What counts as infertility?
- If a woman is under 35 and hasn’t conceived after 12 months of regular, unprotected sex, consider evaluation.
- If she is 35 or older and hasn’t conceived after 6 months, consider evaluation.
- Immediate evaluation for women over 40 or anyone with known risk factors (like PCOS, endometriosis, prior surgeries, or known male issues).
- The definition is inclusive of all relationship types and sexual orientations.
Why infertility happens?
- Women’s fertility falls with age because egg number and quality decline; miscarriage risk rises.
- Male problems are involved in about 40–50% of cases and are the only cause in about 20%.
- About 30% of couples have “unexplained” infertility—problems that standard tests don’t detect.
What’s the infertility work-up?
- Detailed medical, menstrual, sexual, family, and lifestyle history and a physical exam.
- Blood tests for hormones and measures of egg supply (like AMH and ultrasound counts).
- Tests of the uterus and fallopian tubes (e.g., HSG or ultrasound with fluid) to look for blockages or abnormalities.
- Semen analysis to check sperm count, movement, and shape.
How is ovulation checked?
- Home ovulation (LH) kits are cheap and useful.
- A single progesterone blood test about a week after ovulation can confirm it happened.
- Basal body temperature tracking is less commonly used now.
Treatment options
- Depends on the cause: medicines to stimulate ovulation (e.g., for PCOS patients), surgery to fix problems, or assisted reproduction like IVF.
- IVF may use techniques like ICSI (injecting a sperm into an egg) or genetic testing of embryos in specific situations.
- Both partners are encouraged to optimize lifestyle: take prenatal vitamins/folic acid, avoid smoking, limit alcohol, manage weight, and reduce harmful exposures.
Special situations
- Urgent referral for women over 40 or anyone facing cancer treatment who wants fertility preserved.
- Very high or low BMI and other health issues may change treatment options and risks.
Ideally you want to discuss any concerns or questions you may have on your infertility with a trusted gynecologist or infertility specialist.
