By Sarah Azad, MD – Obstetrics & Gynecology

Infertility is a deeply personal and sometimes overwhelming experience for couples. While it can feel isolating, it is pretty common, affecting approximately one in eight couples worldwide.  Fortunately, modern medicine offers many solutions to overcome this trial. At the same time, individuals and couples may also face cultural or religious considerations that shape the choices available to them. 

When Is It Time to Seek Help?

One of the most common questions couples ask is, “How long should we try before seeing a doctor?” The answer largely depends on age, as fertility naturally declines over time.

• Under age 35: It is recommended to try for up to 12 months before seeking medical evaluation.
• Age 35 and older: Because fertility declines more quickly after 35, it is recommended to seek evaluation after 6 months of trying without success.

It is important to note that “trying” means having unprotected, penetrative sexual intercourse at least two to three times per week. This frequency ensures exposure to sperm during the time of ovulation.  While ovulation is usually predictable, many factors can affect the timing of ovulation in any given month.  

Couples with known risk factors—such as irregular cycles, prior pelvic infections, endometriosis, or male partners with a history of testicular surgery or chemotherapy—may benefit from earlier evaluation rather than waiting the full 6–12 months.

Who Should You See First?

The first step is usually an appointment with your OB/GYN (obstetrician-gynecologist). OB/GYNs are trained to evaluate infertility and either begin initial testing and treatment or refer to a reproductive endocrinologist (a fertility specialist) if needed. Family physicians and internists can also start the process, but OB/GYNs are best equipped to address reproductive health concerns directly.

What Does the Initial Work-Up Involve?

The goal of infertility evaluation is to identify potential barriers to conception in either partner. In about 40% of cases, infertility is due to a female factor; in 30–40%, a male factor; and in about 20%, both partners contribute. Sometimes, no clear cause is found (“unexplained infertility”).

A standard infertility evaluation typically includes:

1. Medical History and Physical Exam
   The doctor will ask about menstrual cycles, prior pregnancies, contraceptive history, medical conditions, medications, surgeries, and lifestyle factors.
   
2. Laboratory Tests
   Bloodwork may include:
   • Hormone levels (to assess ovulation and ovarian reserve)
   • Thyroid function tests
   • Prolactin levels
     
3. Pelvic Ultrasound
   An ultrasound can identify structural problems, such as ovarian cysts, fibroids, or abnormalities of the uterus.
   
4. Hysterosalpingogram (HSG)
   An HSG is an X-ray procedure that uses contrast dye to check if the fallopian tubes are open and to evaluate the shape of the uterine cavity.
   
5. Semen Analysis (for the male partner)
   This is a critical part of the evaluation. It measures sperm count, motility (movement), and morphology (shape). Male factor infertility is more common than many realize and can often be improved with lifestyle changes, medications, or procedures.

Possible Outcomes and Treatment Options

After the work-up, the physician will discuss the findings and possible next steps. Depending on the results, options may include:

1. Continue Trying Naturally
   If all results are normal and the couple is relatively young, the recommendation may be to keep trying with guidance on timing intercourse.
   
2. Ovulation Induction
   For women who do not ovulate regularly, medications (such as clomiphene citrate or letrozole) can stimulate ovulation.
   
3. Intrauterine Insemination (IUI)
   This involves placing prepared sperm directly into the uterus around the time of ovulation.
   • Ovulation induction with IUI: Used when ovulation is irregular or when mild male factor infertility is present.  Often, it is recommended when there is no identifiable cause of the infertility (“Unexplained infertility”).
   • IUI alone: Sometimes recommended if semen analysis is abnormal or if proper timing of intercourse is difficult for the couple to achieve.
     
4. In Vitro Fertilization (IVF)
   Ovaries are stimulated, and multiple eggs are retrieved. These eggs are then fertilized with sperm in the laboratory, and the resulting embryos are transferred into the uterus. IVF is used for blocked fallopian tubes, severe male factor infertility, failed IUI attempts, or unexplained infertility that has not improved with simpler treatments.

Special Considerations for Muslim Patients

For Muslim couples, religious guidance often plays a role in making decisions about fertility treatments. Islamic bioethics addresses many aspects of assisted reproductive technology. While rulings may vary slightly depending on the school of thought, the following are widely accepted principles:

1. IVF
   • Generally permitted, but only when using the wife’s own eggs and the husband’s sperm.
   • The couple must be married at the time of fertilization and embryo transfer.
     
2. Donor Egg or Donor Sperm
   • Prohibited in Islamic law, as it introduces a third party into the marital relationship. This process does disrupt the concept of lineage (nasab).
     
3. Frozen Embryos
   • Permitted if created using the couple’s own gametes within a valid marriage.
   • Embryos can be stored and later transferred back into the wife’s uterus.
     
4. Genetic Testing on Frozen Embryos
   • Generally permissible, especially if used to avoid serious genetic diseases.
     
5. Donation of Leftover Embryos
   • Not permissible to donate embryos to other couples, since it involves third-party reproduction.
     
6. Donation for Science
   • Permissible, as long as embryos are not being implanted in another woman.
     
7. Status of Embryos After Death of a Spouse
   • Embryo transfer after the death of one partner is not permissible, since the marriage contract is considered terminated at death.

Other Relevant Issues for Muslim Patients

• Embryo Reduction (Selective Reduction): If multiple embryos implant (e.g., in triplets), some scholars allow reduction for medical necessity, though this is debated.
• Freezing Eggs or Sperm: Permissible if needed for medical reasons (e.g., before chemotherapy), or for future use with the intention that they are only used within a valid marriage.
• Third-Party Surrogacy: Not allowed, as it involves a third party.
• Counseling and Emotional Support: Many Muslim couples may feel stigma around infertility. Seeking support through faith-based counseling and community resources can be beneficial.

Final Thoughts

Infertility is a journey that affects both partners physically, emotionally, and spiritually. Understanding the basics—when to seek help, what the evaluation entails, and what treatment options are available—empowers couples to make informed decisions. For Muslim patients, additional considerations rooted in Islamic bioethics guide which options are religiously permissible.

With the right combination of medical care, faith, and support, many couples can achieve their dream of parenthood. Even when the path is challenging, knowing that compassionate, ethical, and effective options are available can help provide hope and direction.

About the Author

Dr. Azad is an OBGYN at El Camino Women’s Medical Group based in Mountain View, California U.S. She is dedicated to providing high-quality medical care while ensuring women feel comfortable and empowered in their healthcare journey.

She also founded the Muslimobgyn blog, where she shares expert insights on women’s health through the lens of Islamic values and principles.

Dr. Azad earned her medical degree from Saint Louis University School of Medicine, completed her residency at Santa Clara Valley Medical Center, and later founded her private practice at El Camino Medical Group.

With a special focus on infertility, PCOS, weight management, and overall wellness, Dr. Azad is passionate about helping women navigate their reproductive health with confidence.

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