Trying for a While? When to See a Fertility Specialist

TL;DR: See a doctor after 12 months of regular unprotected sex without a pregnancy, after six months if you are 35 or over, and straight away if you are over 40 or already know of something that affects fertility, like very irregular periods, past pelvic infection, endometriosis or a known sperm problem. Both partners should be checked from the start. First tests are usually simple: blood tests to confirm ovulation, an STI check, a pelvic scan, and a semen analysis. A cause is found for most couples, and needing help is common.

Every month the period arrives, and with it a quiet sinking feeling. Then the questions start: at family gatherings, at church, on the phone from your mother-in-law. "Any good news?" If you have been trying for a while, you may be caught between not wanting to panic and not wanting to waste time. This guide is about that middle place: how long is long enough, what happens when you do see someone, and how to look after yourself and your relationship along the way.

How long should you try before seeing a doctor?

The usual guide is 12 months of regular unprotected sex. The World Health Organization defines infertility as not achieving a pregnancy after 12 months or more of regular unprotected sex, and estimates that about one in six people of reproductive age experience it at some point in their lives. You are far from alone.

Age shortens that timeline. The American Society for Reproductive Medicine recommends starting an evaluation at 12 months for women under 35 and at six months for women 35 and older, with more immediate evaluation over 40. In the UK, NICE recommends that women aged 36 or over are offered a specialist referral as soon as they present, without waiting out the year.

For perspective, NICE reports that over 80% of couples conceive within a year when the woman is under 40 and they have regular sex without contraception. Of those who do not, about half conceive in the second year. So a year without a pregnancy is a good reason to get checked, and still leaves plenty of room for hope.

When should you go sooner?

Do not wait the full year if you or your partner already has a known or suspected reason for difficulty. Both NICE and ASRM say testing should start without delay in these situations. Go sooner if:

• Your periods are very irregular, far apart, or have stopped.
• You have been diagnosed with PCOS, endometriosis or fibroids.
• You have had a pelvic infection, a sexually transmitted infection, or pelvic or abdominal surgery.
• You have had treatment for cancer.
• Your partner has had testicular problems, surgery or injury, or a known low sperm count.
• Either of you finds sex difficult or painful.

What commonly causes difficulty conceiving?

Causes are spread across both partners, and sometimes there is more than one. According to the NHS, common causes in women include problems with ovulation, often linked to polycystic ovary syndrome (PCOS) or thyroid problems, as well as blocked or scarred fallopian tubes, endometriosis and fibroids. The WHO notes that tubal damage is often caused by untreated sexually transmitted infections, and also by complications of unsafe abortion or infection after childbirth, and that the relative importance of different causes varies between countries, partly because of differences in how common STIs are.

In men, the most common cause is poor semen quality: a low sperm count, sperm that do not move well, or sperm with an unusual shape. And for around one in four couples, no clear cause is found, which is called unexplained infertility. If you want to read more on specific conditions, see our guides to PCOS and fertility, endometriosis signs and fibroids.

What tests happen first?

The NHS says it is best for both partners to see the doctor, because problems can affect either or both of you. You will be asked about your periods, past pregnancies, sexual health, medicines, how often you have sex, and lifestyle. Be as open as you can, even about the awkward parts. A sex-related issue can sometimes be the easiest thing to fix.

For women, first tests usually include:

• A blood test for progesterone in the second half of your cycle, around day 21 of a 28 day cycle, to check whether you are ovulating. If your cycles are irregular, the timing is adjusted and you may also have tests for the hormones FSH and LH.
• A chlamydia test, usually a swab or urine sample.
• An ultrasound scan of your womb and ovaries.
• A test to check your fallopian tubes are open, such as an X-ray with dye (hysterosalpingogram) or a special ultrasound. Keyhole surgery (laparoscopy) is usually only offered if there is a reason to suspect a problem.

NICE advises a thyroid test only if you have symptoms of thyroid disease, and notes that the egg reserve test called AMH should not be used to predict your chance of natural conception. It is used to plan IVF, not to tell you whether you can get pregnant on your own. If a clinic is selling AMH testing as a fertility verdict, it is fair to ask questions.

For men, first tests usually include:

• A semen analysis, checking sperm count, movement and shape against WHO reference values. If the result is abnormal, NICE recommends repeating it, ideally about three months later.
• A chlamydia test.

We cover the male side in depth in male fertility: why it is half the conversation.

The weight nobody sees

Trying for a baby when it is not happening can be lonely, and in many African families it is rarely a private matter. A 2025 review of 48 studies from across Africa found that infertility-related stigma was widespread and deeply embedded in cultural norms, with psychological, relational and health consequences for the people affected. The WHO notes that women in particular often face social stigma, emotional stress, depression, anxiety and low self-esteem, and can even face violence or divorce. It also notes that women in relationships with men are often assumed to be the one with the fertility problem, whether they are or not.

A few things can help. Decide together, as a couple, what you will share and with whom. A simple line such as "we are in God's hands and seeing a doctor" can close a conversation kindly. Go to appointments together where you can, so the burden is not left on one person. And take your own mental health seriously: if you are struggling with low mood, anxiety, or strain in your relationship, tell your doctor. Our post on talking about mental health with your African family may help with the harder conversations.

Before your first appointment

Bring what you can: the dates of your last few periods, how long you have been trying, any previous test results, and a list of medicines and herbal remedies you both take. If you have not started folic acid, our preconception checklist is a good place to begin, and your fertile window explains how timing works.

Where Asele fits

Doctors will ask about your cycle in detail, and months of history are hard to recall on the spot. Asele lets you log your periods and symptoms as you go, and the Health Brief turns that history into a short summary you can bring to your appointment. If you want to talk through what a test means before or after, Amara can help in Yoruba, Hausa, Igbo, Swahili, French or English. You can find us at Asele.

This post is education, not medical advice. If you are worried about your fertility, see a doctor, whatever stage you are at.

References

1. World Health Organization. Infertility fact sheet. who.int
2. American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion, 2021. asrm.org
3. NICE. Fertility problems: assessment and treatment (NG257), 2026. Defining infertility and initial assessment; Initial advice; Investigation
4. NHS. Infertility: causes. nhs.uk
5. NHS. Infertility: diagnosis. nhs.uk
6. Ekpor E, Brobbey SS, Kumah CY, Akyirem S. Experience of infertility-related stigma in Africa: a systematic review and mixed methods meta-synthesis. International Health, 2025. pubmed.ncbi.nlm.nih.gov