Trying to conceive can be an exciting, hopeful journey—but when months go by without success, it can also become confusing and emotionally taxing. If you’ve been wondering whether it’s time to seek professional help, this guide explains the most important signs that suggest a fertility evaluation may be necessary.
Why Fertility Evaluations Matter
Fertility evaluations help uncover the root causes of delayed conception. They assess hormone levels, ovulation status, egg reserve, and the structure and function of reproductive organs. Early detection of fertility issues allows you to take timely action, explore treatment options, and increase your chances of achieving a healthy pregnancy.
Top Signs It’s Time to Schedule a Fertility Evaluation
1. You’ve Been Trying to Conceive Without Success
- Under 35? Seek evaluation after 12 months of regular, unprotected sex without conception.
- 35 or older? Seek help after 6 months.
- Over 40? Consider a consultation even before trying, to proactively assess fertility.
This timeline is based on the natural decline in fertility with age—particularly due to diminished egg quality and quantity after age 35.
2. Irregular or Absent Menstrual Cycles
A normal cycle occurs every 21 to 35 days. Irregular periods may signal:
- Anovulation (not releasing an egg)
- Polycystic Ovary Syndrome (PCOS)
- Thyroid dysfunction
- Premature ovarian insufficiency (POI)
If your periods are consistently irregular, too light, too heavy, or absent, it’s time for a fertility workup.
3. You’ve Had Multiple Miscarriages
If you’ve experienced two or more miscarriages, it may point to:
- Uterine abnormalities (e.g., septum, fibroids)
- Genetic issues
- Hormonal imbalances (e.g., progesterone deficiency)
- Blood clotting disorders
- Chromosomal abnormalities in you or your partner
A fertility evaluation can help uncover the cause and guide future pregnancy planning.
4. You Have a Known Reproductive Condition
Certain medical conditions are known to interfere with fertility. If you’ve been diagnosed with any of the following, an early fertility evaluation is recommended:
- PCOS
- Endometriosis
- Uterine fibroids or polyps
- Pelvic inflammatory disease (PID)
- Blocked fallopian tubes
- Primary ovarian insufficiency (POI)
- Hypothalamic amenorrhea
These conditions may reduce ovulation, damage reproductive organs, or create a hostile uterine environment.
5. You Have a History of Pelvic Surgery or STIs
Pelvic or abdominal surgeries, such as for endometriosis, appendicitis, or fibroids, can lead to scar tissue or adhesions that interfere with fertility.
Sexually transmitted infections—especially chlamydia and gonorrhea—can lead to tubal blockage or pelvic inflammatory disease (PID), which impairs natural conception.
6. You Have Symptoms of a Hormonal Imbalance
Fertility is closely tied to hormone function. Watch for these signs:
- Excess facial or body hair (hirsutism)
- Severe acne
- Unexplained weight gain
- Hair thinning or loss
- Chronic fatigue
- Cold intolerance or heat sensitivity
These may be linked to PCOS, thyroid disorders, or elevated prolactin—each of which can impact ovulation.
7. You’re Over 35 and Want to Plan Ahead
Even if you haven’t started trying to conceive, it’s wise to assess your fertility early if you’re in your mid-30s or older. Age is a major factor in fertility decline, and a proactive evaluation can:
- Measure AMH levels (egg reserve)
- Evaluate menstrual health and ovulation
- Guide decisions on egg freezing or early treatment if needed
8. You’ve Had Cancer Treatment
Chemotherapy, radiation, and certain surgeries can affect fertility. If you’ve undergone cancer treatment, a fertility evaluation can determine if your ovarian function is intact or if fertility preservation options (like egg or embryo freezing) should be discussed.
9. Your Partner May Have a Fertility Issue
Fertility isn’t just about female health—male factor infertility accounts for up to 40–50% of cases. If your partner has:
- A history of undescended testes
- Past urogenital surgery or trauma
- Low libido or erectile dysfunction
- A history of chemotherapy or radiation
- Varicocele (enlarged veins in the scrotum)
… then a semen analysis may be needed as part of the couple’s evaluation.
What to Expect in a Fertility Evaluation
A comprehensive female fertility evaluation typically includes:
- Detailed medical history and menstrual tracking
- Bloodwork for hormone levels (AMH, FSH, LH, estradiol, TSH, prolactin)
- Transvaginal ultrasound to assess ovaries and uterus
- Ovulation monitoring (e.g., progesterone levels)
- HSG to check fallopian tube openness
- Additional imaging or laparoscopy, if needed
Take the First Step Toward Clarity
Fertility struggles are deeply personal, but you don’t have to navigate them alone. If you identify with any of the signs listed above, a timely evaluation can bring answers, relief, and a clearer path forward.
