When to See a Fertility Doctor
How long should you try on your own—and what are the warning signs?
General Guidelines
- Under 35: See a specialist after 12 months of trying
- 35-39: See a specialist after 6 months of trying
- 40+: Consider seeing a specialist before or shortly after you start trying
- Known issues: See a doctor immediately if you have PCOS, endometriosis, or other conditions
When to Seek Help by Age
The standard medical guidelines for when to see a fertility specialist are based on age and time trying. Here's what major medical organizations recommend:
12 Months of Trying
If you're under 35 and have been trying for 12 months with well-timed intercourse (during your fertile window), it's time to see a specialist.
Why this timeline? About 80% of couples under 35 will conceive within 12 months. If you haven't, there may be an underlying issue worth investigating.
6 Months of Trying
If you're 35-39, the recommendation is to seek help after 6 months of trying. Fertility declines more rapidly in this age range, so earlier intervention can make a significant difference.
Why shorter? Time matters more as egg quality and quantity decline. Earlier testing can identify treatable issues and avoid unnecessary delays.
Immediately or Within 3 Months
If you're 40 or older, consider seeing a fertility specialist before you start trying—or within the first few months. At this age, time is your most valuable resource.
Why so soon? Fertility declines significantly after 40, and treatments are more effective the sooner they're started. A baseline workup can help you understand your options.
📊 What the Numbers Say
Per cycle pregnancy rates by age (with well-timed intercourse):
• Under 30: ~25% per cycle
• 30-35: ~20% per cycle
• 35-40: ~15% per cycle
• Over 40: ~5-10% per cycle
Red Flags: See a Doctor Now
Regardless of age or how long you've been trying, certain signs warrant immediate evaluation:
🚩 Female Factors
- Irregular or absent periods: Cycles shorter than 21 days, longer than 35 days, or completely missing
- Very painful periods: Pain that interferes with daily activities (possible endometriosis)
- History of pelvic inflammatory disease (PID): Past infections can cause tubal damage
- Known PCOS, endometriosis, or fibroids: These conditions can affect fertility
- Two or more miscarriages: May indicate an underlying issue
- Previous cancer treatment: Chemotherapy and radiation can affect fertility
- History of STIs: Some infections can cause scarring
- Thyroid disorders: Can affect ovulation
🚩 Male Factors
- Known low sperm count or motility: Previous semen analysis showed issues
- History of testicular surgery, injury, or undescended testicles: Can affect sperm production
- Previous cancer treatment: Chemo and radiation affect sperm
- Erectile dysfunction or ejaculation problems: Physical barriers to conception
- History of STIs: Can cause blockages
- Varicocele: Enlarged veins in scrotum
⚠️ Don't Wait If...
If you have any known risk factors, don't wait the standard timeline. It's better to get tested early and rule out issues than to lose valuable time.
Types of Fertility Doctors
Understanding who to see can be confusing. Here's a breakdown:
| Provider | What They Do | When to See Them |
|---|---|---|
| OB/GYN | General reproductive health; basic fertility testing; Clomid prescriptions | First stop for initial evaluation; may refer to specialist |
| Reproductive Endocrinologist (RE) | Fertility specialist; advanced testing; IUI, IVF, and other treatments | After trying without success; complex cases; if IVF is needed |
| Urologist/Andrologist | Male fertility specialist; semen analysis; male factor treatment | When male factor is suspected or confirmed |
| Reproductive Immunologist | Immune-related fertility issues; recurrent pregnancy loss | Multiple miscarriages; implantation failure |
When to Go Straight to an RE
Consider going directly to a reproductive endocrinologist (rather than starting with your OB/GYN) if:
- You're over 38
- You have known fertility issues (PCOS, endometriosis, etc.)
- You've already done basic testing with your OB
- You suspect you'll need IVF
- Your insurance covers RE visits
What to Expect at Your First Visit
Your first fertility appointment will typically include:
Detailed Medical History
For both partners: menstrual history, pregnancy history, sexual history, previous surgeries, medications, family history, lifestyle factors (smoking, alcohol, drugs), and any previous fertility testing.
Physical Exam
Pelvic exam for women; genital exam for men (usually at a separate appointment with a urologist).
Initial Testing
Blood tests and imaging may be ordered at or soon after the first visit. Some tests are time-sensitive (need to be done on specific cycle days).
Discussion of Goals and Timeline
Your doctor will discuss your conception goals, timeline, and potential treatment paths based on initial findings.
💡 Pro Tip
Bring your partner to the first appointment if possible. Male factor contributes to about 40-50% of infertility cases, so both partners should be evaluated from the start.
Common Fertility Tests
For Women
| Test | What It Measures | Timing |
|---|---|---|
| Day 3 FSH & Estradiol | Ovarian reserve/function | Cycle day 2-4 |
| AMH (Anti-Müllerian Hormone) | Ovarian reserve; egg quantity | Any cycle day |
| TSH & Prolactin | Thyroid function; prolactin levels | Any cycle day |
| Day 21 Progesterone | Confirms ovulation occurred | 7 days after ovulation |
| Antral Follicle Count (AFC) | Number of follicles visible on ultrasound | Cycle day 2-5 |
| HSG (Hysterosalpingogram) | Checks if fallopian tubes are open | After period ends, before ovulation |
| Saline Sonogram (SIS) | Evaluates uterine cavity for polyps, fibroids | After period ends, before ovulation |
For Men
| Test | What It Measures |
|---|---|
| Semen Analysis | Sperm count, motility, morphology, volume |
| Hormone Testing | FSH, LH, testosterone (if semen analysis is abnormal) |
| DNA Fragmentation Test | Sperm DNA integrity (ordered if indicated) |
How to Prepare for Your Appointment
Gather Your Records
- Previous fertility test results (if any)
- Cycle tracking data (apps, BBT charts, OPK photos)
- List of medications and supplements
- Previous surgical records (especially pelvic surgeries)
- STI testing history
Prepare Questions
Write down your questions beforehand. Consider asking:
- What tests do you recommend and why?
- What's the likely cause of our difficulty?
- What are our treatment options?
- What are the success rates for someone in our situation?
- What's the timeline and cost of treatment?
- What lifestyle changes do you recommend?
Know Your Cycle
Be prepared to discuss:
- When your last period started
- How long your cycles typically are
- When you typically ovulate (if you track)
- Any cycle irregularities
For Men
Before a semen analysis, abstain from ejaculation for 2-5 days (not too short, not too long). Avoid hot tubs and saunas. Let the doctor know about any medications.
The Bottom Line
Don't wait too long to seek help. The standard guidelines are 12 months for women under 35, 6 months for 35-39, and immediate evaluation for 40+. But if you have any red flags or known issues, see a specialist sooner.
Fertility testing is informative, not scary. Many issues are highly treatable, and the sooner you identify them, the better your chances. Seeking help isn't giving up—it's taking the next step toward your goal. 💚