The standard guidelines — and their limits
General guidance suggests seeking a fertility evaluation after 12 months of unprotected sex without conception (or 6 months if you're over 35). But these are population-level averages, not personal rules. If you have irregular or absent periods, known PCOS, endometriosis, previous pelvic inflammatory disease, or a history of surgeries in the pelvis, earlier evaluation makes sense. Don't wait a year if you already know something may be affecting your fertility.
What a fertility workup involves
For women, the initial assessment typically includes a transvaginal ultrasound to check the ovaries and uterus, an AMH (anti-Müllerian hormone) blood test to assess ovarian reserve, a day 2 FSH/LH/oestradiol panel, and a hysterosalpingogram (HSG) or sonohysterogram to check if the tubes are open. Male factor accounts for around 40% of infertility cases, so semen analysis should happen simultaneously rather than only if the female workup is normal.
Low ovarian reserve — what it means
A low AMH or high FSH indicates lower ovarian reserve, meaning fewer eggs remain. This doesn't mean pregnancy is impossible, but it does mean time is more pressing and the response to fertility treatments may be lower. Women with low reserve are typically advised not to delay treatment. It's also worth noting that AMH predicts quantity, not egg quality — a nuance that matters in counselling.
Choosing a fertility specialist
Look for a reproductive endocrinologist or a gynaecologist with a dedicated fertility subspecialty. Ask about their approach to unexplained infertility, their policy on elective single embryo transfer (which reduces twins), and their success rates for your age group rather than aggregate clinic statistics. A good fertility specialist will explain your options clearly and not push you toward the most expensive intervention first.