and having multiple prior abdominal surgeries (which can lead to scar tissue). You can get pregnant with 1 functional tube. If both are blocked, IVF is the best way to conceive, by bypassing the tubes altogether. 

Endometriosis – This is where the lining of the uterus is found outside of the uterine cavity – it can be in the pelvic cavity, ovaries, on the bowel/bladder etc. It causes painful periods and linked to infertility via a variety of mechanisms. Medicated IUIs and IVF are two ways to help overcome endometriosis related infertility. Surgery is not considered a first line approach but may have a role in cases where the pain cannot be controlled by medication. 

Uterine anomalies – Patients can be born with a septum/wall inside the uterine cavity, or a duplicated uterine cavity or different shapes to their uterus which can lead to infertility, miscarriage, preterm delivery etc. We diagnose this with ultrasound, HSG, or MRI (which tends to give the clearest picture). Some types can be fixed (ie. septums). 

Unexplained Infertility – When the HSG and semen analysis are normal, it is unexplained and we do not know why pregnancy has not occurred. It could be egg quality, or other unseen/un-testable factors. The answer is treatment – either medicated IUI or IVF. 

Fertility Preservation – Young patients may want to take advantage of the fact that they have a lot of eggs and most are presumed to be healthy and have high reproductive potential. If they have any known reason to need or want to do IVF in the future (ie. born without a uterus and will need a gestational carrier, known carrier of a cancer mutation ie. BRCA) it makes even more sense to egg/embryo freeze early.

Male Infertility – Severe issues like azoospermia where there is a complete lack of sperm will sometimes require a procedure to extract sperm from the testes. In cases that are not treatable, we can offer donor sperm as an alternative. Men or women can have sexual dysfunction where inseminations can help to get sperm into the reproductive tract right before ovulation.

Recurrent Pregnancy Loss – I have had many young patients with recurrent pregnancy loss. They deserve a thorough work up and targeted treatment. Up to 50% will not have any findings and those cases can be a mystery – the good news is persistence usually pays off – a high proportion will eventually get pregnant and have a live birth. 

A *lot* of my 20-something year old patients with infertility feel a major sense of frustration – because they are continually told by others ‘not to worry’ and that ‘everything will be ok’ – there is almost a dismissive over-confidence when it comes to how people view infertility in the younger population. If you’re a Gen Z/young Millenial – have you experienced this? Please share your experience in the comments below.

My name is Lucky Sekhon and I'm a double board-certified OBGYN, and Reproductive Endocrinologist & Infertility specialist practicing at RMA of New York. My mission is to empower women with practical and scientifically accurate information to make the right fertility decisions for themselves.

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