When to talk to a doctor about fertility

Couples routinely wait longer than they need to, usually out of a sense that asking is admitting something. The timelines exist so you do not have to guess.

The timelines

The difference is not arbitrary. Fertility declines gradually from around 32 and more quickly after about 37, so the cost of waiting is not the same at every age.

• Under 35 — an evaluation after twelve months of regular unprotected intercourse without conceiving
• 35 or older — after six months
• Over 40 — talk to your ob-gyn now rather than waiting out a period first

Reasons to go sooner, whatever your age

• Cycles that are irregular, very long, very short, or absent
• Known endometriosis, PCOS, or a thyroid condition
• Previous pelvic surgery, or a history of pelvic infection
• Two or more pregnancy losses
• Known problems on your partner's side, or previous chemotherapy or radiation for either of you
• Pain with periods or with sex that is severe enough to disrupt your life

What the first appointment is actually like

Less dramatic than people expect. It is mostly a conversation — your cycles, your history, how long you have been trying, anything relevant on both sides.

Testing usually starts simply: blood tests for hormones and thyroid, a check that ovulation is happening, imaging to look at the uterus and tubes, and a semen analysis. That last one matters, because a substantial share of infertility involves a male factor and it is the easiest thing on the list to test.

Both of you get investigated. A workup that only looks at the woman is an incomplete workup.

Going is not committing to anything

An evaluation is information. Plenty of couples find something straightforward and treatable, and plenty find nothing wrong at all, which is its own kind of useful.

You are not signing up for IVF by making an appointment, and you can stop at any point.

Bring this with you

• Roughly how long you have been trying, and how regularly
• Your last few cycle dates, if you have them anywhere
• Any previous pregnancies or losses
• Medications and supplements, both of you, including the natural ones
• The questions you actually want answered, written down

And the other part

Wanting a baby and not getting one is a particular grief, made harder by being largely invisible and by arriving again every month.

It is worth telling somebody — a friend, your church, a counsellor. This is not a thing to carry between the two of you alone for years.