Updated July 14, 2026

When you’re ready to start or grow your family and pregnancy isn’t happening as quickly as you hoped, it can be frustrating, confusing and emotionally exhausting — especially if you feel like you’re doing everything “right.” Maybe you’ve been timing intercourse, tracking ovulation, using predictor kits, monitoring your cycle or downloading apps to help identify your fertile window.

At some point, many people begin to wonder: Is this still normal, or could there be a medical reason we’re not getting pregnant?

Infertility is common, affecting about 1 in 8 couples. Katie Cameron, M.D., M.B.E., from the Johns Hopkins Fertility Center, explains some of the factors that can affect your ability to conceive, when it may be time to seek an evaluation, and what fertility treatment options may be available.

How is infertility defined?

Infertility is defined as the inability to become pregnant after one year of unprotected sex for women under 35 and after six months for women 35 and older.

What are some common medical conditions affecting infertility?

One or more factors may contribute to fertility problems. The most common problems include:

Fallopian tube obstruction

Blocked or scarred fallopian tubes can prevent sperm and egg from meeting. A history of pelvic infection, inflammation,  pelvic surgery or endometriosis can increase the risk of fallopian tube obstruction.

Ovulation disorders

Sometimes women do not ovulate regularly or predictably. Irregular menstrual cycles can be caused by conditions such as:

• Polyendocrine metabolic ovarian syndrome (PMOS) (formally called PCOS)
• Thyroid disease
• Elevated prolactin levels
• Other hormonal imbalances 

Ovulation can also be affected by very low body weight, significant changes in weight, excessive exercise or stress. 

Uterine factors

Conditions that affect the uterus can sometimes make it harder for an embryo to implant or for a pregnancy to develop. These may include:

• Uterine fibroids
• Endometrial polyps
• Scar tissue inside the uterus
• Differences in the shape of the uterus

Some uterine factors are found during an infertility evaluation, even when a person has no symptoms.

Male factor infertility

In more than 30% of infertility cases, there is a sperm-related factor, such as a low sperm count, low motility or differences in sperm shape.

Male factor infertility can be related to prior injury or surgery, or medical conditions such as:

• Diabetes
• Certain medications
• Hormonal or genetic factors
• Smoking
• Heavy alcohol use
• Other lifestyle and environmental exposures

What is the impact of stress on fertility?

It is completely normal to feel anxious or overwhelmed when you are trying to conceive, especially when pregnancy is taking longer than expected. While severe or prolonged stress can affect overall health and may sometimes influence sleep, hormones, sexual desire or menstrual cycles, stress alone is rarely the sole explanation for infertility.

“What we know is that infertility itself can be stressful,” says Cameron. “Managing stress may not be a cure for infertility, but it can help support your overall well-being while you are going through the process.”

If you are feeling persistently anxious, sad or overwhelmed, it may be helpful to seek support from a mental health professional, fertility counselor, support group or trusted care team.

Is age a major factor for infertility in women?

Age is one of the most important factors affecting fertility, largely because both the number and quality of eggs decline over time.

Women are born with all the eggs they will ever have. That number gradually decreases throughout life, and the decline becomes faster in the late 30s. At the same time, egg quality also changes. As eggs age, they are more likely to pass on an abnormal number of chromosomes when they fertilize, which makes it harder to get pregnant and can increase the risk of miscarriage.

“Age affects fertility in two major ways,” says Cameron. “The number of eggs available decreases, and the chance that each egg can lead to a healthy pregnancy also goes down over time.”

This does not mean that pregnancy is impossible after a certain birthday. Many people conceive in their late 30s and 40s. But as age increases, it often takes longer to get pregnant, and fertility treatment may be less successful because treatment depends heavily on the quality of the eggs available.

For people who know they want children in the future but are not ready to try now, fertility preservation, such as egg freezing, may be an option to discuss with a reproductive endocrinologist.

What is an infertility evaluation?

An infertility evaluation is the first step in understanding why pregnancy may not be happening and which treatment options may be most helpful. Because fertility depends on eggs, sperm, ovulation, the uterus and the fallopian tubes, the evaluation usually looks at more than one part of the reproductive process.

For many patients, an infertility evaluation includes:

• A detailed medical history. Your doctor will ask about your menstrual cycles, prior pregnancies, medical conditions, surgeries, medications, family history and how long you have been trying to conceive. When applicable, your partner’s medical and reproductive history is also reviewed.
• Blood work. Blood tests may be used to evaluate ovulation, ovarian reserve, hormone levels, thyroid function and other factors that can affect fertility.
• Imaging of the uterus and fallopian tubes. Ultrasound and other imaging tests can help evaluate the ovaries, uterus and fallopian tubes. These tests may look for conditions such as fibroids, polyps, ovarian cysts or blocked fallopian tubes.
• Semen analysis. A semen analysis evaluates sperm count, movement and shape. Male factor infertility is common, so sperm testing is an important part of the evaluation when a sperm-producing partner is involved.

The goal of the evaluation is not only to identify possible causes of infertility, but also to help your care team recommend a personalized treatment plan.

When should I consider an infertility evaluation?

Most people will conceive within the first year of trying, but it is important to seek help sooner in certain situations.

In general, an infertility evaluation is recommended after 12 months of regular unprotected intercourse if you are under 35, or after six months if you are 35 or older.

You should seek an evaluation right away if you have irregular or absent periods, which are a sign that ovulation is not happening regularly, and waiting longer usually does not improve the chances of pregnancy without understanding the cause.

“We don’t want patients to feel like they have to wait a full year in every situation,” says Cameron. “Age matters, but so do your menstrual cycles, medical history and any known risk factors.”

Some people need fertility care from the very beginning, not because anything is “wrong,” but because they need medical assistance to build their family. This may include LGBTQ+ patients, single parents by choice, or anyone who will need donor sperm, donor eggs or embryos, or a gestational carrier. For some people, it can feel unfair that such a personal part of life requires medical care, but a fertility specialist can help make the process feel more supported, informed and manageable.

You should also consider an evaluation sooner if you have:

• Known or suspected endometriosis.
• A history of pelvic infection or pelvic surgery.
• Recurrent pregnancy loss.
• Known uterine or fallopian tube concerns.
• Sperm-related concerns.

What are my infertility treatment options?

Treatment depends on the results of your evaluation, your age, your goals, and the cause or causes of infertility. Some people need only a small amount of help, while others may benefit from more advanced treatment.

• Ovulation induction or ovarian stimulation. Oral or injectable medications can help the ovaries release an egg more regularly. In some cases, these medications may also help the ovaries release more than one egg in a cycle, which can increase the chance of pregnancy but may also increase the risk of twins or multiples.
• Intrauterine insemination, or IUI. IUI is a procedure in which a prepared sperm sample is placed directly into the uterus around the time of ovulation. IUI may be done in a natural cycle or combined with ovulation medications, depending on the situation.
• In vitro fertilization, or IVF. During IVF, eggs are retrieved from the ovaries and fertilized with sperm in the laboratory. The resulting embryo is then transferred into the uterus. IVF can be helpful for many causes of infertility, including blocked fallopian tubes, severe male factor infertility, some cases of endometriosis, fertility preservation and situations in which other treatments have not been successful.
• Donor eggs, donor sperm, donor embryos or gestational carrier care. Some patients need or choose to use donor eggs, donor sperm, donor embryos or a gestational carrier to build their family. This may be because of medical factors, age-related fertility changes, genetic considerations, family structure or personal circumstances.

Every person’s path to parenthood is different. A fertility specialist can help you understand which options are most appropriate for your situation and create a plan that fits your goals.

Medically reviewed by Katie Cameron, M.D., M.B.E.