What should a couple do if they are not pregnant after 3 months of trying with regular intercourse?

Not Pregnant After 3 Months: Continue Trying

Continue regular unprotected intercourse for at least 9 more months before initiating formal infertility evaluation, as the standard definition of infertility requires 12 months of attempting conception. 1, 2, 3

Standard Timeline for Infertility Evaluation

• The 12-month threshold is evidence-based: Approximately 85% of couples with no fertility issues will conceive within the first year of regular unprotected intercourse, meaning 3 months is well within the normal timeframe for conception 1, 2, 3

• Infertility is formally defined as failure to achieve pregnancy after 12 months (or longer) of regular unprotected intercourse, affecting approximately 15% of couples 1, 2, 3

• One in eight couples encounter problems when attempting to conceive a first child, but this determination cannot be made at only 3 months 1

When Earlier Evaluation IS Warranted (Before 12 Months)

You should not wait the full 12 months and should seek evaluation now if any of these apply:

Female Partner Factors:

• Age >35 years: Evaluation should begin after only 6 months of trying due to age-related fertility decline 1, 2, 3
• History of irregular or absent menstrual cycles (oligo-amenorrhea), suggesting ovulatory dysfunction 2
• Known or suspected endometriosis, pelvic infections, or history of ectopic pregnancy 2, 4
• Known uterine or tubal disease 2

Male Partner Factors:

• History of bilateral cryptorchidism (undescended testicles) 1
• Prior chemotherapy or radiation therapy 5
• History of testicular trauma or surgery 5
• Known genetic conditions affecting fertility 5

Either Partner:

• Concerns about fertility potential in either partner warrant earlier evaluation 1

What to Do During These 9 Months

Optimize Timing of Intercourse:

• Aim for intercourse every 2-3 days throughout the menstrual cycle, with particular focus on the fertile window (5 days before ovulation through day of ovulation) 1, 4
• Consider tracking ovulation using basal body temperature charting, ovulation predictor kits, or cervical mucus monitoring to time intercourse appropriately 1, 6

Address Modifiable Lifestyle Factors (Both Partners):

Critical lifestyle modifications that directly impact fertility:

• Smoking cessation: Tobacco use significantly impairs fertility in both men and women 7, 2, 5
• Limit alcohol consumption: Excessive alcohol negatively affects fertility 7, 2
• Achieve healthy weight: BMI between 18.5-25 optimizes fertility; obesity is a major risk factor for ovulatory dysfunction (particularly PCOS) 7, 2
• Avoid recreational drugs: All recreational drugs can impair fertility 7
• Limit caffeine: Keep intake to less than 5 cups per day 7
• Avoid gonadal toxin exposure: This includes excessive heat exposure (hot tubs, saunas, tight underwear for men) 1, 5

Red Flags Requiring Immediate Evaluation (Do Not Wait)

Seek evaluation now if:

• Female partner has absent menstrual periods (amenorrhea) for 3+ months, as this indicates anovulation requiring hormonal assessment 8, 2
• Known severe male factor from prior semen analysis 3
• Either partner has known infertility diagnosis from previous relationships 1

What Happens at 12 Months If Not Pregnant

Initial Evaluation Will Include:

For the female partner:

• Confirmation of ovulation via serum progesterone level at cycle day 21 (>30 nmol/L or >5 ng/mL confirms ovulation) 4, 9
• Assessment of tubal patency via hysterosalpingography or hystero-contrast sonography 2, 4, 9
• Hormonal assessment including FSH, LH, prolactin, TSH, and possibly testosterone if signs of hyperandrogenism present 8

For the male partner:

• Two semen analyses performed at least 1 month apart after 2-3 days of abstinence 1, 10
• Reproductive history focusing on developmental history, prior fertility, systemic illnesses, surgeries, sexual history, and gonadotoxin exposure 1
• Physical examination of genitalia including testicular size/consistency, presence of vas deferens and epididymides, and varicoceles 1

Common Pitfall to Avoid

Do not assume something is wrong at 3 months—this creates unnecessary anxiety and may lead to premature, costly interventions when natural conception remains highly likely over the next 9 months 2, 3. However, do not ignore modifiable risk factors during this waiting period, as optimizing lifestyle factors now can improve your chances of conception 7, 2, 5.