When to See a Fertility Specialist, and What the Workup Includes

Knowing when to stop trying on your own is one of the hardest calls in getting pregnant. The good news is that the thresholds are clear, set by the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG). Infertility is common: the World Health Organization estimates about 1 in 6 people of reproductive age experience it at some point.⁵ This guide covers when to go, who should go sooner, and what a fertility workup includes for both partners.

When should you see a fertility specialist?

See a specialist after 12 months of regular, unprotected sex if the person trying to get pregnant is under 35, and after 6 months if they are 35 or older.¹ Those are ASRM’s thresholds for starting an evaluation when there is no known reason to worry. For women older than 40, ACOG and ASRM say more immediate evaluation and treatment are warranted.²

Sources: ASRM and ACOG.¹²³

Who should go sooner?

ASRM says diagnostic testing should start without delay when there is a condition known to cause infertility.³ That includes:

• Irregular cycles, cycles shorter than 25 days, bleeding between periods, infrequent periods or no periods
• Known or suspected disease of the uterus, fallopian tubes or pelvis, or endometriosis
• Known or suspected male subfertility
• Sexual dysfunction
• Conditions that can reduce ovarian reserve, such as chemotherapy, radiation or a fragile X (FMR1) premutation

If you have had a pelvic infection, mention it: it can point to suspected tubal disease, which is on that list. If you are over 35, read getting pregnant after 35; over 40, getting pregnant after 40. With cycles that are long or unpredictable, see irregular periods and PCOS and getting pregnant.

What counts as infertility?

ASRM updated its definition in 2023. Infertility is now defined as a disease, condition or status marked by any of: being unable to achieve a successful pregnancy based on your history, age, findings or test results; or needing medical help, such as donor sperm or eggs, to achieve a pregnancy alone or with a partner. For people having regular unprotected sex with no known cause, it keeps the 12-month (under 35) and 6-month (35 or older) evaluation thresholds.¹ The definition explicitly says it must not be used to deny or delay treatment because of relationship status or sexual orientation.¹

For single people, same-sex couples and anyone using donor sperm, ASRM recommends a directed history, exam and lab evaluation like any other patient, with tubal and uterine testing tailored to risk.³

What does a fertility workup include?

ASRM says the evaluation should be systematic, quick and cost-effective, starting with the least invasive tests for the most common causes.³ When a male partner is contributing sperm, both partners should be evaluated at the same time.³⁴

For the person with ovaries and a uterus

From ASRM’s 2021 committee opinion.³ A progesterone level above 3 ng/mL, taken about a week before the expected period, is presumptive evidence that ovulation happened.³ ASRM lists tests that should not be ordered routinely, including laparoscopy for unexplained infertility, sperm DNA fragmentation, postcoital tests, thrombophilia and immune testing.³

Ovarian reserve tests guide treatment; they do not tell you whether you can conceive naturally. ASRM says they should not be used as a fertility test in people who are not infertile.⁶ See AMH explained.

For the male partner

The AUA/ASRM guideline recommends a reproductive history and one or more semen analyses at the first evaluation.⁴ Because semen results vary from test to test, it advises considering at least two analyses a month apart, especially if the first is abnormal.⁴ Hormone tests (FSH and testosterone) are recommended for men with low libido, erectile problems, low or absent sperm, small testes or signs of a hormone problem, and a male reproductive specialist should see men with abnormal results.⁴

Infertility is due in whole or in part to male factors in about half of infertile couples.⁴ A semen analysis is cheap and fast; an at-home lab kit is a reasonable way to start (see semen analysis results).

Can you start with an at-home test?

You can, as long as it does not delay an evaluation you already qualify for. An at-home sperm test gives useful information quickly. At-home hormone tests give a number, not a verdict: in a JAMA study of 750 women aged 30 to 44, low AMH and high FSH did not lower the chance of conceiving within 6 or 12 cycles.⁷ AMH explained covers which questions these tests cannot answer.

If cost is the barrier, a cash-price clinician such as Sesame can order the blood tests, ultrasound and semen analysis.

Who to see: OB-GYN, reproductive endocrinologist or urologist?

An OB-GYN or primary care clinician can start the basic workup. A reproductive endocrinologist (an OB-GYN with further training in infertility) runs fertility clinics and offers treatments such as ovulation induction, IUI and IVF. For a male partner with abnormal results, the AUA/ASRM guideline calls for evaluation by a male reproductive expert, usually a urologist.⁴ If tests come back normal, read unexplained infertility; for treatment options, IUI vs IVF and IVF cost.

Looking after yourselves

Six or twelve months of negative tests is hard. Booking an evaluation is a step forward, not a failure, and it often brings answers or a plan quickly. The Support section covers coping and counseling options, and the rest of the Investigate hub explains each test.