There’s no single quiz that can tell you why you’re not getting pregnant, but you can work through the most common factors systematically to narrow down what might be going on. About one-third of fertility problems trace back to the female partner, one-third to the male partner, and the remaining third are either unexplained or involve both partners. That means the answer rarely comes from checking just one thing. Below is a structured self-assessment covering the factors that matter most, so you can walk into a doctor’s appointment with better questions.
How Long Have You Been Trying?
This is the first and most important question. Even among couples with no fertility problems at all, getting pregnant takes time. In a large North American study, about 79% of women aged 25 to 27 conceived within 12 cycles of trying. For women aged 34 to 36, that number was roughly 75%. For women 40 to 45, it dropped to about 56%. The per-cycle odds of conception are simply lower than most people expect, so several months of trying without success is completely normal.
The standard threshold for seeking a medical evaluation is 12 months of regular unprotected sex if you’re under 35, and 6 months if you’re 35 or older. If you’re over 40, earlier evaluation is reasonable. These aren’t arbitrary cutoffs. They reflect the point at which the odds of conceiving without help start to meaningfully decline and the benefit of medical testing outweighs the cost of waiting.
Are Your Periods Regular?
Irregular or absent periods are the single biggest clue that something is interfering with ovulation, and ovulation problems account for the majority of female infertility cases. A “regular” cycle falls between 21 and 35 days. If your cycles are consistently shorter than 21 days, longer than 35 days, or vary wildly from month to month, you may not be ovulating reliably.
PCOS is the most common cause of irregular ovulation and the most common cause of female infertility overall. Key signs include irregular or missing periods, difficulty conceiving, acne, and excess hair growth on the face or body. Some women with PCOS have all of these symptoms; others only notice the irregular cycles. Many women first learn they have PCOS when they start trying to get pregnant. If any of this sounds familiar, it’s worth bringing up with your doctor rather than continuing to wait.
Other conditions that disrupt ovulation include primary ovarian insufficiency (when the ovaries stop functioning normally before age 40), excess production of the hormone prolactin, and thyroid disorders. Extreme stress, very high or very low body weight, and rapid weight changes can also shut down ovulation temporarily by disrupting the hormonal signals between your brain and ovaries.
What Does Your Weight Tell You?
Body weight has a measurable, U-shaped relationship with fertility. In a study of over 3,600 U.S. women aged 18 to 45, the inflection point for infertility risk sat at a BMI of about 19.5. Below that point, being underweight increased the risk. Above it, every single-unit increase in BMI predicted a 3% increase in infertility risk. That means a woman with a BMI of 30 faces a roughly 30% higher risk than someone at 19.5, all else being equal.
This doesn’t mean you need a “perfect” BMI to conceive. Most women across a wide weight range get pregnant without difficulty. But if you’re significantly underweight or carrying substantial extra weight and also struggling to conceive, weight is one modifiable factor worth discussing with a provider.
Are You Tracking Ovulation Accurately?
Many women assume they’re timing intercourse correctly but are actually missing their fertile window. The two most popular home tracking methods, LH test strips and basal body temperature, both have real limitations.
LH strips detect the hormone surge that typically triggers ovulation within a day or two. But it’s possible to ovulate without a detectable surge, to detect a surge that doesn’t actually result in ovulation, or to catch the surge after ovulation has already happened. LH testing also only identifies the last one to two days of your fertile window, which means if you’re relying on the strip alone, you may be starting too late. Pairing LH strips with cervical mucus monitoring improves accuracy significantly.
Basal body temperature tracking is even more limited for timing purposes. The temperature shift confirms ovulation has already occurred, which is useful for understanding your cycle pattern over time but doesn’t tell you when to have sex this cycle. If you’re using BBT alone, you’re essentially guessing based on previous months, and natural variation in cycle length makes that unreliable. A combination of methods works better than any single one.
Have You Considered Male Factors?
Because one-third of infertility cases involve a male factor, no self-assessment is complete without considering the other partner. A semen analysis is one of the first tests a fertility specialist will order, and it’s far simpler and less invasive than most female fertility testing.
The key metrics are sperm count, motility (how well sperm swim), and morphology (sperm shape). A count below 15 million sperm per milliliter of semen, or below 39 million total per ejaculate, is considered low. Poor motility means sperm can’t reach or penetrate the egg effectively. Many male fertility problems produce no obvious symptoms, so there’s no way to assess this at home. If you’ve been trying for months, a semen analysis should be on the checklist early, not as a last resort.
Do You Have Symptoms Worth Flagging?
Some physical symptoms suggest conditions known to cause infertility and warrant evaluation without waiting for the standard 12- or 6-month timeline. These include:
- Painful periods or chronic pelvic pain: may indicate endometriosis, which can affect the fallopian tubes and uterine lining
- Irregular, very heavy, or absent periods: suggest ovulation problems, possibly PCOS
- Bleeding between periods: may point to uterine or hormonal issues
- History of pelvic infections or sexually transmitted infections: can cause tubal damage
- Previous chemotherapy or radiation: can reduce egg supply prematurely
- Known sexual dysfunction in either partner: warrants earlier evaluation
If any of these apply, guidelines from the American Society for Reproductive Medicine recommend starting diagnostic testing without delay rather than waiting months.
What Testing Looks Like
If your self-assessment points to potential issues, or if you’ve simply hit the time threshold for your age, the initial fertility workup is more straightforward than many people expect. For women, it typically starts with a medical history discussion, blood tests timed to specific days of your menstrual cycle, and a pelvic ultrasound. The blood work measures hormone levels that indicate how well your ovaries are functioning and how many eggs you likely have remaining. Two key markers are FSH (follicle-stimulating hormone), usually drawn on day three of your cycle, and AMH (anti-Müllerian hormone), which can be drawn at any time.
If those initial results don’t reveal a clear answer, the next step is often a hysterosalpingogram, an imaging procedure that checks whether your fallopian tubes are open and your uterus is structurally normal. For the male partner, a semen analysis is the standard first test. Together, these initial steps identify a cause in the majority of couples, and they can usually be completed within one or two menstrual cycles.