Let's get you ready

Questions to ask

• Given my age and how long we've been trying, do you agree it's time for an evaluation?

  Under 35, guidelines suggest an evaluation after twelve months of trying, or sooner if there's a known reason to (irregular cycles, a history of pelvic infection or surgery, endometriosis, or a partner with a known issue).

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• What does a complete initial evaluation include here, and can we do all of it in one cycle?

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• Has my partner had a semen analysis? If not, can we order one now?

  Male factors contribute in roughly 40–50% of cases, and the test is simple. It's the most commonly skipped part of an evaluation.

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• Should I see a reproductive endocrinologist now, or is this something your office does fully?

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• If everything comes back normal, what would you look at next, and when?

  'Everything looks normal' should be the start of a plan, not the end of the conversation.

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• Which of these tests and treatments are typically covered, and can your office help me check my benefits before we start?

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Things to bring

• Cycle history: typical length, regularity, any tracking you've done
• How long you've been trying and any prior pregnancies or losses
• Your partner's health history and any prior semen results
• Any prior test results, even if they seemed normal
• A list of medications and supplements for both of you

Tests to ask about

• Whether the timing has really been covered. Worth ruling out before anything else, because it's the most common fixable thing. Most people are aiming at a narrower window than they think, and waiting for a positive LH test means starting four days late. How to know when you ovulate → · How often to try →
• Ovulation. Regular cycles usually mean you're ovulating. If cycles are irregular, a progesterone level drawn in the second half of the cycle — about a week before your next period is due, which is roughly seven days after you ovulate — can confirm it. Timing is the whole point of that test: drawn mid-cycle it tells you almost nothing.
• Ovarian reserve. AMH (any cycle day), antral follicle count by ultrasound, or day 2–4 FSH and estradiol. These estimate egg quantity, not quality, and a low result doesn't mean you can't conceive.
• Uterus and tubes. A transvaginal ultrasound plus an HSG (X-ray with dye) to check whether the tubes are open. A saline sonogram checks the cavity only, unless it's done with contrast (HyCoSy).
• Semen analysis. For your partner, at the start, not after everything else comes back normal.
• Thyroid. TSH is commonly checked as part of an infertility evaluation; ask whether it's included.

Nail this down before you leave

• Exactly which tests are being ordered, for both of you, and when
• Who will call with results and what happens at the follow-up
• Whether you're being referred to a specialist, and to whom

If they say everything looks normal

• Which of the standard tests have actually been done, and which haven't?
• If everything is normal, what would you look at next, and when?
• Is there anything in my history that would make you consider additional testing?
• What's the plan from here, and at what point would you change it?

What happens next

The evaluation usually takes one to two cycles. Once it's underway, move to I'm getting a workup to understand what each test is looking for.

The results that most often decide the next step: whether you're ovulating, whether the tubes are open, your ovarian reserve range, and the semen analysis.

If all of those come back normal, the next conversation is usually about 'unexplained infertility' and the options for it. That's a plan, not a dead end.