There's a common misconception that seeing a fertility specialist means something is "wrong" with you or that you'll be pushed into expensive treatments. In reality, many people who see a reproductive endocrinologist end up conceiving naturally or with minimal intervention once issues are identified.
Getting evaluated is about understanding your situationânot necessarily about starting aggressive treatment.
The General Guidelines by Age
When to Seek Help Based on Age
After 12 months of trying
If you've been having regular, unprotected sex timed around ovulation for a year without success, it's time for an evaluation. About 85% of couples conceive within 12 monthsâif you haven't, there may be an identifiable issue.
After 6 months of trying
Time is more valuable at this age. Fertility declines more rapidly after 35, so waiting a full year means losing precious time if treatment is needed. Six months of well-timed intercourse should be enough for most fertile couples.
Immediately or within 3 months
Every month matters after 40. Don't waitâsee a specialist right away or within a few months of starting to try. Fertility treatments also become less effective with age, so earlier intervention improves your odds.
Signs You Should See a Specialist Sooner
Regardless of how long you've been trying, certain situations warrant earlier evaluation:
Irregular or Absent Periods
If your cycles are very irregular (varying by more than 7-10 days) or absent, you may not be ovulating consistently. No ovulation = no pregnancy. Getting evaluated sooner rather than later makes sense.
Painful Periods or Suspected Endometriosis
Severe menstrual pain, pain during sex, or other endometriosis symptoms warrant evaluation. Endometriosis can affect fertility, and earlier treatment may improve outcomes.
History of Miscarriage
Two or more miscarriages (recurrent pregnancy loss) deserve investigation. There may be underlying causesâchromosomal, hormonal, anatomical, or immunologicalâthat can be identified and treated.
Known Medical Conditions
PCOS, thyroid disorders, diabetes, STI history, previous pelvic surgery, or known male factor issues are all reasons to see a specialist early. You already have information suggesting potential issues.
Genetic Concerns
If you or your partner carry known genetic conditions or have a family history of genetic disorders, seeing a specialist can help you understand options like PGT (preimplantation genetic testing).
Male Partner Concerns
History of undescended testes, testicular injury, chemotherapy, known low sperm count, or difficulty with erection/ejaculation. Male factor is involved in about half of infertility casesâdon't overlook it.
If something feels offâeven if you can't pinpoint whyâit's okay to seek evaluation. You know your body. A good fertility specialist won't dismiss your concerns, and getting information doesn't obligate you to pursue treatment.
Types of Fertility Specialists
Reproductive Endocrinologist (RE)
An OB-GYN who completed an additional 3-year fellowship in reproductive endocrinology and infertility. REs are the specialists for diagnosing and treating infertility, performing IUI and IVF, and managing complex cases.
When to see: For comprehensive fertility evaluation, ovulation disorders, unexplained infertility, recurrent miscarriage, or when IUI/IVF may be needed.
Reproductive Urologist
A urologist who specializes in male reproductive issues. They diagnose and treat male infertility, including low sperm count, varicocele, hormonal issues, and obstructions.
When to see: For abnormal semen analysis results, suspected male factor infertility, or when the male partner needs evaluation and treatment.
OB-GYN
Your regular gynecologist can perform initial fertility testing (hormone levels, ultrasound, HSG) and prescribe basic ovulation medications like Clomid or letrozole.
When to see: For initial evaluation if you're just starting to investigate. They can do basic workup and refer to an RE if needed.
What to Expect at Your First Appointment
A fertility evaluation typically involves both partners and includes:
Medical History
Detailed review of both partners' health, menstrual history, sexual history, and any prior pregnancies
Physical Exam
Pelvic exam for her, possibly testicular exam for him if seeing a urologist
Blood Work
Hormone testing (FSH, AMH, TSH, prolactin, others) to assess ovarian reserve and hormonal balance
Ultrasound
Transvaginal ultrasound to count antral follicles (AFC) and check for fibroids, cysts, or other issues
Semen Analysis
Assesses sperm count, motility, and morphology. Essentialâmale factor is involved in ~50% of cases
HSG or SHG
X-ray or ultrasound to check if fallopian tubes are open and uterine cavity is normal
The initial evaluation usually takes 1-2 menstrual cycles to complete all testing. After that, your RE will discuss findings and options with you.
Questions to Ask Your Fertility Specialist
- What tests do you recommend and why?
- What do my results suggest about our chances?
- What treatment options do you recommend, and in what order?
- What are the success rates for recommended treatments at your clinic?
- What are the costs, and what does insurance cover?
- Are there lifestyle changes that could improve our chances?
- How long should we try each treatment before moving to the next?
- When would IVF become the recommendation?
How to Find the Right Specialist
Check credentials: Look for board certification in reproductive endocrinology and infertility (ABOG subspecialty). For male partners, a reproductive urologist should be board-certified in urology with fellowship training in male reproductive medicine.
Review success rates: In the US, IVF clinics report data to the CDC and SART (Society for Assisted Reproductive Technology). Compare clinics, but understand that rates depend partly on patient populationâclinics that take difficult cases may have lower rates despite excellent care.
Consider convenience: Fertility treatment often requires frequent monitoring appointments (sometimes every 1-2 days during treatment cycles). A clinic that's reasonably accessible matters.
Trust your gut: You should feel heard, respected, and confident in your care team. If a clinic feels rushed, dismissive, or just not right, it's okay to seek a second opinion.
What If You're Not Ready for Treatment?
Getting evaluated doesn't mean you have to start treatment immediately. Many people choose to:
- Get informationâknow what you're dealing with, then decide
- Make lifestyle changes firstâoptimize what you can control before medications
- Try longer naturallyâwith the peace of mind that nothing major is wrong
- Preserve fertilityâegg freezing if you're not ready but want to keep options open
A good RE will present options without pressuring you. It's your body, your timeline, and your decision.
Not Sure Where You Stand?
Our quiz can help you understand your situation and whether it's time to seek help.
Take the Fertility Quiz âThe Bottom Line
Seeing a fertility specialist is about getting information and understanding your options:
- Follow age-based guidelinesâ12 months under 35, 6 months at 35-39, immediately at 40+
- Don't wait if you have red flagsâirregular periods, pain, miscarriage history, known conditions
- Evaluation isn't commitmentâyou're getting information, not signing up for IVF
- Include your partnerâmale factor is involved in half of cases
- Earlier is usually betterâtime is a factor you can't get back
The couples who wish they'd acted differently almost always wish they'd sought help sooner, not later. When in doubt, get evaluated. The worst outcome is informationâand information is power.