How Long Should You Try to Conceive Before Fertility Testing?

The 12-month and 6-month rule

ASRM defines infertility in part as the inability to achieve a successful pregnancy based on a person's medical, sexual and reproductive history. For couples who have regular, unprotected intercourse and no known reason to suspect impaired fertility in either partner, ASRM says evaluation should begin at 12 months if the female partner is under 35, and at 6 months if she is 35 or older.

The World Health Organization uses the same 12-month marker in its definition: infertility is the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. WHO estimates that about one in six people of reproductive age experiences infertility at some point in their lives.

Two details matter in practice. First, the clock starts when you begin having regular, unprotected intercourse with the goal of conceiving, not when you first think about a baby. Second, the rule is about when to get evaluated, not a verdict. A normal workup is a useful answer too.

Why age changes the timeline

ASRM shortens the waiting period for women 35 and older, and for women over 40 its committee opinion on evaluating infertile women says a more immediate evaluation and treatment may be warranted.

ASRM's guidance on optimizing natural fertility makes the same point for women over 35: it says consultation with a reproductive specialist should be considered after 6 months of unsuccessful attempts.

The age that counts in these rules is the female partner's. That does not mean the male partner's health is irrelevant, which is why the next sections cover testing both of you.

Reasons to get tested sooner

ASRM's committee opinion says diagnostic testing should be started without delay, rather than after 12 or 6 months, when there is a known or suspected reason for infertility. The conditions it lists include:

• Irregular cycles, bleeding between periods, infrequent periods (oligomenorrhea) or absent periods (amenorrhea)
• Known or suspected uterine, tubal or peritoneal disease, or endometriosis
• Known or suspected male subfertility or sexual dysfunction
• Conditions that reduce ovarian reserve
• A woman over 40, for whom ASRM says a more immediate evaluation may be warranted

The same document asks about earlier pelvic infection, sexually transmitted infections and pelvic inflammatory disease when it takes a history, because they can scar the reproductive tract. The NICHD, part of the National Institutes of Health, lists past pelvic infections or surgery among the questions a provider asks when evaluating a woman, and a history of testicular or penile injury, high fevers or mumps in a man.

If any of these apply to you, you do not have to wait out the full 12 or 6 months. Talk to a clinician now. If you are not sure whether something counts, that is a good reason to ask.

Why both partners should be tested

Fertility is not only a female issue. The NICHD says problems in males and females are about equally likely, and that both partners may contribute. The American Urological Association states that infertility is due in whole or in part to the male in approximately one-half of infertile couples.

ASRM's committee opinion says that when a male partner is part of the couple, evaluation of both partners should begin at the same time, and that at least one semen analysis should be obtained at the start of the evaluation. Testing only one partner can leave part of the picture blank.

For more on how his testing works, see our guides to at-home semen analysis and the male fertility test.

What a basic fertility workup includes

ASRM says the evaluation of a woman should be systematic, prompt and cost-effective, starting with the least invasive tests that find the most common causes. Its conclusion is that the evaluation should cover ovulatory status and the structure and patency (openness) of the female reproductive tract, alongside a semen evaluation for the male partner.

The NICHD describes what this can look like:

• A history and exam, including menstrual regularity, past pregnancies and pelvic infections or surgery
• Hormone blood tests, such as FSH and AMH, which help estimate remaining egg supply, and a progesterone test around day 23 of the cycle to show whether ovulation occurred
• Imaging, such as a pelvic ultrasound, and tests of the fallopian tubes and uterus when indicated
• For him: a history, an exam and a semen analysis, with blood hormone tests when indicated. Because sperm production varies, more than one sample may be needed

You can read more about each piece in our pages on the female fertility test, the AMH test and fertility testing for couples.

Making the most of the months you are trying

While you wait, timing and a few habits make the most of each cycle. These points come from ASRM's committee opinion on optimizing natural fertility:

• The fertile window is best defined as the 6-day interval ending on the day of ovulation. Peak fecundability was seen when intercourse occurred within 2 days before ovulation.
• Intercourse every 1 to 2 days during the fertile window gives the highest reproductive efficiency, and having sex more often than that is not linked to lower fecundity.
• Calendar apps are limited: in one study of 949 volunteers they reached a maximum accuracy of 21% in predicting the day of ovulation. If you use them, use them to time frequent intercourse rather than to replace it.
• Cervical mucus is a useful marker, and ovulation predictor kits can help. The opinion notes false positives in about 7% of cycles and that ovulation can occur up to 2 days after the urinary LH surge.
• Smoking and recreational drugs should be discouraged in both partners, alcohol and caffeine kept to minimal or moderate use, and women trying to conceive should take a daily folic acid supplement (400 micrograms).

The same opinion says evidence that specific diets, supplements or sexual positions improve natural fertility is weak. For a longer walk-through of the basics, see trying to conceive.

How Gala Fertility fits

Gala Fertility is an online program for male-female couples who are trying to conceive. Both partners must be 18 or older, and it is not available in New York, New Jersey or Rhode Island. You complete one intake together, reviewed by a licensed clinician, and both of you are tested: her bloodwork at a Quest lab and a pelvic ultrasound, his semen analysis with a kit sent home, and his bloodwork if your clinician indicates it.

A clinician reviews every result and explains it to you both in one video visit. Some findings are best handled in person, such as blocked fallopian tubes, low ovarian reserve, changes in the uterus or certain semen results. If your results show one of these, your clinician refers you to a fertility clinic or a reproductive urologist and explains why. IUI, IVF and other in-person care at a clinic you are referred to are not included in the program.

No program can promise a pregnancy, and testing is a way to learn where you stand. If you fit the timelines above, you can start your fertility intake together.

This article is general education, not medical advice. If you have symptoms or a known condition, talk to a clinician.

Sources

1. ASRM. Definition of infertility: a committee opinion. 2023.
2. ASRM. Fertility evaluation of infertile women: a committee opinion. 2021.
3. ASRM. Optimizing natural fertility: a committee opinion. 2021.
4. World Health Organization. Infertility. Fact sheet.
5. NICHD, NIH. What causes infertility?
6. NICHD, NIH. How do health care providers diagnose infertility?
7. American Urological Association. Male infertility guideline.

This article is for general information and is not medical advice. Talk to a licensed provider about your own health.