What causes trouble getting pregnant?

Ovulation may be infrequent or absent with polycystic ovary syndrome, changes in ovarian function, or premature ovarian insufficiency. Diminished ovarian reserve describes a reduced supply of eggs and may affect treatment planning, while age-related changes can affect egg number and quality. Endometriosis may affect pelvic anatomy, inflammation, or the movement of an egg and sperm. Fibroids or other uterine changes can alter the cavity or interfere with implantation. Blocked or damaged fallopian tubes may follow pelvic infection or surgery. Male factor infertility, including changes in sperm number, movement, or shape, can contribute. Sometimes testing does not identify one clear explanation; this is called unexplained infertility.

Book a fertility assessment when difficulty conceiving is causing concern, or sooner if periods are very irregular, pelvic pain is significant, there is a history of pelvic infection or surgery, or either partner has a known fertility concern. Assessment usually considers both partners. It may include menstrual history, hormone testing, ultrasound, tubal assessment, and semen analysis. Bring a list of medicines, previous pregnancies, operations, and cycle dates. Avoid assuming the cause is on one side; conception depends on ovulation, sperm, the tubes, and the uterus working together.

Seek earlier specialist advice for absent periods, recurrent pelvic pain, suspected endometriosis, previous ectopic pregnancy, prior chemotherapy, or known ovarian or sperm concerns. Arrange urgent care for severe one-sided pelvic pain, fainting, shoulder-tip pain, or heavy bleeding after a positive pregnancy test, because these symptoms can signal an ectopic pregnancy or another emergency.

What tests should we have, and should they be arranged for both partners? Could my cycle pattern, pain, previous infection, or surgery affect fertility? What do the results say about ovulation, the tubes, the uterus, ovarian reserve, or sperm?