Why do under 35s have to wait 12mo for treatment and over 35 only 6mo?

[mariannaf]

The older you get the longer, on average, for the average person, it should take to conceive, right? So why is it that couples over 35 have to wait a shorter amount of time before the docs will seriously consider helping them?

Let's say 2 couples have been trying for 6 months. One couple is 40 years old and the other is 25 years old. At 25yrs the average couple who are healthy would (probably) conceive before 6months and the fact that they haven't might indicate that there's an issue. Whereas at 40 the average may be above 6 months, and certainly longer average time at 40 than at 25, so the fact they haven't might mean they haven't been trying long enough. So why would the docs be willing to help the 40y.o but not 25y.o?

The reason I'm asking all this - we've been trying 5mo and so far no luck. We would be going via the private route anyway whether we go after 12 months or now, so is it worth flexing the truth a little and going to a private fertility clinic already for IVF or other treatments? We are 29 (me) and 34 (him). We've done sperm testing - he has borderline low sperm motility (29%) and borderline low sperm morphology (3%). We've also checked my uterus, fallopian tubes, done hormone testing on me - all fine. He is taking supplements

Because the older couple have less time to have the investigations, possible failed cycles before a successful pregnancy (which is less likely anyway) because they're older. Miscarriage rate also goes up for older women.

Younger couples have more time on their side - you definitely do at your ages.

I don't think a 40yo couple would be eligible for IVF on the NHS where I was living and looking into it.

It's because of the time you have left and the likelihood that IVF will be a success - above a certain age, the chances of a live birth from IVF start decreasing quite quickly. If you're struggling to conceive, waiting 6 months once you get to a certain age could really decrease the chances. Some CCGs won't find over a certain age and waiting lists can be long so you can get to a stage where it's a race against time.

I don't think the same rules apply to private IVF so there's nothing stopping you starting now really other than the fact that 5 months is not an unusual length of time to not conceive and IVF is expensive, difficult/hard on your body and very stressful.

Surely it's because older women have less time to conceive so for them the waiting time for help has to be shorter.

@RidingMyBike ok so let's say 39 year old couple.

I just mean, if 6 months indicates an issue for a 36yo couple, surely it'll indicate an issue for a 30yo couple because the latter ones 'should' take a shorter time to conceive if there's no issue.

So given that the advice would be "seek medical help to conceive" after 6mo if I was 39, should I be seeking it after 5-6mo at 29?

On average, most couples take about 12 months, or slightly more, to conceive. It took us over 3 years (including failed IVF). So not to conceive within 12 months isn't necessarily a red flag, it's still within the normal range.

I don’t think the “seek medical advice to conceive” after 6 months post 35 is really accurate - it’s more about checking that there’s nothing obviously wrong, since time is not on your side should you need interventions. I believe up to a year is normal.

Having said that, I had a gut feeling something was wrong and paid for private investigations after 6 months when I was 33. I was right and we needed some treatment - we’d have been waiting much much longer on the NHS. If your tests are normal and his are ok - just not optimal - then I’d give it up to a year trying - also because the supplements may help. Often you don’t have that kind of time to play with if you’re older.

No, because 6 months is a normal amount of time to be trying - several of my friends took between 3 and 6 months to conceive naturally. Beginning the fertility investigations is stressful and invasive and could be counter-productive if you do it too soon ie could have conceived naturally but it makes you so stressed about trying?

Do you know if you had the timing right every month for all five months? I know when we were trying there were some months that were a write off because of work travel or illness. You've already embarked on some testing - why, that's some stress already?

I found the book "Taking charge of your fertility" helpful - gave me the signs to look for and what was good, what warrants further investigation.

It took 7 months to conceive our first, then I miscarried and it took another 3 months to conceive again. We have perfectly normal fertility (well we don't anymore because dh has had a vasectomy and I'm 41 but at 22 and 25 we did). Women over the age of 35 don't have much time on their hands, that's why they get seen quicker.

so is it worth flexing the truth a little

You mean lying. No.

The book was really helpful - we did eventually conceive naturally about five years after we started trying. But it would never have happened without the book and finding out when ovulation is for me. Knowing the signs of ovulation was a lot more use than using ovulation tests which don't work well for someone with my condition (PCOS). I only ovulate 3-4 x per year which makes it a lot harder timing wise!

It'll also let you know whether there's anything you can do to improve chances that isn't medical intervention eg with PCOS losing weight is likely to produce a more regular cycle. Healthy diet, exercise, reducing stress all make a difference.

I was told with NHS back logs
And current waits - it can be 12 months 4 even over 35s
With current gynae wait 66 weeks in some areas

Unfortunately had an early miscarriage on our 2nd cycle of trying

Have gynae next week as have other issues - abnormal ca125.

To those trying - utilise the tests you can have - thyroid test - 65 gbp from boots - very worth checking tsh and t4

On NHS - you want vit d - b12 and feretin checked - all v important in conception and pregnancy

150 gbp gets you in depth private hormone and fertility testing with hertility health , highly recommend
You can get those records / results transfered to nhs

Also - floradix liquid
Gynae recommended 2 me - helps many numbers - iron b6 zinc etc

Take daily zinc - helps hormones and even has links to progesterone

Get your day 21 test or 3 days after ovulation - to check ya body is playing ball - to check progesterone

The book - it starts with an egg is v good

Coq10 helps over 35s with egg quality - Holland and bareett sell it
Many American fertility drs swear by it

Oh @mariannaf , I get your frustration...

But I think there are some very wise comments above...

Don't forget that baby making is very much a statistics game, as there are so many factors!
I was shocked to find that even in 19-26, the chances of getting pregnant having had sex the optimal day are 50%! (Graph below)
I used to think it was a given for that age!

Also, as @RidingMyBike says, it's so difficult to know you've DTD at the right time...

I was also getting myself frustrated and despaired, fearing that IVF is the only solution when I actually realised that we were not DTD every 2-3 days (not more, not less), which is the advice.
We were DTD 2-3 times at around about the date we thought I was ovulating and that was us trying.

My DH also had a low morphology at his first test (3%), he then stopped (almost completely) alcohol (even though he didn't drink much anyway), processed food, tried to keep his phone in his back pocket and got some supplements, as well as eating loads of walnuts and almonds (me too), and latest test was 4% (considered normal).

We did decide to explore the IVF privately, and as I was about to remove and intrauterine polyp for the IVF to start... and starting proper DTD every 2-3 days we just conceived.
Hopefully it's a sticky one but at least we know that the systems work and we don't really need IVF.

This book, it starts with the egg has been mentioned a lot, I will look into it!

No, because it can often take 2 or more years for healthy couples with no issues to conceive. Sometimes it just takes time.

Plus, IVF has a less than 25% success rate. It costs an awful lot of money and resources for people to continue to be childless as a result because making humans is far from a perfect science.

Because they have less natural time left.

We had to wait three years to get even started on clomid and then IVF. They changed it two years a bit later. 12 months sounds fine to me.

I think that success rate depends on the couple. I have had four embryo transfers 1)BFN 2)My daughter 3) Miscarriage 4) My son so three pregnancies. It isn't always that low a success rate. Regarding the OP they do need to give it time to see if anything happens first.

Pretty obvious answer, their biological clock is ticking

Also keep trying naturally for as long as possible. I wouldn't jump to IVF straight away having had experience of it.

You've asked this on another thread. There's more chance of an underlying issue with older couples and less time left. For younger couples, far more will conceive by 12 months, so treatment is a waste of either their money or taxpayer money, as well as introduction of a huge amount of stress and unnecessary hormones for many couples.

Two things here:

1. As people have said, it's just a way to ensure women who don't have as much time to play with fertility-wise get a tiny headstart in the very long NHS IVF process. I think the way you're phrasing it makes it sound like women over 35 call up their GP after 6 months, who immediately agrees they must be infertile, and then they start IVF immediately. The reality is that for any woman of any age in that process, there is a really long time between speaking to the GP and starting IVF. (I started TTC at 34, went to GP after 6 months, am now 36 looking at a 9-12 month wait time for my NHS IVF rounds to start... we're having to go private). On top of that IVF itself is usually a very long process, often taking months, sometimes years before women have a baby or give up. So to allow for enough time, they need to start older women on the process sooner.
2. The 6/12 month thing is really an NHS thing about initial investigations. As you know because you've already done it, if you're going private, you can have those tests whenever you want. You also don't have to wait until 12 months to book a private consultation, have a chat with them, and see what they say about your partner's semen analysis result. But it really is normal to take up to a year and unless there's something clearly wrong they're not going to start you on a painful, invasive and expensive process until at least 12 months.

I completely understand that when you are TTC and it's not happening that you can feel impatient but it's completely normal for conception to take a year.

I hope it all works out for you.

Totally agree…the book is by Toni wechsler. I was only ovulating 2 in 3 times and likewise had a husband with low sperm motility etc so this book can definitely help maximise your chances…and 5 months is absolutely nothing in conceiving terms so you may already be stressing yourself out unnecessarily?

Because they have less time available to get things sorted. In my area all fertility tests etc and a referral needs to be done before you turn 38 or you aren't able to get IVF on the NHS so they have to start the process quicker than for under 35s who have more time. Up to 12 months is considered perfectly normal, no need for younger folk to worry after 6 months.

When I was TTC and scouring boards for answers why it hadn't happened 4 months in when we were doing everything right, I cane across someone's comment that really helped me understand and persevere. She wrote that she had IVF and had had 10 eggs removed and all were mixed (don't know the scientific word sorry!) With sperm so should theoretically all have produced babies. Only 3 of her eggs became viable and then only 1 was in tact enough to be inserted. It just goes to show that even if you time it perfectly each month if the egg isn't quite right, it's not going to happen. If this woman had done it naturally that good egg could have come in month 1, month 5 or month 10! I eventually conceived on month 6 and baby is due in January - I know it feels like ages and ages when you're in it but I'd personally keep trying a little longer. Good luck!

According to ivf clinics themselves it’s an old fashioned statistic that assumes female menopause (or peri) is the cause. My consultant said the age limit depends on the conditions causing infertility and that people with pcos (which is treatable and lets women stay fertile for much longer) or male factor infertility can afford to wait longer tham someone with unknown.

My consultant also said that in realty young people try for 2 years before they even think about getting help and that in practice younger people who go to ivf have been ttc for at least 5 years and have had some kind of nhs help.