When is fertility a concern, specifically after how many months of trying to conceive, and what is this condition referred to as?

Fertility Concerns and Infertility Definition

Fertility becomes a concern after 12 months of regular unprotected intercourse without achieving pregnancy, which is the standard definition of infertility. 1

Standard Definition of Infertility

• Infertility is defined as the failure to achieve pregnancy after 12 months or longer of regular unprotected intercourse 1
• This condition affects approximately 15.5% of women and is present in one in eight couples attempting to conceive a first child (primary infertility) 1
• In approximately 50% of involuntarily childless couples, a male-associated factor is found, usually together with abnormal semen parameters 1

When Earlier Evaluation Is Warranted

• For women aged >35 years, earlier assessment after 6 months of regular unprotected intercourse is justified due to age-related decline in fertility 1, 2
• Women with a history of oligo-amenorrhea (infrequent menstruation) should be evaluated earlier 1, 3
• Those with known or suspected uterine or tubal disease or endometriosis should not wait the full 12 months 1
• Women with a partner known to be subfertile should seek evaluation sooner 1
• Immediate evaluation is recommended if risk factors of male infertility are present 1
• For women older than 40 years, immediate evaluation and treatment are warranted due to rapidly declining fertility 2

Causes of Infertility

• The most common known causes include male factor (26%), ovulatory failure (21%), and tubal damage (14%) 1
• In 28% of couples, infertility remains unexplained despite thorough evaluation 1
• Polycystic Ovary Syndrome (PCOS) is the most common cause of anovulatory infertility, affecting at least 7% of adult women 1, 3
• Endometriosis affects at least one-third of women with infertility 1

Initial Evaluation Approach

• Both partners should be investigated simultaneously to categorize the cause of infertility 1
• For women, tests focus on ovarian reserve, ovulatory function, and structural abnormalities 2
• For men, a basic medical history and semen analysis are warranted from the outset 2
• Imaging of reproductive organs can detect tubal patency and pelvic pathology 1

Clinical Terminology

The medical term for the inability to conceive after 12 months of regular unprotected intercourse is "infertility" 1, 2. Some clinicians may also use terms like "subfertility" to describe reduced fertility with a longer time to pregnancy but not absolute inability to conceive 1.

Important Considerations

• Premature investigation (before 12 months) in couples without risk factors can lead to unnecessary testing, false-positive diagnoses, and potentially harmful treatments 4
• Studies show that 50% of couples who have tried to conceive for 6 months without success will naturally conceive in the next 6 months without any treatment 4
• Lifestyle factors such as smoking, alcohol consumption, obesity, and high caffeine intake can negatively affect fertility and should be addressed 1, 5
• The prevalence of fertility diseases is lower in couples who have been trying to conceive for only 6 months compared with those who have been trying for 12 months 4

By following these evidence-based guidelines for when to investigate fertility concerns, clinicians can help patients avoid unnecessary interventions while ensuring timely care for those who need it.