Reassurance and Continued Attempts Are Appropriate After Only a Few Months
For a couple with no known medical history who have been trying to conceive for only a few months, the next step is to continue regular unprotected intercourse for a full 12 months before initiating a formal infertility evaluation, unless the female partner is over 35 years of age. 1, 2
Standard Timeline for Infertility Evaluation
- Infertility is formally defined as failure to achieve pregnancy after 12 months or longer of regular unprotected intercourse 1, 2
- A few months of unsuccessful attempts does not meet the clinical definition of infertility and does not warrant immediate medical evaluation 1
- Approximately 15% of couples will experience infertility by the 12-month mark, but many couples conceive naturally within the first year 2, 3
Age-Based Modifications to This Timeline
If the female partner is over 35 years old, evaluation should begin after only 6 months of unsuccessful attempts rather than waiting the full year 1, 2, 3
- For women over 40 years, more immediate evaluation and treatment are warranted due to rapid decline in ovarian reserve 3
- Age-related decline in fertility justifies earlier assessment in older women 2
Optimizing Natural Conception During the Waiting Period
While continuing to try naturally, the couple should optimize their approach:
- Women with regular menstrual cycles should have vaginal intercourse every 1-2 days beginning soon after the menstrual period ends to maximize the likelihood of pregnancy 1
- The couple should be educated about the 6-day fertile window ending on the day of ovulation, characterized by slippery, stretchy cervical mucus 1
- Over-the-counter ovulation prediction kits, digital applications, or cycle beads can help identify the fertile window 1
- Smoking, alcohol consumption, recreational drugs, and most commercially available vaginal lubricants should be avoided as these may reduce fertility 1
- Fertility rates are lower in women who are very thin or obese, and those consuming high levels of caffeine (more than 5 cups per day) 1
When to Pursue Earlier Evaluation
Even before the 12-month mark, earlier assessment is justified if:
- The female partner has a history of oligo-amenorrhea (infrequent menstruation) 1, 2
- Known or suspected uterine or tubal disease or endometriosis exists 1, 2
- The male partner is known to be subfertile or has risk factors for male infertility (such as history of bilateral cryptorchidism) 1
- Either partner has concerns about their fertility potential 1
What the Formal Evaluation Will Include (When Appropriate)
When the couple does meet criteria for evaluation, both partners should be assessed simultaneously:
For the female partner:
- Reproductive history including coital frequency and timing, menstrual cycle characteristics, previous pregnancies, and sexual history including STDs 1
- Physical examination including BMI calculation, thyroid examination, breast examination, assessment for androgen excess, and pelvic examination 1
- Assessment of ovulatory function, ovarian reserve, and tubal patency 2, 3
For the male partner:
- At least two semen analyses performed at least one month apart 1
- Reproductive history including frequency and timing of intercourse, prior fertility, childhood illnesses, systemic illnesses, sexual history, and gonadal toxin exposure 1
- Physical examination of genitalia including penile examination, testicular measurement and palpation, presence of vasa and epididymides, and assessment for varicocele 1
Common Pitfall to Avoid
The most common pitfall is premature anxiety and unnecessary testing after only a few months of trying. Most couples with no known risk factors will conceive naturally within 12 months, and initiating evaluation too early can create unnecessary emotional, logistical, and financial burden 2, 4. The couple should be reassured that a few months without success is normal and does not indicate a problem.