In this article 5 sections
Difficulty becoming pregnant can be confusing, especially when periods seem regular and neither partner feels unwell. Infertility describes a problem achieving pregnancy. It is a health condition, not a reflection of how much someone wants a baby or how well they have looked after themselves.
Pregnancy depends on several things happening together. An egg needs to be released, sperm need to reach and fertilise it, and the resulting embryo needs to develop and attach inside the uterus. A difficulty at any of these stages can reduce the chance of conception, and sometimes more than one factor is involved.
When difficulty conceiving needs assessment
For a woman younger than 35, assessment is usually recommended after 12 months of regular unprotected sex without pregnancy. From 35 onwards, it is generally appropriate after six months. Around age 40 or above, discussing pregnancy plans promptly can help avoid losing time that may affect treatment choices.
These timeframes do not mean you must wait with a known concern. Very irregular or absent periods, significant pelvic pain, a previous ectopic pregnancy, cancer treatment or a known sperm problem are reasons to seek advice earlier. A doctor can also help when pain, erection problems or difficulties with ejaculation are making intercourse difficult.
Common causes in women
Ovulation problems can mean that an egg is released infrequently or not at all. Conditions such as polycystic ovary syndrome (PCOS) and some thyroid disorders can affect this process. The pattern of your periods, symptoms and selected tests help the doctor understand whether ovulation is likely to be happening.
Other causes include damage to the fallopian tubes, endometriosis and certain problems within the uterus. Age also matters because both the number of remaining eggs and their likelihood of developing into a healthy pregnancy change over time. A scan finding or blood-test result needs to be interpreted in this wider picture, rather than treated as a complete diagnosis by itself.
Common causes in men
Male fertility can be affected by the number of sperm, how they move, their shape or whether sperm can reach the semen. Hormone conditions, obstruction, some medicines and previous illness or treatment may contribute. Often, there are no obvious symptoms, which is why feeling healthy does not rule out a sperm-related problem.
A semen analysis is usually an early part of the assessment. If a result is outside the laboratory's reference range, the doctor may repeat it and arrange further evaluation. One unusual result does not automatically mean pregnancy is impossible or that donor sperm will be needed.
When the tests do not find a clear cause
Sometimes standard investigations show ovulation, open tubes and semen results that do not explain the difficulty. This is called unexplained infertility. It does not mean the problem is imaginary, or that stress must be responsible; the tests cannot measure every part of conception.
The next step depends on age, how long you have been trying and the overall findings. Some couples may continue trying with a review date, while others may consider treatment. The recommendation should explain what it is expected to improve and when the plan will be reassessed.
What happens after the first consultation
A useful assessment considers both partners from the beginning. Bring previous reports, a brief pregnancy and medical history, and a list of medicines or supplements. Tests may include semen analysis, an ultrasound, selected hormone tests and an assessment of the fallopian tubes, depending on your history.
An appointment does not commit you to IVF. Treatment may address an underlying condition, support ovulation or involve intrauterine insemination (IUI) or in vitro fertilisation (IVF) when appropriate. The aim is to understand the likely difficulty and choose a next step that makes sense for your health, priorities and circumstances.