There's a common misconception that seeing a fertility specialist means something is "wrong" with you. In reality, fertility specialists help couples navigate the path to pregnancy—whether that means identifying and treating an issue, optimizing timing, or simply providing reassurance that everything is on track.
But timing matters. Fertility does decline with age, and certain conditions benefit from early intervention. Here's how to know when it's time to seek help.
The Standard Timeline: When to Seek Help by Age
Official ASRM Recommendations
The American Society for Reproductive Medicine (ASRM) provides age-based guidelines for when couples should seek evaluation:
Why Age Changes the Timeline
These aren't arbitrary numbers. They're based on two realities: the natural decline in fertility with age and the fact that fertility treatments also become less effective over time.
Under 35: About 85% of couples will conceive within 12 months of trying. Seeking help after a year identifies the ~15% who may benefit from evaluation while avoiding unnecessary intervention for the majority who just needed more time.
35-39: Monthly conception rates drop, and the window for effective treatment narrows. Six months of unsuccessful trying at this age warrants investigation—not because something is definitely wrong, but because time is more precious.
40+: With monthly conception odds around 5-10% and declining egg quality, there's little benefit to waiting. An early evaluation ensures you're making the most of the time you have, whether that means optimizing natural conception or moving to treatment.
💡 Important Nuance
These timelines assume you're having regular, unprotected sex during your fertile window. If you've only been loosely trying (not tracking ovulation, having infrequent sex), the clock hasn't really been running. True "trying" means sex every 1-3 days around ovulation for the recommended timeframe.
Warning Signs: When to See a Specialist Sooner
Regardless of how long you've been trying, certain symptoms or history warrant earlier evaluation. Don't wait for the standard timeline if any of these apply:
⚠️ Red Flags That Warrant Earlier Evaluation
Irregular or Absent Periods
Cycles shorter than 21 days, longer than 35 days, or completely absent may indicate ovulation problems. See a specialist before your standard timeline.
Painful Periods or Sex
Severe menstrual cramps, pain during intercourse, or chronic pelvic pain may suggest endometriosis, which affects fertility and benefits from early treatment.
History of Miscarriage
Two or more miscarriages warrant evaluation for recurrent pregnancy loss. Testing can identify treatable causes and guide future attempts.
Previous Pelvic Surgery
Surgery for appendicitis, ovarian cysts, ectopic pregnancy, or other abdominal conditions may have caused scarring affecting fertility.
History of STIs
Chlamydia or gonorrhea can cause tubal damage even without symptoms. If you have a history of STIs, get evaluated early.
Known Male Factor Issues
If your partner has had testicular injury, surgery, chemotherapy, or a previous abnormal semen analysis, seek help immediately.
PCOS Diagnosis
Polycystic ovary syndrome is a common cause of irregular ovulation. If you have PCOS, work with a specialist from the start.
Chronic Health Conditions
Thyroid disorders, diabetes, autoimmune conditions, or cancer history may affect fertility and warrant specialized care.
Partner Factors to Consider
Fertility is a couple's issue, and male factors contribute to about 40-50% of infertility cases. Your partner should be evaluated if he has any of the following: history of testicular injury, surgery, or undescended testicles; chemotherapy or radiation treatment; erectile dysfunction or ejaculation problems; very low libido; known hormonal issues; or previous fertility testing showing abnormalities.
A complete fertility evaluation should always include both partners. It's inefficient to spend months testing and treating one partner while ignoring the other. A basic semen analysis is inexpensive and can quickly identify or rule out male factor issues.
Types of Fertility Providers: Who Should You See?
Not all fertility help comes from the same type of doctor. Understanding your options helps you get the right care at the right time.
Provider Types and When to See Them
Your regular OB/GYN can perform initial fertility evaluations, including basic blood work, ovulation assessment, and referrals for semen analysis and imaging. Many can prescribe first-line treatments like Clomid or letrozole for ovulation induction.
✓ Good first stop for basic evaluation and simple ovulation issues
Board-certified OB/GYNs with additional fellowship training in reproductive medicine. REs specialize in diagnosing and treating infertility, performing IVF and other advanced reproductive technologies, and managing complex cases.
✓ See an RE if: initial treatments fail, you need IVF/IUI, you have complex medical history, or you're 38+
Urologists with specialized training in male reproductive health. They diagnose and treat male infertility, perform surgical sperm retrieval, and address conditions like varicocele that affect sperm production.
✓ See if semen analysis is abnormal or male factor is suspected
Specialists in immune-related fertility issues, including recurrent pregnancy loss and implantation failure. Not always needed, but may help in specific cases.
✓ Consider after multiple IVF failures or recurrent miscarriages without clear cause
Should You Start with Your OB/GYN or Go Straight to an RE?
This depends on your situation. Your OB/GYN is a reasonable first stop if you're under 35 with no known issues and just hitting the 12-month mark. They can run basic tests and try simple interventions.
However, consider going directly to a reproductive endocrinologist if you're 38 or older, have known fertility-affecting conditions (PCOS, endometriosis, tubal issues), have had previous fertility treatment, have had multiple miscarriages, or your partner has known male factor issues.
The advantage of an RE: they won't waste time on interventions unlikely to work for your specific situation. They can quickly assess what's happening and recommend the most efficient path forward.
What to Expect at Your First Appointment
Your first fertility consultation will likely last 30-60 minutes and cover your complete medical and reproductive history. Coming prepared helps maximize this time.
📋 Pre-Appointment Checklist
Medical History
- Dates of last 3-6 periods
- Typical cycle length
- Previous pregnancies/outcomes
- Past surgeries (any type)
- Current medications
- Chronic conditions
- Family history (fertility issues, early menopause)
TTC History
- How long you've been trying
- Ovulation tracking methods used
- Frequency of intercourse
- Previous fertility testing
- Previous treatments tried
- Lifestyle factors (smoking, alcohol, exercise)
Partner Information
- His age and general health
- Previous children
- Known medical issues
- Previous semen analysis results
- Medications
- Lifestyle factors
Practical Items
- Insurance cards
- Referral (if needed)
- Previous test results/records
- List of questions
- Notebook for notes
- Partner (if possible)
Initial Tests Often Ordered
After your consultation, the specialist will likely order some combination of the following tests:
For the female partner: Blood work for hormone levels (FSH, LH, estradiol, AMH, thyroid, prolactin), often drawn on cycle day 2-4. Transvaginal ultrasound to assess ovaries (antral follicle count) and uterus. HSG (hysterosalpingogram) to check if fallopian tubes are open. Possible progesterone test mid-luteal phase to confirm ovulation.
For the male partner: Semen analysis is the cornerstone test—it evaluates sperm count, motility, and morphology. If abnormal, repeat testing and possibly hormone evaluation or referral to a reproductive urologist.
📝 Questions to Ask Your Specialist
- What do you think is causing our difficulty conceiving? — Get their initial assessment even before all tests are complete.
- What tests do you recommend and why? — Understand the purpose of each test.
- What are our treatment options? — Ask about the range from least to most aggressive.
- What are success rates for each option given our specific situation? — Get personalized numbers, not just clinic averages.
- What's the timeline? — How long for testing, treatment cycles, expected time to conception?
- What will this cost, and what does insurance cover? — Get specific numbers before starting.
- Are there lifestyle changes that could improve our chances? — What can you do while pursuing treatment?
- What's your recommendation for our next steps? — Get a clear action plan.
Understanding Costs and Insurance
Fertility care costs vary widely depending on your location, insurance coverage, and what treatments you need. Here's a general sense of what to expect:
💰 Typical Cost Ranges (Without Insurance)
| Service | Typical Cost Range |
|---|---|
| Initial consultation | $200-$500 |
| Blood work panel | $200-$600 |
| Semen analysis | $100-$300 |
| Transvaginal ultrasound | $200-$500 |
| HSG (tubal testing) | $500-$1,500 |
| Clomid/Letrozole cycle (with monitoring) | $500-$1,500 |
| IUI cycle | $500-$2,000 |
| IVF cycle (medications + procedure) | $15,000-$25,000 |
Note: These are rough estimates. Costs vary significantly by location and clinic. Always get specific quotes before starting treatment.
Insurance Coverage for Fertility
Coverage varies dramatically. As of 2024, 21 states have laws requiring some fertility coverage, but the extent varies. Some plans cover diagnostic testing but not treatment. Others cover IUI but not IVF. A few cover multiple IVF cycles.
Questions to ask your insurance: Is fertility testing covered? Is treatment covered, and if so, what types? Is there a lifetime maximum? Do you need a specific diagnosis? Are there waiting periods? Is preauthorization required?
If coverage is limited: Ask your clinic about payment plans, fertility financing companies (like Prosper Healthcare Lending), employer benefits (some large employers offer fertility coverage even when insurance doesn't), and clinical trials that may provide treatment at reduced cost.
Finding the Right Fertility Specialist
🔍 Resources for Finding a Specialist
SART (Society for Assisted Reproductive Technology)
Searchable database of fertility clinics with success rate data. All SART member clinics report outcomes.
sart.org →ASRM Find a Provider
Search for reproductive endocrinologists and other fertility specialists by location.
asrm.org →CDC ART Success Rates
Official success rate data for all US fertility clinics. Compare outcomes by age and diagnosis.
cdc.gov/art →RESOLVE: The National Infertility Association
Patient advocacy organization with resources, support groups, and help navigating the fertility journey.
resolve.org →What to Look for in a Clinic
Success rates: Look at age-specific success rates for your diagnosis, not just overall clinic rates. A clinic with lower overall rates might excel with your particular situation.
Experience with your diagnosis: If you have a specific condition (PCOS, male factor, recurrent loss), look for specialists with expertise in that area.
Location and logistics: Fertility treatment often requires frequent monitoring appointments, sometimes on short notice. Consider how far you're willing to travel and whether the clinic's hours work for your schedule.
Communication and support: You'll be going through an emotionally intense process. A clinic with good communication, available nurses/coordinators, and mental health support makes a real difference.
Cost transparency: Good clinics provide clear cost estimates upfront. Be wary of clinics that won't discuss costs or seem evasive about pricing.
Frequently Asked Questions
Not necessarily. Many couples who see fertility specialists conceive with simple interventions like timed intercourse with monitoring, ovulation induction medications (Clomid/letrozole), or IUI. IVF is typically recommended after simpler treatments haven't worked or when there's a specific indication (blocked tubes, severe male factor, advanced age).
Absolutely. Some couples seek a fertility evaluation for peace of mind, especially if they're planning to delay pregnancy or have concerns about their reproductive health. Many clinics offer "fertility assessments" that provide baseline testing without requiring a diagnosis of infertility.
Yes, if possible. Fertility is a couple's issue, and the specialist will want to discuss both partners' health history. Having both people present ensures everyone hears the same information and can ask questions. It also allows immediate discussion of his testing (semen analysis).
Start with the evaluation—sometimes simple, affordable interventions work. Ask about payment plans, look into fertility financing, check if your employer offers any benefits, and research grants (organizations like Baby Quest Foundation offer grants for treatment). Some clinics offer shared-risk programs where you pay a set fee and get a refund if treatment doesn't work.
Basic testing typically takes 2-4 weeks, as some tests need to be done at specific points in your cycle. A semen analysis can be done anytime. HSG is usually done in the first half of your cycle. Blood work for FSH/estradiol is drawn on cycle day 2-4. You can often begin initial treatment within 1-2 months of your first consultation.
The Bottom Line
Seeking help isn't giving up on natural conception—it's being proactive about your path to parenthood. Many couples who see specialists go on to conceive with minimal intervention. The evaluation itself often provides answers and peace of mind. Don't let fear or stigma keep you from getting information that could help.