When to See a Doctor About Fertility

The thresholds, stated plainly

You do not have to wait until you feel desperate enough to justify the appointment. There are published thresholds, and meeting one is the whole qualification.

The general rule

• NICE (UK): if you have not conceived after 1 year of unprotected vaginal intercourse, with no suspected or known clinical cause, both partners should be offered further clinical assessment and investigation.
• ACOG (US): evaluation after 12 months; after 6 months if you are older than 35; and if you are older than 40, evaluation is recommended before you start trying.
• Healthdirect (Australia): 12 months under 35, 6 months over 35.
• WHO: defines infertility as failure to achieve pregnancy after 12 months or more of regular unprotected intercourse.

The rule that overrides it

NICE recommends offering referral at first presentation — no waiting period at all — if either of these applies:

• the woman or person trying to become pregnant is aged 36 years or over, or
• either partner has a suspected or known clinical cause of infertility, or a history of predisposing factors.

That second clause is broad and under-used. It covers a great deal more than people assume.

If you are using donor sperm or artificial insemination

The threshold is 6 cycles of insemination, not 12 months. NICE also gives the cumulative figures: 47% to 57% of women under 40 conceive within 6 cycles of IUI, and about half of those who do not will do so with a further 6 cycles, giving 72% to 81% cumulative depending on age.

Reasons to go now, whatever the calendar says

Any of the following counts as a suspected or known cause, or a predisposing factor:

• Irregular, very long, very short or absent periods. NICE notes that regular monthly cycles suggest you are likely ovulating; the absence of them is the single clearest reason to be seen early.
• Known PCOS or endometriosis. Both are explicitly clinical causes.
• Previous pelvic inflammatory disease, chlamydia, or any pelvic infection. NICE notes tubal damage occurs in about 10–12% after one episode of pelvic infection, 23–35% after two, and 54–75% after three.
• Previous ectopic pregnancy or pelvic or abdominal surgery.
• Three or more miscarriages.
• Previous or planned cancer treatment. NICE recommends expediting referral where planned treatment may cause infertility, so fertility preservation can be discussed.
• For a male partner: undescended testes, testicular surgery or torsion, mumps after puberty, chemotherapy or radiotherapy, varicocele, or current or previous testosterone or anabolic steroid use.
• Difficulty having intercourse. NICE recommends offering an initial consultation to discuss options for conception to anyone unable to, or who would find it very difficult to, have vaginal intercourse.
• Chronic viral infection such as hepatitis B, hepatitis C or HIV.

One change that stops the clock resetting

NG257 added a recommendation in 2026 that is worth knowing if you have had a loss while trying. If a miscarriage or ectopic pregnancy happens during the year of trying that makes you eligible for investigation, during a period of expectant management for unexplained infertility, or during a course of insemination, the timeframe continues — it does not restart. If you are told your twelve months begins again, this is recommendation 1.16.7.

What to expect at the first appointment

The first appointment is history-taking and arranging tests. It is not a judgement on whether you have tried hard enough.

Expect questions on cycle length and regularity, how long you have been trying, frequency of intercourse, previous pregnancies, contraception history, surgery, infections, and medication. NICE flags specific drug categories worth mentioning: GLP-1 agonists, testosterone replacement, finasteride, NSAIDs, vaginal lubricants, anabolic steroids and cannabis. NICE also states the environment should allow you to discuss sensitive issues including sexual abuse.

Tests you should expect

• Mid-luteal serum progesterone to confirm ovulation — day 21 of a 28-day cycle, offered even if cycles are regular. If cycles are long or irregular, taken later (for example day 28 of a 35-day cycle) and repeated weekly until your period starts.
• Serum gonadotrophins (FSH and LH) if cycles are irregular.
• Semen analysis for a male partner, compared against WHO reference values, with a repeat confirmatory test if abnormal.
• Chlamydia screening before any uterine instrumentation.
• Rubella status if you are unsure whether you were vaccinated.
• Tubal assessment — hysterosalpingography if you have no relevant comorbidities, or laparoscopy and dye if conditions such as endometriosis, PID or previous ectopic are suspected.
• Coeliac serology may be considered where subfertility is unexplained.

Tests NICE says not to expect routinely

• Basal body temperature charts — not recommended to confirm ovulation.
• Post-coital cervical mucus testing — no predictive value on pregnancy rate.
• AMH as a predictor of natural conception — NICE advises against this; AMH and antral follicle count predict ovarian response for assisted conception, and FSH is not recommended as a predictor of assisted conception outcome either.
• Prolactin unless you have an ovulatory disorder, galactorrhoea or a pituitary tumour; thyroid function only if you have symptoms of thyroid disease.
• Sperm DNA fragmentation testing — NICE advises against it.
• Hysteroscopy unless a uterine or endometrial abnormality is clinically suspected.

Knowing this list is useful in two directions: it stops you feeling short-changed when a test is not ordered, and it helps you question paid-for add-ons that current guidance does not support.

How to make the appointment count

1. Bring dates. When you started trying, cycle lengths for the last 6–12 months, any pregnancies or losses with dates.
2. Both partners attend if you can. NICE frames investigation as covering both, and it halves the time to a complete picture.
3. Name the reason you qualify. "I am 37" or "I have PCOS" changes the pathway from waiting to referring.
4. Ask for tests to be arranged in parallel. Sequential testing can add months.
5. Ask what happens if results are normal. Unexplained infertility is a real category, and knowing the next step in advance prevents a stall.

If you are told to wait and you already meet a threshold

This happens, and it is usually a misunderstanding of the guidance rather than obstruction. Politely name the recommendation: NG257 section 1.16 for the UK, or ACOG's evaluation thresholds elsewhere. Ask for the reason for the delay to be recorded. Ask whether a different clinician in the practice takes fertility referrals. You are not being difficult by doing this; you are asking for the standard that already exists.

Around 1 in 7 couples in the UK have difficulty conceiving, and the WHO estimates about 1 in 6 people of reproductive age experience infertility in their lifetime. Asking for help at the point the guidance says to ask is the ordinary use of the system, not an escalation.