When to start an Infertility Assessment

Every year millions of American couples struggle with infertility. Infertility is defined as the inability to conceive after 12 months of unprotected vaginal sex. It has been found that a third of the time this as a result of a pre-existing issue with the male partner and another third due to the female partner. The final third is usually a combination of problems in both partners. Hence, both partners are advised to visit the OB/GYN doctor during the first assessment.

If a problem is found in the semen samples provided by the male partner, he is usually referred to a urologist for further investigation. Both partners may also be referred to a fertility endocrinologist after the first assessment by the OB/GYN.

A fertility endocrinologist is an OB/GYN who specializes in fertility issues men and women experience. The focus of this article will be on the probable causes of infertility in a woman and what to expect on your first infertility assessment. For more information on Fetal OB/GYN specialists in Manhattan, visit us at 67th Street OB/GYN-Total Women Health’s Care today.

Potential causes of Infertility  

There are numerous reasons for infertility in a woman, from age to stress to preexisting conditions, or even over-exercising can cause a woman to be less fertile. Below are a number of reasons you may be experiencing difficulties with conception.

  • For women, fertility drastically reduces with age. For the average woman under 35, there is a 20-25% chance of conception every time she has unprotected vaginal sex during her ovulation window as long as no birth control prevention protocol is in place. After age 40, this number falls to less than 10%2.
  • Lifestyle habits can reduce fertility. Drinking moderately or regularly reduces fertility in both men and women. Excessive exercise/ low body weight has also been shown to reduce fertility.
  • Irregular ovulation in women; this is mostly seen in women with irregular menstrual cycles or hormonal issues.
  • Genetic conditions that run in the family may also reduce fertility.
  • Problems with the reproductive organs.
  • Thyroid and Pituitary gland issues.
  • Complications arising from STDs

Whatever the case might be, a lot of times there are treatments and other options available to improve fertility. However, if carrying a child to term is not a viable option then a surrogate or adoption may be suggested. It is advised that you see a counselor throughout this entire process as issues involving infertility can be emotionally and mentally difficult.

First Infertility Assessment and Tests

At your first infertility assessment, you and your partner would both be grilled extensively on your medical history, family history, occupation, previous sexual relationships, past pregnancies/outcome, all forms of birth control used in the past, alcohol usage, surgeries and finally STD history. A semen sample will then be collected from the male partner, while the female will be given a physical examination. Urine and blood samples would be collected for further testing.

Based on this examination, a number of tests will be ordered to assess your reproductive organs. In order for a woman to conceive, an egg must be released from her ovaries, pass through the Fallopian tubes (it is fertilized by the sperm here) and finally reach the uterus and attach the lining3. Hence tests to check the ovaries, fallopian tubes and uterus will be ordered. Below are some of the tests used to investigate the causes of infertility.

Ovulation testing

This is to determine if there are any ovulation disorders. Blood samples will be taken during the ovulation window to assess the state of ovulation in this test.


An X-ray is used to determine if there is a blockage in either of the Fallopian tubes and examine the uterus. Note, problems in the uterus and tube blockage has also been shown to be a side effect of some STDs if left untreated for an extended period3.

Ovarian testing

This is to check the state of the eggs and quantity available. Though routine, it is especially important for those who have a history of premature menopause in their families.


This is used to view your uterus and Fallopian tubes to check for disease and is clearer than an ultrasound.

In rare cases, your doctor may request further investigation. In these instances, the additional tests below are ordered.

Genetic testing

This is used to determine if your infertility might be linked to a genetic condition.


Here a thin, lighted device is used to check your uterus for abnormalities and is inserted through your cervix3. The objective of this test is to look for signs of disease in your uterus and Fallopian tubes.


Here a small device with a camera is inserted through your navel and is used to view the Fallopian tubes, ovaries and uterus. The entire procedure is a minimally invasive surgery and is used to diagnose problems with the ovaries, blockages, and irregularities in the Fallopian tubes, scarring and endometriosis3.

Even with these tests and the treatment options available, there is still no guarantee you would conceive. However, a proper checkup and treatment increase your odds of getting pregnant. Before the more expensive and intensive tests are ordered, it is usually advised that a couple should keep trying naturally for a few more months to one year if the female partner is under 35. This is because 50% of women who do not conceive within the first year, get pregnant on the second without any medical intervention4.

If you are uncertain if you need medical intervention or not, schedule an appointment to speak to one of our OB/GYNs in Manhattan today.