Delayed pregnancy When to start testing and treatment methods

Has it been over a year since your marriage without a successful pregnancy, despite regular unprotected intercourse? If so, this could be a case of what is medically known as delayed conception or primary infertility—a common issue affecting around 15% of couples worldwide. In this article from Dalili Medical, we’ll take a detailed look at fertility testing for both men and women, explore the potential causes, outline the essential diagnostic tests, and discuss when it’s time to seek medical help and start a treatment plan.

What Is Infertility?

Infertility is defined as:

The inability to conceive after 12 months of regular unprotected sexual intercourse.

If the woman is over 35 years old, infertility is diagnosed after 6 months of trying to conceive.

Types of Infertility

Primary infertility: No previous pregnancies have occurred.
Secondary infertility: The couple conceived before (even if the pregnancy didn’t result in a live birth), but are now struggling to conceive again.

⏳ When Should You Start Infertility Testing?

Doctors recommend beginning fertility evaluations in the following cases:

After 12 months of unprotected intercourse without pregnancy
After 6 months if the woman is 35 or older
If there are known health issues (e.g., irregular periods or varicocele)
If there is a history of recurrent miscarriages

❗ What Causes Infertility?

Infertility may be due to factors related to the woman, the man, both partners, or may sometimes be unexplained even after testing.

1. Female Causes of Infertility

Ovulation disorders (e.g., PCOS, irregular ovulation)
Blocked fallopian tubes (due to infections or previous surgery)
Endometriosis
Uterine issues (fibroids, septum)
Hormonal imbalances (thyroid dysfunction, high prolactin)
Advanced maternal age (35+)

2. Male Causes of Infertility

Low sperm count or poor motility
Abnormal sperm morphology
Varicocele (enlarged veins in the testicles)
Infections (testicular or prostate-related)
Hormonal issues (e.g., low testosterone)
Blocked sperm ducts
Exposure to chemicals or heat

3. Shared or Unexplained Causes

Lifestyle habits (smoking, obesity, stress)
Immune-related issues (e.g., antisperm antibodies)
10–20% of infertility cases remain unexplained after full testing

Infertility Testing: Most Important Exams

Both partners should be evaluated simultaneously, starting with basic exams and moving to more specialized ones as needed.

Female Fertility Tests

1. Hormonal Blood Tests (Done on days 2–3 of the menstrual cycle)

Test	Purpose
FSH & LH	Assess ovarian function and ovulation
Estradiol (E2)	Evaluate estrogen levels
Prolactin	Rule out high prolactin levels
TSH	Check thyroid function
AMH	Estimate ovarian reserve
Testosterone	If signs of hormonal imbalance are present

2. Ovulation Testing

Progesterone test on day 21
Home ovulation kits (detect LH surge)
Follicular tracking via ultrasound

3. Uterine and Tubal Tests

Transvaginal ultrasound to assess ovaries and uterus
HSG (Hysterosalpingogram): X-ray with dye to check fallopian tube patency
Diagnostic laparoscopy: Used in cases of suspected endometriosis or adhesions

Male Fertility Tests

1. Semen Analysis

One of the most crucial tests. Evaluates:

Parameter	Normal Range
Volume	≥ 1.5 ml
Count	≥ 15 million/ml
Motility	≥ 40% total motility
Morphology	≥ 4% normal forms
Color/Viscosity	May indicate inflammation or infection

⚠️ Test should be repeated at least twice, spaced over 1–2 months.

2. Hormonal Tests

FSH, LH, Testosterone, Prolactin
TSH to assess thyroid function
Antisperm antibodies test
Karyotyping for men with severe sperm abnormalities

3. Additional Tests

Scrotal Doppler ultrasound: Detects varicocele
Semen culture: Checks for infection
Sperm DNA fragmentation test: In cases of repeated miscarriage or IVF failure

Shared Tests for Both Partners

Blood type compatibility (Rh)
Infection screening: CMV, Rubella, Hepatitis B/C, HIV
Immune testing: Rare, in suspected immune-related infertility

When to Consider Assisted Reproductive Techniques?

If test results show a condition that is difficult to treat naturally, the following options may be recommended:

✅ 1. Ovulation induction + timed intercourse
✅ 2. Intrauterine insemination (IUI)
✅ 3. In-vitro fertilization or ICSI (IVF/ICSI)
✅ 4. Surgical correction for varicocele or tube blockage

???? Tips to Naturally Boost Fertility

Maintain a healthy weight
Avoid smoking, alcohol, and recreational drugs
Reduce caffeine and manage stress
Take fertility supplements (e.g., folic acid, zinc)
Time intercourse during the fertile window

❓ Frequently Asked Questions

Does infertility mean permanent sterility?

No. Many infertility cases are treatable either with medication or assisted reproductive technologies.

Is semen analysis alone enough?

No. It's essential to assess both partners to get a full picture.

How often should tests be repeated?

Depending on the results, some tests (especially semen analysis and ovulation tests) may be repeated for confirmation.

Dalili Medical Summary

Infertility is not the end of the journey—it's the start of a diagnostic and treatment path that, when managed early and correctly, can lead to successful pregnancy. Running proper fertility tests early on can save time and improve the odds of conceiving.

Medical Advice: Don’t wait for years. If no pregnancy occurs within a year of trying (or 6 months if the woman is over 35), start testing right away—even if there are no obvious symptoms.