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Most experts suggest that couples who have no known fertility problems should wait until one year after trying regular unprotected sexual intercourse to get pregnant before they seek out help. However, it is recommended for women over age 35 who are seeking their first pregnancy and women with certain disorders to seek assistance prior to attempting to become pregnant. These disorders include:

• Menstrual or ovulatory irregularities
• Tubal problems
• Miscarriages
• Thyroid conditions
• Sexual dysfunction
• Pelvic disease

In addition, couples may want to seek fertility help if the man has known sperm deficiencies or a history of illness or surgery in the genital region. 

Fertility specialists are a group of experts in the field of reproductive endocrinology who have received special training in issues relating to treating infertility. During a visit to a fertility specialist, a physician is likely to obtain a medical history of both partners, including previous history of sexually transmitted diseases (STDs), pelvic infections and other illnesses.

A physical examination of the fallopian tubes, cervix and uterus will be performed on the woman. In addition, blood tests may be performed to check for hormonal imbalances in both the female and male partner. An assessment of a woman’s ovulatory regularity will be undertaken, as will an x-ray with a dye of the fallopian tubes and uterus – called a hysterosalpingogram. Finally, a qualitative and quantitative examination of a man’s sperm will be completed.

Sperm motility may be evaluated through the use of the postcoital test. The couple is asked to have unprotected sexual intercourse about eight hours before the test is scheduled. The test examines the female partner's cervix for the presence of sperm in the mucus. It provides information about sperm pickup, motility and storage within the cervical canal. This test is no longer widely used.

In some cases, a woman will also undergo an examination known as laparoscopy. Performed using general anesthesia, it involves inserting a thin viewing device through an incision and into the abdomen and pelvis to examine the fallopian tubes, ovaries and uterus.

A similar procedure, hysteroscopy, also can be done whereby the inside of the uterus is examined with an illuminated instrument to detect the presence of polyps, fibroids, septums or other barriers to successful pregnancy implantation.

Between 75 and 85 percent of fertility problems are diagnosed after a patient’s initial evaluation. When a diagnosis is not made, additional testing may be necessary. In some cases, insurance will cover diagnostic testing. Couples should consult with their provider before undergoing tests if insurance coverage is a concern. In some cases, testing can take up to three months or longer.

Many couples also find preconception counseling to be beneficial. This is especially true of women over age 35, who are at increased risk of giving birth to children with chromosomal abnormalities (e.g., Down syndrome).