PCOSEndometriosisUterine fibroidsIrregular periodsDifficulty conceivingRecurrent miscarriageAll conditions →
The 40-week journeyFirst trimesterSecond trimesterThird trimester
All servicesFertility & IVF
About Dr HemangiFAQContact the clinic
Contact the clinicWhat we treat
Fertility

Difficulty conceiving

Two people, one investigation. Half of what we find is on the male side, and it is the easiest thing to test.

Any step can be the one that needs help — which is why both partners are tested.

01

What it actually is

Doctors generally start investigating after twelve months of regular unprotected sex without conception — or after six months if you are over 35, because time matters more then. If you already know something relevant, such as very irregular cycles, severe period pain, or previous pelvic surgery, there is no reason to wait out the clock.

The most important principle is that this is an investigation of a couple, not of a woman. A semen analysis is simple, quick and non-invasive, and male factors contribute in roughly half of all cases. Starting anywhere else wastes months.

Difficulty conceiving affects a substantial minority of couples. Ovulation problems, tubal factors, male factors and endometriosis account for most identifiable causes, and in a meaningful proportion no single cause is found.

1Egg releasedcycle & hormones2Tubes opentubal test3Healthy spermsemen analysis4Lining readyscan & timing
Four things all have to work. One round of tests — for both partners, usually inside a single cycle — checks all four.

For general understanding only. These are drawings, including the ultrasound view — they are built from typical measurements to explain the idea, and are not real scan images or a picture of your own baby.

02

What you might notice

  • Twelve months of regular unprotected sex without conception — or six months if you are 35 or older
  • Very irregular or absent periods, which make ovulation unpredictable
  • Severe period pain or pain with sex, which may point to endometriosis
  • Previous pelvic infection, ectopic pregnancy or pelvic surgery
  • Two or more pregnancy losses
  • Known problems on a previous semen analysis

Don't wait for an appointment if…

  • You are 35 or older and have been trying for six months
  • Periods have stopped entirely
  • Known tubal disease, previous ectopic pregnancy, or previous pelvic infection
  • Testicular surgery, injury, undescended testis or previous chemotherapy in the male partner
03

The tests that are actually useful

Not everyone needs every test. This is what each one is for, so you know why it was ordered — or why it wasn't.

A blood testHormones, thyroid and iron — the numbers no scan can show.
An ultrasoundThe shape of the uterus, the thickness of the lining, and the follicles on each ovary.
A camera, sometimesA keyhole look inside, offered only when it would change the plan.

Not everyone needs all three. Each answers a different question — which is why a test you were not offered is often the right call.

Semen analysisFirst, always. It is quick, non-invasive and inexpensive, and it changes the entire plan when abnormal. Repeated if the first result is unexpected.
Confirming ovulationCycle history, mid-luteal progesterone, and follicular tracking on ultrasound where needed.
Ovarian reserve — AMH and antral follicle countIndicates how many eggs remain, which informs timing and which treatments are realistic. It does not measure egg quality.
Thyroid function and prolactinBoth affect ovulation and both are simple to correct.
Tubal assessment — HSG or HyCoSyChecks whether the fallopian tubes are open. There is little point inducing ovulation if the path is blocked.
Pelvic ultrasoundAssesses the uterus, the lining and the ovaries, and identifies fibroids, polyps or endometriomas.
Diagnostic laparoscopyWhere endometriosis or adhesions are suspected — and treatable in the same operation.
04

Treatment, in the order it's usually tried

  1. Start simpleLifestyle, pain relief, or a tablet — whatever is least disruptive to your life.
  2. Add if neededA hormonal option or a longer course, if the first step has not settled things.
  3. A procedureDay-case surgery when medicine cannot fix the structure causing the problem.
  4. Specialist routeFertility treatment or a referral, planned with you rather than sprung on you.

You move up a rung only if the one below it has not done the job — and you can stop at any step you are happy with.

Timing and tracking

Understanding your own fertile window, with follicular monitoring where cycles are unpredictable.

A surprising number of couples are simply mistiming. This costs nothing and is always step one.

Ovulation induction

Letrozole or clomiphene, with ultrasound monitoring.

For women who are not ovulating reliably. Monitoring matters — it is what keeps the response safe and measurable.

Surgery where there is something to correct

Laparoscopy or hysteroscopy for endometriosis, adhesions, polyps or cavity fibroids.

Done in-house as minimal access surgery. Correcting the structural problem sometimes removes the need for anything further.

IUI

Intrauterine insemination, with or without ovulation induction.

Appropriate for specific situations, particularly mild male factor and unexplained infertility, and only where the tubes are open.

IVF and ICSI

A full IVF cycle, with ICSI where the male factor requires it.

The right answer for some couples and the wrong first answer for many. You will be told plainly which group you are in, and roughly what it will cost, before you commit.

05

What you were probably told that isn't true

It is usually a problem with the woman.
Male factors contribute in roughly half of cases, and the test is far simpler. Investigating only one partner is how couples lose a year.
Just relax and it will happen.
Stress is real and worth addressing, but it is not a diagnosis and this advice delays people who have a findable, treatable cause.
IVF is the answer to infertility.
IVF is one treatment among several. Many couples conceive with ovulation induction, surgery, or corrected timing.
A normal AMH means everything is fine.
AMH estimates quantity, not quality, and says nothing about the tubes, the uterus or the sperm.
Next step

Bring this to someone who has time.

A 25–40 minute consultation, on video, with a doctor who will explain what applies to you specifically — and what doesn't.

This page is general information, not medical advice. Nothing here can diagnose you or replace an assessment of your own history, examination and results. If something here matches what you are experiencing, the next step is a consultation — not a conclusion. If you are in severe pain, bleeding heavily, or feel unwell, seek urgent care rather than waiting for an appointment. Awaiting final clinical review before publication.