When to Start an Evaluation
Per ACOG and ASRM guidance, the general timeline for starting an evaluation is:
- After 12 months of trying, for women under 35 with regular, unprotected intercourse.
- After 6 months of trying, for women 35 and older, since age itself affects fertility and time matters more.
- Right away, for women of any age with a known condition that affects fertility — irregular or absent periods, a diagnosed condition like PCOS or endometriosis, a history of pelvic infection or surgery, or a partner with a known fertility issue.
If any of this describes you, you don’t need to wait out the standard timeline before coming in.
What the Evaluation Involves
A fertility evaluation looks at the three areas most commonly involved in infertility, and it typically starts with a detailed conversation about your cycle, health history, and any prior pregnancies:
- Ovulation: If your cycles are regular, between about 21 and 35 days, that’s usually a reliable sign you’re ovulating and less additional testing is needed. If your cycles are irregular, bloodwork checking hormone levels can help confirm what’s happening and why.
- Structural Evaluation: A pelvic ultrasound checks the uterus and ovaries for fibroids, polyps, or ovarian cysts that could be involved. A hysterosalpingogram (HSG), an X-ray test using contrast dye, checks whether the fallopian tubes are open, since blocked tubes are a common and otherwise hard-to-detect contributor to infertility.
- Semen Analysis: Since male factors are involved in a substantial share of infertility cases, a semen analysis for your partner is typically recommended early in the process, not as an afterthought.
Depending on what these initial steps show, your provider may recommend more targeted testing — including evaluating for endometriosis.
When No Clear Cause Is Found
In a meaningful share of cases — up to about 30% — the initial workup doesn’t turn up a clear explanation. This is called “unexplained infertility”, and while it can be frustrating to hear, it doesn’t mean nothing can be done. Treatment can still move forward based on your age, how long you’ve been trying, and your goals, often starting with ovulation-supporting medication even when ovulation itself is tested normally.
Your Treatment Options
Treatment depends entirely on what the evaluation finds:
- Ovulation Induction: Medication such as letrozole or clomiphene that encourages ovulation, often the first step for irregular ovulation or unexplained infertility.
- Treating Underlying Conditions: Such as PCOS or endometriosis, which can restore fertility on its own for some women.
- Laparoscopic Surgery: to address fibroids, endometriosis, or scar tissue found during the evaluation that may be interfering with conception.
- Referral for Advanced Treatment: Such as intrauterine insemination (IUI) or in vitro fertilization (IVF), for couples whose evaluation points toward a cause best addressed by a reproductive endocrinology specialist, or when initial treatment hasn’t led to pregnancy.
Your provider will walk through what’s realistic and reasonable at each step, rather than moving straight to the most intensive option available.
Symptoms That Shouldn’t Wait: When to Call Us Sooner
Most fertility questions are well-suited to a scheduled visit rather than an urgent one. A few things are worth calling about sooner:
- You’re 35 or older and have been trying for six months without success.
- You have a known condition — PCOS, endometriosis, fibroids, or a history of pelvic infection or surgery — and haven’t yet had a fertility-focused conversation.
- Very irregular or absent periods, which can be a sign of an ovulation issue worth addressing before a full year has passed.
- A prior pregnancy loss alongside current difficulty conceiving, which is worth a dedicated conversation rather than folding into general fertility questions.
Choose the Women Who Know: Care From Providers Who Speciality in Fertility
Trying to conceive without answers is exhausting, and our providers are here to actually find them. Drs. Mironda Williams, Deanna Guthrie, and Karen Greene, along with nurse practitioners Mary Corbitt, APRN and Brittany Bulger, APRN, take good care of women at every step of this journey, from the first conversation through treatment. Call us today at 770-487-9604 to schedule your fertility evaluation.
Frequently Asked Questions
When should I actually see someone about fertility?
After a year of trying if you’re under 35, or after six months if you’re 35 or older. If you have a known condition like PCOS or endometriosis, or very irregular periods, it’s worth coming in sooner rather than waiting out the standard timeline.
Does my partner need to be tested too?
Yes, early in the process. Male factors are involved in a significant share of infertility cases, so a semen analysis is a standard, early part of a thorough evaluation rather than a last resort.
What if all my tests come back normal?
It happens in up to about 30% of evaluations, called unexplained infertility. It’s frustrating, but it doesn’t mean treatment isn’t possible — many women in this situation still respond well to ovulation-supporting medication or other treatment.
Will I need surgery as part of my fertility evaluation?
Not usually as a first step. Surgery is considered when imaging or your history points toward something like fibroids, endometriosis, or scar tissue that’s likely interfering with conception, not as routine testing.
Do you perform IVF at Rosa Gynecology?
Our providers evaluate and treat many causes of infertility directly, including ovulation induction and surgical treatment. For more advanced treatment like IUI or IVF, we’ll refer you to a reproductive endocrinology specialist and stay involved in your care alongside them.
I have PCOS. Does that mean I can't get pregnant?
No. PCOS is a common, treatable cause of ovulation-related infertility, and most women with PCOS who want to conceive are able to, often with medication that supports ovulation. Our PCOS page covers this in more depth.
