Infertility is the inability to become pregnant after one year of regular, unprotected sex. For women 35 and older, most providers recommend starting an evaluation sooner, usually after six months, because fertility naturally declines with age.
Infertility is more common than many people realize, and it does not mean something is wrong with you. It often means something is making pregnancy more difficult, and there may be steps you can take to improve your chances.
Some women have clear signs that something may be off, like irregular cycles, very painful periods, or a known condition like polycystic ovarian syndrome (PCOS) or endometriosis. Others feel completely healthy and are caught off guard when they cannot get pregnant on their timeline. In many cases, infertility comes down to ovulation patterns, sperm health, or how the fallopian tubes and uterus are functioning.
It is also important to know that fertility involves both partners. Roughly one-third of infertility cases are primarily related to female factors, one-third to male factors, and one-third to a combination or an unknown cause.
Common Causes of Infertility
There are many possible factors that can interfere with pregnancy. Some are straightforward and treatable. Others may require more support or specialized care.
Ovulation issues are among the most common issues preventing conception. If ovulation is irregular or absent, pregnancy becomes much harder to achieve. PCOS is a leading cause of irregular ovulation. In addition, hormone imbalances, thyroid problems, high stress, and significant weight changes can also interfere with conception.
Problems with the fallopian tubes can prevent sperm from reaching the egg, or keep a fertilized egg from traveling to the uterus. Past pelvic infections or inflammation are common contributors to tubal damage.
Uterine factors like fibroids, polyps, or structural differences can sometimes inhibit implantation or increase the risk of early pregnancy loss. Many women with these conditions still conceive, but an evaluation can help clarify what role these issues may be playing.
Endometriosis causes inflammation and scar tissue that can interfere with fertility. Some women do not realize they have it until they start trying to conceive. The good news is that treatment options exist, and managing endometriosis can improve fertility outcomes in some cases.
Age-related changes also play a role. Fertility declines gradually beginning in one’s early 30s and becomes more noticeable after 35, largely due to changes in egg quantity and quality. Age is only one piece of the picture, but it helps guide when to seek evaluation.
Male factor infertility is just as important. Low sperm count, reduced motility, or abnormal sperm shape can make conception more difficult. Smoking, heavy alcohol use, heat exposure, certain medications, and untreated medical conditions can also affect sperm quality.
When infertility testing returns in normal range, but pregnancy is not achieved, this is known as “unexplained infertility.” It can be frustrating, but it does not mean there are no options. Many couples with unexplained infertility conceive with the right guidance and next steps.
When to See Your OBGYN
If you are under 35 and have been trying to get pregnant for 12 months, it is time to schedule an evaluation. If you are 35 or older and have been trying for six months, it is worth coming in sooner. And if you have irregular cycles, very painful periods, a history of endometriosis, PCOS, pelvic infections, or prior pregnancy losses, consider an earlier visit even if you have not been trying for long.
If you are not sure what category you fit, a conversation with your provider can be a helpful starting point. Preconception counseling can help you better understand your cycle, your timing, and the health factors that may be affecting your fertility.
What to Expect During a Fertility Evaluation
A basic fertility workup does not have to be overwhelming. For most patients, it begins with a detailed conversation and a step-by-step approach.
Your provider will ask about your menstrual cycle, how long you have been trying to conceive, if you’ve had past pregnancies, contraception history, and any symptoms like pelvic pain or heavy bleeding. Lifestyle factors that can affect fertility, including sleep, stress, nutrition, and substance use, are also part of the picture.
If your cycles are regular, your provider may focus on timing and signs of ovulation. If your cycle is irregular, lab work and ultrasound can help clarify hormone patterns. Bloodwork may be used to check hormone levels, thyroid function, and other markers, and some labs are timed to specific days in your cycle.
A pelvic ultrasound can evaluate the uterus and ovaries and identify findings like fibroids or ovarian cysts. A semen analysis is one of the most important early tests, because it can quickly reveal sperm factors and help avoid unnecessary delays. If there is concern about the fallopian tubes or uterine cavity, additional studies may be recommended.
Not every patient needs every test right away. Your evaluation is tailored to your history and symptoms.
Healthy Habits to Support Conception
Daily habits can support fertility for both partners. Aim for consistent sleep, balanced meals, and regular physical activity. If you smoke or vape, stopping can improve both egg and sperm health. Cutting back on alcohol and building in time for stress recovery, even a walk after dinner or ten minutes of quiet breathing, can also help.
Starting a prenatal vitamin is a smart step while trying. Folic acid is especially important in early pregnancy, often before you know you are pregnant.
Timing matters, too. Many couples benefit from having sex every two to three days throughout the cycle rather than focusing on just one or two days. This approach takes some of the pressure off and improves the chance that sperm will be present during the fertile window.
Your Next Step Toward Answers
Infertility can take an emotional toll, and it is easy to feel overwhelmed or isolated. But for many patients, simply having a plan and a care team in their corner brings real relief.
At Care for Womens Medical Group, we support patients with preconception counseling, cycle and ovulation guidance, basic infertility workups, and coordination with fertility specialists when advanced reproductive care is needed. If you do conceive through fertility treatment, our team also provides coordinated prenatal support and works alongside your fertility specialist so you feel confident throughout your pregnancy.
If you have questions about fertility or want to start an evaluation, schedule an appointment with Care for Womens Medical Group. We will help you understand what may be going on, walk you through your options, and guide you toward the next steps that fit your goals.
