Infertility is commonly defined as not achieving pregnancy after 12 months of regular unprotected intercourse when the female partner is under 35, or after 6 months at age 35 or older. Evaluation may need to begin sooner when known risk factors are present.
Fertility is a couple-level issue. Female and male factors may occur alone or together, so both partners should usually be assessed early rather than completing months of testing on one person first.
When to seek evaluation
- after 12 months of trying when the female partner is under 35
- after 6 months at age 35 or older
- more promptly after age 40
- earlier with absent or irregular periods, known endometriosis, prior pelvic infection or surgery, chemotherapy, recurrent pregnancy loss, sexual dysfunction, testicular concerns, or other known risks
These timelines are guides, not barriers to care. Anyone worried about fertility can discuss preconception health and appropriate timing with a clinician.
The core questions
An evaluation usually asks whether ovulation occurs, whether sperm are present and functional, whether the fallopian tubes are open, whether the uterus can support pregnancy, and whether timing and sexual function allow sperm and egg to meet.
Female history and examination
Relevant information includes cycle timing, bleeding and pain, prior pregnancies, pelvic infection or surgery, endometriosis symptoms, medications, chronic illness, family history, and prior cancer treatment. Age is central because egg quantity and quality decline over time, although individual trajectories vary.
Confirming ovulation
Regular cycles often suggest ovulation, but they do not prove it in every case. Tools may include cycle history, urine luteinizing-hormone tests, appropriately timed progesterone testing, or ultrasound monitoring.
Apps estimate fertile days from past patterns and can be wrong, especially with irregular cycles. Frequent intercourse across the fertile window is usually more practical than trying to identify one perfect day.
Ovarian reserve testing
Anti-Müllerian hormone, antral follicle count, and selected cycle-day hormones can help estimate the number of recruitable follicles and likely response to stimulation. They do not directly measure egg quality and cannot reliably predict whether someone will conceive naturally in a given month.
A low result does not mean pregnancy is impossible, and a high result does not guarantee fertility. Interpretation must include age, history, ultrasound, and treatment goals.
Uterus and fallopian tubes
Pelvic ultrasound evaluates the uterus and ovaries. A hysterosalpingogram or related test may assess whether the fallopian tubes are open and whether the uterine cavity has major abnormalities. Fibroids, polyps, adhesions, endometriosis, and tubal damage affect fertility differently depending on location and severity.
Male fertility testing
Semen analysis is a first-line test. It measures volume, sperm concentration, movement, and shape. Results can fluctuate, and an abnormal test may need repeating under standardized conditions.
History should cover puberty, prior pregnancies, testicular injury or surgery, infections, medications, testosterone or anabolic-steroid use, heat exposure, ejaculation, sexual function, smoking, cannabis, alcohol, and occupational exposures.
Using testosterone can markedly suppress sperm production. It should not be started or stopped without medical guidance when fertility matters.
Hormone and genetic testing
Hormone testing should be targeted. Thyroid, prolactin, androgen, or other testing may be appropriate based on cycles and symptoms. In men with very low sperm counts or other findings, hormone and genetic evaluation may guide diagnosis and treatment.
Ordering every available hormone or immune panel rarely improves care and can create confusing incidental results.
What “unexplained infertility” means
Sometimes standard testing shows ovulation, open tubes, a suitable uterine cavity, and semen values within reference ranges, yet pregnancy has not occurred. This is called unexplained infertility. It does not mean nothing is wrong; it means routine tests have not identified a single correctable cause.
Next steps depend on age, duration of trying, prior pregnancies, preferences, and resources and may include continued attempts, medication with intrauterine insemination, or IVF.
Lifestyle and preconception care
- avoid smoking and recreational drugs
- limit or avoid alcohol while trying and during pregnancy
- review medications and supplements for reproductive safety
- use folic acid or a prenatal vitamin as advised
- support adequate nutrition, sleep, movement, and chronic-condition control
- avoid extreme dieting and unproven fertility cleanses
Lifestyle can support reproductive health, but it cannot reopen blocked tubes, reverse reproductive aging, or correct every sperm disorder.
Supplements and add-on tests
CoQ10, inositol, DHEA, antioxidants, and fertility blends are frequently marketed. Evidence is condition-specific and often mixed. DHEA is a hormone and can cause adverse effects or interfere with treatment. High-dose antioxidants are not automatically beneficial for sperm and may disrupt normal signaling.
Commercial tests of egg quality, sperm DNA, immune function, microbiomes, or implantation should be used only when results are likely to change management and evidence supports the specific situation.
Choosing the next step
- Complete parallel female and male assessment.
- Identify time-sensitive factors such as age or markedly reduced ovarian reserve.
- Treat clear causes when treatment improves the chance of pregnancy or health.
- Compare expectant management, ovulation induction, IUI, IVF, surgery, or donor options based on diagnosis.
- Discuss success rates in terms of live birth, not only positive tests or embryo numbers.
- Consider financial, emotional, ethical, and physical burdens alongside medical outcomes.
When urgent care is needed
A positive pregnancy test with one-sided pelvic pain, shoulder pain, fainting, or heavy bleeding may indicate ectopic pregnancy and requires urgent assessment. Sudden severe testicular pain, marked swelling, fever, or severe pelvic pain also needs prompt care.
This article is educational and is not an individualized fertility evaluation or treatment plan.