Fertility, First Steps

Trying to fall pregnant and it not happening yet is common, and it is rarely anyone’s fault. This is when to ask for help, and what a first assessment actually involves.

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When to ask for help

As a general guide, it is reasonable to seek an assessment after around a year of regularly trying to conceive without success, or after around six months if you are over 35. If you already know of a factor that could affect fertility, such as irregular periods, a past pelvic infection or surgery, or a known condition, it is reasonable to ask sooner rather than waiting out the clock.

There is no such thing as asking too early. An assessment does not commit you to any treatment.

It takes two to assess

Fertility involves both partners, and around half the time a contributing factor is found on the male side. A first assessment should always include both people, not just the woman.

What a first assessment usually covers

For the woman:

• A history of your cycle, past pregnancies, and any relevant surgery or illness
• Confirmation of regular ovulation, often through cycle tracking and blood tests
• A pelvic ultrasound
• A check that the fallopian tubes are open, where indicated

For the male partner:

• A semen analysis
• A history of general health, lifestyle, and any relevant past illness or surgery

What happens next depends on what is found

• If everything checks out normally, the plan is often simple: timed intercourse, lifestyle support, and a re-check if pregnancy has not occurred after a further period of trying.
• If ovulation is irregular, treatment to support it is often the first step.
• If a tubal or anatomical factor is found, further assessment or a referral for specialist treatment may be recommended.
• If male-factor findings are significant, a referral to a fertility specialist is usual.

Some couples need one adjustment. Some need a referral for more involved fertility treatment. Both outcomes are normal, and neither is a reflection of anything you did or did not do.

If a referral for treatment is the next step

Once your assessment has pointed to a specific cause, the treatment itself usually follows one of three paths. Which one applies to you depends entirely on what was found, not on preference between them.

Ovulation induction. For irregular or absent ovulation, often linked to PMOS. Medication brings on ovulation on a predictable schedule, with cycles monitored by blood tests and sometimes scans.

Intrauterine insemination (IUI). For mild male-factor issues or unexplained difficulty. A prepared sperm sample is placed directly into the uterus around ovulation, in a clinic visit with no sedation needed.

In vitro fertilisation (IVF). For blocked tubes, more significant male-factor issues, or when a direct approach is the better first choice. Eggs are collected, fertilised with sperm in a laboratory, and a resulting embryo is transferred back a few days later. One full cycle typically spans four to six weeks, and more than one cycle is common before a pregnancy is achieved.

Contact your care team without waiting for your next scheduled visit if you develop severe abdominal pain or bloating during ovarian stimulation, since this can signal a rare but serious reaction to fertility medication.

The part that is not clinical

Trying to conceive without success can be exhausting and isolating, even when everything checks out fine. That is a normal reaction, not a sign that something is wrong with you. Say so to your care team. It changes how the conversation goes, and it is worth saying out loud.

Your next step

Bring a note of how long you have been trying, your cycle pattern if you track it, and any past health history for both partners. Talk to your care team about a first assessment. It is a conversation, not a commitment.