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Infertility is the failure to conceive after 12 months of regular unprotected intercourse, or after 6 months if you are 35 or older. If you are 40 or over, or you already know about a relevant problem — absent or very irregular periods, known endometriosis, previous pelvic surgery or infection, prior chemotherapy, or a known issue with your partner's semen analysis — evaluation should start immediately rather than after a waiting period.

Roughly a third of cases trace to a female factor, a third to a male factor, and the rest to a combination or to no cause that testing finds. Both partners are evaluated. Testing only the woman is a common and expensive mistake, because semen analysis is the cheapest, fastest and least invasive test in the entire workup.

When to come in

You are under 35 and have been trying for a year
You are 35 to 39 and have been trying for six months
You are 40 or older and are trying — come now
Your periods are absent, very irregular, or came late and never settled
You have had two or more pregnancy losses
You have known endometriosis, fibroids, PCOS, pelvic inflammatory disease, or previous pelvic or tubal surgery
Your partner has had testicular surgery or injury, chemotherapy, or a known abnormal semen analysis
You are simply thinking ahead and want to know where you stand

The evaluation

Four questions have to be answered: are you ovulating, are the tubes open, is the uterine cavity normal, and is the sperm adequate.

Ovulation. A mid-luteal progesterone level, cycle tracking, or ovulation predictor kits. Regular monthly cycles are strong evidence that you are ovulating; absent or highly irregular cycles are the clearest sign that you are not. See PCOS and missing periods.

Blood work. Thyroid function, prolactin, and androgens where the pattern suggests it. Ovarian reserve testing with AMH and antral follicle count on ultrasound estimates the quantity of eggs remaining. Understand what that tells you: ovarian reserve testing predicts response to fertility medication, not your chance of conceiving naturally. A low AMH in a woman with regular cycles is not a diagnosis of infertility, and it is regularly misread as one.

Imaging. Pelvic ultrasound for fibroids, polyps, ovarian cysts and the appearance of the ovaries — see ultrasound. Hysterosalpingogram, an X-ray with contrast, to check whether the fallopian tubes are open and to outline the uterine cavity.

**Hysteroscopy** where the cavity needs direct assessment, or to remove a polyp, a submucosal fibroid or scar tissue found on imaging.

**Laparoscopy** in selected cases, when endometriosis or pelvic adhesions are suspected and would change management.

Semen analysis for your partner, ideally early. It is repeated if abnormal, since results vary between samples, and an abnormal result leads to referral to a urologist or male fertility specialist.

What is treatable, and where

Common findings and what follows:

Ovulation disorders, most often PCOS. Ovulation induction with letrozole or clomiphene, alongside weight, insulin resistance and thyroid management where relevant. This is among the most successfully treated causes of infertility.
Thyroid disease or high prolactin. Corrected medically, often restoring ovulation on its own.
**Uterine fibroids and polyps** distorting the cavity. Removed surgically — see myomectomy.
**Endometriosis.** Surgical treatment improves fertility in selected cases; in others, moving to assisted reproduction is the better route.
Blocked tubes, severe male factor, or unexplained infertility that has not responded to first-line treatment. These call for intrauterine insemination or IVF, which we arrange by referral to a reproductive endocrinologist. We continue to care for you throughout, and once you are pregnant we provide prenatal care.

Being told you need a specialist is not being turned away. It is being sent to the right place without losing months first.

Age, honestly

Fertility declines with age, gradually from the early thirties and more steeply after 35, driven by both the number and the quality of remaining eggs. Miscarriage risk rises on the same curve. That is not a reason for panic at 34 and it is not a reason for false reassurance at 41. It is the reason the evaluation thresholds are shorter as you get older, and the reason a delay of a year matters more at 39 than at 29.

Male fertility declines too, more slowly and later, and it is not zero-risk to ignore.

Cost and coverage

Illinois is one of a small number of states with an infertility insurance mandate. Certain group health plans issued in Illinois are required to cover diagnosis and treatment of infertility, including in vitro fertilisation, subject to conditions. Not every plan is covered by the mandate — self-funded employer plans in particular are generally exempt. Call the number on your insurance card and ask specifically whether your plan is subject to the Illinois infertility mandate, what it covers, and what prior authorisation is required. We do not publish prices for this; what you pay depends almost entirely on your plan.

Talk to us

Medical disclaimer

This page is general health information, not medical advice for any individual, and not insurance advice. Which tests and treatments are appropriate depends on your age, history and findings, and should be decided with a physician. Seek urgent care for severe one-sided pelvic pain, shoulder-tip pain, or fainting with a positive pregnancy test, which can indicate an ectopic pregnancy.