Most people arrive here before they know which treatment they need. They know something isn't working, and often they have a diagnosis on a piece of paper that nobody has properly explained. This page describes the conditions we see most often, in plain language, so you can work out which one sounds like your situation and what usually follows.
Often more than one factor is present, which is why a full evaluation of both partners matters. If none of these quite fits, that is common too — start with fertility testing and diagnosis.
PCOS
If your cycles are irregular, unpredictable or absent, PCOS is the first thing we would look for. It is really a heterogeneous group of women suffering from conception delay due to ovulation disorders, and irregular cycles are the sine qua non for not ovulating. The practical problem is timing: not knowing when to time intercourse or have insemination leads to very low pregnancy rates, either on your own or under medical care. Getting ovulation to happen reliably is the mainstay of treatment and helps almost half of patients; the other half need the IVF level of care.
Endometriosis
If you have very painful periods, daily pelvic pain or pain during intercourse — and have been told for years it is just severe PMS — endometriosis is worth ruling out. For a majority of sufferers the diagnosis is difficult to come by, because their only symptom may be infertility. For an estimated 30–50% of women with endometriosis, the condition results in an infertility diagnosis. For women currently trying to conceive, our approach is to go directly to IVF rather than operate first.
Unexplained infertility
If every test came back normal and you still are not pregnant, this is where you are. Unexplained infertility doesn't mean nothing is wrong, and it doesn't mean nothing can be done — it means ovulation, tubes, uterus, egg count and sperm parameters all looked normal on standard testing. There are aspects of egg quality, sperm function, fertilization and embryo development that routine testing does not capture. Treatment focuses on improving the chances of fertilization and implantation, usually starting with IUI.
Male factor infertility
A male factor is present in nearly half of couples experiencing a delay in conceiving, yet the male partner is often the last piece of the workup. Most of those cases are mild to moderate and are addressable with IUI or with ICSI during IVF. If you have not had a semen analysis yet, that should be one of the first steps — not the last.
Diminished ovarian reserve
If you have been given an AMH number and told it is low, read this carefully. AMH doesn't measure egg quality, but it helps predict how you'll respond to fertility medications — specifically, the number of eggs likely to be retrieved in a given cycle. Ovarian reserve testing predicts how a patient will respond to fertility medication — the number of eggs likely to be retrieved. It does not predict whether she will conceive. We treat patients with diminished ovarian reserve routinely, and a dedicated page on this diagnosis is in preparation.
Recurrent pregnancy loss
Repetitive pregnancy loss is one of the areas both of our physicians have extensive experience in, and it is among the conditions we are most often asked about. We begin a workup after two spontaneous losses, or after one loss with a PGT-A normal embryo — see recurrent pregnancy loss for what that evaluation involves.
Not sure where you fit?
If you are under 35 and have been trying to conceive for a year without success, or over 35 and trying for six months, it is a good time to schedule an evaluation. Anyone with irregular cycles, known conditions such as endometriosis or PCOS, prior pregnancy losses, a history of chemotherapy, or same-sex couples and single parents by choice should not wait — an initial consult is appropriate at any point.