Read the full Q&A with Dr. McCarthy below.
When someone is just beginning to explore their fertility, what are the first things you want them to understand about the process?
The first thing I want people to know is that fertility is not a simple yes-or-no issue. It is a process that depends on many factors working together at the same time: egg quality, sperm quality, open fallopian tubes, a healthy uterus, timing, and overall health. Fertility does decline with time, especially with age, but age is only one part of the picture. Some people conceive quickly in their late 30s, while others run into challenges much earlier. When pregnancy is not happening easily, it does not necessarily mean something is seriously wrong. It simply means it is worth taking a closer look. That is why individualized evaluation matters so much.Next, it is important to remember that infertility is common and needing help is not a personal failure. Many people feel isolated or ashamed when they begin this process, but fertility struggles are incredibly common and very medical. This is not about blame. It is about gathering information and making a plan.
Finally, I want patients to know that there is not just one path forward. For some people, the answer may be reassurance. For others, it may be medication, surgery, insemination, IVF, use of donor gametes, or simply a clearer understanding of their reproductive timeline. The goal of an evaluation is not to push everyone into treatment. The goal is to give patients good information so they can make informed choices.
What are some of the most common myths or misunderstandings about fertility that you find yourself correcting?
A lot of patients also overestimate the chances of conceiving naturally each month. Even in healthy couples with no known fertility problems, the chance of pregnancy in any one cycle is actually only 10-20%, depending on the woman’s age. Human reproduction is way less efficient than many people realize. This is part of why it can take time even when nothing major is wrong.Another major misunderstanding is when to seek care. Women should be evaluated if they haven’t conceived after 6 months if they are over the age of 35 or 1 year if under the age of 35.
Finally, many people hear the message that “stress causes infertility.” Stress can absolutely affect well-being and sometimes the menstrual cycle, but most people are not infertile because they failed to relax. That idea can make patients feel guilty at a time when they already feel vulnerable, and it is rarely helpful.
What does an initial fertility evaluation usually involve?
An initial fertility evaluation usually starts with a very detailed conversation. We review menstrual history, prior pregnancies, miscarriages, medical and surgical history, medications, family history, sexual history, and lifestyle factors. We also talk about how long the patient has been trying, whether cycles are regular, and whether there are symptoms that might point to a condition like endometriosis, PCOS, fibroids, or diminished ovarian reserve.For the female partner, the evaluation often includes bloodwork to look at ovarian reserve and hormones involved in ovulation and reproductive function. An ultrasound is commonly done to look at the uterus and ovaries and a hysterosalpingogram, or HSG, may be done to evaluate the fallopian tubes, because open tubes are essential for natural conception and for IUI to work.
For the male partner, a semen analysis is one of the most important first-line tests. It gives us information about sperm concentration, movement, and shape. If the results are abnormal, we may recommend repeat testing or evaluation by a urologist specializing in male fertility.
What questions do you hear most often from patients during their first visit?
One of the first questions patients ask is, “What is wrong?” That is a very natural question, but often the honest answer at the first visit is that we don’t know yet. The first visit is usually about gathering the right information so we can start answering that question thoughtfully and accurately.Patients also commonly ask, “What are my chances?” They want to know whether pregnancy is still realistic, how age affects things, and whether they are already behind. This is one of the most emotionally loaded parts of the conversation, because people are often scared of hearing bad news. I try to answer with honesty, but also with perspective and a plan.
And very often, beneath these questions, there is another one patients do not always say out loud: “Am I already too late?” That fear is extremely common, and part of the first visit is helping patients feel informed rather than overwhelmed.
How do you help patients make sense of their results and decide what their next steps might be?
A big part of fertility care is helping patients translate complicated medical information into something that feels understandable. Most patients are being handed a lot of information very quickly, and it can be a lot to process. My job is to step back and explain what the results mean in plain language.Then we talk about options in a structured way. For some patients, the next step may be ovulation induction with or without IUI, while for others it may be IVF, surgery, fertility preservation, or referral for male-factor evaluation. I frame the options around the patient’s specific goals: how long they have been trying, how urgently they want pregnancy, how many children they hope to have, how aggressive they want to be, and what feels manageable emotionally and financially.
There is not always one perfect answer. Sometimes there are several reasonable next steps, and part of the process is helping patients choose the one that best fits their values and timeline.
What message would you share with someone who is feeling overwhelmed or unsure as they start their fertility journey?
Feeling overwhelmed is completely normal. Fertility can be emotional, confusing, and deeply personal. Many people walk into this process feeling like everyone else somehow knows what they are doing, while they are lost and behind. That is simply not true. Most patients feel uncertain at the beginning.I want them to know that they do not need to figure everything out at once. You do not need to decide today what you would do in every possible future scenario. The first step is just getting good information. Once we understand more, the path usually becomes much clearer.
I would remind them that fertility treatment is a process, not a single moment. There may be uncertainty, waiting, and disappointment along the way, but there is also support, structure, and a team to guide them. The goal is to take this one step at a time rather than carrying the whole journey at once.
And maybe most importantly, I would tell them that needing help is not a sign that their body has failed them or that they have done something wrong. Fertility challenges are medical, common, and often treatable. They deserve compassionate care and honest information, not guilt or shame.
What do you wish more employers understood about the time, emotional energy, and logistics involved in fertility treatment?
I wish more employers understood that fertility treatment is not something patients can neatly schedule outside of work hours. Many parts of treatment are time-sensitive and depend on the body’s response in real time. Monitoring appointments may happen early in the morning, but follow-up testing, procedures, retrievals, transfers, and recovery do not always fit into a predictable or convenient schedule.I also wish employers understood the emotional load. Fertility treatment is not just a medical condition with appointments attached to it. It often involves uncertainty, grief, repeated decision-making, financial stress, physical discomfort, and the pressure of time. Patients may be trying to function normally at work while also managing very private, very difficult emotions.
There is also a significant logistical burden. Patients may need frequent blood draws, ultrasounds, medication teaching, pharmacy coordination, injections, procedures, and last-minute schedule changes. For some, it also includes travel to specialty centers, coordinating care between partners, and navigating insurance barriers.
Supportive workplace policies can make a huge difference. Flexibility with scheduling, understanding around last-minute medical visits, privacy, and a culture that does not minimize fertility treatment all matter. Patients should not have to choose between protecting their job and pursuing the care they need to build their family. At the end of the day, fertility care is healthcare. The more employers understand that reality, the better they can support employees through it.
We’re grateful for Dr. McCarthy’s expertise and for her ability to make fertility information more accessible and easier to navigate. No matter where you are in your family‑building journey, WIN is here to support you with guidance, resources, and support every step of the way.
If you’d like help understanding your options or exploring next steps, our team is always here to support you. For personalized guidance, schedule a consultation with a WIN Nurse Care Advocate. They can answer any questions you may have and ensure you’re fully prepared for the journey ahead.
