Infertility is formally defined as not being able to get pregnant after one year of regular, unprotected sex. If you’re 35 or older, that window shortens to six months. But many people start wondering about their fertility long before that timeline is up, often because something feels off: irregular periods, pain during sex, or simply a gut feeling that something isn’t right. Here’s what to actually look for and what happens when you get tested.
The Timeline That Matters
For women under 35 with regular cycles and no known health issues, the standard recommendation is to try for at least one year before seeking a fertility evaluation. That might feel like a long time, but even healthy couples with no fertility problems only have about a 20 to 25 percent chance of conceiving in any given cycle. It takes time.
If you’re 35 or older, providers typically recommend evaluation after six months of trying. And if you’re over 40, most reproductive specialists suggest seeking evaluation right away rather than waiting. These aren’t arbitrary cutoffs. Egg quantity and quality decline meaningfully with age, and earlier intervention gives you more options.
You also shouldn’t wait out the full timeline if you already have a reason to suspect a problem. Very irregular or absent periods, a known condition like endometriosis or PCOS, a history of pelvic infections, or a partner with a known reproductive issue are all reasons to get evaluated sooner.
Signs You Might Notice on Your Own
Some fertility problems produce noticeable symptoms. Others don’t. But paying attention to a few key signals can help you decide whether to seek evaluation earlier.
Irregular or Absent Periods
A period that comes like clockwork every 24 to 35 days generally suggests you’re ovulating. Cycles that are wildly unpredictable, consistently longer than 35 days, or completely absent are one of the strongest signs that ovulation isn’t happening regularly. Without ovulation, pregnancy isn’t possible.
Cervical Mucus Changes
Around ovulation, cervical mucus normally becomes clear, stretchy, and slippery, often compared to raw egg whites. This typically happens for three or four days mid-cycle. If you consistently track your mucus and never see this fertile-type discharge, it could signal an ovulation problem. Mucus that is foul-smelling or has a cheese-like texture may point to an infection worth investigating.
Painful Periods or Pelvic Pain
Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, is a major cause of fertility trouble. Up to half of people with endometriosis have difficulty conceiving. It can block fallopian tubes, but it also appears to damage egg and sperm quality in less obvious ways. Severe menstrual cramps, pain during sex, and chronic pelvic pain are its hallmarks, though some people with endometriosis have no symptoms at all and only discover the condition during fertility testing.
Signs in Men
Male factors contribute to roughly half of all infertility cases, yet they’re often overlooked. Most male fertility issues produce no obvious symptoms. One exception is a varicocele, an enlargement of veins in the scrotum that contributes to about 40 percent of male infertility cases. You might notice a dull ache in the testicle that improves when lying down, scrotal swelling, or a lump that feels like a tangle of spaghetti. Larger varicoceles can lower testosterone, which may cause reduced sex drive, decreased muscle mass, or testicle shrinkage.
How Fertility Testing Works
If you’ve hit the appropriate timeline or have concerning symptoms, a fertility evaluation typically covers both partners. The process is more straightforward than most people expect.
Blood Tests for Women
Hormone blood draws, usually done on day three of your menstrual cycle, measure how hard your body is working to produce eggs. The most common is FSH (follicle-stimulating hormone). Levels under 6 are considered excellent, 6 to 9 is good, 9 to 10 is fair, and anything above 10 starts to indicate diminished ovarian reserve, meaning fewer eggs are available. Levels above 13 suggest it will be very difficult to stimulate egg production with fertility medications. Your provider may also test AMH (anti-Müllerian hormone), which gives a snapshot of your remaining egg supply and can be drawn on any day of your cycle.
Checking the Fallopian Tubes
A hysterosalpingogram, or HSG, is an X-ray that maps the inside of your uterus and fallopian tubes. During the test, a contrast dye is placed into the uterus. If the tubes are open, the dye spills out the far ends and shows up clearly on the X-ray. If it stops short, that indicates a blockage. The test also reveals whether the uterus has an abnormal shape, scarring, or other structural issues that could interfere with implantation. The procedure takes about 15 to 30 minutes and can cause cramping similar to menstrual pain.
Semen Analysis for Men
A semen analysis is typically the first and most important test for men. It measures three key factors: sperm concentration (normal is at least 15 million per milliliter), total motility or movement (at least 40 percent of sperm should be moving), and morphology or shape (at least 4 percent of sperm should have a normal form). Falling below any of these thresholds doesn’t mean pregnancy is impossible, but it does reduce the odds per cycle and may guide treatment decisions.
Lifestyle Factors That Affect Fertility
Some fertility problems are tied to conditions you can’t control. But several lifestyle factors have a measurable impact and are worth addressing while you’re trying to conceive or preparing for evaluation.
Body weight plays a significant role. A BMI under 20 (underweight) or over 30 (obese) increases the likelihood of hormonal imbalances that impair reproductive function. For BMIs between 25 and 30, the research is mixed, but maintaining a weight in the normal range is generally favorable. Smoking is linked to decreased egg quality, reduced egg reserve, and higher rates of both infertility and miscarriage. Drinking more than six alcoholic drinks per week is considered excessive enough to significantly affect reproductive outcomes.
These factors matter for men too. Smoking, heavy drinking, and obesity all reduce sperm quality. Heat exposure to the testicles, whether from frequent hot tub use, laptops on the lap, or tight clothing, can temporarily lower sperm production.
What “Infertile” Actually Means
One of the most important things to understand is that an infertility diagnosis is not the same as being told you can never have children. It means that something is reducing your chances enough that unassisted conception hasn’t happened within the expected window. For many couples, the evaluation itself identifies a treatable issue: a hormonal imbalance, a blocked tube, a varicocele, or an ovulation problem that responds to medication. Even unexplained infertility, where no clear cause is found, often responds to treatment. The diagnosis is a starting point, not an endpoint.