Understanding Infertility

What Is Infertility?

Infertility is generally defined as not becoming pregnant after 12 months of regular, unprotected intercourse when the female partner is under age 35, or after six months when the female partner is 35 or older. Earlier evaluation may be appropriate based on age, medical history, known reproductive conditions, irregular or absent periods, previous fertility treatment, or other concerns.

Infertility does not necessarily mean that pregnancy is impossible. Rather, it indicates that one or more factors may be making conception or successful pregnancy more difficult.

What Can Cause Infertility?

Pregnancy depends on several reproductive processes working together. An egg must develop and ovulate, sperm must be available and capable of fertilization, the egg and sperm must be able to meet, and an embryo must develop and implant within the uterus. A challenge at one or more of these stages can contribute to infertility.

Potential factors include:

• Ovulation or hormonal disorders
• Age-related fertility decline
• Diminished ovarian reserve
• Fallopian tube damage or blockage
• Endometriosis
• Uterine conditions, including fibroids, polyps, or structural differences
• Sperm-related factors
• Certain genetic or medical conditions
• Multiple contributing factors
• Factors that cannot be identified through standard fertility testing

Infertility can involve either reproductive partner. When applicable, a fertility evaluation considers both egg-related and sperm-related factors to develop a more complete understanding of what may be affecting conception.

Types of Infertility

Infertility is not a single diagnosis. Different terms may describe when fertility challenges occur, which reproductive factors are involved, or whether testing has identified an explanation.

Primary Infertility

Primary infertility generally refers to difficulty becoming pregnant in someone who has not previously achieved a pregnancy.

Secondary Infertility

Secondary infertility refers to difficulty becoming pregnant or carrying a pregnancy after a previous pregnancy. Fertility can change over time due to age, changes in ovarian reserve or sperm health, new medical or reproductive conditions, or other factors.

Female Factor Infertility

Female factor infertility is a broad term for reproductive factors involving ovulation, eggs, ovarian reserve, the fallopian tubes, the uterus, endometriosis, age, or other aspects of the female reproductive system.

Male Factor Infertility

Male factor infertility refers to sperm or reproductive factors that may make conception more difficult. These may involve sperm count, motility, morphology, production, delivery, or other aspects of male reproductive health.

Unexplained Infertility

Sometimes standard fertility testing does not identify a clear reason pregnancy has not occurred. This is known as unexplained infertility. It does not necessarily mean that there is no biological explanation; rather, currently available testing has not identified a specific cause.

Combined-Factor Infertility

Sometimes more than one factor contributes to difficulty conceiving. For example, an ovarian reserve or ovulation concern may occur alongside a sperm-related, uterine, or tubal factor. Identifying these different contributors can help a fertility specialist determine which treatment options may be most appropriate.

How Is Infertility Evaluated?

A fertility evaluation is designed to identify factors that may be affecting conception and gather the information needed to determine appropriate next steps. The evaluation is individualized based on your age, reproductive history, medical history, and family-building goals.

Depending on your circumstances, fertility testing may include:

• Review of your medical and reproductive history
• Ovarian reserve testing, including AMH testing when appropriate
• Hormone testing
• Ultrasound evaluation of the ovaries and uterus
• Assessment of ovulation and menstrual cycles
• Evaluation of the fallopian tubes
• Semen analysis
• Additional genetic or diagnostic testing when appropriate

Not every patient needs every test. A reproductive endocrinologist can determine which evaluations are most useful based on your individual circumstances and use the results together rather than relying on any single fertility test.

When Should You See a Fertility Specialist?

In general, people under age 35 may consider a fertility evaluation after 12 months of trying to conceive without pregnancy, while those age 35 and older are often advised to seek evaluation after six months.

There are also circumstances in which it may make sense to speak with a reproductive endocrinologist sooner. These may include:

• Irregular or absent menstrual periods
• Known or suspected endometriosis
• Known uterine or fallopian tube conditions
• A history of pelvic surgery or certain pelvic infections
• Concerns about ovarian reserve
• Known or suspected sperm-related factors
• Recurrent pregnancy loss
• Previous unsuccessful fertility treatment
• A medical history that may affect fertility

People approaching age 40 or older may also benefit from seeking an evaluation without waiting six months, because reproductive age can meaningfully affect fertility and treatment planning.

Understanding Your Fertility

Infertility describes difficulty achieving a reproductive goal, but the diagnosis alone does not explain why that difficulty is occurring or determine what should happen next. Two people with the same broad infertility diagnosis may have very different reproductive circumstances and treatment options.

At Spring Fertility, our reproductive endocrinologists look at the individual factors that may be contributing to fertility challenges and consider them alongside your age, reproductive history, priorities, and family-building goals.

Depending on what we learn and what you hope to achieve, your path forward may include continued attempts to conceive, timed intercourse, intrauterine insemination (IUI), in vitro fertilization (IVF), or other individualized approaches. The goal is not simply to assign a diagnosis, but to understand the reproductive factors that matter for you and use that information to help determine the most appropriate path forward.