When to See a Fertility Doctor: Signs It's Time to Get Help

The Standard Timeline

Medical guidelines provide clear recommendations for when to seek fertility evaluation, based primarily on age.

The Official Recommendations

What "Trying" Means

These timelines assume you're actively trying with reasonable timing:

• Having unprotected intercourse during your fertile window
• Sex every 1-3 days during that window (or at least 2-3 times during it)
• Cycles are occurring regularly

If you've been having sex randomly without tracking ovulation, you may want to spend 3-4 cycles with proper timing before counting toward these guidelines.

When to See a Doctor Sooner

Certain conditions or risk factors warrant earlier evaluation—even before the standard timeline. If any of these apply to you, consider seeing a specialist sooner.

Menstrual Irregularities

• Irregular periods (varying by more than 7-9 days month to month)
• Very long cycles (over 35 days consistently)
• Very short cycles (under 21 days)
• Absent periods (amenorrhea)
• Very light or very heavy periods

Known Medical Conditions

• PCOS (polycystic ovary syndrome)
• Endometriosis (diagnosed or suspected)
• Uterine fibroids or polyps
• Thyroid disorders
• Pituitary disorders
• Diabetes (especially poorly controlled)

Medical History Factors

• History of pelvic inflammatory disease (PID)
• Sexually transmitted infections (especially chlamydia or gonorrhea, which can cause tubal damage)
• Previous abdominal or pelvic surgery
• History of ectopic pregnancy
• Two or more miscarriages
• Cancer treatment (chemotherapy or radiation)

Partner Factors

• Known or suspected male fertility issues
• History of undescended testicles
• Previous vasectomy (even if reversed)
• Use of testosterone or anabolic steroids (current or past)
• Cancer treatment

Symptoms Worth Investigating

• Painful periods that interfere with daily life
• Pain during sex
• Chronic pelvic pain
• Unusual discharge or bleeding between periods

What to Expect at Your First Appointment

Your first fertility appointment is primarily about gathering information. Here's what typically happens:

Before the Appointment

You'll likely be asked to:

• Complete intake forms about your medical history
• Gather information about your menstrual cycle patterns
• Bring any relevant medical records
• Know your partner's medical history (if applicable)

During the Appointment

Detailed medical history: Expect questions about your cycles, pregnancies, contraceptive history, sexual history, lifestyle, and general health.

Physical exam: Usually includes a pelvic exam and possibly an ultrasound to look at your uterus and ovaries.

Discussion of testing: The doctor will recommend tests based on your history. These may happen that day or be scheduled for specific cycle days.

Initial assessment: You may get preliminary impressions, though full evaluation takes a few weeks as test results come in.

Who to See

OB-GYN: Can run initial tests and treat simple issues. Good starting point if you have an established relationship.

Reproductive Endocrinologist (RE): Fertility specialist with advanced training. Essential for complex cases, IVF, or if initial treatment hasn't worked. We recommend going directly to an RE if you have known risk factors or are 35+.

Common Fertility Tests

A complete fertility workup evaluates both partners. Here are the standard tests:

For Women

Day 3 Blood Tests (early cycle):

• FSH (follicle-stimulating hormone) — Indicates ovarian function
• Estradiol — Evaluated alongside FSH
• AMH (anti-Müllerian hormone) — Measures ovarian reserve; can be tested any day
• LH (luteinizing hormone) — Useful for PCOS diagnosis

Day 21 Progesterone (or 7 days post-ovulation):

• Confirms ovulation occurred

Thyroid Panel:

• TSH and possibly T3/T4
• Thyroid dysfunction affects fertility and pregnancy

HSG (Hysterosalpingogram):

• X-ray with dye to check if fallopian tubes are open
• Also evaluates uterine cavity shape
• Done days 5-12 of cycle (after bleeding, before ovulation)

Pelvic Ultrasound:

• Visualizes ovaries and uterus
• Counts antral follicles (part of ovarian reserve assessment)
• Detects fibroids, polyps, cysts, or structural issues

For Men

Semen Analysis:

• Evaluates sperm count, motility, and morphology
• Usually requires 2-5 days of abstinence before the test
• Should be repeated if results are abnormal

Additional tests if needed:

• Hormone testing (FSH, testosterone)
• DNA fragmentation testing
• Physical exam by urologist

At-Home Testing Options

If you want preliminary data before your appointment, at-home tests can provide useful information:

Treatment Options Overview

Depending on your diagnosis, treatment ranges from simple lifestyle changes to advanced reproductive technology.

Level 1: Lifestyle & Timed Intercourse

For mild issues or unexplained infertility, you might start with:

• Optimizing timing with monitored cycles
• Addressing weight, nutrition, or lifestyle factors
• Supplements for egg or sperm quality

Level 2: Medication

• Clomid (clomiphene) — Stimulates ovulation; often first-line for anovulatory cycles
• Letrozole (Femara) — Similar to Clomid; often preferred for PCOS
• Metformin — For PCOS-related insulin resistance
• Thyroid medication — If thyroid is the issue

Level 3: IUI (Intrauterine Insemination)

Washed sperm placed directly in the uterus around ovulation. Often combined with ovulation-stimulating medication. Success rates: 10-20% per cycle.

Level 4: IVF (In Vitro Fertilization)

Eggs retrieved and fertilized outside the body; embryos transferred to uterus. Most effective treatment for many diagnoses. Success rates vary by age: 40-50% per cycle for women under 35, declining with age.

Level 5: Advanced Options

• IVF with donor eggs
• Gestational carrier (surrogacy)
• Donor sperm
• Embryo adoption

Your doctor will recommend a path based on your specific diagnosis, age, and preferences. You don't have to do everything—treatment is collaborative.

How to Prepare for Your Appointment

Gather Your Data

• Cycle history: Dates of last several periods, typical cycle length
• Tracking data: OPK results, BBT charts, app data
• Medical records: Previous test results, surgical records, ultrasound reports
• Medication list: Current medications and supplements
• Partner info: Their medical history, any known issues

Questions to Think About

• How long have you been trying?
• How are you timing intercourse?
• Any symptoms or irregularities you've noticed?
• Your goals and concerns for treatment

Practical Considerations

• Check insurance coverage for fertility testing and treatment
• Bring your partner if possible (they may have questions too)
• Plan for a longer appointment (1-2 hours is typical)
• Bring a notebook or plan to take notes

Questions to Ask Your Doctor

Here's a list of questions to consider asking at your consultation:

About Your Situation

• Based on my history, what do you think might be causing difficulty conceiving?
• What tests do you recommend, and what will they tell us?
• Are there any red flags in my history?

About Testing

• When during my cycle should I schedule tests?
• How long until we have all results?
• What are the costs, and what's covered by insurance?

About Treatment

• What treatment options would you recommend for someone in my situation?
• What are the success rates for each option?
• What are the risks and side effects?
• How much does treatment cost?
• How many cycles should we try before moving to the next level?

About Timeline

• How long should we expect the evaluation to take?
• If we need treatment, how soon could we start?
• Given my age, is there urgency to move quickly?

Frequently Asked Questions