Skip to the answer
Gyna

Getting pregnant and testing

When should I get fertility testing or see a specialist?

The short answer

If you're trying through regular unprotected sex, here's where the lines are.

  • Stopped periods, pelvic pain, unusual bleeding, difficulty having sex, or past pelvic disease or surgery? Talk to your clinician now.
  • Over 40? Talk to your clinician now.
  • 35–40? Get checked after 6 months (NHS starts earlier checks at 36).
  • Under 35? Get checked after 12 months.

Already in fertility care or using a donor? Ask your clinic.

A normal ovarian reserve result doesn't mean you have time to wait.

Confidence varies by claim Sources are linked. Not yet reviewed by a clinician.

How we check answers

What can I do with this?

Start by finding your line. Under 35, it's twelve months of regular unprotected sex. Thirty-five and over, six. Over 40, now. If you've already passed your line, this is the page telling you the waiting part is done.

And if you've had an ovarian reserve test come back normal, that doesn't move your line. ASRM says these markers are poor predictors of fertility in women who aren't infertile, and ACOG calls AMH an imperfect predictor of your reserve rather than of conception. A reassuring number tells you the number was reassuring. It doesn't tell you that you have time.

The sources reviewed here do not compare being evaluated at 6 months against 12 and measure live birth, so this page won't tell you that going in earlier gets you one.

Then check the overrides, because they beat the clock. ASRM says evaluation should begin straight away, whatever the calendar says, if there's an obvious medical problem affecting your ability to conceive: periods that have stopped, sexual difficulties, a history of pelvic disease, or previous pelvic surgery. The NHS puts the same idea more simply. If you already know you may have a fertility problem, go sooner.

Both of you get assessed, not just you. Infertility can come from either partner or from neither identifiably, and a semen analysis is part of the first workup. If a first sample comes back abnormal, it's normally repeated at around three months.

Expect a few cycles, not a verdict on day one. ACOG says most evaluations finish within a few menstrual cycles and ASRM says most testing completes within six months. In about a quarter of cases no cause is found at all, which is a real and common result. It means the tests didn't find the reason. It doesn't mean there isn't one, and it isn't a reason to stop.

What this page can't do is tell you that going in earlier will get you a baby. The sources reviewed here do not establish that. What it can tell you is that after your threshold, another few months of waiting is unlikely to teach you anything you don't already know.

But does this apply to me?

This answer is written for women and couples trying to conceive through regular unprotected sex, who haven't sought care yet. Your age is the modifier that changes it most, and it changes in three bands: under 35, 35 to 40, and over 40.

It doesn't describe you if you're already in fertility care. Your clinic's plan is ahead of anything here. It also doesn't describe your route if you're conceiving by donor insemination or intrauterine insemination (IUI), which includes most same-sex couples and single women using a donor. Those routes have their own cumulative curves and their own thresholds, and the twelve-month clock doesn't describe how you get to care at all. Take the timing from your clinic, not from this page.

Other things that move your line: how long you've already been trying, whether your cycles are regular, known endometriosis or pelvic disease or past pelvic surgery, a history of pregnancy loss, and your partner's history. Where you live matters too, because it changes what happens after the referral rather than what the guidance says.

One number that does not apply to you personally: the cumulative percentages. When you read that 82% of women aged 35 to 39 conceive within a year, that describes a group of women. It is not your chance, and no honest reading of it can be.

Care and safety

When should I bring in a clinician?

The thresholds are the strong part of this page. What's weaker is everything that sounds like a forecast. The cumulative percentages are observational, they come to you through guidelines rather than the original papers, and the two source tables differ in the tail. The figure for how many evaluations find nothing rests on a single NHS sentence. And the claim that ovarian reserve tests don't predict natural conception is stated directly by ASRM but supported here by a paper we can only read as an abstract.

The thing we most want you to avoid is the quiet one. A normal test result is not evidence that you have time. It's evidence that the test was normal. If you've passed your threshold, that's still true with good numbers in your hand.

And nothing here supports the idea that you've caused this or waited too long. You haven't done anything wrong by not knowing where the line was. That's what the page is for.

Go to a clinician now, without waiting for a threshold, if your periods have stopped, if you have pelvic pain or bleeding that isn't normal for you, if sex is painful or difficult, or if you already know about a pelvic condition or previous pelvic surgery. Those aren't questions for a website.

Understand the answer

So what does this mean for me?

What does the research actually say?

Start with something that changes how you should read every number below. The thresholds you'll be given aren't trial results. The sources reviewed here do not compare checking couples at 6 months versus 12 and then count the babies. They instead describe cumulative-conception curves: big groups of couples followed month by month, with the share who've conceived plotted against time. The thresholds sit on top of those curves. They mark the point where waiting longer stops producing new information. That's a good reason for them to exist. It just isn't the reason most of us assume.

The curves reach you second-hand too, and you should know that. Your age tables come from two cohort studies, from 2004 and 2016, and we're reading them inside the guideline that reproduces them rather than in the papers themselves. We'd rather have the papers. Until we do, treat the tables as the direction of travel and not as a decimal point.

What we can read directly is the biology underneath, and it's blunter than the guidance sounds. A model built from 325 measurements of real human ovaries, from before birth to menopause, found that 81% of the variation in how many follicles (egg-containing sacs) a woman has comes down to her age alone. By 30, about 12% of your peak pre-birth follicle population is left. By 40, about 3%.

Which sounds like a countdown. So look at what the same model says about you. Its average predicted age at menopause is 49.6 years, and its 95% prediction interval runs from 38.7 to 60.0. That's a spread of more than twenty years around the average. The curve is steep and it's real, and it still can't tell you where on it you're standing.

"So can't a test tell me?" It's the obvious next question, and the honest answer is not yet, not for this. A 2023 systematic review pooled 41 studies covering 28,858 women. Lower AMH (anti-Mullerian hormone, a blood marker of ovarian reserve, or remaining egg supply) for your age does track with an earlier menopause. But AMH on its own couldn't pin down when. For women under 40 the estimates and their confidence intervals ranged from 2 to 12 years.

It gets sharper as menopause gets close, which is exactly when you no longer need it. An earlier review of the same hormone said the rest plainly: there are only very limited data on how AMH relates to natural fertility at different stages of life. Both of those we can only read as abstracts, so that's as far as we'll take them. Notice what they're measuring, though. AMH is being tested against menopause. Not against your chance of getting pregnant this year.

Your partner's test has a similar catch. Semen analysis is the cornerstone of the male workup, and the review we hold says outright that it isn't a test of fertility. The WHO reference ranges it's scored against were built from over 1,900 men who'd recently fathered a child, so they describe what fertile men's samples look like rather than a line between fertile and not. Results swing enough that at least two properly collected samples are recommended. So a low first result isn't a diagnosis, and a normal one isn't a guarantee.

One last thing, because it's where the research and the guidance meet. ACOG puts the same curve in a single sentence you can hold onto: about 25,000 eggs remain at 37, against 300,000 to 500,000 at puberty. The guideline and the model are describing the same thing. Neither of them is describing you personally, and neither is a reason to wait.

What comes after an evaluation, and how well the treatments work, is a different question from this one. We've kept it off this page rather than answer it badly here.

How does this compare with the official guidance?

The age-based thresholds here follow ACOG and ASRM: 12 months under 35, 6 months from 35 onward, and earlier assessment for known problems. ACOG advises discussion now over 40. The NHS also advises earlier assessment with age, but uses a different age boundary. These are professional recommendations, not our own trial findings.

Where they disagree with each other, you get all of it rather than the tidiest version. ACOG and ASRM set the earlier-evaluation line at 35 and over. The NHS sets it at 36 and over. If you're 35 you're at the threshold in one health system and not in the other, and you're entitled to know that rather than be handed whichever number we preferred.

On your chance each cycle at 40, ACOG says less than 10%. ASRM's own patient booklet says less than 5%. Those are two cited authority documents differing by a factor of two, so we give you the range and who said what, and we don't split the difference.

And the NHS advises seeing your GP after a year while also recording that infertility is usually only diagnosed and treated after two. If you're in the UK, that gap is your actual timeline, and reading the 12-month line as a promise about what happens next will leave you unprepared.

Where we say more than they do, it's on two points. The first is what the thresholds are. A guideline states them; it doesn't usually explain that they're a convention laid over a curve rather than a tested intervention. Read as a prediction about you, they'll mislead you in both directions.

The second is the testing. ASRM states that markers of ovarian reserve are poor predictors of fecundity (the chance of conception) in women who aren't infertile, and ACOG calls AMH a useful but imperfect predictor of ovarian reserve, which is not the same as a predictor of conception. Both of those sentences are true and both are buried in documents written for clinicians, while the tests themselves are marketed straight to you as an answer about your future.

So we'll say it where you can see it: an ovarian reserve result does not tell you whether you can get pregnant, and it does not tell you that you have time. None of these bodies has reviewed this page.

Why is this our answer?

Thirteen sources: nine authority documents (NICE twice, ACOG twice, ASRM twice, NHS twice, WHO) and four research papers. We only had the abstracts for two of the papers, so we've stayed inside them.

Confidence isn't the same across the page. The thresholds are as solid as anything gets here: ACOG and ASRM give the age-based thresholds, while the NHS uses 36 rather than 35 for earlier assessment.

The age percentages are population statistics from cohort studies, and they reach you through the guidelines that reproduce them rather than from the original papers.

Sources for each main claim

What else are you wondering?

Explore all getting pregnant and testing questions

Check the evidence

How sure can I be?

See the full evidence snapshot and sources

Evidence snapshot

The same fields appear on every Gyna answer, including when the research did not report something reliably.

Question and decision
When should I get fertility testing or see a specialist? The decision is whether to stop waiting and seek care. Not what is wrong, and not what treatment to have.
Who was studied
Women and couples trying to conceive through regular unprotected intercourse who have not yet sought care. Not people already in fertility treatment, and not people conceiving by donor insemination or IUI, for whom the thresholds differ.
What was compared
Timing of clinical evaluation: 12 months of trying, 6 months at 35 and over, or immediately where a medical reason overrides the clock. There is no comparator, because the reviewed sources do not compare couples evaluated at one threshold rather than another.
Outcome measured, and over what period
Cumulative conception over 12 and 24 cycles, and the point at which continued waiting stops being informative. Not live birth, and not any outcome of the evaluation itself: no source here measures whether being evaluated earlier changes what happens.
Kinds of evidence included
Nine authority documents (NICE, ACOG, ASRM, NHS, WHO), one modeling study of ovarian follicle populations, one narrative review of semen analysis, and two reviews of anti-Mullerian hormone held at abstract level only. Thirteen in total.
Studies and participants
Not reliably derivable for the thresholds, which are guideline consensus rather than a pooled analysis. Where a research total is known it is stated: 325 histological measurements in the ovarian-reserve model; 41 studies and 28,858 women in the AMH review; and over 1,900 recent fathers behind the WHO semen reference ranges.
What the evidence shows
Evaluate after 12 months under 35, after 6 months at 35 and over (NHS: 36 and over), and without waiting past 40. Immediately at any age for absent periods, sexual dysfunction, pelvic disease or prior pelvic surgery. Over 80% of couples where the woman is under 40 conceive within a year, and about half of the remainder conceive in the second year. NICE's reproduced cumulative table, at intercourse roughly twice weekly: 92% by 12 cycles at 19 to 26, 87% at 27 to 29, 86% at 30 to 34, 82% at 35 to 39. Chance per cycle at 40 is under 10% (ACOG) or under 5% (ASRM). Relative fertility at 40 is about half that of the late 20s and early 30s.
Consistency and disagreement
Three genuine disagreements, all reported rather than resolved. ACOG and ASRM set the earlier-evaluation age at 35 while the NHS sets it at 36. ACOG puts the chance per cycle at 40 below 10% while ASRM's patient booklet puts it below 5%. And the NHS advises seeing a GP at one year while recording that infertility is usually only diagnosed and treated after two. A fourth, smaller one: ASRM's committee opinion puts meaningful male decline at about 50 while its patient booklet says the 60s, and this page uses the committee opinion.
Confidence in this answer
high for the ACOG/ASRM age thresholds and immediate-evaluation triggers, with the NHS age-36 difference retained; moderate for the cumulative conception rates, which are observational and reach the page through the guidelines that reproduce them; moderate for the limits of ovarian reserve testing, stated directly by ASRM but supported here by an abstract-only review; insufficient for whether evaluating earlier improves live birth, which is not tested in the sources reviewed here and which this page declines to answer
Strength of the sources
The age thresholds rest on ACOG and ASRM guidance, with the NHS's different age boundary stated explicitly. Other bodies provide definition and care context. The population percentages rest on cohort studies we are reading inside a guideline rather than in the original papers, which is a weaker link. Two of the four research papers are held as abstracts only and are used no further than their abstracts state.
Review status
Sources are linked. Not yet reviewed by a clinician.
Who this does and does not describe
Describes people trying to conceive through regular unprotected intercourse who have not yet sought care. Does not describe people already in fertility treatment, or people conceiving by donor insemination or IUI, including most same-sex couples and single women using a donor, whose route to care the 12-month clock does not describe. Cumulative percentages describe groups and are not an individual prognosis.
Harms, trade-offs and when to seek care
The harm this page guards against is delay, and ACOG records that 52.9% of patients experience a full year of infertility before seeking advice. The second is false reassurance from a test: a normal ovarian reserve result is not evidence of time remaining, and ASRM states these markers are poor predictors of fecundity in women who are not infertile. The third is self-blame, and nothing here supports it. Absent periods, pelvic pain, abnormal bleeding, painful or difficult sex, or known pelvic disease are reasons to see a clinician now rather than at a threshold.
Last searched, and the records behind this
Last evidence search 2026-09-05. The source links are listed below.

Sources

Open the original guidance or study rather than taking our summary on trust.

  1. Human Ovarian Reserve from Conception to the Menopause

    pmc.ncbi.nlm.nih.gov

  2. Semen analysis and sperm function tests: How much to test?

    pmc.ncbi.nlm.nih.gov

  3. Anti-Müllerian hormone for the diagnosis and prediction of menopause: a systematic review

    Human Reproduction Update · 2023

  4. The physiology and clinical utility of anti-Mullerian hormone in women

    Human Reproduction Update · 2014

  5. NG257 chapter: Initial advice to people concerned about delays in conception

    NICE · Published 31 March 2026

  6. Fertility problems: assessment and treatment (NG257)

    NICE · Published 31 March 2026; last reviewed 31 March 2026

  7. Evaluating Infertility (FAQ136)

    ACOG · Published April 2020; Last reviewed May 2026

  8. Optimizing natural fertility: a committee opinion (2022)

    ASRM · 2022 (Fertil Steril 2022;117:53-63; replaces 2013 version)

  9. Anticipatory Counseling Regarding Ovarian-Factor Fertility Decline (Committee Statement)

    ACOG · November 2025

  10. Age and Fertility (patient education booklet)

    ASRM / ReproductiveFacts.org · Created 2012 (no update date listed)

  11. Infertility

    NHS · Page last reviewed 9 August 2023

  12. Low sperm count

    NHS · Page last reviewed 26 January 2024

  13. Infertility (fact sheet)

    WHO · 28 November 2025

How we looked, and what we found

We read the sources on 2026-09-05, working from our own research library rather than an open web search. Thirteen documents made it onto the page: NICE NG257 including its March 2026 chapter on initial advice, ACOG's Evaluating Infertility and its November 2025 committee statement on ovarian-factor decline, ASRM's 2022 committee opinion and its Age and Fertility booklet, the NHS pages on infertility and low sperm count, the WHO infertility fact sheet, and four research papers.

Every sentence that carries a decision on this page is mapped to the sources behind it, and you can see that map below. Where two authorities disagreed we kept both and named them. Where a source is an abstract rather than a full paper we've said so at the point we use it, because an abstract can't be checked the way a paper can.

We also read one review of treatments for unexplained infertility and left it out. It answers what to do after an evaluation, and this page stops at whether to have one.

Four things we wanted and don't have: the 2016 cohort of women aged 30 to 44 that NICE's age figure is built on, the 2004 cohort behind the cumulative-probability table, the 2017 JAMA study of ovarian reserve biomarkers and conception in women without infertility, and a primary source for how often no cause is found. Those are the four papers that would most improve this page, and until we hold them the relevant claims stay where they are rather than being upgraded.

Who wrote this, and when will we revisit it?

Written by the Gyna evidence team from our research library. The source links below show what supports each main claim and where the evidence is limited.

Last updated
2026-09-09

Tell us something here is wrong